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July 2nd, 2020:

How it’s going at the hospitals

In a word, it’s bad.

At Lyndon B. Johnson Hospital on Sunday, the medical staff ran out of both space for new coronavirus patients and a key drug needed to treat them. With no open beds at the public hospital, a dozen COVID-19 patients who were in need of intensive care were stuck in the emergency room, awaiting transfers to other Houston area hospitals, according to a note sent to the staff and shared with reporters.

A day later, the top physician executive at the Houston Methodist hospital system wrote to staff members warning that its coronavirus caseload was surging: “It has become necessary to consider delaying more surgical services to create further capacity for COVID-19 patients,” Dr. Robert Phillips said in the note, an abrupt turn from three days earlier, when the hospital system sent a note to thousands of patients, inviting them to keep their surgical appointments.

And at The University of Texas MD Anderson Cancer Center, staff members were alerted recently that the hospital would soon begin taking in cancer patients with COVID-19 from the city’s overburdened public hospital system, a highly unusual move for the specialty hospital.

These internal messages highlight the growing strain that the coronavirus crisis is putting on hospital systems in the Houston region, where the number of patients hospitalized with COVID-19 has nearly quadrupled since Memorial Day. As of Tuesday, more than 3,000 people were hospitalized for the coronavirus in the region, including nearly 800 in intensive care.

“To tell you the truth, what worries me is not this week, where we’re still kind of handling it,” said Roberta Schwartz, Houston Methodist’s chief innovation officer, who’s been helping lead the system’s efforts to expand beds for COVID-19 patents. “I’m really worried about next week.”

What’s happening in Houston draws eerie parallels to New York City in late March, when every day brought steep increases in the number of patients seeking care at overburdened hospitals — though, so far, with far fewer deaths. But as coronavirus cases surge in Texas, state officials here have not reimplemented the same lockdown measures that experts say helped bring New York’s outbreak under control, raising concern among public health officials that Houston won’t be able to flatten the curve.

“The time to act and time to be alarmed is not when you’ve hit capacity, but it’s much earlier when you start to see hospitalizations increase at a very fast rate,” said Lauren Ancel Meyers, a professor of integrative biology who leads the University of Texas at Austin COVID-19 Modeling Consortium. “It is definitely time to take some kind of action. It is time to be alarmed.”

[…]

Although hospital executives in Houston stress that they have the ability to add additional intensive care beds in the region to meet the growing demand — for a few more weeks, at least — the strain on hospitals is already being felt in other ways.

Houston Fire Chief Samuel Peña said his paramedics sometimes have to wait for more than an hour while emergency room workers scramble to find beds and staffers to care for patients brought in by ambulance — a bottleneck that’s tying up emergency medical service resources and slowing emergency response times across the region.

Part of the problem, Peña said, is that when his crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it. That’s a problem that’s likely to deepen as a growing number of medical workers have been testing positive for the virus, according to internal hospital reports. Just as New York hospitals did four months ago, some Houston hospitals have posted on traveling nurse websites seeking nurses for “crisis response jobs.”

“If they don’t have the nursing staff, then you can’t place the patient,” Peña said. “Then our crews have to sit with the patient in the ER until something comes open. It has a huge domino effect.”

There’s more, so read the rest. If you’re thinking that the death rate is low and that that’s a small blessing, that is true, but it’s also a bit illusory. For one thing, the sheer number of deaths will increase as the infection rate rises, not all deaths for which COVID-19 is a factor are recorded as COVID-19 deaths, and it is already the case that people are avoiding going to the hospital now for other reasons because of COVID-19, and that some of them will also die as a result. The official death count numbers have always been underestimated, and there’s no good way to spin it. Even if we were to go into total lockdown right now, we won’t begin to see the positive effects of that for another two weeks. We really need masking and better social distancing to have an effect or it’s going to get much worse. Oh, and the Texas Medical Center is above 100% ICU capacity. So we’ve got that going for us.

And as you ponder all that, ponder also this.

Despite Texas’ surge of new COVID-19 cases and hospitalizations, Lt. Gov. Dan Patrick said Tuesday evening that he doesn’t need the advice of the nation’s top infectious disease doctor, Anthony Fauci.

“Fauci said today he’s concerned about states like Texas that ‘skipped over’ certain things. He doesn’t know what he’s talking about,” Patrick told Fox News host Laura Ingraham in an interview. “We haven’t skipped over anything. The only thing I’m skipping over is listening to him.”

Patrick also said Fauci has “been wrong every time on every issue,” but did not elaborate on specifics.

Dan Patrick does not care if you live or die. You and everyone you know mean nothing to him.

Second lawsuit filed by bars against Abbott

This one was expected.

Several Texas bar owners filed a $10 million federal lawsuit Tuesday afternoon against Gov. Greg Abbott, in an attempt to void his executive order shutting down bars for a second time since the beginning of the coronavirus pandemic.

All of the plaintiffs are members of the Texas Bar and Nightclub Alliance. This is the second lawsuit filed against Abbott this week after more than 30 Texas bars filed a lawsuit in Travis County over his recent shutdown order on Monday.

In addition to the damages, the lawsuit asks the court to stop Abbott from enforcing his executive order which closes bars and to prevent him from issuing similar orders in the future without proper notice. The suit said Abbott should give businesses more than 24 hours notice before shutting them down, “unless in the case of imminent threat of harm.” The lawsuit also asks that future shutdown orders have a clear end date and lay out conditions that would have to be met for the order be extended.

[…]

The lawsuit noted that the Texas Alcoholic Beverage Commission recently posted a notice on its website saying it observed a “high level of compliance” by permit holders. The lawsuit claims that Abbott is abusing his emergency powers “without proper legal notice.”

“With the erratic legal situation fueled (if not created) by the Governor and given that Plaintiffs have largely complied with the spirit & letter of the Governor’s voluntary guidelines, it came as an unfortunate surprise,” the lawsuit states.

The bar owners say in the suit that Abbott’s order violates their constitutional rights for due process, equal protection, and their patrons right to assembly, and “may very well leave long-term scarring on the republican form of government if left unchecked.”

“It wasn’t like he even reduced the bars and nightclubs to 25% — we’re closed to 100%,” said Michael Klein, one of the plaintiffs and Texas Bar and Nightclub Alliance president, drawing a distinction between bars and other businesses which are allowed to operate at limited occupancies. “You better have some pretty good scientific evidence if you’re going to take one group of alcoholic beverage licenses over another, or one group of businesses.”

See here and here for the background. The Woodfill lawsuit was filed in state court and this one is in federal court, and someone who is much better versed in legal matters than I am will need to explain the reasons for that. I actually think these guys have some reasonable claims – sufficient notice, a deadline and criteria for the order, etc – though whether those claims are justiciable in federal court is a question I can’t answer. I figure both sets of plaintiffs are going to ask for an order suspending this action on Abbott’s part, and if so we’ll get some kind of rulings quickly. I have no idea what to expect, but can’t wait to see what happens.

More and better police data, please

Like this.

The Texas Commission on Law Enforcement will ask nearly 2,000 Texas law enforcement agencies to resubmit information legislators intended be used to analyze whether police were treating minority motorists differently — but which turned out to be worthless because TCOLE neglected to ask departments to include the race of the drivers in some of the data.

The change comes days after Hearst Newspapers published a story detailing how the information, required by the 2017 Sandra Bland Act, was impossible to use.

“I’m trying to jump on it pretty fast,” said state Rep. Garnet Coleman, D-Houston, a sponsor of the bill, who said he spoke Monday morning with TCOLE and they had agreed to correct the problem.

Coleman said he also has asked the agency to work with academic experts to ensure the information it is asking of Texas law enforcement agencies can be used to actually conduct racial bias analyses. Alex del Carmen, a criminal justice professor at Tarleton State University who helps train police executives, said he worked Sunday to create a survey that would produce the necessary information.

Coleman said the new list of questions will be used to gather the information for 2020. But he added the agency said it would also contact police departments to ask them to redo their 2019 surveys, originally submitted in March.

I mean, I’m glad this is happening now, but it’s more than a little embarrassing that the initial data collection was this lacking. Whose job was it to do quality assurance? Kudos to the Chron for bringing this to light.

And let me just add, while it is quite fashionable now to dunk on the idea of “running government like a business”, as someone who has worked for a Large Corporation for many years, this kind of data collection is absolutely the sort of things successful businesses do. It’s critical, to know if what you’re doing is working, to identify and learn from errors, to spot trends and respond to them, and so on and so forth. And really, it’s not that hard to do. Shame on TCOLE for such a shoddy first effort.

And also like this.

Two state lawmakers who reviewed a copy of the Houston Police Department’s audit of its narcotics division are calling on Chief Art Acevedo to release the document to the public.

“The reality is, there’s nothing in this the public should not be aware of,” Texas Sen. Paul Bettancourt said. “The real question is, what are they going to do about it?”

The police department performed the audit after last year’s disastrous Harding Street raid. Two homeowners died in the raid, and investigators later accused former officer Gerald Goines of lying to obtain the warrant on which he based the raid. He is now charged with murder.

In the wake of the incident, the police department launched an internal criminal probe, along with an administrative audit of the Narcotics Division.

[…]

In February, after questions from the Chronicle, Rep. Gene Wu, D-Houston, and a coalition of other Houston-area state representatives called on Acevedo to make the document public. The chief balked, saying he did not want to endanger the county’s criminal case against Goines and said the document included the names of undercover officers and could reveal information about confidential informants.

Because of the nondisclosure agreement, Wu said he could not comment on the specifics of the document. But he said that reviewing it only confirmed his belief that it should be public.

“Even without the redactions, there is little that can be gleaned from it that is not already public knowledge or could in any sense jeopardize an ongoing investigation or prosecution,” he said.

Yes, release the audit. The public needs to know. The criminal case will be fine – Kim Ogg is filing a bunch more charges now, in part because everyone involved seems to have a problem with telling the truth – but even if that were a problem, this is HPD’s mess. They need to come clean. The Chron editorial board and Odus Evbagharu, Chief of Staff to State Rep. Jon Rosenthal, have more.

UPDATE: And just like that, a draft of the audit was released on Twitter. Here’s a Chron story about it. Now let’s see some followup on this, because audits are all about actions.

Texas blog roundup for the week of June 29

The Texas Progressive Alliance did not need to pause its collection of blog content for your roundup this week.

(more…)

The lack of testing is becoming a more serious problem

It was already serious. Now it’s extra serious.

As the new coronavirus continues to spread in Texas, leaders of some of the state’s biggest cities said Monday that their testing sites were being strained, forcing them to turn away people in the middle of the day or limit who is eligible to take a test.

In Travis County, interim County Judge Sam Biscoe said the county’s public testing is being rationed to only people with symptoms. Previously, local leaders had encouraged anyone to get tested, including asymptomatic people and people that had come into contact with COVID-19 patients.

“The rapid increase in cases has outstripped our ability to track, measure, and mitigate the spread of the disease,” Biscoe wrote in a letter to Gov. Greg Abbott asking to allow metropolitan areas to issue their own stay-at-home orders.

The largest laboratory analyzing tests is also strained, Biscoe said, to the point that the county has decided to prioritize cases from severely ill patients in hospitals. Residents in Travis County who don’t show symptoms still have other options, like private facilities, to get tested.

In Houston, Mayor Sylvester Turner said his city’s two public testing sites, where testing is still available to people who are symptomatic or asymptomatic, reached their maximum capacities before noon.

“The capacity on those sites will be increased from 500 [daily tests] to 650 each,” Turner said. “It is clear that there is a demand out there, and we need to ramp up as best as we can to meet that demand.”

Meanwhile, the two community-based testing sites in the city of Dallas are reaching their capacity “by noon or early afternoon daily,” according to city spokesperson Roxana Rubio. In these sites, testing is restricted to symptomatic patients, high-risk people, first responders, essential workers and asymptomatic patients who have engaged in large group settings.

The obvious problem here is that if you think you need a test but can’t get one, you have the choice of self-quarantine and hope for the best, or keep on keeping on, and hope you’re not the 2020 equivalent of Typhoid Mary. If everyone could reliably get a test and get their results in a reasonable amount of time, people would be much freer to move around, and maybe even socialize with other people who can confidently state that they are safe. Indeed, if we could do this at scale, we could do much more targeted quarantining, and thus let larger portions of society open up safely. Wouldn’t that have been nice? Other countries have managed to do it. Just not this one. SIt with that for awhile.

Meantime, in Houston, the spread of this disease is having a bad effect on crime.

With more than 10 percent of its workforce out due to COVID-19, the Houston Forensic Science Center is dangerously close to having to limit its responses to crime scenes, the agency’s director said Monday.

Of 200 total staff, 10 have tested positive for the novel coronavirus, said Dr. Peter Stout, CEO and president of the agency, which manages Houston Police Department’s forensic laboratory and crime scene unit. Another 12 are self-quarantining while they await test results. None of the exposures appear to have been transmitted through their work, Stout said.

Stout said he’s “very worried” because about one-fourth of the agency’s team dedicated to crime scene investigation is out of commission due to COVID-19. He’s concerned what that might mean for the center’s ability to collect evidence at murders, police-involved shootings and child deaths.

“We’re precariously close to having to shift around so we can have any capacity to make scenes that come up,” said Stout.

[…]

Delays in collecting evidence could mean further backlogs in criminal cases, prosecutors said.

“The pandemic is stretching the criminal justice system thin, causing backlogs up and down the system,” said Michael Kolenc, a spokesperson for the Harris County District Attorney’s Office. “We will address any impact on a case by case basis.”

The center was already severely understaffed for a city the size of Houston before the pandemic, Stout said. There are usually 27 people working in the CSI unit. In cities like Dallas and Austin, the standard is around 100 crime scene investigators, Stout added.

“It’s not even close to the right magnitude of what we should have,” said Stout. “Especially this year, with the escalation in homicides, we were in a real pinch with the crime scene unit already.”

The unit is now only able to travel to scenes of homicides, officer-involved shootings, deaths of children and around 1 percent of aggravated assaults reported in the city, said Stout.

“It’s a serious issue,” Stout said.

Sure sounds like one. Maybe we’ll do a better job with the next pandemic.