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Harris County’s COVID situation continues to improve

Keep it up.

Harris County’s 14-day average test positivity rate for COVID-19 has fallen below 5 percent for the first time since the start of the pandemic, County Judge Lina Hidalgo announced this week.

Despite the positivity rate and vaccination efforts that have resulted in 44 percent of all eligible Harris County residents being fully inoculated, Hidalgo said she continues to worry about the unvaccinated population’s behavior going forward.

“The concern is that amongst the unvaccinated, folks will stop taking the precautions they need to take, and spread the virus,” Hidalgo said. “The other concern, and this is perhaps the most significant, is making sure people continue to get vaccinated.”

Hidalgo said she thinks President Joe Biden’s goal to have 70 percent of the United States’ eligible population vaccinated by July 4 largely is in the hands of the community.

Indeed. Looking at the Trib’s COVID tracker page, 37.8% of Harris County residents (about 1.7 million people; note that the 44% figure cited above is for eligible residents, so limited to those 12 and over) have been fully vaccinated, but 3.7 million (over 75%) have had at least one dose administered. We’re right at the statewide average, and hopefully things will continue to trend upward, if a bit more slowly now.

I hope also that people will take to heart the warning about the continued danger for unvaccinated people, especially now as more businesses are removing their mask requirements. If you need an example, consider this:

I know, I’m as shocked as you are that a bunch of Bitcoin humpers are largely unvaccinated, but that’s not important right now. The point is that any arbitrary “herd immunity” percentage is immaterial when enough unvaccinated people are together in the same space. The virus will do what it always does. Your best counter-measure is to get vaccinated.

Our COVID numbers are staying down

Let’s keep this going.

While the East Coast struggles with a fourth wave of rising COVID-19 infections, Texas experts say the state is doing “reasonably well” as case rates stabilize across the state.

Case rates and hospitalizations have plateaued in the region in recent weeks, averaging roughly 3,500 new daily reported cases, the lowest it’s been since early-to-mid September. The decline in hospitalizations has been an even more welcome trend, with fewer than 3,000 patients hospitalized for COVID, the lowest it’s been since June.

Medical experts such as Dr. Carl Vartian, an infectious disease specialist and chief medical officer at HCA Houston Healthcare Clear Lake and Mainland hospitals, suspect the winter freeze, increasing vaccination rates and the prevalence of antibodies in Texas’ population have kept case rates low over the last month.

[…]

“Texas is doing better than most states, which are seeing a pretty sharp rise in the number of daily new cases,” said Ben Neuman, a virologist at Texas A&M University.

The lower rate of infections doesn’t mean that Texans can let their guard down, though. Fewer than 37 percent of state residents have received at least one dose of the COVID-19 vaccine, and just over 20 percent have been fully vaccinated.

“You have to plateau before you rise, and I think that’s where we’re headed,” Neuman said.

The flat line of case rates starts with a sharp drop-off in testing. According to data from the Department of State Health Services, results from PCR testing dropped sharply during the winter freeze in February, and have not rebounded. As of April, Texas is testing at just half the rate it was before the state iced over.

While the number of daily tests has declined heavily, so too has the positive test rate. It’s now under 5 percent, and the second-lowest it’s been since the start of the pandemic, according to state data. Even with the reduced number of tests being conducted, fewer people are testing positive for COVID.

The low number of tests mean there could be a lag before a potential surge, Neuman said.

In Houston, medical experts are cautiously optimistic there won’t be a rise.

Usually, case rates spike first, followed by hospitalizations the week after and ventilator demand and deaths after that. So far, all three have stayed low in Houston, Vartian said.

The freeze was basically a one-week lockdown in the middle of February, and that no doubt helped keep infections down. I don’t know what it’s like anywhere else, but at least in my little part of the world people are still masking up, despite the Governor’s order. I won’t extrapolate from such a limited data point, but I feel hopeful that at least in the big cities people are still inclined to be cautious.

And I take heart at the progress in getting shots into arms. The Astros are getting their shots. The Rockets are getting their shots. Judge Hidalgo has gotten her first shot. People are celebrating the ways that their lives have been improved by getting vaccinated. (Can confirm, by the way.) I’m hopeful. We still have to be careful, but I can see the road ahead, and it’s going someplace good.

Still code red

We’ll turn it down a notch when the data says we should.

The counts of coronavirus patients in local hospitals have been falling for two months. Restaurant patios are packed. Houston’s symphony and pro soccer teams are resuming at limited capacity. The state is relaxing restrictions on many businesses next week.

So, why is Harris County still at its highest threat level, urging residents to stay home?

Simple, County Judge Lina Hidalgo says: The metrics her office compiled in forming the threat level system in June have not all been met.

Hospitalization trends met the county’s goals weeks ago. A change to the way new cases were tallied cleared that hurdle on Monday, as did the last hospital target — COVID-19 patients making up less than 15 percent of intensive care beds. The lone barrier to downgrading from red (“stay home”) to orange (“minimize ALL contacts”) is now the county’s test positivity rate, which, at 7.7 percent, exceeds the 5 percent target.

Hidalgo said she understands the public is tired of vigilance, but she loses no sleep over being a holdout.

“What I’m trying to do is have at least one level of government that’s offering research and numbers-based information and consistently refuses to be swayed by political one-liners,” she said. “That continues to be my commitment. When you have folks pretending we can just go back to normal, it puts the community at risk and it gives people false hope.”

[…]

Dr. James McDeavitt, senior vice president at Baylor College of Medicine, called the county’s 5 percent target reasonable and widely used, but said, broadly, COVID-19 indicators suggest this is an appropriate time to slowly reopen.

Setting goals and then ditching them when the public grows tired of the restrictions they support would be a mistake, McDeavitt said. When Abbott reopened the state in May, Texas had not hit the benchmarks his own advisors had set.

“On the other hand,” McDeavitt added, “if you set metrics and slavishly wait until every single one of those numbers is where it needs to be, that is also problematic. You need to look at the big picture — and I know from talking to the county that’s what they do. Everybody is trying to find the right balance.”

Hey, if Greg Abbott isn’t going to pay attention to his own metrics, someone has to. To be fair, other counties have lowered their threat levels, and Dr. McDeavitt’s point about where the metrics are is well-taken. Positivity rate is a key figure, but it’s also affected by the number of tests that are given, which in turn is affected by test availability. It may be that we need to have a discussion about this, and it may be that we need to reassess what our risks are these days. But still, the fact that Judge Hidalgo is consistent about the metrics we have set for Harris County is a good thing.

And so the re-reopening begins

Are we really ready for this?

Gov. Greg Abbott announced Thursday that most of Texas will be able to loosen some coronavirus restrictions, including letting many businesses increase their capacity to 75%, as soon as Monday.

Retail stores, restaurants and office buildings, which have been open at 50% capacity, will be permitted to expand to 75% capacity. Hospitals will be allowed to offer elective procedures again and nursing homes can reopen for visitations under certain standards.

The new reopening stage applies to 19 of the state’s 22 hospital regions. The three hospital regions excluded are in the Rio Grande Valley, Laredo and Victoria. Abbott said those regions’ hospitalizations are still “in the danger zone,” which he defined as places where coronavirus patients make up 15% or more of all hospitalizations.

At the same time, Abbott said the state was not yet ready to reopen bars, saying they are “nationally recognized as COVID-spreading locations.” He stressed, though, that the state is looking for ways to let bars reopen safely.

[…]

“Gov. Abbott’s press conference today was notable for what he didn’t say,” state Rep. Chris Turner of Grand Prairie, who chairs the House Democratic Caucus, said in a statement. “There was no mention of a contact tracing program, no mention of improving the state’s unreliable data and no mention of expanding Medicaid to increase access to health care for the millions of Texans who are uninsured.”

The Texas Democratic Party said Abbott is “basing his decisions on dirty data.”

Abbott began the news conference by hailing the state’s progress in the fight against coronavirus, saying the “biggest reason” for improvements has been that Texans are taking the pandemic seriously and exercising personal responsibility.

The governor reminded Texans that doctors have said the goal is not to eradicate the virus but to “contain the disease, to limit its harm and to maximize the health care system’s ability to treat both COVID patients as well as other medical needs of the community.”

When it comes to further reopenings, he emphasized the state will consider all data but “rely most heavily” on hospitalizations, calling that metric the “most important information about the severity of COVID in any particular region.” It is also the “most accurate information available on a daily basis,” Abbott said.

To that end, the regions that will be allowed to further reopen must have seen coronavirus hospitalizations make up less than 15% of all hospitalizations for seven consecutive days, according to the governor. If coronavirus hospitalizations rise above the 15% threshold for seven consecutive days in a region, a “course correction is going to be needed,” Abbott said, suggesting the solution would be a reversal of the area’s latest reopenings.

Given that many other countries have essentially eradicated the virus, one could certainly disagree with Abbott’s assertion about what the goal should be. Though to be fair, it does seem impossible to set such a goal while Donald Trump is President, so perhaps this is just Abbott acceding to that reality. The Chron adds some details.

The new regional threshold marks a significant shift for the Republican governor as the state’s pandemic response moves into the fall, with flu season arriving and many schools about to reopen for in-person instruction. He previously resisted committing to a regional approach, and said he would rely on a range of metrics — not just hospitalizations — to determine policies.

But the state’s health agency has been dogged by data backlogs, and some counties said they had lost confidence in state metrics such as the number of new daily infections and the percent of positive COVID tests, also known as the positivity rate. While the state has remedied at least some of the issues, hospitalization data have been more reliable throughout the pandemic.

Other large states, including New York and California, are currently using regional reopening plans based on several criteria, including new cases and test positivity. Public health experts caution against relying on hospitalizations alone, since they lag behind infections and therefore provide a delayed glimpse into the community spread of the virus.

All but two of the state’s 22 hospital regions have previously surpassed the new 15-percent threshold, according to the state’s calculation. The governor did not provide the methodology for how they calculated the percentages, and a spokesman did not immediately respond to questions about how the benchmark was selected.

The state has reported nearly 700,000 infections since March and nearly 14,500 deaths, a toll similar to that in other large states, including California and Florida. New York has reported fewer infections but more deaths, stemming from a surge earlier this year.

Texas has been below 10 percent test positivity for at least two weeks now. Earlier this week, state health officials unveiled a new method of calculating the rate, which shows it first dropped below 10 percent in mid August. Abbott has said before that he would consider further reopenings once the state remained below that threshold for two weeks.

Yes, our lousy data quality is an issue. I get that there’s a lot of pressure to let businesses get back to “normal” again. But let’s be real here: One, plenty of people will still not change their habits to what they were in the Before Times until they feel confident that the pandemic is truly under control. Public opinion is clear that most people do not feel this way, and as such this greatly limits the upside of any reopening scheme. Two, we have been down this road before, and the last time we went this way Abbott basically ignored all the metrics that he himself set and just went about loosening restrictions even though none of his own stated criteria were being met. There’s no reason to believe he has learned this lesson. Three, even if we had complete clarity on hospitalizations, that’s a lagging indicator, meaning that by the time the hospitals have started to fill up again, it’s already too late to stop it. Four, see above about the lack of our data quality, which again strongly suggests that even if Abbott is sincere about turning the car around at the first sign of trouble, that first sign may not be at all apparent when it’s happening.

Finally, the reason why people finally started to take the pandemic seriously is because Greg Abbott finally started taking it seriously, and conveying a message that we all needed to be wearing face masks and social distancing and avoiding large gatherings, especially indoors. We certainly haven’t gotten that message from Donald Trump or his biggest toadies like Dan Patrick. If you want to praise everyone for their personal responsibility, then you need to emphasize that they have to continue being personally responsible, which means wearing masks and so on. If that makes the rock-filled heads of Steven Hotze and his ilk explode, then so be it. Abbott loves being in front of the parade, but he does a crappy job of leading it. As I said the last time we re-opened, I really hope this works out. And I really hope Abbott is serious about backing off at the first sign that it isn’t. A statement from Mayor Turner is here, and the Dallas Observer, Reform Austin, the Texas Signal, and the Houston Press have more.

We suck at COVID data, the continuing story

Would have been nice to have known this when it was happening.

State health officials published new data this week that showed the state’s positivity rate was higher in the spring that originally disclosed, even as public officials cited the data to justify business reopenings during the pandemic.

The Department of State Health Services on Monday announced a new method for calculating the positivity rate, or the proportion of positive tests, and conceded the previous method obscured the extent of viral transmission by combining old and new cases. The new formula relies on the date a coronavirus test was administered, rather than the date it was reported to health officials and verified as a case.

As Texas prepared for the first phase of reopening in late April, Gov. Greg Abbott repeatedly pointed to the state’s positivity rate, even as the number of new cases and deaths continued to rise. Announcing his initial reopening order on April 27, Abbott declared that the “COVID-19 infection rate has been on the decline over the past 17 days.”

The following week, the governor downplayed a new single-day record in new COVID-19 cases by again pointing to the positivity rate.

“Despite concentrating on areas where we think there may be a high level or number of people who could test positive, the fact remains that more than 95% of the people who were tested test negative,” Abbott said during a May 5 news conference.

State data at the time placed the seven-day average positivity rate at 5.84%, near the 5% benchmark recommended by the World Health Organization before governments ease restrictions. The actual rate, however, was higher. According to the new method employed by DSHS, Texas’ seven-day average positivity rate was actually 8.4%, near the 10% threshold Abbott had called a “warning flag” indicating a high level of community spread.

Following the reopening of bars, restaurants, stores and child care centers throughout May, Texas saw a surge in cases beginning in June. The state’s reported seven-day average positivity rate under the old method jumped from 4.27% at its lowest point in late May to 17.4% at its peak in mid-July. After revising the data, the state’s new chart shows that the positivity rate jumped from 5.81% in May to a peak of 21% in early July.

See here, here, and here for earlier entries in this chronicle. This stuff is hard, I don’t want to minimize that. Doctors and scientists have made mistakes and have changed their tune on COVID-related matters over time, as new data has come in and revised our understanding of what we thought we knew. Maybe no one could have known this at the time, I’m not in a position to judge. But as we’ve said before, the state rushed to reopen on Greg Abbott’s orders even as the Abbott-defined metrics for reopening were not being met. Now we know we were even further from the desired levels than we thought, and many more people have gotten sick and died or are suffering from long-term effects of the virus. We can have some level of sympathy for Greg Abbott, we can recognize that anyone would have made bad decisions if they were given bad data, and still hold him responsible for the outcome. His decision to reopen as he did was risky at the time, and it’s so much worse now. That’s all on him.

Who knows what our positivity rate is?

From the We Still Suck At Data Department:

As schools begin to reopen and Gov. Greg Abbott faces pressure to relax shutdown measures, it is impossible to determine where Texas stands on a COVID-19 metric that has guided the governor’s decisions on when to tighten or loosen restrictions on businesses and public activity.

Over the past week and a half, the state began reporting coronavirus data from a backlog of 500,000 viral tests that officials say accumulated because of coding errors from Quest Diagnostics, Walgreens and CHRISTUS Health — all private entities that process the tests.

The result has been an ongoing miscalculation of the “positivity rate,” the rate at which people test positive for the virus.

Last week, it reached as high as 24.5 percent, and suddenly dipped back down again to about 11 percent this week as more backlogged tests were included in the data. Abbott has said a sustained positivity rate below 10 percent would allow for further reopenings in the state.

The influx of backlogged tests, dating as far back as March, has also exposed a convoluted reporting system that requires state officials to receive lab results, send them back to counties and wait for them to return to the State Department of Health Services before counting them.

The result is a mess of information reported recently to the public in “data dumps” that include test results from months prior, skewing statewide coronavirus statistics and positivity rates.

“The timing of it is horrible because it’s right at the beginning of opening the schools, when you want your data to be as accurate as possible, and it’s not,” said Darrell Hale, a Republican commissioner in Collin County.

The county on Wednesday pasted a disclaimer to its COVID reporting site declaring “no confidence” in the state’s numbers, which Hale said have ballooned in recent days even as lab-confirmed COVID-19 hospitalizations have declined.

[…]

Abbott faulted private labs for the glitches, as well as technological issues in the state’s own reporting system, which did not have the capacity to process more than 48,000 tests per day until Aug. 1. The state did not disclose the issue as it built up throughout July, when as many as 67,000 tests were conducted each day.

It may well be that the private labs can’t keep up with the demand. But:

1. Greg Abbott knew about this problem for at least a few weeks without ever saying anything about it.

2. The positivity rate was and is one of Abbott’s key metrics that were supposed to guide how and when we reopened things. Greg Abbott is currently not allowing local health authorities to make their own decisions about whether it is safe to open schools even though the data that we all need to know what the risks are cannot be trusted.

3. Greg Abbott continues to support and defend the federal government and its completely disastrous response to the pandemic, even though the federal government is the one entity in the country that could have marshaled the responses to meet the demand for testing. Nearly six months into this crisis, the federal government, under Donald Trump, which Greg Abbott supports, has made zero headway on this issue.

So yeah. Our data sucks, we are reaping the consequences of that failure, and the responsibility for it in this state rests with Greg Abbott.

We still suck at COVID data

I’m sure none of this is important.

The government’s official data on the coronavirus outbreak is startling: More than 4.6 million cases in the U.S. More than 440,000 in Texas. More than 70,000 in Harris County.

But those numbers don’t include all positive COVID-19 patients.

Texas, unlike 27 other states, excludes the results of increasingly popular, rapid COVID-19 tests from the numbers it reports publicly — obscuring the scope of the pandemic, records and interviews show. The antigen tests are used in doctor’s offices, hospitals and stand-alone clinics and deliver results in less than 30 minutes.

But conflicting guidance from the Texas Department of State Health Services created confusion among local health departments about what test results to report. A reliance on faxed test results has created a paper backlog that makes it impossible for the state to do its own tally.

And while there is no way to independently estimate the scope of the undercount, based on the 11 Texas counties that publish antigen tests results separately of their own accord, the state’s tally is short by at least tens of thousands of cases — but likely far more, a Houston Chronicle analysis found.

And the undercount is about to get worse. The federal government is rolling out a program to use thousands of antigen tests in nursing homes across the country — including Texas.

State Rep. Gina Hinojosa, D-Austin, who serves as vice-chair of the House committee that oversees the state’s public health agencies, said the lack of reliable data is hindering the overall COVID-19 response effort in Texas.

“The only way people will be inspired to act right without government mandates is if they have the information they need to make smart choices,” Hinojosa told the Chronicle. “And that has been just impossible to come by.”

The problem, apparently, is that the state considers a positive antigen test to be a “probable” positive for COVID-19, not a definite positive. I mean, I figure a couple of data geeks could work out a decent solution for this in less than a day’s work, so color me baffled by the confusion here. And if you’re confused for other reasons, please note that antigen tests are different from antibody tests, which determine if you have had COVID-19 in the past, and thus should be in a separate category. It would be nice if we could get this all straightened out. The Trib has more.