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Anti-vaxxer defamation lawsuit against Houston Methodist dismissed

Of interest.

A state district judge has dismissed Dr. Mary Talley Bowden’s defamation lawsuit against Houston Methodist Hospital, which suspended the doctor’s privileges in late 2021 over COVID misinformation.

Judge Mike Engelhart, of the 151st Civil District Court, heard arguments Monday afternoon after the hospital asked to dismiss the case and strike evidence from the record. The ruling appeared on online docket Tuesday, but the written order has not been made available.

Bowden responded shortly after the decision on Twitter: “We will appeal.”

That’s the early version of the dismissal story. An earlier version, from before the ruling came down and which has more background on the suit, is here.

The hearing was the latest development in the months-long dispute between Bowden, an ear, nose and throat specialist who practices in River Oaks, and the hospital. The feud started in November 2021, after Methodist announced her suspension from its “provisional staff” and issued a statement saying the doctor spread “harmful” misinformation about COVID vaccines and treatment. The hospital also cited “unprofessional behavior,” including vulgar language on social media, as a key reason for the suspension.

The doctor, who later resigned, had been touting the benefits of ivermectin for treatment of COVID-19 at a time of intense public debate around the off-label use of the antiparasitic drug to treat the virus. Bowden also had suggested the COVID vaccines are dangerous. Large studies still show no benefit of ivermectin against the virus, and evidence shows the COVID vaccines are safe and effective.

Bowden filed her defamation lawsuit against the hospital in July 2022, saying she lost patients and was exposed to “public hatred, contempt, ridicule and financial injury.” Methodist has argued that medical evidence backs up its statements. The hospital also contends that Bowden repeated the alleged defamatory statements herself in multiple conservative media appearances and profited from the ordeal.

The central issue in Monday’s hearing was whether the doctor’s claims could be dismissed under the Texas Citizens Participation Act, which protects free speech.

LeRoy argued that Bowden became a public figure by “inserting herself” into a public debate about COVID, and that Methodist had to respond when she falsely stated the hospital denied care for unvaccinated patients — a claim Bowden later walked back. Bowden also could not provide clear enough evidence to show hospital officials made false statements or acted with reckless disregard for the truth, LeRoy said.

Biss countered that Bowden could prove the hospital made false statements, in part because the hospital portrayed her as an “unfit medical doctor” despite using her COVID data. Bowden previously had said she had been “sharing data” with physicians at Methodist to help them publish research.

“It wasn’t so dangerous or harmful that Houston Methodist didn’t rely and collaborate with Dr. Bowden,” Biss said.

LeRoy said that sharing data with physicians for research “does not mean she is right.”

“This is exactly the type of case that the (Texas Citizens Participation Act) is made for — accusations about a serious issue of public concern that aren’t based in any specific evidence,” LeRoy said.

Here’s a fairly simple explanation of the Texas Citizens Participation Act, sometimes called the Texas Anti-SLAPP Statute. More lawyerly explanations of it are here and here. My interpretation of this is that Houston Methodist successfully argued that Bowden’s lawsuit was an attempt to suppress their ability to freely talk about COVID. I’m happy to hear from real lawyers about this.

I think you can guess where my sympathies lie on this one. Looking in my archives I had not previously noted this case, but I did write about another unsuccessful anti-vaxxer lawsuit against Houston Methodist. We’ll see what if anything happens on appeal, a process that is likely to take years if it does go anywhere.

FDA suggests annual COVID booster

I like the idea of this, which is to make COVID shots simpler and thus hopefully more likely to be taken, but it seems to be more nuanced than that.

The US Food and Drug Administration wants to simplify the Covid-19 vaccine process to look more like what happens with the flu vaccine, according to documents posted online on Monday. That could include streamlining the vaccine composition, immunization schedules and periodic updates of Covid-19 vaccines.

The FDA said it expects to assess circulating strains of the coronavirus at least annually and decide in June which strains to select for the fall season, much like the process to update annual flu vaccines.

Moving forward, the agency said, most people may need only one dose of the latest Covid-19 shot to restore protection, regardless of how many shots they’ve gotten before. Two doses may be needed for people who are very young and haven’t been exposed, who are elderly or who have weakened immune systems, according to the FDA’s briefing document for its vaccine advisers.

The agency is urging a shift toward only one vaccine composition rather than a combination of monovalent vaccines – which are currently used for primary shots and target only one strain – and bivalent vaccines – which are currently used for booster doses and target more than one strain.

The FDA briefing documents do not say whether the annual shot would contain a single strain, two strains or more. The annual influenza vaccine immunizes against four strains.

“This simplification of vaccine composition should reduce complexity, decrease vaccine administration errors due to the complexity of the number of different vial presentations, and potentially increase vaccine compliance by allowing clearer communication,” the FDA said.

The agency’s independent vaccine advisers, the Vaccines and Related Biological Products Advisory Committee, are scheduled to meet Thursday to discuss the future of Covid-19 vaccine regimens and will be asked to vote on whether they recommend parts of the FDA’s plan.

Vaccine experts had mixed responses.

[…]

Dr. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine, said he sees the plan for an annual update as a balance between what science says is needed to fight the virus and what’s actually practical.

“I think it’s a balance, trying to do what the science says, which is the need for adaptability and flexibility. Yet the practicality that’s unlikely the companies can probably make that switch more than once a year,” he said.

But this plan also has some weaknesses, he notes. Annual updates are fine as long as the virus continues to evolve incrementally, based on previously circulating viruses. But he questions whether the world has enough genomic surveillance to catch a radically different variant that pops out of left field, as Omicron did.

“We don’t have the surveillance mechanisms in place globally. We don’t have the genomic sequencing in place globally. We don’t have the carefully orchestrated dance that took decades to build for influenza surveillance in place for coronavirus surveillance,” Hotez said.

The NYT has more from the scientists.

The proposal took some scientists by surprise, including a few of the F.D.A.’s own advisers. They are scheduled to meet on Thursday to discuss the country’s vaccine strategy, including which doses should be offered and on what schedule.

“I’m choosing to believe that they are open to advice, and that they haven’t already made up their minds as to exactly what they’re going to do,” Dr. Paul Offit, one of the advisers and director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said of F.D.A. officials.

There was little research to support the suggested plan, some advisers said.

“I’d like to see some data on the effect of dosing interval, at least observational data,” said Dr. Eric Rubin, one of the advisers and editor in chief of the New England Journal of Medicine. “And going forward, I’d like to see data collected to try to tell if we’re doing the right thing.”

Still, Dr. Rubin added, “I’d definitely be in favor of something simpler, as it would make it more likely that people might take it.”

Only about 40 percent of adults aged 65 and older, and only 16 percent of those 5 and older, have received the latest Covid booster shot. Many experts, including federal officials, have said that the doses are most important for Americans at high risk of severe disease and death from Covid: older adults, immunocompromised people, pregnant women and those with multiple underlying conditions.

In its briefing documents, the F.D.A. addressed the varying risks to people of different ages and health status.

“Most individuals may only need to receive one dose of an approved or authorized Covid-19 vaccine to restore protective immunity for a period of time,” the agency said. Very young children who may not already have been infected with the virus, as well as older adults and immunocompromised people, may need two shots, the documents said.

But some scientists said there was little to suggest that Americans at low risk needed even a single annual shot. The original vaccines continue to protect young and healthy people from severe disease, and the benefit of annual boosters is unclear.

Most people are “well protected against severe Covid disease with a primary series and without yearly boosters,” said Dr. Céline Gounder, an infectious disease physician and senior fellow at the Kaiser Family Foundation.

The F.D.A. advisers said they would like to see detailed information regarding who is most vulnerable to the virus and to make decisions about future vaccination strategy based on those data.

“How old are they? What are their comorbidities? When was the last dose of vaccine they got? Did they take antiviral medicines?” Dr. Offit said. At the moment, the national strategy seems to be, “‘OK, well, let’s just dose everybody all the time,’” he said. “And that’s just not a good reason.”

I am obviously not remotely qualified to weigh in on the merits. I like the idea of yearly boosters, because I already get a yearly flu shot and this is appealing as a neat and orderly risk-mitigation device. I’d like to think it might help increase the number of people who get boosted, but I’m not quite that optimistic. It would be nice to say that the science should prevail over the politics in this debate, but you can’t take the politics out of it, and you still need people to buy into whatever eventually gets recommended. Just try to make a good decision and don’t draw it out to the point where the only thing people hear about is the argument over the decision. StatNews has more.

COVID rates tick down again in Houston

Always a good headline to read.

COVID-19 data from the Texas Medical Center this week suggests the current wave may be subsiding, though experts urge caution as a new, highly infectious variant continues to circulate.

The average number of daily hospitalizations in the medical center had been rising steadily for a month, but dropped last week by about 20 percent, from 182 to 146. Regional COVID hospitalizations also have dropped from a five-month high of 1,002 on Jan. 5 to 836 on Monday, according to the Southeast Texas Regional Advisory Council.

Most significantly, the viral load in the city’s wastewater — the most reliable indicator of future virus spread — dropped by about 34 percent last week, according to data published Tuesday.

“I would be very surprised if we saw this (trend) reverse at this point,” said Dr. James McDeavitt, senior vice president and dean of clinical affairs at Baylor College of Medicine.

Even with a hopeful outlook, researchers cautiously are eyeing the progress of XBB.1.5, which public health officials say is the most transmissible form of COVID yet. It quickly has become the dominant strain nationwide. The variant accounts for 80 percent of cases in the Northeast, according to the Centers for Disease Control and Prevention, though it has yet to beat out other infectious strains in Houston and much of the South.

Here’s that wastewater dashboard again. We’re still at a very high level compared to the July 2020 baseline, but at least we’re going in the right direction now. Hospitalization rate is the bigger concern, but again as long as we’re now trending downward, the overall picture is improving. There’s an argument to be made that we shouldn’t obsessively track each new alphabet-soup variant, at least not while they’re all about the same level of lethality. The fact that successive versions are more transmissible than their predecessors are just how viruses work. I’m not sophisticated enough to make a judgment about that, but I have limited my worry to the prospect of a deadlier strain.

There are still other things to worry about:

The United States has faced a triple threat of respiratory viruses over the past few months, with COVID-19, the flu and RSV driving infections and hospitalizations in the Houston area and elsewhere.

Each of the three are capable of causing mild to severe illness by themselves. But it’s also possible to contract more than one virus at a time — and a new study suggests a coinfection may lead to more severe illness in young children.

The term “flurona” became popular on social media last year as a surge in COVID-19 and the re-emergence of the flu caused a wave of infections. However, doctors were seeing patients — particularly young children — with coinfections before the pandemic, said Dr. Amy Arrington, medical director of the Special Isolation Unit at Texas Children’s Hospital.

“It’s not uncommon that we see younger kids getting co-infected,” she said. “I think a lot of parents today in Houston can say they feel like their child’s been sick for the past few months straight.”

Younger children might be more susceptible to coinfections because they haven’t been exposed to a respiratory virus before, Arrington said. They may be getting infected at daycare, or from an older sibling who picked up the virus at school.

Coinfections are uncommon, but doctors might be seeing them more frequently this fall and winter for a few reasons, said Dr. Luis Ostrosky, chief of infectious diseases at UTHealth Houston and Memorial Hermann Hospital.

The collision of COVID-19, the flu and RSV, as well as other respiratory viruses like rhinovirus and enterovirus, has created more opportunity for infection, he said.

“Tripledemic” was the word I heard. Fortunately, RSV and flu rates have been dropping as well. You can still get a flu shot, and for sure you can and should get your bivalent booster. Hell, I’m ready for whatever the next generation COVID booster is now. I’ll be among the first in line when that becomes available. You are your only real defense here, so do what you need to do.

New year, new omicron variant

Stay safe out there.

A new omicron COVID-19 variant is spreading fast across the United States and beginning to make inroads in Houston, where the positivity rate continues to rise.

The new strain, XBB.1.5, was first detected on the east coast in late October and gained traction in December. Over the last four weeks, it has quickly edged out the previously dominant strains to make up 40 percent of cases nationally. It appears to be more transmissible than its predecessors, based on early lab results, with properties that help it evade vaccine immunity, said Dr. Luis Ostrosky, chief of infectious diseases with UTHealth Houston and Memorial Hermann Hospital.

Ostrosky and other experts say the new strain is likely contributing to the rise in cases throughout Houston, where the percentage of positive tests jumped from 8.1 percent to 11.1 percent last week, according to the most recent data from the Texas Medical Center. The average number of weekly COVID hospitalizations also saw a sharp uptick last week, from 529 to 663, including intensive care unit admissions.

The numbers are still a far cry from the original omicron wave one year ago, but infectious disease experts worry how waning immune protection will factor into the surge.

“We are at a moment in the pandemic where a lot of people got sick over the summer and immunity is going down from natural infection,” Ostrosky said. “Vaccine rates are not great and boosting rates are abysmal in this country … It does appear we’re converging into this immunity cliff.”

Only 15 percent of Americans over 5 years old have received the updated booster shot, first authorized for adults in August. About 30 percent of the country’s population has yet to complete the primary series, according to the Centers for Disease Control and Prevention.

While the updated booster shot may not prevent infections from the newest variant, public health experts still say it’s the best way to prevent severe disease from COVID.

Same song, next verse. The good news for now, as Your Local Epidemiologist notes, is that this latest version of omicron, like all of its predecessors, isn’t any more virulent or deadly than before. Thus, hospitalization rates remain fairly stable, though they are currently going up. Flu and RSV infections are also declining, which helps. None of this matters if you or a loved one are getting sick. Get that bivalent booster and take the usual precautions. We will get through this.

It’s winter surge time again

Sorry to be the bearer of bad news, though I think you already suspected this.


COVID-19 cases are rising across Texas two weeks after the Thanksgiving holiday, echoing last year’s surge of the omicron variant.

There are more than 18,000 positive cases across the state this week, up from a little over 7,000 the week of Thanksgiving.

“Thanksgiving this year was kind of like PTSD,” said epidemiologist Katelyn Jetelina, author of Your Local Epidemiologist. “I think all of us epidemiologists were holding our breath, just to make sure this was going to be a regular Thanksgiving.”

While hospitalizations and deaths are still low thanks to COVID-19 vaccinations and the updated bivalent booster that targets omicron, cases have been steadily climbing since November.

The change this year, Jetelina said, is the combination of flu, RSV, and now COVID. The Texas Department of State Health Services reports the intensity of influenza-like illness has remained “very high” in the past few weeks, with an increase in the number of influenza outbreaks and more than 28,000 positive flu tests in the week ending in Dec. 3.

“RSV and flu are just back with vengeance,” she said. “We’re starting to get a sneak peek of what this new normal is.”

Other states, like New York, have issued a health advisory to encourage people to mask indoors while cases are high. Jetelina said it’s important to think about protecting the most vulnerable members of the community, like the elderly and folks who are immunocompromised.

“I’m going to have 90-year-old people at my house for Christmas this year,” she said. “That, to me, means I am wearing an N-95 mask in public everywhere I go the week before Christmas. It helps ensure I don’t miss the event because I’m sick, but it also helps break that transmission chain so I don’t bring it to my grandparents.”

She says it’s not too late to get vaccinated to protect against COVID and the flu.

“I’m tired, everyone’s tired, [but] the virus isn’t tired of us,” she said.

We saw this coming in October, and we know what a “tripledemic” is. The virus levels in the wastewater are high. You know what I’m going to tell you: Get your bivalent booster and your flu shot. Wear that mask in crowded indoor spaces. Isolate yourself if you feel sick. Think about the high-risk people in your life. We’re not in 2020 any more, and the current dominant strains are thankfully not as virulent as delta was. You really can do a lot to maximize your safety while giving up very little. But you have to actually do it.

Santa Claus is back

So, you know, you better watch out, and all that.

Some Santas who stayed home the past two years out of concern for their health have returned, but performers have pressing issues, including inflation, on their minds. Many are older, on fixed incomes and travel long distances to don the red suit. They spend hundreds on their costumes and other accoutrements.

Santa booker HireSanta.com has logged a 30% increase in demand this Christmas season over last year, after losing about 15% of its performers to retirement or death during the pandemic, said founder and head elf Mitch Allen.

He has a Santa database of several thousand with gigs at the Bloomingdale’s flagship store in New York, various Marriott properties and other venues around the U.S. Most of Allen’s clients have moved back to kids on laps and aren’t considering covid-19 in a major way, he said, but Santa can choose to mask up.

Another large Santa agency, Cherry Hill Programs, is back up to pre-pandemic booking numbers for their 1,400 or so Santas working at more than 600 malls and other spots this year, said spokesperson Chris Landtroop.

“I can’t even explain how excited we are to see everyone’s smiles at all locations this season without anything covering up those beautiful faces,” she said.

Cherry Hill Santas are also free to wear masks, Landtroop said.

[…]

Allen and other agencies are juggling more requests for inclusive Santas, such as Black, deaf and Spanish-speaking performers. Allen also has a female Santa on speed dial.

“I haven’t been busted yet by the kids and, with one exception, by the parents, either,” said 48-year-old Melissa Rickard, who stepped into the role in her early 20s when the Santa hired by her father’s lodge fell ill.

“To have a child not be able to tell I’m a woman in one sense is the ultimate compliment because it means I’m doing Santa justice. It cracks my husband up,” added Rickard, who lives outside Little Rock. “I know there are more of us out there.”

By mid-November, Rickard had more than 100 gigs lined up, through HireSanta and other means.

“A lot of it is word-of-mouth,” she said. “It’s ‘Hey, have you seen the female Santa?'”

Rickard charges roughly $175 an hour as Santa, depending on the job, and donates all but her fuel money to charity. And her beard? Yak hair.

Eric Elliott’s carefully tended white beard is the real deal. He and his Mrs. Claus, wife Moeisha Elliott, went pro this year after first taking on the roles as volunteers in 2007. Both are retired military.

They spent weeks in formal Claus training. Among the skills they picked up were American Sign Language and other ways to accommodate people with disabilities. Their work has included trips into disaster zones with the Texas-based nonprofit Lone Star Santas to lend a little cheer.

The Elliotts, who are Black, say breaking into the top tier of Santas as first-time pros and Clauses of color hasn’t been easy. For some people, Eric said, “We understand that we’re not the Santa for you.”

Hope this is a better year for the Santa community. I’ve noted the Lone Star Santas and another Texas-based Santa employment agency before. These folks don’t make a lot of money doing this but they do have fun. That goes a long way.

I regret to inform you that “tripledemic” is a word

The good news is that we may avoid it here in Houston.

A collision of three respiratory viruses — COVID-19, influenza and RSV — may not hit Houston as severely as other parts of the country, experts say, but pediatric hospitals are still preparing for a busy winter season with at least some virus overlap.

Texas Medical Center data published Tuesday shows early signs of another COVID wave, with an uptick in hospitalizations and the positivity rate, which jumped from 3.2 percent to 5 percent last week. COVID wastewater surveillance also offers a grim outlook, as the viral load rose for the fifth straight week, to 196 percent of the baseline set in July 2020. Newer variants make it difficult to predict the size and severity of the next wave of infections, experts say.

Meanwhile, RSV and flu, two respiratory viruses that commonly infect children, continue to circulate at high levels, weeks after patients began filling beds and prolonging wait times in Houston pediatric hospitals. Despite the ongoing strain, infectious disease experts believe Houston can avoid a so-called “tripledemic,” in which three simultaneous virus surges overwhelm hospital systems.

Statewide surveillance shows both RSV and flu have either peaked or declined.

“At least for us, here in Houston, the story that’s being written is we had this very early peak of flu and RSV and they’re starting to come down,” said Dr. Wesley Long, the medical director of diagnostic microbiology at Houston Methodist. “But then we’re probably going to see a winter speed bump of COVID.”

Dr. Melanie Kitagawa, medical director of the Texas Children’s Hospital pediatric ICU, said there are roughly 50 children admitted to Texas Children’s with RSV, or respiratory syncytial virus, which usually causes mild cold-like symptoms but can be severe for infants and older adults. That number has remained steady for at least a month, but flu admissions have been decreasing across the hospital system, she said.

Flu and RSV admissions have stayed at consistently high levels at Children’s Memorial Hermann for weeks, said Dr. Michael Chang, an infectious disease pediatrician at the hospital who is affiliated with UTHealth Houston.

Chang expects RSV to become more manageable before COVID ramps up. The percentage of positive RSV tests has dropped across the state since early October, from roughly 25 percent to less than 15 percent, according to the Texas Department of State Health Services.

For him, flu rates are more of a concern. Texas’ flu infection rate of 29 percent is among the highest in the nation, according to the Centers for Disease Control and Prevention.

“For flu, what I really worry about is that people have returned to normal behaviors, and vaccine uptake doesn’t seem to be really good,” he said. “From what I’ve seen of the new COVID numbers, we may see an unfortunate confluence of (COVID) and significant flu cases. But luckily I think we will avoid a full ‘tripledemic.’”

There are recent signs that the flu is waning as well.

See here for some background. We have milder winters here, so because we can still do stuff outside we can have a smaller winter effect from COVID. But the bottom line is the same as it always has been for minimizing the spread of these viruses. Get your COVID boosters, especially the bivalent booster. Get your flu shot. Keep wearing your facemask in crowded indoor spaces, and avoid such spaces where possible. You have the power and the choice to minimize your risk.

Beware of RSV

Worrying.

Two common respiratory viruses continue to keep Houston pediatric hospitals unusually busy this time of year, with both the flu and RSV seeing a second surge following a rise in cases over the spring and summer, respectively.

Before the COVID-19 pandemic, children sickened with either illness flocked to hospitals later in the winter months, from November to January. But intense isolation, social distancing and masking appears to have changed when those viruses spread, experts say, with a swath of young children being exposed for the first time.

It’s also unusual to see both viruses surging twice in the same year, puzzling top pediatric doctors in Houston.

“I was not necessarily expecting a surge right now,” said Dr. Michael Chang, a pediatric infectious disease specialist at UTHealth and Children’s Memorial Hermann Hospital. “Having had a summer (RSV) surge, I was expecting that was it. It’s very unusual to have two surges in a single season. It happens, rarely, but it’s very uncommon.”

Both RSV, or respiratory syncytial virus, and the flu have similar symptoms with slight differences. Both illnesses produce cold-like symptoms. The flu is more associated with a higher fever, while a key indicator of RSV is wheezing, according to the Cleveland Clinic. Nearly all children catch RSV before age 2. Both illnesses often do not require hospitalization, but young infants and older adults with compromised immune systems are at higher risk of severe illness from RSV.

RSV saw a massive spike last summer, and Chang and other pediatric doctors had warned of another summer surge this year. But when cases initially started to rise in June, the numbers never dropped back to baseline levels. The statewide positivity rate for antigen tests hovered around 10 percent until September and early October, when the positivity rate jumped again to more than 25 percent, according to the Texas Department of State Health Services.  Last summer, the statewide positivity rate for antigen tests surpassed 30 percent.

[…]

Influenza A, one strain of the flu, also is on the rise after an increase in March and April. Houston Methodist’s respiratory pathogen data shows the hospital system is seeing year-long high in weekly cases with 656.

Despite the unusual pattern, parents of young children in the Houston area should not panic, doctors say. While national reports indicate record high patient volumes in some parts of the country, Houston is better equipped than other large cities to handle the surge, with two large pediatric hospitals in Texas Children’s and Children’s Memorial Hermann. The dual virus threat also is nothing new for pediatricians, as the flu and RSV season often overlapped before the pandemic.

“This is how every December and January used to be in children’s hospitals across the country,” Chang said.

COVID cases remain low in the Houston area. While some hospitals may hit capacity on busier days, and patients may encounter long wait times, the small percentage of RSV and flu patients who need hospitalization should be able to find beds, doctors say. Dr. James Versalovic, chief pathologist at Texas Children’s Hospital, said parents should consult with pediatricians if their children have persistent symptoms, including coughing, fever, poor feeding or rapid breathing. Virtual appointments are also available if area hospitals are strained.

It’s not just happening in Harris County, either. It’s having some negative effects.

With respiratory illnesses spreading among children more widely and earlier than in previous years, hospital leaders and medical experts say pediatric hospital beds across the state are in short supply.

After two years of mild flu seasons — a result of mitigation strategies to limit the spread of COVID-19 — medical experts say the number of children developing respiratory illnesses is already much higher this year, leading to more visits to health care centers and increasingly strained resources to treat those children.

Experts say the strain stems from overburdened hospital systems still reeling from the impact of the COVID-19 pandemic and a shortage of medical providers.

Dr. Gerald Stagg, a pediatrician working in Mount Pleasant, said cases of respiratory syncytial virus, known as RSV, and an earlier flu season have added pressure to hospital systems on top of other respiratory illnesses caused by COVID-19 and other viruses.

“I’ve been doing this for 42 years and I’ve never seen anything quite like it,” Stagg said of the number of children needing treatment for respiratory illnesses this year.

With the higher rates of respiratory illnesses, Stagg said not only are hospitals filling up, but clinics like his are having trouble keeping up with the huge uptick in visits from children with the flu.

Stagg said it’s become more difficult over the last two months to find beds in larger medical systems for sick children who require higher levels of care than what rural hospitals are able to provide.

“We’ve had to even send kids to Arkansas or Louisiana from our Texas facility because we couldn’t find a bed,” Stagg said.

He added that the shortage of hospital beds is a risk to children with serious illnesses that are not respiratory because there isn’t sufficient space in intensive care units for them.

Carrie Kroll, the vice president of advocacy, public policy and political strategy at the Texas Hospital Association, said the shortage of pediatric beds is a workforce issue. Hospital systems are still dealing with staffing shortages after droves of nurses and other hospital workers, suffering from pandemic-related burnout, retired or left the field.

“A bed is a bed. If it doesn’t have anyone to staff it, you can’t put a kid in it,” Kroll said.

[…]

Dr. Iván Meléndez, the Hidalgo County health authority, said his region has enough beds and resources to meet the needs of the community at the moment.

Meléndez did warn that this year could have significantly more cases of the flu than previous ones. Federal health data released Friday reported 880,000 cases of influenza and 360 flu-related deaths nationally. The last time the country saw similar rates of the flu was in 2009. And flu season has just started; it generally spans from October to May.

Earlier this month, Hidalgo County reported one of the first deaths of a child due to the flu this season.

“We’re thinking this may be the third since the turn of the century of being a ‘high-flu’ year,” Meléndez said.

He said the prevalence of the flu this year is an unintended consequence of masking and isolating during the COVID-19 pandemic.

“As a community, worldwide, we didn’t develop those antibodies that are usually present in the community at some level to protect people,” he said.

To address the surge of respiratory illnesses, Meléndez and other medical experts strongly recommended vaccinations against the flu and COVID-19.

Sure would be nice if we had a governor that was capable of delivering that message. There’s no vaccine for RSV, but the flu shot and the bivalent booster are easily available, so do what you can to protect yourself. Your Local Epidemiologist has more.

Is this just the calm before the next COVID wave?

Things look good now, at least in the Houston area, but COVID never sleeps.

As the U.S. heads into a third pandemic winter, the first hints are emerging that another possible surge of COVID-19 infections could be on its way.

So far, no national surge has started yet. The number of people getting infected, hospitalized and dying from COVID in the U.S. has been gently declining from a fairly high plateau.

But as the weather cools and people start spending more time inside, where the virus spreads more easily, the risks of a resurgence increase.

The first hint of what could be in store is what’s happening in Europe. Infections have been rising in many European countries, including the U.K., France, and Italy.

“In the past, what’s happened in Europe often has been a harbinger for what’s about to happen in the United States,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “So I think the bottom line message for us in this country is: We have to be prepared for what they are beginning to see in Europe.”

Several computer models are projecting that COVID infections will continue to recede at least through the end of the year. But researchers stress there are many uncertainties that could change that, such as whether more infectious variants start to spread fast in the U.S.

In fact, scientists are watching a menagerie of new omicron subvariants that have emerged recently that appear to be even better at dodging immunity.

“We look around the world and see countries such as Germany and France are seeing increases as we speak,” says Lauren Ancel Meyers, director of the UT COVID-19 Modeling Consortium at the University of Texas at Austin. “That gives me pause. It adds uncertainty about what we can expect in the coming weeks and the coming months.”

However, it’s not certain the U.S. experience will echo Europe’s, says Justin Lessler, an epidemiologist at the University of North Carolina who helps run the COVID-19 Scenario Modeling Hub.

That’s because it’s not clear whether Europe’s rising cases are related to people’s greater susceptibility to new subvariants they’ve not yet been exposed to. In addition, different countries have different levels of immunity.

“If it is mostly just behavioral changes and climate, we might be able to avoid similar upticks if there is broad uptake of the bivalent vaccine,” Lessler says. “If it is immune escape across several variants with convergent evolution, the outlook for the U.S. may be more concerning.”

In fact, some researchers say the U.S. is already starting to see early signs of that. For example, the levels of virus being detected in wastewater are up in some parts of the country, such in Pennsylvania, Connecticut, Vermont and other parts of the Northeast. That could an early-warning sign of what’s coming, though overall the virus is declining nationally.

“It’s really too early to say something big is happening, but it’s something that we’re keeping an eye on,” says Amy Kirby, national wastewater surveillance program lead at the Centers for Disease Control and Prevention.

But infections and even hospitalizations have started rising in some of the same parts of New England, as well as some other northern areas, such as the Pacific Northwest, according to Dr. David Rubin, the director of the PolicyLab at Children’s Hospital of Philadelphia, which tracks the pandemic.

“We’re seeing the northern rim of the country beginning to show some evidence of increasing transmission,” Rubin says. “The winter resurgence is beginning.”

As the story notes, we’re overall in a much better place because there’s a lot more immunity thanks to vaccinations and our previous high rate of infections. The COVID levels in wastewater here is low now, and while we’re hardly a leader in vaccinations, we at least have warmer winters so there are still plenty of opportunities to be outside, and fewer times where you have to be congregated inside. But also, not nearly enough people have had their bivalent boosters yet, and there are concerns about the flu season. So, you know, remain appropriately cautious – masking in places where you used to have to mask is still an excellent idea – and get those shots.

The wastewater is looking good now

In terms of COVID levels, anyway.

The COVID-19 viral load in Houston’s wastewater has sunk to its lowest point in seven months as the city puts the latest wave, driven by the highly contagious omicron subvariant BA.5, in the rear view.

The wastewater levels are 71 percent of what the Houston Health Department detected during the July 2020 wave, which the city uses as a benchmark, according to Texas Medical Center data published Tuesday. The COVID hospitalization rate and positivity rate also continue to decline steadily.

Harris County last week dropped its COVID community level from “medium” to “low,” which recommends staying up to date on vaccinations and testing if you have symptoms. Scientists are looking to other countries for signs of what comes next.

“Our history has typically been a winter surge,” said Dr. Luis Ostrosky, chief of infectious diseases with McGovern Medical School at UTHealth Houston. “So let’s enjoy it while we can.”

Several new omicron off-shoots have been detected in the United Kingdom, India, Singapore, Denmark and Australia, according to the journal Nature. BA.5 continues to dominate cases in the United States, though one subvariant, BA.4.6, has gained some traction and now makes up roughly 12 percent of cases, according to the Centers for Disease Control and Prevention. Ostrosky urged people to get their updated booster shots, which better target omicron variants.

The dashboard is here, and you can see it as a graph here. COVID from the omicron wave peaked in the wastewater in July, but it was at almost ten times the level as it had been in July of 2020. It is now at 71% of the July 2020 levels, which is much better in so many respects. Get up to date on your boosters – I got my bivalent booster the other day – and get a flu shot (got one of those as well, at the same time), because there’s concern this could be a bad flu season. And even with these levels going down, hopefully for the foreseeable future, it’s still a good idea to wear a mask in crowded indoor spaces. Might help you avoid catching a winter cold, too.

The new county COVID risk assessment system

We’ll see how it works.

Harris County has revamped its method for assessing the public’s risk for contracting COVID-19, replacing the threat level system that has been in place since early in the pandemic with a community level system that places a greater emphasis on new cases.

The change was made due to a “decoupling” of the relationship between new cases and new hospitalizations during the most recent wave of COVID-19 fueled by the BA.5 subvariant of omicron, Judge Lina Hildalgo said during a news conference Thursday. Harris County did not see a spike in hospitalizations as COVID-19 cases surged this summer, she said.

The new system will allow the public to make their own decisions about the level of risk they are comfortable with taking, knowing that the chance of being hospitalized with a severe illness is relatively low if they have been vaccinated and boosted, Hidalgo said.

“We’re turning a page on a phase of this virus, and I’m very hopeful that we won’t have to go back to a time when surge hampered the entirety of the community,” Hidalgo said.

Hidalgo said the threat level system had been an important tool for gauging risk throughout the pandemic. It had been updated before, but this week’s changes represent a “wholesale redesign,” she said.

The new system uses a trio of color-coded community levels that indicate the risk for contracting COVID-19. Low is green, medium is yellow and high is orange. Harris County is currently yellow, but Hidalgo anticipated the community level could rise to orange with the risk for transmission increasing with children back in school.

[…]

The Harris County Public Health website offers guidance for each of the three threat levels, including recommendations for wearing a mask, traveling and social gatherings when the county is green, yellow or orange. The site will continue to offer other pertinent information, such as wastewater monitoring data and the percentage of county residents who have been vaccinated and boosted.

I had to find the appropriate webpage for this on my own – click the embedded image to get there. The old threat level webpage now gives a 404 error. This new system seems fine and reasonable. The main concern is about what might come next.

Q: So how are we doing these days? The numbers certainly look better than they did.

A: They are falling, no doubt about it. But we have to keep in mind that we don’t have a lot of details about the real number of cases. Most of us are getting diagnosed at home using home testing kits. The numbers were always underestimating by a factor of four or five. Now it’s probably seven to 10. So you have to have to look trends.

Numbers are going down. But here are numbers I keep reminding people of: We’re still losing 400 or 500 Americans a day to COVID, which makes it the third or fourth leading cause of death on a daily basis in the United States. There’s still a lot of terrible messaging. People say we don’t have as many hospitalizations. Or that everybody has been infected or vaccinated or vaccinated with breakthrough. All of that is true. On a population level, it has had mitigating effects. But that doesn’t help you make an individual health decision.

People conflate that with individual health decisions. If you’re unvaccinated, there’s still a possibility you could lose your life to COVID. Even if you’re vaccinated and not boosted, there’s that possibility. And we’re seeing the boosters aren’t holding up as well as we’d hoped. That’s one of the reasons I’m strongly encouraging people to get this new booster, which has the mRNA for the original lineage and an added one against BA.5. After four or five months, there’s risk again for being hospitalized. The coverage declines from 80 percent to 50 percent protection against hospitalization.

Then this BA.5, even though it’s going down, it’s a long, slow tail. It’ll be around well into the fall. And the toughest thing to get people to understand is what’s going to happen in the winter. Obviously there’s no way to predict. But I think it’s still quite likely that we’re going to see a new variant just like we have the last two winters. Last winter it was omicron, BA.1. The winter before that we saw alpha. And new variants are arising because we’ve done such a poor job vaccinating low and middle-income countries.

We don’t know what a next variant could look like. More like the original lineage? Or something more like BA.5? The advantage of the new combined booster is that it gives you two shots on goal. It’s more likely to cross-protect against what’s coming down the pike. That’s no guarantee. But we’ve never done this before in terms of what the FDA does. We’ve never vaccinated against something that might be lurking out there. It’s a paradigm shift. What’s happening, and I don’t think the FDA will phrase it this way, but we’re creeping toward a universal coronavirus vaccine.

That’s from a Q&A with Dr. Peter Hotez, who knows better than I do. But I do know enough to say that you should get the omicron booster. And I also know enough to say that political stunts that endanger public health are bad. I think that about covers it.

Ken Paxton keeps trying to kill the SAISD vaccine mandate

On brand, always on brand.

Texas Attorney General Ken Paxton has filed another petition seeking to reverse a Bexar County judge’s decision that rejected the state’s bid for a temporary injunction to block the San Antonio Independent School District’s staff vaccine mandate.

Even though SAISD’S vaccine mandate remains on pause despite the court’s ruling in its favor, Paxton said he will “continue fighting for medical freedom.”

“Nobody should be bullied, coerced, and certainly not fired because of their COVID-19 vaccination status,” said Paxon in his announcement, adding the decision is not only an affront to individual liberty, but “illegal under Texas law.”

“The governor’s executive order specifically protects workers from the type of mass firings that San Antonio ISD is seeking, and I will continue to fight in court to defend GA-39 and Texans’ medical freedom,” he said.

The petition was filed Sept. 7 with the Texas Supreme Court.

An SAISD spokeswoman said in a statement that the vaccine mandate remains suspended and that no employee was ever disciplined for refusing to get the vaccine.

See here and here for the previous updates. There’s a recitation of the long history of this legal saga in the story if you want that. I remind you that this mandate was never enforced and remains on pause, not that these things matter to Ken Paxton. The appellate court ruling that Greg Abbott doesn’t have the power he claimed to have when he forbade these mandates seems pretty clear to me, but you never know what SCOTx will do. Now we wait to see if they’ll take this up.

Monkeypox case rate slows

Some good news.

Monkeypox infection rates are slowing in Houston, data shows, with health officials pointing to changing behavior as the key reason for the decline.

The 14-day average of daily new cases dropped by 43 percent, from .23 cases per 100,000 people, to .13, between Aug. 23 and Sept. 2, the last day for which data is available. As of Wednesday, Houston and Harris County had recorded a combined total of 693 cases.

Dr. David Persse, Houston chief medical officer, said he thinks it’s too early to attribute the drop to vaccinations, which became available in Houston in late July. Most people have yet to receive full protection from their second dose, administered about a month after the first dose.

“I believe the change … is largely because of individuals changing behavior and thinking twice about some of the high-risk behaviors,” Persse said during a Thursday Q&A session with reporters.

[…]

More than 5,200 people have received their first dose of the vaccine from the Houston Health Department. Harris County Public Health has administered the first dose to an additional 3,600 people.

Persse and Dr. Erick Brown, Harris County’s local health authority, said there are “plenty” of doses left and encouraged eligible people to schedule appointments by calling Houston’s hotline at 832-393-4220 or Harris County’s hotline at 832-927-0707.

“I’d like to strongly emphasize we are not out of the woods,” Brown said.

Monkeypox was never the public health crisis that COVID was – it’s a lot less contagious, and a lot less deadly – but we also had a vaccine already in place and needed to get it to a much smaller population in order to get the outbreak under control, and we didn’t do as well as we should have. We’re in better shape now, and I have hope we can continue to drive the numbers down. In the meantime, if you’re eligible for this vaccine, please do get it.

Our overall vax level is down

Not great!

The coverage rate for routine childhood vaccines – or the percentage of kids getting them – dropped during the COVID-19 pandemic and have yet to recover, according to statistics from the Texas Department of State Health Services.

Health care providers said many families skipped doctor’s visits during the pandemic to avoid exposure to the virus. But the drop is also due to a rise in “conscientious exemptions,” or parents and guardians who refuse to get their children vaccinated for religious, moral or philosophical reasons.

While anti-vaccine movements have existed since the smallpox vaccine debuted in the early 1800s, some worry the pushback against the COVID-19 vaccine may have a detrimental effect on the uptake for routine childhood immunizations, too.

“I think that, certainly, [the pandemic] is a good explanation for this,” said Terri Burke, the executive director of the Houston nonprofit The Immunization Partnership. “But there is no question that the vaccine hesitancy, skepticism, misinformation [and] disinformation that circulates around the COVID vaccine has bled over into childhood vaccines.”

A study published in the journal Vaccine found that from 2019 to 2020, immunization rates fell 47 percent among 5-month-olds and 58 percent among 16-month-olds.

Texas did see a slight increase in vaccination rates earlier this year, but they still remain below pre-pandemic levels, said Tasmiah Nuzhath, a Texas A&M School of Public Health doctoral candidate who led the study. That’s a concern because regardless of the reason, a lower percentage of vaccinated children means heightened for outbreaks of a disease like the measles, she said.

“Even a few-percentage dip in vaccination rates will put children at risk of getting sick, and could affect community protections against serious diseases,” Nuzhath said.

[…]

In the Houston area, there are some signs that coverage rates may be slowly recovering from the pandemic. The HOPE Clinic, for example, had a large demand for the shots before students returned to school this fall, Clinical Director Kara Green said.

The Immunization Clinic in Stafford has also seen more children coming in for their vaccines this year, but coverage rates are “still not where [they] should be,” Nursing Director Yvette Cheeks said.

During the 2011-12 school year, coverage rates were at least 97.4 percent for each of the routine vaccines required for kindergarten students, and at least 96.6 percent for each required for seventh grade.  By 2021-22, rates fell to a range of 93.5 percent to 95.9 percent for kindergarten, and 91.9 percent to 98 percent for seventh grade.

Some of the decline can be attributed to children who haven’t gotten their shots yet, but may do so later. Those “delinquency” rates topped 3 percent for the chickenpox, polio and DTaP (diphtheria, tetanus and acellular pertussis) vaccines for kindergarten and around 6 percent for the meningitis and DTaP vaccines for seventh grade.

It’s also due to a rise in conscientious exemptions. Ten years ago, the chickenpox vaccine for kindergarten had the highest rate of conscientious objections at 0.8 percent. By last year, rates hit at least 2.1 percent for each kindergarten vaccine and at least 1 percent for each seventh grade vaccine.

Those percentages may not seem like a lot, but they represent an increase from 28,432 conscientious objections across Texas in 2011-12 to 85,726 last year, according to TDSHS statistics.

Green and Cheeks believe coverage rates could increase through better access to the vaccines. Both the HOPE Clinic and the Immunization Clinic offer vaccines to lower-income and uninsured patients.

However, Green noted that the HOPE Clinic sees families cancel their child’s vaccine appointment due to issues such as a lack of transportation, or not having child care for their other children. Pop-up vaccination clinics at Houston schools or other community sites could help increase uptake, she said.

“I think if we make it easier for families to get these things done, then we really open up a lot of opportunities,” she said.

We need to do everything we can to make sure that all needed vaccines are easily available to all that want them. That’s a bigger problem that can be solved locally, but we have to try. Anyone can claim to be “pro-life”, but unless you’re pro-getting-lifesaving-shots-into-kids-arms, you’re just full of hot air.

Your omicron booster will be ready this week

I’ll be getting mine.

Most Texans will be eligible in the coming days for a second round of Covid-19 booster shots after updated vaccines got final federal approval this week.

The new doses, from Pfizer-BioNTech and Moderna, are designed to fight off severe infection from the latest versions of the omicron variant, which have proven especially easy to spread. Federal health officials hope the new round of boosters can add a layer of immune protection heading into a potential uptick of infections this fall as people head back indoors.

The new boosters will be available to anyone 18 and older for Moderna’s, and anyone over the age of 12 for Pfizer-BioNTech’s. Older adults have been eligible for several months.

“If you are eligible, there is no bad time to get your COVID-19 booster and I strongly encourage you to receive it,” the Centers for Disease Control Director Rochelle Walensky said Thursday after endorsing an advisory committee’s recommendation to make the shots widely available.

The updated vaccines add spike protein components from the omicron subvariants BA.4 and BA.5, which helps restore protection that has waned since previous vaccine rounds. The CDC recommends waiting two months after your most recent COVID shot before getting the booster.

A spokesperson for the Texas Department of State Health Services said the doses are expected to ship out in the next few days, so Texans should be able to make appointments next week. Like previous boosters, these will be available at pharmacies, standalone health clinics and through local health departments, the agency said.

Both CVS and Walgreens were allowing patients to schedule the updated boosters as of Friday.

As the story notes, while COVID deaths in Texas are way down – about 100 a month statewide at this time – people are still getting infected. Plenty of people I know have been sidelined for a week or two in recent months. Long COVID and other risks remain as well. I’m still pretty vigilant about masking in indoor spaces, which usually puts me in a distinct minority, but it’s just a numbers game, and sooner or later that catches up to you. I’ll add on another layer of defense for that, thanks very much.

The latest COVID wave may be peaking in Houston

Hopefully

Texas Medical Center data released Tuesday suggests the latest wave of COVID-19 might have reached its peak in the Houston area, though several key metrics used to track the virus remain high.

The medical center’s weekly data report shows that COVID-19 hospitalizations, the positivity rate of coronaviruus tests and the amount of virus detected at the city of Houston’s wastewater treatment plants all trended downward for the second straight week. Those trends indicate the Houston area has likely crested the peak of a recent surge caused by the extremely contagious BA.5 subvariant, said Dr. James McDeavitt, executive vice president and dean of clinical affairs at Baylor College of Medicine.

“All the numbers are pointing to the fact that we’ve peaked maybe a week, a week and a half ago,” McDeavitt said. “I fully expect we will continue to trend down over the next several weeks.”

The line graphs from the TMC show a mountain range of peaks from prior waves of COVID-19, such as those caused by the delta and omicron variants. The latest BA.5 wave shows that after several weeks of steady climbing, the line is finally on the descent.

During previous waves, the virus did not pick up steam again after the numbers started to trend downward, McDeavitt said. He expects the same trajectory from BA.5.

It appears the current wave has at least reached a plateau, said Dr. Ashley Drews, an infectious disease specialist at Houston Methodist. The fact that the key metrics have stabilized is an encouraging sign, she said.

“We’re cautiously optimistic that things are turning in the right direction, and we’re going down,” Drews said.

[…]

During the week of July 25, TMC hospitals admitted an average of 219 patients with COVID-19 per day. That’s down from an average of 226 during the week of July 18, and 240 during the week of July 11.

However, the numbers remain much higher than they were before the emergence of BA.5. Three months ago, TMC hospitals admitted an average of 80 patients per day.

The good news is that the percentage of patients who need to be treated in an ICU remains lower than prior surges of COVID-19.

Last week, less than 14 percent of the 912 patients admitted with COVID-19 were treated in an ICU, according to TMC data. That’s lower than the percentage of patients treated in an ICU at the peaks of the omicron wave (17 percent) and the delta wave (22 percent).

[…]

The amount of virus detected at the city of Houston’s wastewater treatment plants, which has been a reliable indicator of community spread, also fell for the second straight week.

Wastewater loads reached an all-time high during the week of July 11, at 927 percent higher than a baseline established in June 2020. That fell to 774 percent during the week of July 18, and to 725 percent over the past week.

The amount of virus in the wastewater is still much higher than before the recent surge. Three months ago, it was less than 100 percent higher than the June 2020 baseline.

So, the data is starting to go in the right direction, which is good. But there’s still a lot of COVID out there, and all of the levels are still a lot higher than they were before the wave began, even if they never approached the heights of the previous peaks, and that’s bad. You should still be exercising caution, which is to say wearing your mask and avoiding indoor crowds if you can. And of course, get vaxxed and boosted as needed. We may be back on the downswing, but there’s no reason to believe we won’t trend up again at some point, and we’ve still got a ways to go to get to the lower levels we want.

SAISD vaccine mandate upheld again

Also still on hold, but the state loses again at the appellate level.

A state appellate court upheld San Antonio Independent School District’s authority Wednesday to mandate its workers get vaccinated against COVID-19, almost a year after the district instituted the requirement for all staff to help stem the spread of the virus.

The 4th Court of Appeals on Wednesday denied Texas Attorney General Ken Paxton’s request to overturn a Bexar County judge’s decision not to grant the state a temporary injunction to block the staff vaccine mandate. Judge Mary Lou Alvarez of the 45th District Court issued that ruling in October, allowing SAISD to continue enforcing the mandate.

The court also ordered that the costs of the appeal be assessed against the state.

Paxton filed a lawsuit against SAISD in September, after first suing the district over the mandate in August because the vaccine had not been approved by the federal Food and Drug Administration. The August lawsuit was dropped after the FDA approved the Pfizer COVID-19 vaccine.

The lawsuit has wound its way through the state court system over the past year. Paxton’s office appealed Alvarez’s ruling to the 4th Court of Appeals and also requested the appellate court temporarily block the mandate while it considered Paxton’s appeal. The attorney general then requested the state Supreme Court step in and halt the mandate, which it did in mid-October.

The Texas Supreme Court’s ruling forced SAISD to stop enforcing the mandate while the 4th Court of Appeals considered the state’s appeal of the temporary injunction that Alvarez denied.

[…]

Paxton’s lawsuit argued that SAISD’s vaccine mandate violated Gov. Greg Abbott’s executive order prohibiting governmental entities from implementing COVID-19 vaccine mandates, which the governor claimed he had the authority to do under the Texas Disaster Act. Attorneys for SAISD challenged that reasoning, contending the Act does not give the governor the power to suspend all state laws.

Wednesday’s ruling by the 4th Court of Appeals determined that the Texas Disaster Act does not give Abbott the authority to suspend parts of the Education Code that allow school districts to issue vaccine mandates.

“The Texas Disaster Act expressly limits the Governor’s commander-in-chief authority to state agencies, state boards, and state commissions having emergency responsibilities,” the ruling states. “The District is not a state agency, a state board, or a state commission. Rather, the Texas Disaster Act defines the District as a ‘local government entity.’”

See here for the previous update. This sounds like a solid ruling, one that SCOTx ought to uphold, though who knows what they’ll actually do. It would also be written on sand to some extent, in that if the Republicans retain full control of government next year they’ll just amend the Texas Disaster Act to make it cover school districts and/or explicitly exclude anything having to do with vaccinations. In the meantime, even though the policy remains on hold during the litigation, it’s surely the case that the mandate got some holdouts vaccinated during the period while it was in effect. That will always be a win, no matter what happens from here.

We need more monkeypox vaccines

We have a chance to get on top of this. Let’s try to take it.

Houston-area leaders on Monday evening called for more vaccines to combat the small but growing number of local monkeypox infections.

There are 57 reported cases in the Houston area, including 10 in unincorporated Harris County. The Houston area recently received just over 5,000 doses of the JYNNEOS monkeypox vaccine from the state, but demand still far exceeds supply, health officials say. A two-dose series, administered four weeks apart, is required for full vaccination.

“What we learned from COVID is when the demand is high and supply is limited, people are very, very frustrated,” Mayor Sylvester Turner said during a news conference at Houston TranStar headquarters. “Now with monkeypox, with all the attention that’s been brought to it, the demand is very high.”

The World Health Organization over the weekend declared monkeypox a global health emergency. Monkeypox for years has been endemic in certain parts of Africa but has spread worldwide in recent weeks, with most cases among men who have sex with men.

[…]

The risk to the general public is low, health officials say. There have been no reported deaths among the roughly 2,800 cases in the U.S., and hospitalizations are mostly for pain management. There is at least one hospitalized monkeypox patient in Houston.

Even so, cases continue to rise around the world, and Turner and Harris County Judge Lina Hidalgo suggested at the press conference that a more preventative approach is needed in Houston.

“We have an opportunity to leap frog ahead of this virus to try to mitigate it in a way we couldn’t do with covid,” Hidalgo said.

Before the latest shipment, Houston and Harris County health departments have been making due with a few hundred monkeypox vaccines, prioritizing those suspected of coming into contact with a confirmed case.

There was a similar story from Dallas the day before this one came out. The monkeypox vaccine has been around for years, the issue was that it wasn’t readily available around the country. That is starting to change, and a broader group of people are eligible to receive it now, so as I said in the title, maybe we can get ahead of this before it gets to be too big. The good news is that this isn’t an easily transmitted virus, but it is very much out there now and the number of people who are infected with it will grow in the absence of action. Mayor Turner and Judge Hidalgo are on the right page here. They just need some support from the feds.

UPDATE: Followup story, Harris County has received more vaccines, a few hours after having to suspend vaccination appointments.

The current state of the hospitals

Worse than before, but not nearly as bad as before that.

A small but growing share of Houston healthcare workers are calling in sick with COVID, exacerbating long-running staffing issues at some hospitals amid the virus’s resurgence.

But despite spreading infections, medical leaders say the Houston-area healthcare system is managing this wave better than previous bouts with the virus, pointing to better therapeutics and fewer COVID patients requiring critical care.

Anecdotally, doctors say at least half of all COVID patients were admitted for reasons unrelated to the virus. While wastewater data reflects a soaring infection rate, daily new hospitalizations are climbing at a slower pace compared to the record-breaking omicron wave in January and February, according to Texas Medical Center data.

“I don’t anticipate we’re going to have major operational problems” among medical center hospitals, said Dr. James McDeavitt, executive vice president and dean of clinical affairs at Baylor College of Medicine.

The latest Texas Medical Center data, published Tuesday, show hospitalizations have nearly doubled over the last five weeks, from 121 in early June to 240 last week. In January, it took only five weeks for omicron to spark a nearly 600 percent increase in daily COVID hospitalizations, as admissions jumped from 74 to a record 515, according to TMC data.

Meanwhile, the increasing viral load detected in the city’s wastewater — 927 percent higher last week than July 2020 — appears to be as high as ever. Two weeks ago, the viral load was 843 percent of the July 2020 baseline. The citywide positivity rate also saw a slight increase from 29 percent two weeks ago to 31 percent last week, while the positivity rate in the medical center dropped slightly from 16.1 percent to 15.9 percent.

[…]

The number of sick hospital staff members reflects a small portion of the overall workforce at Houston hospitals. On Monday, Houston Methodist reported 402 staff members — 1.4 percent of all employees — had tested positive for COVID. Harris Health System said 245 staff members, or 2.4 percent of its workforce, had tested positive for COVID so far this July, compared to roughly 90 staff members throughout most of June.

Additionally, spokespeople for Memorial Hermann Health System, Texas Children’s Hospital and HCA Houston Healthcare say they are not experiencing major staffing issues or operational interruptions amid the current surge.

“Because of our vaccination and booster requirements, our staffing across hospitals is robust and fully intact,” said Dr. James Versalovic, chief pathologist at Texas Children’s Hospital. “I’m happy to say, we have prepared ourselves for this moment.”

More than two years into the pandemic, medical leaders now greet surges with more nuanced messaging, showing concern over rising infections and staffing struggles while assuring the public that hospitals are now better equipped to withstand rising infections.

Versalovic noted that Texas Children’s has seen its COVID population double over the last month. The 7-day rolling average of pediatric COVID patients is now more than 50 in the hospital system. He urged parents to seek out vaccinations as the start of school closes in.

On the one hand, this is basically good news. The hospitals are able to function without being overburdened, our overall vaccination level (and the good luck that this variant, however more contagious it is, isn’t particularly devastating) is helping keep levels in check, and while we’re worse off than we were a couple of months ago we’re much better off than we were in previous waves. One could argue that this is more or less what “endemic” looks like.

On the other hand, Stace is right. We’ve basically given up on trying to keep a lid on this thing – to be sure, there’s far less that governments can do now, thanks to a bunch of wingnut court rulings and Greg Abbott executive orders, but there are plenty of things we could be doing that we aren’t. A lot of leaders who should know better aren’t setting good examples. Even a milder form of COVID is potentially deadly to people with various comorbidities and risk factors, or who are immunocompromised in some way. Just having people mask up again as a matter of course would make all of their lives better, but we’re not doing that.

I’m definitely masking in indoor spaces again, but I’m also willing to be in indoor spaces, and to be among groups of people. I’ve mitigated some of my risk, but I’m engaging in riskier behavior than I had been before. It’s one part denial, one part pandemic fatigue, one part the perhaps naive hope that there will be another booster coming soon, and one part hoping that I’m being cautious enough. I don’t know what happens next if things do get worse from here. I very much hope I don’t have to find out.

COVID hospitalizations up in Houston

Welp.

COVID-19 hospitalizations have nearly doubled in the Houston area over the last month, according to re-published Texas Medical Center data, which paints a clearer picture of the risk associated with newer, increasingly transmissible versions of the virus.

The medical center discontinued its weekly reports in May, when the omicron wave had officially receded, and COVID drifted out of the public’s mind. But a new COVID surge prompted the medical center to post a revamped dashboard Tuesday, showing that the virus remains a persistent part of life.

Among the more urgent revelations: The average number of daily new hospitalizations rose from 121 in early June to 224 last week. That number is nearly half of the record-breaking hospitalization peak in early January, when an average of 515 COVID patients were admitted per day, according to the updated TMC data.

“Hopefully it’s peaking,” Dr. Paul Klotman, president and CEO of Baylor College of Medicine, said during a Tuesday news briefing. “It’s still a dangerous virus.”

[…]

The increase coincides with the rise of BA.5, a latest subvariant in the omicron lineage, which in a matter of weeks took over as the dominant strain in the U.S. First detected in South Africa, the subvariant made its way to the U.S. in early May and now makes up 65 percent of cases nationwide. In the Houston Methodist system, BA.5 comprises 57 percent of cases, while BA.4, another highly transmissible strain, makes up 19 percent.

BA.5 is concerning, experts say, because it appears to be more capable of re-infecting people and more resistant to vaccine-induced immunity. Even those who battled a COVID infection a few weeks ago could be susceptible to BA.5, said Dr. Wesley Long, a clinical pathologist and medical director of diagnostic microbiology at Houston Methodist.

“In previous waves, there was a thought that if you were infected, you had natural immunity for a couple of months,” he said. “With this shift from BA.2 to BA.5, that rule isn’t holding true.”

A recent study published in Nature found that BA.4 and 5 — which share similar mutations — are more likely to cause vaccine breakthrough infections compared to BA.2.12, the previously dominant strain. Waning vaccine immunity also compounds the risk.

Even so, vaccines are still effective at preventing severe disease, hospitalization and death, Long said.

“People shouldn’t get the wrong idea and think ‘I don’t need to get my vaccine’ or ‘I don’t need to get my booster,’” he said.

It’s still too early to say whether BA.5 is causing more severe illness than its predecessors. Early research shows it contains mutations found in the delta variant, which was linked to more acute sickness. But the rise in hospitalizations could simply be attributed to the volume of infections in the community, said Klotman.

Yeah, it could be worse. We’ve definitely seen worse. You know what you need to do to keep it from getting worse. All together now: You may be done with COVID, but COVID isn’t done with you. Stace and the Texas Signal have more.

Get your kids vaccinated (I’m saying it again)

We have a long way to go.

In the two weeks since the federal government allowed emergency use of COVID-19 vaccines for children younger than 5, nearly 32,000 Texas kids in that age group have been vaccinated.

That accounts for just over 1% of the state’s youngest residents, a lower rate than doctors had hoped, but faster than the national rate for kids that age — even as Texas deals with a lower-than-average vaccination rate across the state.

[…]

Vaccine acceptance by parents of Texas babies and toddlers is slower than the medical community had hoped it would be after COVID-19 vaccines were approved for use in children ages 6 months to 4 years old in late June.

On June 17, the U.S. Food and Drug Administration granted emergency use authorization, after frequent delays over several months, to Pfizer’s COVID-19 vaccine for children ages 6 months to 5 years, as well as to Moderna’s vaccine for kids ages 6 months to 6 years. The Centers for Disease Control and Prevention recommended their use the following day.

So far, just over 1% of the estimated 1.8 million Texans under 5 have gotten at least one dose. Nationwide, the number is slightly lower, with less than 1% of the country’s 29 million kids under 5 having their first doses.

Hesitancy with the vaccine rises among parents of younger kids because they tend to be more skeptical about the need for them, said Dr. Jaime E. Fergie, director of pediatric infectious diseases and hospital epidemiologist at Driscoll Children’s Hospital in Corpus Christi.

When the vaccine was made available to Texas kids ages 5 to 11 in November, nearly 6% of the population was vaccinated in the first two weeks. For children ages 12-15, when they were approved for the vaccine a year ago, more than 11% were vaccinated in the same time frame, according to the Texas Department of State Health Services.

During that time, the delta variant was making an alarming and devastating impact on the nation’s children, killing twice as many Texas kids in August through October 2021 than COVID-19 did the entire first year of the pandemic. That likely fueled early interest in the vaccine for children ages 5 and up, while recent months with lower community spread have likely bred what Fergie called “complacency” among the parents of the state’s tiniest residents.

“The uptake [for younger children] has been low; it’s been pathetic,” Fergie said. “I think the misconception is that COVID-19 in children is not important. But even though the impact on children is much less than on adults, there is still death for children, and hospitalizations are rising. There are still very powerful reasons to vaccinate children.”

Children accounted for nearly 20% of all COVID-19 cases reported in the U.S. throughout the pandemic. But they are less likely to develop serious illness or die than are patients who are decades older, and the mortality rate has been relatively low compared with adults.

Still, at least 155 Texans age 19 or younger have died from COVID-19 since the beginning of the pandemic, according to state health data. One-third of them were younger than 10.

Some 61% of Texans are fully vaccinated, compared with 67% nationwide.

See here for some background, and go read the rest, it’s a long story. I do think that the earlier authorizations came during the delta period made for a faster initial rollout, though the overall vax rate for kids remains bafflingly low. The fact that with current variants, the shots now are about preventing bad outcomes rather than preventing infection has probably changed the risk calculus for some folks. Add in the lack of any coordinated push for people to get the shots, the continued resistance by numerous Republican factions, and the general weariness with the pandemic, and this is what you get. I don’t know what else to say.

Get your kids vaccinated

A good start, but we can do a lot more.

Texas Children’s Hospital has administered COVID-19 vaccines to nearly 6,000 children ages 6 months through 4 years old since the youngest age group became eligible to receive the shots last week, the hospital said Thursday.

“We’ve been waiting for a long time to be able to protect our youngest children,” said Dr. Stan Spinner, the chief medical officer and vice president of Texas Children’s Pediatrics. “We’ve had families asking for a long time ‘When is this vaccine going to be available for our kids?’ And now it is.”

Still, the overall share of children younger than 5 who have received the shot is incredibly low — hovering around 1 percent statewide.

Another 3,000 children are scheduled for vaccine appointments at Texas Children’s Hospital or more than 60 Texas Children’s Pediatrics locations in the Houston, Austin and College Station areas, hospital spokeswoman Natasha Barrett said during a news conference.

Vaccines are also available to kids under 5 at other hospitals, including Children’s Memorial Hermann, as well as pediatrician’s offices, pharmacies and other locations.

Across Texas,the overall interest in vaccines for children has been lagging. Just 26 percent of Texas residents aged 5 to 11 and 59 percent of residents aged 12 to 17 are fully v accinated, according to data from The New York Times. Just 4 percent of Texas residents under 18 years old have received a booster.

However, Texas Children’s doctors said they have also been encouraged by that fact that families with children 5 to 11 years old have been signing up for booster shots of the Pfizer-BioNTech vaccine. The U.S. Food and Drug Administration approved booster shots for that age group last month.

My kids are older and got vaxxed and boosted at their first opportunities. If there’s an omicron-specific booster this fall, they’ll get that, too. I’ve definitely been disappointed by the low vaccination rate among younger kids, but maybe that will turn around now. Even with the lower hospitalization and mortality rates, so many people have gotten an infection lately that perhaps the ongoing threat of this pandemic is sinking in again. We all still need to do our part to try to keep this under some control.

Bexar County raises its COVID threat level

Hopefully not a sign of things to come.

Local health officials raised San Antonio’s COVID-19 risk level to high this week after warning of a “silent surge” just two weeks ago.

That surge continues, according to data from the city’s Metropolitan Health District, which is documenting an increase in new cases and hospitalizations.

As the July Fourth holiday approaches, San Antonio Metropolitan Health District chief Claude Jacob urged folks who will be getting together with friends and family to follow COVID-19 prevention strategies: “mask up in crowded indoor places, get tested if you have been exposed or have symptoms and stay up to date with COVID-19 vaccine and boosters.”

Dr. Bryan Alsip, chief medical officer at University Health, said the curve is starting to rise again, “but it’s not as steep an increase. It doesn’t look like the previous waves, not yet, so I think we have to wait and see how that turns out.”

The actual number of COVID-19 cases are suspected to be much higher than what is officially reported, as most people aren’t reporting positive home tests to any health authority.

Metro Health does not collect at-home test data, a spokeswoman said. Some rapid test kits include a way to report results through a mobile app, she noted, and urged everyone who uses a self-test to report positive results to their healthcare provider.

Alsip echoed Metro Health’s prevention strategies, noting that most people have stopped wearing masks. “Now that we know that the data support this high level [of transmission], while we’re in that higher risk timeframe, it would be a good additional layer of protection.”

He also warned that COVID-19 can now include a constellation of symptoms beyond the fever, cough and shortness of breath that characterized the disease at the beginning of the pandemic.

For the record, Harris County is still at Moderate threat level. Given the viral load in Houston’s wastewater these days, it’s not hard to imagine it going up. They key metric is hospitalizations, and that at least has remained at a sufficiently moderate level. It’s still the case that everyone needs to be vaxxed and boosted – kids under the age of five can now get vaccinated, and it looks like we’re getting an Omicron-specific booster later this year – and masking in indoor public places as well as anytime you may feel ill are still necessary. City and county governments can’t do much beyond exhort you to do the civic-minded thing, and for that matter the feds are pretty limited thanks to a bunch of sociopathic court rulings, so this is where we are. Do your part, if only for yourself, and we can make this be less bad than it otherwise would be.

COVID vaccines for kids under 5 are now available

It’s been a long wait.

On Saturday, the Centers for Disease Control and Prevention Director Dr. Rochelle Walensky signed off on Covid vaccines for the youngest Americans. Her endorsement means shots can begin immediately, finally ending the two-and-a-half year wait on the part of parents of children under 5.

Walenksy accepted the recommendation within hours after the CDC advisory committee voted unanimously in favor of the Pfizer-BioNTech and Moderna vaccines for children as young as 6 months. A Centers for Disease Control and Prevention advisory committee on Saturday endorsed Pfizer-BioNTech and Moderna’s Covid-19 vaccines for the youngest children, the last step before CDC Director Dr. Rochelle Walensky could issue her final sign-off.

The unanimous recommendations from the CDC’s Advisory Committee on Immunization Practices followed the Food and Drug Administration’s authorization of the shots on Friday.

President Biden responded to the announcement Saturday hailing it as a “monumental step forward.”

“For parents all over the country, this is a day of relief and celebration,” Biden said. “As the first country to protect our youngest children with COVID-19 vaccines, my Administration has been planning and preparing for this moment for months, effectively securing doses and offering safe and highly effective mRNA vaccines for all children as young as six months old.”

Shortly before Saturday’s votes — one for Moderna and a separate one for Pfizer — many panel members celebrated the milestone, noting that parents will soon have two effective tools to protect their youngest children from Covid after more than two years of living with the virus.

“We want to say today that if you’re not going to immunize your children, we think that’s a misplaced concern and that you should immunize your children to save their lives,” said committee member Dr. Sarah Long, a pediatrician at St. Christopher’s Hospital for Children in Philadelphia.

While young children are generally less likely than adults to experience the most serious outcomes of the virus, some do. Among children 6 months old through age 4, there have been more than 2 million confirmed cases of Covid, more than 20,000 hospitalizations and more than 200 deaths, according to CDC data. Covid is the fifth most common cause of death in children younger than 5.

“This is an opportunity, which one doesn’t get very often, to participate in preventing the death of young children,” said committee member Dr. Beth Bell, a clinical professor in the department of global health at the University of Washington. “A death of a young child is an incredible tragedy, and we know that this disease is killing children.”

It’s a function of where we are now in this pandemic that this isn’t bigger and more exciting news than it is. The vaccination rate for kids in the 5 to 11 year old range remains disappointingly low, and the estimates I’ve seen suggest that maybe 20% of the under-five crowd will get their shots. We could of course mandate COVID vaccines for enrollment in schools, but, well, I think you know what would happen then. The best way forward, as even a modest number of kids getting their shots will help save lives, is for those of us who have kids in that age range to get them vaccinated, and for the rest of us to help persuade our family and friends who do to do the same. Your Local Epidemiologist, who has two young kids of her own, has some ideas on that front. COVID is still out there killing people, y’all. We should try to remember that.

Fifth Circuit upholds dismissal of Methodist vaccine mandate lawsuit

Good.

A federal appeals court on Monday upheld the dismissal of a lawsuit challenging Houston Methodist’s COVID-19 vaccine mandate, which last year thrust the hospital into the national spotlight as the first healthcare system in the U.S. to require the shots for its employees.

The lawsuit, filed on behalf of 117 Houston Methodist employees who refused to abide by the policy, was dismissed in June 2021 by U.S. District Judge Lynn Hughes, who at the time decried arguments comparing the requirement to those made under Nazi Germany.

In its opinion, the U.S. Fifth Circuit Court of Appeals said it affirmed the original ruling “because plaintiffs do not demonstrate any error in the district court’s judgment on the arguments made in that court but instead make an entirely new argument on appeal.”

The plaintiffs’ attorney, Jared Woodfill, said “this battle is far from over.”

“We believe employment should not be conditioned on your willingness to take an experimental shot,” he said in an email to the Chronicle. “During oral argument, the court indicated that one way to potentially address this case of first impression is to take it back to state court. We will pursue every legal avenue available to our clients, including taking this case to the United States Supreme Court.”

Woodfill added that a “companion case” has been filed in Harris County, though records of that lawsuit could not be found by press time.

[…]

The lawsuit brought three separate claims of wrongful termination, alleging violations of state and federal law. In their appeal, the plaintiffs “pivoted” from focusing on the federal law violations to state law, the appeals court notes in its opinion.

The plaintiffs “now even equivocate on whether federal law supports their claim,” according to the opinion. “Federal law does not, and the district court did not err in dismissing plaintiffs’ claim.”

See here for the previous update. As noted at the time, Texas state law isn’t exactly employee-friendly, so the odds of a better result for the vaccine refuseniks seems quite low. But hey, they have Jared Woodfill, Super Genius, on their side. What could possibly go wrong?

When we had more deaths than births in Texas

Seems like that would be a bad thing.

In the midst of the nation’s deadliest pandemic, Texas recorded more births than deaths every month since 2016 — with one exception.

Provisional data from the Texas Department of State Health Services shows that January 2021 was the only month when, statewide, the number of deaths was greater than the number of births.

Nine months before in April 2020, the world was one month into the COVID-19 pandemic. In January 2021, the seven-day average number of deaths from COVID-19 peaked in Texas, according to The New York Times, and vaccines had just become available to select groups of individuals.

Twenty counties — including Bexar County — recorded more births than deaths every month until the pandemic, when they began having months with more deaths than births.

The number of births for a county is determined by the mother’s residence.

Thirty one counties — including more populous ones like Harris, Dallas and Travis — always recorded more births than deaths, even during the pandemic.

Five counties — Bowie, Kerr, Potter, Smith, and Wichita — reported more deaths than births for all 22 months of pandemic data available.

There are charts and maps in the story, and they calculate the birth and death rates on a per 100K people basis to make everything more easily comparable. One thing the story doesn’t go into, which is a thing that has been widely reported on elsewhere, is differences in voting patterns across the counties. I’m not going to dive into all of the data here, but I will note this much about those five counties that had a net loss (not counting migrations) for each month:

Bowie – Trump 70.9%
Kerr – Trump 75.3%
Potter – Trump 68.5%
Smith – Trump 69.0%
Wichita – Trump 69.7%

You get the picture.

Are we going to raise the COVID threat level again?

Maybe, but not yet.

Coronavirus infections are on the rise across Houston, wastewater tracking shows, even as fewer people seek testing two years into the pandemic.

Four months after the city saw record infection rates caused by the highly contagious omicron variant, new COVID-19 cases are once again climbing, according to data collected by Rice University and the Houston Health Department. The most recent sewage samples show increased viral loads at all but a few of the city’s three dozen wastewater treatment plants.

Citywide, the amount of virus particles detected in wastewater is up 242 percent above baseline, with an overall positivity rate of 14 percent. Both metrics increased by about a third over the previous samples, taken in early May. At the 69th street plant, serving much of the Inner Loop, officials said virus levels are 123 percent above baseline, with a 22 percent positivity rate.

Despite the uptick, health officials do not anticipate raising Harris County’s threat level to the highest level. The county’s threat level is currently set at moderate, signally a controlled level of COVID spread.

“Even though we see positivity rates going up, our hospital rates continue to remain low, said Dr. Erika Brown of the Harris County Health Department.

[…]

New of the rise in viral levels in the wastewater comes days after researchers at Houston Methodist reported new insight into how the omicron variant is mutating in Houston and across Texas.

Researchers demonstrated that two dominant sublineages of omicron have developed “unprecedented numbers” of spike protein mutations, leading to increased transmissibility. The mutations also enhance its ability to evade vaccines and the immune system.

This is a press release about the study in question; it’s from late April, which I’d classify as more than “days” ago, but whatever. The COVID levels in our wastewater continue to rise, but if the hospitals are still not seeing an increase in patients, then the threat level will stay where it is. I don’t know how long we can maintain this balance, but I sure hope it continues.

That press release is worth a read:

“One of the surprising findings in this study was that many mutations with critical roles in immune escape in previous variants of SARS-CoV-2 do not play the same roles in immune escape in omicron, and, in some cases, the effects of these mutations are completely reversed,” said Gollihar, who is the head of antibody discovery and accelerated protein therapeutics in Houston Methodist’s Center for Infectious Diseases. “The virus also appears to be stabilizing itself to allow for more mutations to evade our immune systems.”

He said this study is the first to systematically dissect each of the omicron mutations across the entirety of the spike protein. Previous studies miss contextual and long-range interactions across the protein.

“We developed a comprehensive map showing various mechanisms of immune escape by omicron that allows us to identify which antibodies retain neutralization activity against the virus,” Gollihar said. “This and future work will enable clinicians to make informed decisions about the use of monoclonal antibody therapy and aid in the development of next-generation vaccines.”

Having this new information about key features of omicron’s spike protein mutations and how they synergize, Gollihar and his team say it’s possible that the continuing accumulation of mutations may set the stage for greatly altering the equilibrium and stability of the spike protein in a way that allows for new, more virulent strains to develop. Understanding this evolution is critical, they say, to better inform future therapeutic targets and vaccine formulations, as the SARS-CoV-2 virus will continue to evolve with new variants inevitably arising and spreading.

Looking forward, they add, the strategy used in this study also will be applicable to future zoonotic outbreaks and other microbial pathogens, providing a powerful platform for investigating evolutionary trajectories of infectious agents and engineering appropriate and adaptable vaccines.

“We will continue to monitor the virus for changes in the spike protein and add new antibodies to test as they are discovered. Continuing to do so will allow us to design better probes for antibody discovery in hopes of engineering new therapeutics by finding potent neutralizing antibodies across all variants,” Gollihar said. “We have also recently expanded the platform to other pathogens where we hope to stay ahead of other potential outbreaks.”

I’m in awe of the work these folks have done and continue to do – I’m speaking of the researchers worldwide, not just these specific ones. We’re in a constant race with this virus, and so far we’ve been able to keep up. As above, I sure hope that continues, too. Stace has more.

Checking in again on the wastewater

COVID levels keep creeping up.

After the U.S. death toll from COVID-19 hit 1 million deaths on Monday, new data shows numbers on the rise again.

The latest Houston Health Department wastewater results from May 9 show levels are now higher than they were in July of 2020.

The viral load on May 9 was 127 percent higher in comparison to July 6, 2020.

The July 2020 readings serve as a baseline for wastewater testing, since that was during the summer surge of cases.

The positivity rate in Houston is also now at 8 percent. At the end of March, Houston’s wastewater positivity rate was 2 percent.

Since the results are delayed, levels are likely higher now.

Houston Methodist is also reporting a rise in cases over the last two weeks.

[…]

“We have also seen our first cases of BA.4 and BA.5, which we will continue to monitor, since literature suggests these variants escape immunity from previous Omicron infection,” [Dr. Wesley Long of Houston Methodist] tweeted. “Vaccines are still our best defense against COVID-19 along with masking and distancing.”

Long also says while the wastewater levels are nearly 30 percent higher than the July 2020 surge, that the public shouldn’t be fearful, but shouldn’t ignore the trend either.

“The bottom line is, the amount of virus in the community is going up,” Long said. “That’s one thing we know for sure. I wouldn’t be worried, but I would be paying attention.”

There was a story in the Sunday print edition of the Chron about the Houston wastewater tracking, with a byline from the NY Times, but I could not find it online. Note that this KHOU story reports on the May 9 virus level in two different ways, saying that the viral load is “127 percent higher” and also that it is “nearly 30 percent higher”. The latter is correct – the Houston COVID dashboard says that the COVID load is “127% in comparison to the July 2020 level”, which is to say up 27%. Pay attention in those math classes, people.

At this point, until there is a new type of vaccine, we have what we’re going to get. I heard on the CityCast Houston podcast that the vax level in Harris County is about 67%, which is better than it used to be but still too low to really slow things down. What we can do is whatever we can to get the unvaxxed people in our lives to get the shots, and we can get boosted – one if we’re under 50, two if we’re over. Get your kids boosted, which also very much means getting them vaxxed in the first place – only about 30% of kids in this range have had two shots, which is just madness to me. Wear your masks when in indoor public places again, and avoid needless indoor public gatherings. You have to take care of yourself now, so do it. Until it gets worse – and I still hope it won’t – this is the best you can do.

UPDATE: The May 16 numbers are now on the dashboard, and they show that we are at 170% of the July 6, 2020 level. Not great!

Are we about to get more COVID in Houston?

We could be.

New data from the Texas Medical Center shows COVID-19 cases have leveled off over the past week, but some trends suggest the Greater Houston area could be on the verge of seeing higher virus spread.

TMC hospitals reported an average of 351 new cases per day during the week of April 18, the same number it reported during the previous seven-day period. The number of new cases does not include anyone who used an at-home test and did not report a positive result.

Those numbers represent a significant decline from last month, when the hospitals were reporting an average of 2,592 new cases per day.

However, the effective reproduction rate – or the average number of people who will be infected by someone with COVID – increased to 1.0 last week, up from 0.82 one week earlier. The rate essentially measures how well collective behaviors like wearing masks and social distancing are slowing the spread of the virus, with any rate higher than 1.0 meaning that spread is increasing.

The amount of virus being detected at the city of Houston’s wastewater treatment plants has also increased to the highest rate since Feb. 7, according to data from the Houston Health Department. Twenty-one of the city’s 39 wastewater treatment plants saw an increase in viral load in samples that were collected and analyzed April 18. By comparison, 16 plants saw in increase in samples collected and analyzed one week earlier.

The TMC’s weekly update also shows new hospitalizations have increased to an average of 59 admissions per day during the week of April 18, up from 42 the week before. TMC hospitals admitted an average of 89 new patients per day last month.

The data isn’t strongly conclusive, but it’s also early in what could be a trend, and as we know with this virus once you really start to see an uptick, it’s already too late. On the other hand, lots of people have COVID antibodies now, and that plus the number of vaxxed people who haven’t had COVID is probably enough to mitigate any crazy spread, or at least to make it less harmful, at this time. But of course there are still plenty of high-risk people out there, and lots of kids haven’t been vaxxed, and no one wants to get even a mild case of COVID. So, you know, stay cautious. You can still wear a mask even if you don’t have to, and you can get that second booster if you’re eligible. It’s never a bad idea to minimize your exposure to this thing. Stace has more.

Paxton threatens HISD over its COVID sick leave policy

We live in such stupid times.

Best mugshot ever

Attorney General Ken Paxton and Republicans in the Legislature are taking aim at Houston ISD, arguing that the district’s COVID sick day policy violates state law.

This academic year, Houston ISD is offering 10 additional days of paid sick leave to employees who are vaccinated against the coronavirus but test positive during the school year. Unvaccinated staff, however, must use personal leave time if they are infected.

In a nonbinding opinion last week, Paxton said the policy likely constitutes a “vaccine passport,” the documentation certifying a person’s vaccination status shown in exchange for “entry or services.” The GOP-led Texas Legislature last year outlawed such requirements for both private businesses and public agencies, and Gov. Greg Abbott issued a similar executive order banning the practice last summer.

“A court would likely conclude that, by offering additional paid leave only to those employees showing proof of COVID-19 vaccination or a medical exemption, the Houston Independent School District’s COVID-19 paid leave policy violates” the executive order, Paxton wrote.

Tejal Patel, a spokesperson for Houston ISD, said Paxton’s opinion “does not change the implementation” of the district’s paid leave policy. The last day of classes is just about seven weeks away.

“No court has ruled that the district’s policy of awarding additional leave days to vaccinated employees violates” the executive order, Patel said. “The district continues to evaluate its COVID protocols in our efforts to maintain a safe learning and working environment.”

The point of this was that since HISD couldn’t mandate that employees get vaccinated, they took the approach of incentivizing it by offering a reward to those who did. And it worked pretty well, as the story notes – over 20,000 of the district’s 24,000 employees have been vaccinated. In practice, this is no different than a million corporate wellness programs out there. The one I’m most familiar with offered a discount on your health insurance premium if you jumped through certain hoops, which ranged from things like taking a dumb survey to getting a blood test. If you participated – it was completely voluntary – you got a couple hundred bucks off the cost of your insurance for the year. This made sense for the insurer as well, as it (supposedly, at least) led people towards healthier lifestyles, which meant they’d pay out fewer claims.

So I struggle to see how one differs from the other. Except of course that we’re dealing with the extremely whiny snowflakes who refuse to get a COVID shot and who therefore must be catered to at every turn by politicians like Ken Paxton and Paul Bettencourt, who requested the opinion. God knows, we cannot deprive these special delicate flowers of anything. I approve of HISD’s response. So far, the school districts have done pretty well for themselves ignoring Paxton and Abbott. No guarantees here, and of course the Lege can deal with this next year if the Republicans remain in control, but for now I’d say keep on keeping on and hope for the best.

New variants being detected

Got to keep an eye on that.

Two new omicron subvariants that health officials say are contributing to a COVID uptick in New York State have been identified in Houston, according to researchers at Houston Methodist.

Genome sequencing efforts within the hospital system have detected 83 cases of BA.2.12 and three cases of BA.2.12.1 — two sub-lineages of the dominant variant BA.2 — since the start of the year.

Local case numbers, however, are sitting at their lowest point in nearly a year, according to the Harris County Public Health COVID dashboard, which reports an average of 20 new cases per 100,000 people over the last seven days. That number was as high as 1,256 in mid-January, during the height of the omicron surge.

It’s a different story in New York, which has seen a 70 percent increase in new cases over the two weeks, from a daily average of 3,231 on March 13 to 5,467 on Thursday, according to the New York Times virus tracker.

[…]

Houston wastewater surveillance data show an increasing viral load at a growing number of the city’s treatment plants as of April 4, when samples were last collected.

The city’s wastewater dashboard shows 14 out of 39 total wastewater treatment plants experiencing an increase from the week before, compared to eight on March 28.

The wastewater data is here. As of April 4, the virus level was at 38% of where it was on July 6, 2020, which is the date when this collection project started and is used as the baseline. We’ll have to keep an eye on that of course, but we also have to consider infections versus hospitalizations and deaths. It makes sense to wear a mask in most indoor settings – I do, and plan to continue doing so for the foreseeable future – but it’s not clear yet that we need to do more than that. Other than get vaxxed and boosted, of course, which if you haven’t by now I don’t know what to say to you.

Grand jury indicts three Hidalgo aides

Not great.

Three Harris County staffers at the center of a mounting investigation into a since-canceled vaccine outreach contract have been indicted with misuse of official information and tampering, according to district clerk records.

Aaron Dunn, Wallis Nader and Alex Triantaphyllis face one felony count on each of the charges. Warrants for their arrest have been issued. Documents elaborating on the charges were not yet available on the district clerk’s website.

Lawyers for at least two of the defendants professed their innocence Monday as the charges were made public.

“Aaron Dunn is innocent — he has been an honest public servant,” attorney Dane Ball said.

A lawyer for Triantaphyllis said she believes upcoming court proceedings will “shine a light” on the lack of wrongdoing.

“These charges against my client are unsupported by a full and objective review of the facts and the voluminous evidence in this case,” lawyer Marla Poirot said in a statement. “In his service to Harris County, Alex has made the people the top priority and worked to ensure that taxpayer resources are utilized as effectively and efficiently as possible.”

Nader’s lawyer could not be reached for comment. The three defendants are expected Tuesday in the 351st District Court.

In the months leading up to the indictments — the Texas Rangers, at the request of the Harris County District Attorney’s Office, identified the three staffers in search warrants as having a role in potentially steering a vaccine outreach contract in 2021 to a vendor by giving them early access.

The three worked under County Judge Lina Hidalgo at the time of the $11 million contract, which she canceled in September amid accusations that her office manipulated the procurement process.

Dunn has since left the office, while Triantaphyllis is the judge’s chief of staff and Nader is her policy director. According to lawyers for Hidalgo and the aides, the three did not view Elevate Strategies, owned by Democratic political consultant Felicity Pererya, as a potential vendor while planning the contract, their lawyers have said. Pererya’s company ultimately won the bid.

The lawyers have argued that one of the documents outlining the outreach contract’s scope of work were sent by mistake. Another was sent as part of an unrelated project.

There are reasons to be dubious of the evidence, but once there’s a headline like this, it’s hard to shake no matter what happens next. I certainly have my doubts about these indictments. We’ll know more soon enough. That’s all I’ve got to say at this time.

COVID hospitalizations at a low in the state

Good news (say it with me) for now.

Texas hospitals are treating fewer than 1,000 patients with COVID-19 for the first time in two years. According to the Texas Department of State Health Services, hospitalizations totaled 993 on Sunday. The last time COVID-19 patients in Texas numbered less than a thousand was April 4, 2020, before the state’s initial surge in hospitalizations, which rose to nearly 11,000 by late July that year.

“Less than a thousand [hospitalizations] is a good place to be and this is what we’ve kind of been waiting for and watching really closely,” said Chief State Epidemiologist Dr. Jennifer Shuford.

Fewer people are getting severely ill and needing medical care, said Dr. Shuford, because nearly the entire Texas population has now developed at least some immune response to SARS-CoV-2, the virus that causes COVID-19.

“We expect, based on some antibody studies that we’ve done, that about 99% of our population has some antibodies to COVID-19, either from vaccination or from prior infection.”

Other infectious disease experts are also cautiously optimistic that vaccinations, combined with four waves of widespread infections – the most recent of which was driven by the omicron variant – will help minimize future surges in cases and hospitalizations.

“I do think that the antibody seroprevalence does have something to do with the declining severity of the illness that we’re seeing in terms of decreased hospitalizations,” said Dr. Robert Atmar, an infectious disease expert who teaches at Baylor College of Medicine.

Dr. Atmar said while he was not aware of how DSHS estimated Texas’ overall immune response, the high rate is possible, especially if infection rates for the virus have been under reported.

“It wouldn’t be surprising if a large percentage of the population had been infected and/or vaccinated. 99% just seems high, but it’s certainly not unreasonable that that might be the case,” he said.

I’m just some guy on the Internet, and I also think 99% is a little high. I do agree that between our mediocre vaccination rate and our undoubtedly high infection rate that a lot of people have at least some immunity at this point, and that is keeping the rate low for now. To some extent, as I understand it, this is how a pandemic becomes endemic – there’s enough residual immunity out there to keep infection rates modest and generally tamp down on larger outbreaks. But that surely comes with no guarantees, and the next bad mutation could happen at any time. If we’re lucky, that will either be relatively mild or be mostly stopped by vaccinations, but at this point who knows what could happen. I’ll be getting booster #2 in the near future, and you should be getting whichever booster you can if you haven’t already. It’s still your best bet.

Here comes BA.2 in Houston

But don’t panic, it’s just a change in the virus composition, not an increase in viral load.

Houston is seeing an uptick in the number of BA.2 cases, with genome sequencing and wastewater testing picking up higher levels this week compared to last week.

The more contagious omicron subvariant was identified in 24 percent of patients who were sequenced at Houston Methodist, a jump from the 1 to 3 percent previously reported. BA.2 was also detected at six wastewater treatment plants on March 21 — the most recent day for which data is available — after the Houston Health Department last week said it had not been detected at any plants.

“Previously, we saw some indications of mutations consistent with BA.2 but were not confident in the determination at the time,” health department spokesman Scott Packard said in an email. “Retrospective analysis indicates BA.2 was likely in the wastewater in low levels starting in mid-to-late January.”

The recent data is the first indication of a significant rise in BA.2 in the Houston-area. Eventually, the subvariant is expected to become the dominant strain here, lining up with the nationwide rate, according to the health department.

[…]

In Houston, the average positivity rate over the last two weeks is 1.8 percent, down from the high 30s in the early January. Wastewater testing shows an increasing viral load at nine wastewater plants, while the remaining 30 are plateaued or decreasing.

“Although BA.2 appears to be more contagious than BA.1, the good news is that countries experiencing a spike in cases are not seeing a proportionate spikes in hospitalizations,” Packard said. “That means being up to date on vaccines (initial shots plus boosters) remains highly effective against serious illness, even with BA.2.”

As a reminder, you can see the Houston wastewater dashboard here. I don’t know how long we will be in this trough, but at least in the short term our vax level plus the sheer number of people who contracted the BA.1 version of omicron should help.

In the longer term, as immunity wanes and new variants pop up, it will be time for more shots. A fourth shot has now been authorized by the FDA for us old folks.

A second round of booster shots was greenlighted for everyone over the age of 50 by public health officials on Tuesday, kicking off the regulatory process for shots to likely be available in pharmacies this week.

Everyone 12 and older is already eligible for a booster shot five months after their initial vaccine series if they received an mRNA vaccine like Pfizer or Moderna, or two months after getting the Johnson & Johnson vaccine.

But for those over 50, determined to be a vulnerable age group, officials at the Food and Drug Administration and Centers for Disease Control and Prevention have decided the data on waning immunity justifies making another shot available four months after the first boost. And while anyone who meets that criteria can now get another booster, CDC Director Rochelle Walensky said it was “especially important” for those 65 and older and those 50 and older with underlying medical conditions.

“This is especially important for those 65 and older and those 50 and older with underlying medical conditions that increase their risk for severe disease from COVID-19 as they are the most likely to benefit from receiving an additional booster dose at this time,” Walensky said in a statement on Tuesday.

My niece is getting married in June in Washington state. I expect all of us who will be there for it and who are eligible for that booster will have gotten it by then. I ain’t messing around.