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Baylor College of Medicine

More proof that vaccine mandates work

In the end, most people just get the damn shots. The rest is sound and fury.

Protests, lawsuits and national media coverage surrounded Houston Methodist Hospital in June when it became the country’s first major health system to require a COVID-19 vaccine as a condition of employment.

Now, as other Houston healthcare providers begin to enforce similar mandates, the drama has faded into the background. Hospitals are not facing the same pushback, officials say, and only a small portion of employees are holding out on the vaccine.

“There is a lot of noise around (mandates), and the anti-vaxx movement has been vociferous, but this is more of an outcry from the community rather than when it comes down to the brass tacks in facilities,” said Carrie Kroll, vice president of advocacy, quality and public health at the Texas Hospital Association.

Texas Children’s Hospital and Baylor College of Medicine were the first to reach their vaccine mandate deadlines following Methodist.

Baylor required its roughly 9,000 faculty and staff members to be fully vaccinated by Sept. 15. Those who did not attest to receiving their vaccine were subject to “progressive discipline,” which includes a series of warnings that ends in firing, according to a statement. The vast majority of employees complied, while about 3 percent were granted an exemption, according to numbers provided by the school.

One employee resigned. Another five will be fired after facing warnings.

[…]

Texas Children’s Hospital also passed its first-dose deadline on Sept. 21. Its doctors are employed by Baylor and already covered by the school’s mandate. In a statement, the hospital said “a very small number of employees did not receive the vaccine and therefore chose to leave the organization.”

Texas Children’s spokesperson Natasha Barrett said the hospital could not disclose a specific number of people who left or whether any exemptions were granted.

See here, here, and here for some background. A lawsuit by the (very small number of) fired Methodist employees was dismissed, though it is being appealed. There’s growing evidence from around the country that this is what happens pretty much everywhere that there’s a vaccine mandate – lots of loud whining and complaining and threats to quit, followed by near-universal compliance. This is why I’m happy for the San Antonio ISD vaccine mandate fight to move slowly through the courts, because regardless of outcome it’s going to cause people to get the damn vaccine. And don’t anyone tell Greg Abbott, but Southwest Airlines is doing a mandate now, too. The more, the very much better.

Hospital systems have no excuse for not mandating COVID vaccines now

So get on with it already.

Local hospitals reacted Friday to President Joseph Biden’s sweeping vaccine mandates directed at the health care workers, who make up much of the Houston workforce.

In a move that overrides Gov. Greg Abbott’s executive order barring public institutions from issuing their own COVID-19 restrictions, the administration said it would require vaccinations for employees at health care facilities that accept Medicare and Medicaid reimbursement.

Baylor College of Medicine’s dean of clinical affairs, Dr. James McDeavitt, said Thursday he supported the new measures.

“It is the right thing to do,” he said.

Still, he wished the plan had come sooner. “It is not going to help us with the current delta surge,” he added.

[…]

Five Houston hospital systems already require a vaccine. In June, Houston Methodist became the first hospital in the nation to announce it would require its staff to be fully vaccinated, a move that met months of resistance, including a lawsuit by some employees. Memorial Hermann and Baylor College of Medicine enacted their own vaccine mandates in July; St. Luke’s Health and Texas Children’s Hospital announced similar plans in August.

Thursday’s executive order will bring similar mandates to the city’s remaining health systems.

Until now, Harris Health System and UTHealth had encouraged worker vaccinations but were unable to require it under the governor’s order.

But on Friday, Harris Health System said it “fully intends to embrace the vaccine mandate” for workers at its two hospitals, 18 community health centers and 10 clinics serving the greater Houston area. The system has not yet set a date.

UT Health said it would wait for guidance from the Centers for Medicare & Medicaid Service, expected in October. It had not instituted a mandate as of Friday afternoon.

St. Joseph Medical Center and UTMB Galveston said they are still evaluating Biden’s plan.

While Kelsey-Seybold Clinic said in August it was waiting for full vaccine approval from the U.S. Food and Drug Administration before asking employees to provide proof of immunization, the clinic has not announced a mandate since the Pfizer-BioNTech vaccine gained full U.S. Food and Drug Administration approval late last month.

See here for the background. I agree that the mandate coming out now will have little to no effect on the current surge, given that it takes a few weeks to get both shots and the full effect of them, and that it will take time for these hospital systems to get their programs going. It would still be nice if some of them had more of a sense of urgency about it. This is still by far the best thing we can do for the medium to longer term, and at the very least these hospital systems should be setting a better example. Get it done already, y’all. The Trib has more.

Yes, the wastewater is also pointing to a COVID surge

In case you were wondering.

There is more COVID-19 in the city’s wastewater system now than at any time in the pandemic, city officials said Wednesday, the latest warning that the virus is spreading at an unprecedented rate.

Dr. David Persse, the city’s health authority, said there is more than three times as much virus in the system as there was last July. The volume also is higher than in January, during the most recent spike. Persse said that wastewater data, a precursor to other data points, show the surge will only grow worse in the coming weeks.

“We are at a level of virus in the wastewater that we have never seen before,” Persse said. “The wastewater predicts what we’ll see in the positivity (rate) by two weeks, which predicts what we’ll see in hospitalizations by about two weeks.”

[…]

The findings came during a news conference in which the city announced it will partner with Harris County and up to 17 school districts to vaccinate students over 12 and their families every Saturday in August, an effort they are calling “Super Saturday.” The inoculations will occur in school buildings throughout the region.

Persse described the state of the surge in stark terms, pointing to dire situations in area hospitals and rising cases and hospitalizations. The Lyndon B. Johnson Hospital declared an “internal disaster” Sunday night amid a nursing shortage and an influx of patients, circumstances officials said are occurring in other area hospitals, as well.

Texas Medical Center CEO Bill McKeon earlier this week said the region is “headed for dark times,” and the hospital system has exceeded its base intensive care capacity, opening unused wards to care for new patients.

“If you are currently unvaccinated, you need to consider that you represent a potential danger to yourself, and others, and most particularly your own family,” Persse said. “If you are not vaccinated… your chances getting through this without having to become either vaccinated or infected, is essentially zero.”

Just over 64 percent of Houstonians over 12 have received their first dose of the vaccine, according to city data, and 54.3 percent are fully vaccinated. The numbers among youth residents are more paltry, though: 28.1 percent of 12-17-year-old Houston residents are fully vaccinated, and 38.5 percent have received their first dose.

“If your child is 12 or older, stop and get them the shot,” said Houston ISD Superintendent Millard House II. “Increasing vaccination rates among our communities will help ease the worries of our families and their children returning to school.”

This is another one from earlier in the month, as things were really starting to get bad. We are familiar with this project, and it has been a big success. I just wish it had better news for us, but this is where we are. Getting more of those 12-and-older kids vaccinated would make a big difference as well, so I hope that effort is successful. We’re on our own, so we’d better act accordingly.

More on the Memorial Hermann and Baylor vaccination mandates

Memorial Hermann: Get your shots or get out.

Memorial Hermann on Monday said it will require all employees to be vaccinated by Oct. 9, becoming the third Houston healthcare institution to do so.

The hospital system follows Baylor College of Medicine, which announced its employee vaccine requirement last week, nearly two months after Houston Methodist reached its vaccination deadline.

Managers and other leaders across the organizations must be compliant by Sept. 11. The deadline is Oct. 9 for all other employees, including the system’s affiliated providers and volunteers.

About 83 percent of Memorial Hermann’s workforce is fully vaccinated, including 87 percent of bedside staff, 95 percent of managers and above and all executive leaders, according to the hospital system. Memorial Hermann employs more than 29,000 people.

Exemptions will be made for those who are unable to be vaccinated due to medical or religious reasons. Employees who are not exempt and refuse the vaccine “will be deemed to have voluntarily resigned their position,” said Dr. David L. Callender, Memorial Hermann President and CEO.

He said spiking hospitalizations and COVID cases prompted the move.

“We’ve been waiting a little bit just to make sure the circumstances fully warrant moving forward, and we think they do now, “ Callender said Monday. “We’re seeing the impact of the very aggressive delta variant, a significant spike in new cases and hospitalizations, and about 50 percent of Houston’s population remains unvaccinated, which means the community continues to be at risk.”

See here for the background. I don’t think that justification needs any further explaining. By the way, the Memorial Hermann CEO wrote an op-ed in March, just as we were starting to hear about some scary variants out there, begging Greg Abbott to leave mask mandates in place. We know how that went.

Here’s Baylor, from about a week ago, with a somewhat less punitive approach.

Baylor employees have until Sept. 15 to become fully vaccinated or they may be subjected to discipline, said Dr. James McDeavitt, senior vice president and dean of clinical affairs at the medical school. However, he believes termination will be a “rare event.”

“We thought it was important to make a statement,” McDeavitt said. “As an organization, we are committed to vaccination, and we have been involved in all stages of the pandemic, from the development of vaccines, testing, clinical trials of medications and critical care of patients. (Requiring vaccines) was a necessary step for us to close that loop.”

Baylor’s vaccine policy had been in the works for some time, McDeavitt said, but the spike in cases was a catalyst for releasing the policy this week. “The spreading of the delta variant had a role in the timing of the release of this,” he said.

The policy, which was sent to employees Wednesday, details requirements for annual influenza and COVID-19 shots, except for people who have religious beliefs or a medical condition that would preclude them from becoming immunized.

So far, employee feedback has been positive, he said.

“I haven’t gotten any negative pushback to date,” McDeavitt said.

Baylor looked to Houston Methodist’s example when developing its policy, McDeavitt said. Methodist was the first health system nationwide to require vaccinations for employees in early June. More than 150 hospital employees resigned or were fired over the new policy — fewer than 1 percent of Methodist’s 25,000 employees.

“We will roll this out differently than Houston Methodist did. If someone flat-out refuses to become vaccinated, we don’t intend to jump to termination,” McDeavitt said.

For employees who are vaccine-hesitant, there will be a human resources process to further encourage them to take the shots. McDeavitt hopes no one is terminated over the new vaccination policy.

We’ll see how that works for them. I don’t care either way, as long as it gets the desired result. There’s no indication in that story of how many BCM employees are already vaccinated. MH’s 83% is not bad, but obviously it can – and will – be better. I wish they had done this sooner, but at least they are doing it. Texas Children’s, where are you on this?

More hospital systems to require vaccines

About time.

Memorial Hermann officials are finalizing details on its mandatory vaccine policy for employees.

During a radio interview Wednesday, Dr. David L. Callender, president and CEO, said the system will soon announce the timeline for its employees to become fully vaccinated.

The new measure comes as a fourth wave of the virus spreads across the state, due in large part to the ultra-transmissible delta variant. On Friday, the Department of State Health Services reported 13,871 new confirmed COVID cases, the largest single-day count since last winter’s surge and more than 12 times the number of cases confirmed on July 1.

“We think it’s very important for health care workers across the country to be vaccinated as vaccination is really the only way to stop this pandemic,” Callender said on the Houston Public Media radio show. “We’re working on (the policy), and will be making an announcement early next week.”

As of Friday morning, no details were made available on a vaccination deadline for employees or what type of discipline they may face if they do not comply with the new policy.

[…]

Memorial Hermann follows Baylor College of Medicine, which this week became the second Houston-area health care facility to require vaccines for employees, nearly two months after Houston Methodist reached its vaccination deadline.

Baylor employees have until Sept. 15 to become fully vaccinated or they may be subjected to discipline, said Dr. James McDeavitt, senior vice president and dean of clinical affairs at the medical school. McDeavitt expects most of the system’s employees will comply, and he believes firings connected to the policy will be rare.

I mean, Houston Methodist was doing this back in April, before any of us had ever heard of the Delta variant. They prevailed in a lawsuit, which is now under appeal, so the legal precedent is there for Memorial and Baylor. I honestly don’t know what has taken them so long, but better late than never. Now I’m wondering about other hospital systems – when I went to the Memorial Hermann Twitter page to get their logo for the embedded image, they suggested Texas Children’s Hospital, and now I’m wondering what their policy is. A Google search did not answer that question for me, which suggests the answer is No. Get it together, Texas Children’s!

The COVID wastewater tracking project has been a big success

This has been one of the best things to come out of this interminable and miserable COVID experience.

Lauren Stadler’s environmental engineering students always pose the same question at the beginning of a semester: “What happens to water in the toilet after you flush?”

Historically, humans have worked to quickly dispose and eradicate their own waste, which can carry diseases.

But an area’s waste creates a snapshot of who is there and what they’ve been exposed to, said Stadler, a wastewater engineer and environmental microbiologist at Rice University. She’s working with the Houston Health Department and Baylor College of Medicine’s TAILOR program to find SARS-CoV-2 in the city’s wastewater.

Stadler’s hunt has revealed variants in particular areas, heightening the city’s urgency to procure resources — COVID tests, informational meetings, advertising and now vaccine sites — in an effort to quash them before they proliferate.

“The beauty and challenge of wastewater is that it represents a pool of sample — we’ll never get an individual person’s SARS-CoV-2 strain, but a mixture of everyone in that population,” Stadler said. “We can find a population level of emergence of mutations that might be unique to Houston.”

[…]

Variant tracking has become an important part of the wastewater analysis process, Stadler said.

In February, the city and its research partners began seeing a quick emergence of the B.1.1.7 variant, which is now the dominant variant in the area. According to the Centers for Disease Control and Prevention, nearly 21,000 cases of the B.1.1.7 variant have been detected in nationwide.

Now that the team has gathered data and built a sustainable process, Stadler said they are using this information to forecast future pandemics. “Taking wastewater data, you can predict positivity rates and forecast infection burdens — it has this predictive power essentially. It’ll be very important to identify areas in the city experiencing increases in infection, and we can direct resources.”

The wastewater analysis team works with public works employees to collect weekly samples from nearly 200 sites across the city.

“I think they see this as a monitoring tool beyond the pandemic, and we see it as well,” Stadler said. “Hopefully, when SARS-CoV-2 is behind us, we will be able to monitor for an endemic virus, like flu. We can use wastewater monitoring to look for other viruses, bacterial pathogens and other pathogens of concern.”

See here and here for recent entries. I don’t have much to add, just my admiration for everyone involved and the knowledge they have gained. This was a simple and inexpensive innovation, and it will yield public health benefits for years to come. Kudos to all.

Houston Methodist tells its employees to get vaxxed or else

I’m okay with this.

Four out of five Houston Methodist employees are vaccinated against COVID-19. The sliver who are not will be suspended or fired if they refuse the shot, according to company policy.

The hospital required managers to be vaccinated by April 15 and all other employees — about 26,000 workers in total — by June 7, said Stefanie Asin, a Houston Methodist spokesperson.

With 84 percent of the staff vaccinated, the hospital is close to herd immunity, CEO Marc Boom wrote in a letter to employees this month.

“As health care workers we’ve taken a sacred oath to do everything possible to keep our patients safe and healthy — this includes getting vaccinated,” Boom wrote.

A little more than 4,100 employees have not received at least a first dose of the COVID-19 vaccine. The hospital does not know yet how many employees potentially will be suspended or terminated because of the mandatory vaccination policy.

Since 2009, a hospital policy has mandated its workers receive the flu vaccine each year, unless they have a medical or religious objection qualifying them for exemption.

[…]

Several nursing homes in Houston are requiring COVID-19 vaccinations of their workers, while other hospitals in the Texas Medical Center have not yet followed suit.

“UTMB is not mandating vaccination,” said Christopher Smith Gonzalez, senior communication specialist for the hospital. “But, in view of the high contagiousness of the some of the SARS-CoV-2 variants, UTMB has implemented enhanced respiratory precautions for all unvaccinated individuals caring for or evaluating patients for COVID.”

While 80 percent of Texas Children’s Hospital employees are vaccinated against COVID-19, the hospital does not require inoculation. St. Luke’s Health has vaccinated “thousands of our staff,” vaccinations are not mandatory, according to the health system.

But some are considering it to cut back on health hazards for employees and patients.

“As a provider of health care services, Baylor College of Medicine currently requires vaccination for employees for a variety of infectious diseases,” said Dr. James McDeavitt, senior vice president of Baylor College of Medicine. “For example, flu vaccination for employees has been mandatory for several years. With appropriately defined exemptions (medical contraindications, religious beliefs), we support mandatory vaccination for COVID-19. We do not yet have this requirement in place, but it is under active consideration.”

Memorial Hermann will make COVID-19 vaccines mandatory after it relaxes some of its COVID-19 protocols, such as mask-wearing and social distancing. However, it has not set a deadline for employees to receive the vaccine, said Drew Munhausen, a Memorial Hermann spokesperson.

This all makes sense to me. They’re health care workers, which not only makes them at high risk for catching COVID, it means they’re in very close contact with a lot of extremely vulnerable people as well. The story notes a recent incident in a Kentucky nursing home, where an unvaxxed worker was the cause of an outbreak. While most of the residents, who had been vaccinated, had only mild symptoms, one of them died. None of that should have happened. State law requires that health care facilities have a policy about vaccinations, but doesn’t require that they mandate them; federal law allows employers to require vaccinations, but also doesn’t mandate it. I for sure would want to know that the doctor or nurse or physician’s assistant who is giving me medical assistance, as well as all of the support staff, have been vaccinated for COVID. I understand that some of the employees may be hesitant about the vaccine, and I have some sympathy for them, but only so much.

There is also this:

Houston Methodist was one of several companies to offer incentives for its workers to get a COVID-19 vaccine. The hospital is granting $500 bonuses to anyone who worked during the pandemic and received the vaccine.

“Already we’re seeing positive results as the number of employee infections has dropped inversely with the number of employees receiving the vaccine,” Boom wrote.

Paying people to get vaxxed has its merits. One of the hesitant Methodist employees from the story says that some of her fellow hesitators are thinking about getting the shots to keep their jobs. Clearly, incentives work. Maybe that’s a lesson for us for the broader issue.

You will eventually need a COVID booster shot

Just get used to the idea.

More than 28 percent of Texans 16 and older are now fully vaccinated against COVID-19, having received either one shot of the Johnson & Johnson or two of Moderna or Pfizer. But as scientists continue to study the virus and emerging variants, they’re concluding that even the fully vaccinated may need booster shots to stay protected.

“It might be necessary because of waning immunity,” said Dr. Wesley Long, an infectious disease expert at Houston Methodist Hospital. “It might be necessary if we have a variant strain of COVID that maybe the original vaccines doesn’t protect against as well.”

So far, it’s looking probable people will require a booster shot around the holiday season. But there are still many unknowns.

Although the coronavirus pandemic has ravaged the globe for a year now, clinical trials for the vaccine haven’t been around as long. The most recent data from vaccine manufacturers show that the shots offer at least six months of protection, but researchers won’t know until the end of the year whether immunity lasts a full 12 months.

[…]

To test whether patients have lost protection, public health agencies and vaccine manufacturers will likely keep a close eye on the rate of hospitalizations and deaths. If people lose immunity, it’ll likely taper off gradually rather than come to an abrupt end.

“One of two things can happen: We may lose protection against all COVID-19 symptoms, the mild and the severe, which would be a problem, right?” said Dr. Hana El Sahly, an associate professor of molecular virology and microbiology at Baylor College of Medicine. “Or it might be that we only lose protection against the mild symptoms, but retain protection against the severe symptoms.”

Researchers are still studying how SARS-CoV-2, the virus that causes COVID-19, is similar to other respiratory illnesses. While the disease has drawn some comparisons to influenza strains, the vaccines may work differently than flu shots, which require new vaccines every year to fend off emerging strains.

Even if the COVID-19 vaccine goes the way of the flu shot, experts say it’s not a bad sign.

“People shouldn’t be surprised, and it doesn’t mean that the original vaccines are a failure at all,” Long said. The vaccine will still keep people from dying and help them avoid the hospital.

Yeah, I’ve seen news stories about the likelihood of needing annual COVID shots, like one needs annual flu shots, for some time now. One reason for this is that there are new variants emerging with regularity.

College Station is best known as the home of Texas A&M University, but as of this month, researchers have confirmed it’s now the birthplace of a new COVID-19 strain.

Only one student has tested positive for BV-1, named for the Brazos Valley. They were diagnosed with COVID-19 on March 5 and experienced mild respiratory symptoms. A second test on March 25 turned up positive results, worrying researchers the variant would cause a longer infection in young adults.

“We do not at present know the full significance of this variant, but it has a combination of mutations similar to other internationally notifiable variants of concern,” Ben Neuman, a Texas A&M virologist, said in a statement. “This variant combines genetic markers separately associated with rapid spread, severe disease and high resistance to neutralizing antibodies.”

Viruses mutate, it’s what they do. So far, the known variants have all still been controlled by the existing vaccines, but eventually one or more of them will be more resistant. As long as there continues to be a significant population of people who wish to be a reservoir for the virus (read: anti-vaxxers), the virus will have plenty of opportunity to do its thing. As for the rest of us, vaccinations are all around us.

Walk-in COVID-19 vaccine clinics are now all the rage in Houston, as larger allocations and dwindling demand change the scarcity-fueled dynamic of the past several months.

“Now, there is more supply than there is demand,” said Harris County Judge Lina Hidalgo during a Monday afternoon news conference at NRG Park. “That means we have more vaccines than we have people willing to get them.”

As of Monday, 44 percent of Texans have received at least one dose of the COVID-19 vaccine. In Texas, vaccine administration is beginning to plateau at 250,000 doses per day, while vaccine manufacturers produce more doses a week, with 14.5 million shipped nationwide every week as of mid-April.

Harris County’s vaccine site, NRG Park, has abandoned the waitlist system that frustrated residents who found it difficult to schedule a time slot in advance. While the site, run jointly by the county and the Federal Emergency Management Agency, still recommends scheduling an appointment ahead of time to guarantee a dose, anyone age 16 or older can arrive on foot or by car during operating hours for a shot.

In addition, St. Luke’s Health is operating a walk-in clinic at Texas Southern University this week. Michael E. DeBakey Veterans Affairs Medical Center offers walk-up vaccines for veterans, caregivers and spouses.

Get your shot if you haven’t already. Make sure everyone you know gets theirs. And then be ready to do it again, sometime in 2022. This is the world we live in now.

Finally, a bit of good COVID news

Naturally, it comes from the wastewater.

Researchers who study sewage to monitor the pandemic are detecting less virus in Houston than they have in months, a positive signal that could indicate a forthcoming drop in new COVID-19 cases, doctors said.

The amount of viral load has declined at 28 out of 38 wastewater treatment plants across the city for the first time in five months, said Dr. Paul Klotman, president and CEO of Baylor College of Medicine. He announced the good news during a Friday video update.

“It’s actually a big drop,” Klotman said. “What that means is, in 7 to 10 days, I think we’re going to see a pretty dramatic drop in the number of new cases.”

[…]

Other indicators show signs of improvement. The Houston area’s R(t) value has dipped below 1 for the first time in weeks, meaning community spread is slowing. The test positivity rate for the Texas Medical Center hospital systems dipped from 13.2% last week to 12.7% this week, Klotman said, and the weekly average of COVID-19 hospitalizations is beginning to plateau.

See here, here, and here for the background. As we know, people shed virus in feces and urine, so tracking virus levels in wastewater is a pretty good tool for determining what the true status is and where hotspots are forming. If this is the start of a trend, we’ll see infection and hospitalization levels – not to mention deaths – start to decline rapidly in the next few weeks. Keep wearing your masks and avoiding indoor gatherings, as that’s been our best defense so far, and get that vaccine when you can.

More COVID restrictions are about to happen in Harris County

Blame Greg Abbott and the virus, in whatever order you prefer.

Houston and its surrounding communities on Tuesday became the latest region to require new emergency restrictions after seven straight days of ballooning coronavirus hospitalizations.

The rollback, mandated under Gov. Greg Abbott’s emergency protocols, includes restaurants dropping to 50 percent occupancy from 75 percent, and bars that have not reclassified as restaurants closing immediately. The restrictions remain in place until the region drops below 15 percent COVID-19 hospitalizations for seven straight days.

As of Monday, the latest day of available data, the Houston region was at 19.9 percent, up from just over 13 percent a week earlier. Infections and hospitalizations have been rising steadily in recent weeks, following spikes in other parts of the state and amid holiday gatherings.

All but four of the state’s 22 hospital regions were over 15 percent as of Monday.

Texas Medical Center Hospitals in Houston announced earlier Tuesday that they were putting a hold on certain elective surgeries to save resources for coronavirus patients. Under the governor’s protocols, hospitals are required to postpone elective surgeries that would deplete COVID-19 resources.

“The best thing we can do is take this threshold as a wakeup call,” Harris County Judge Lina Hidalgo said in a news conference Tuesday afternoon. “This is the time to take this for the red alert that it is. We are only going to get through this if we are able to quickly stem the tide of hospitalizations.”

More here.

The rollback comes as Texas Medical Center hospitals already had begun deferring certain elective procedures or readying such a managed reduction strategy, the same one they deployed during the summer when patient censuses spiked. The reduction is not the wholesale delay of elective procedures all Texas hospitals invoked in the spring.

Hospital leaders said Tuesday their systems will continue some elective procedures but suspend those non-urgent cases whose demands on staff and space detract from resources better used to treat COVID-19 patients. Procedures such as mammography and colonoscopy will continue because they don’t tax needed hospital resources, for instance, but some procedures like heart catheterizations might be better delayed.

[…]

The surge of COVID-19 hospitalizations has been relentless. The number of admitted COVID-19 patients in the Houston region has increased for 13 straight weeks, and the 25-county area anchored by Harris County had more than 3,100 hospitalizations on Monday, the highest since July, the peak of the first wave in Texas.

Houston Methodist was just short of 700 COVID-19 patients on Monday. Methodist CEO Dr. Marc Boom emailed employees that if this trend holds the system will surpass its peak July numbers in a matter of days.

“This may well be among the most challenging few weeks we’ve experienced during this pandemic,” Boom wrote in the email to employees Monday. “Together, we will get through this, but it will be difficult.”

Dr. James McCarthy, chief physician executive at Memorial Hermann, said his system exceeded 800 patients and should eclipse July numbers by the third week in January. The system’s number of patients has increased three-fold over the last month, he said.

[…]

The COVID-19 positive test rate statewide is now at 20.53 percent. Methodist’s is nearly 32 percent.

Porsa said said Harris Health is about to enter Phase 3 of its surge plans, which involves closing some of its clinics in order to deploy its nurses and other staff at Ben Taub and Lyndon B. Johnson hospitals, both of which are near capacity. He said the leadership is currently determining which clinics to start with.

Hospital officials said they are encouraged that ICUs aren’t being overloaded with COVID-19. They said their staffs have gotten much better, thanks to better treatment options and nine months of experience with the disease, at getting patients discharged faster now compared to early summer.

But with the Houston area now averaging more than 3,300 new COVID-19 cases a day — compared to roughly 2,330 such cases at the pandemic’s height in July — it appears the peak won’t come before late January or February, hospital officials said. They also worry a more contagious strain — not yet identified in Houston but maybe already here — poses an even greater threat ahead.

“January and February are shaping up to be our darkest days, given these record numbers,” said William McKeon, CEO of the TMC. “Hospitals lag behind in feeling the effects of increases in cases so expect the numbers to keep going in the wrong direction before things get better.”

We’re already passing the levels we had seen at the worst of it in July, and we’re probably a few weeks out from hitting the peak this time around. Remember all this next year, when it’s time to vote for our state government.

More people in Houston than you think have had COVID

About one in seven, which is an awful lot.

Mayor Sylvester Turner

Nearly 1 in 7 Houstonians have been infected with the coronavirus, city officials announced Monday, the infection’s true prevalence according to a study of antibodies in blood samples taken from people at their homes.

The study, conducted by Baylor College of Medicine and the city health department, found 13.5 percent of people tested had antibodies to the virus in their blood in mid-September, about four times the number revealed through diagnostic testing at the time.

“Thank God a vaccine is on the way because without one, given these numbers, we would need five to six times the number of infections to achieve herd immunity,” said Dr. Paul Klotman, president of Baylor. “It would also mean five to six times the number of deaths.”

[…]

Dr. David Persse, the city’s health authority, said he wasn’t sure if the Houston antibody percentage “is good news or bad news.” He said “the takeaway is that the virus is more active in the community than we can otherwise tell.”

Klotman and some others said the percent of Houstonians infected was less than they had expected. The head of the Centers for Disease Control and Prevention last summer said the number of people who’ve been infected is likely 10 times higher than the number of confirmed cases, and one study found New York City was about 20 percent in late April.

The Houston finding suggests about 250,000 Houstonians had been infected as of Sept. 19, the last day blood samples were collected. Only 57,000 infections had been identified by traditional viral testing at that time.

Persse said it is nearly impossible to predict what the percentage will be in January, but Klotman said he believes it has grown appreciably in the past nearly three months.

The test identifies those who previously have been infected with the virus by the presence of antibodies, proteins the immune system makes to fight infections. It is not a diagnostic test that identifies people with active disease, COVID-19.

The study was done by city health employees calling households in randomly selected Census blocks and asking for volunteers to give a blood sample for testing. Harris County launched a similar effort next month, and the city of Houston will do another round in early 2021. I’ll be very interested to see how the three compare. So far, the antibodies people get for having and recovering from COVID-19 are known to last a few months, and beyond that it’s not fully clear how susceptible such a person is. This also shows the dire need for masking and social distancing, because there have been – and are, and will be – a lot of people walking around who don’t know they’re sick. They themselves may be fine, but they could wind up infecting others who won’t be. The vaccines will be a huge help, but we’re still a long way away from that blessed day. So yeah, please keep wearing your mask and avoiding indoor gatherings. The Press has more.

“On the cusp” of another COVID surge

The numbers are already trending up. You know what that means.

Cases of COVID-19 in parts of Texas surged to near catastrophic levels this summer as some hospitals were forced to put beds in hallways, intensive care units exceeded capacity and health officials struggled to stem the tide of the virus.

After peaking in late July and August, cases fell and leveled off in September, and the state’s seven-day positivity rate — or the proportion of positive tests — reached its lowest point since early June.

But health officials are now eyeing a worrying trend: New infections are rising again, and the number of patients hospitalized with COVID-19 is also ticking upward. The state reported 2,273 new cases Monday, and the seven-day average was up by 862 from the previous week. On Monday, at least 4,319 patients were hospitalized with COVID-19, far below the more than 10,000 in July, but that number has steadily risen during the last month.

“I’m no longer pondering if we’re going to see a surge,” said Dr. James McDeavitt, dean of clinical affairs at the Baylor College of Medicine. “We’re already seeing it.”

Eight months since Texas recorded its first case, experts say the state is more prepared to handle another wave, but they fear that if the state fails to control the outbreak, it could quickly spiral out of control.

“The question is whether it’ll be a modest surge, or something like we saw in July, or worse,” McDeavitt said.

[…]

At Houston Methodist, one of the region’s largest health care systems, medical staff were stretched thin this summer, said President Marc Boom. At its peak in July, the system’s staff treated nearly 850 patients with COVID-19 each day. Since then, Boom said, the medical community’s understanding of the virus has evolved, along with how to treat the disease.

Remdesivir, an antiviral medication, has shown promising results in minimizing the severity of illness, especially when administered shortly after symptoms develop. Houston Medical was the first hospital to use convalescent plasma, a therapy in which antibody-rich blood from people who have recovered from COVID-19 is administered to ill patients, Boom said.

“We’ve had tons of experience gained, better outcomes, shorter lengths of stay,” Boom said. “But this is still a serious illness.”

While health authorities are better equipped to deal with new spikes, including an adequate supply of protective gear and sizable quantities of drugs like Remdesivir, a fall surge could still be equally as taxing on hospitals, said Carrie Kroll, vice president of advocacy, quality and public health at the Texas Hospital Association. As colder weather forces people inside and families gather for the holiday season, the chances for transmission increase, she said.

“We certainly have been tested, and we know the beast that it is, and have shown that we were able to make it through those first two spikes,” Kroll said. “But we don’t want to test the limit by putting patients into hospitals.”

See here for the previous update. It’s getting bad all around the country, too. Just a reminder, the July surge was bad, and it took Greg Abbott way too long to react to it. In the meantime, various assholes have decided that it’s a good use of their time to sue everyone in sight to limit the government’s ability to respond to COVID-19. I have one small bit of local optimism in that Harris County has not backed down from being at the top threat level even as the numbers were improving. Our numbers are also trending up, but they’re not as bad as other places. Yet, anyway.

“The trends are going in the wrong direction,” said William McKeon, president of the Texas Medical Center. “You hate to see the sacrifices we made and the successes we achieved lost because people let their guard down.”

Dr. Marc Boom, president of Houston Methodist, said, “We’ve definitely turned the wrong corner. The numbers aren’t growing in an out-of-control fashion, but there’s no doubt we’re in a significant growth trend that we need to stop before the holiday season.”

[…]

The Houston numbers are well below those in other parts of the country, particularly the Midwest and the West. As of Monday, 16 states had added more COVID-19 cases the past week than in any other seven-day period.

The surge is even greater in Europe. There the total of new cases in the five most-affected countries — France, the United Kingdom, Russia, Spain and the Netherlands — was nearly 42 percent greater than the U.S. increase a week ago.

Nor does Houston’s increase compare to the Panhandle and El Paso. El Paso health officials Monday reported their highest number of COVID-19 hospitalizations since the pandemic began — 449 in one day — and said just seven of the city’s ICU beds were unoccupied.

Still, increases in Houston area’s key metrics since early October are cause for concern, said local health officials. Those provided by the Texas Medical Center include:

• The rolling average of 497 COVID-19 cases reported the week ending Sunday represents a 33 percent increase from late September, when the number was 373. It increased gradually the weeks in between.

• The number of COVID-19 patients admitted to TMC hospitals exceeded 100 last week, up from the 80s the previous week and 70s the week before that.

• The TMC COVID-19 test positivity rate, 3.4 percent early in October, has been at 3.9 percent the past week, an 8 percent increase.

• The so-called R(t), or reproduction rate, the rate at which the virus is spreading, did drop to 0.99 Tuesday, but that remains a 55 percent increase over the Sept. 29 rate of 0.64, when the spread was decreasing. The rate last week hit 1.14, which means the virus’ spread was increasing.

“We’re in a yellow zone, not a red zone”, is how one doctor put it. “COVID fatigue”, they say this is. I get that, but you can see what happens when we start to take this less seriously. Until there’s a widely available vaccine, wear your damn mask, stay out of crowded indoor spaces, maintain social distancing, and hope for the best. At least our mild winter weather means we can largely stay outside. It could be worse.

We really can track COVID-19 through wastewater

This is terrific news.

Researchers with the city, Rice University and Baylor College of Medicine were able to sniff out a potential second outbreak of COVID-19 at a homeless shelter in downtown Houston earlier this year by looking down its drains instead of in people’s noses, health officials said Thursday.

Quashing the resurgence at the Star of Hope Men’s Shelter earlier this year was one of the first successes of an effort to track the novel coronavirus through wastewater, city officials said Thursday. The initiative, one of several occurring around the country, attempts to spot outbreaks by sampling water at city treatment facilities, which could help officials tailor their testing and prevention efforts to specific neighborhoods.

To date, the results from testing wastewater largely have aligned with those from nasal swab testing, said Dr. Loren Hopkins, the city’s chief environmental science officer. That has increased the confidence that the wastewater sampling is accurate. The benefit, she said, is that wastewater tests produce quicker results.

“Ultimately, the goal is to develop an early warning system allowing the health department to identify the city’s COVID-19 hot spots sooner and put measures in place to the slow the spread of this virus,” Mayor Sylvester Turner said.

People shed the virus through feces, regardless of whether they experience symptoms. The city was able to detect the virus in the shelter by placing a sampler on the manhole outside the facility after its initial outbreak of COVID-19, the illness caused by the coronavirus.

The ability to home in on a single building still is limited, Hopkins said. City officials have deployed that strategy for the shelter and the Harris County Jail, and they are trying to acquire more equipment to expand the effort in the fall. The health department plans to begin testing long-term care facilities, for example.

[…]

So far, there has been a strong correlation between the viral load in the wastewater and the positivity rates by nasal tests, so the method has not unearthed large swaths of the virus that have gone undetected by tests. Still, that correlation has increased confidence that the wastewater analysis is accurate and can be used as a bellwether for future outbreaks.

From Sept. 7 to Sept. 14, for example, scientists found the virus was increasing in a statistically significant way in the communities served by the Tidwell Timber, Upper Brays and Forest Cove treatment plants, among others, while decreasing in District 23, White Oak and Homestead.

That information, coupled with the local positivity rate and other factors, helped the health department decide where to send strike teams to test people, conduct outreach and provide education about the virus. The city said the wastewater study has resulted in more testing at several congregant living centers.

See here and here for the background. This method is extra useful because it provides a more focused view of where the cases are clustering, and the testing is faster, so the response to the test results is also faster. If we are ever going to get a handle on this disease, especially before there’s a vaccine but also after one is available, it’s going to come from technology like this that gives a real-time and location-specific view of where the virus is happening. We should be rooting for this to ramp up as much and as quickly as possible. Kudos to all for making this happen. The Press has more.

How about some antibody tests?

That would be good.

After months of emphasis on diagnostic screening, contact tracing and research into possible treatments, Houston is about to deploy a new tool in the effort to contain COVID-19: antibody testing.

Baylor College of Medicine researchers last week presented evidence to school leadership that the blood test it developed to detect whether an individual has been infected with the coronavirus is highly accurate and ready for use in studies assessing the virus’ reach in the area. Such studies would provide the answer that hasn’t been ascertainable because of the shortage of diagnostic testing.

“This will tell us the severity of the disease based on prevalence, the number of people who have had the virus but do not show up in case counts because they were asymptomatic and weren’t tested,” said Dr. Paul Klotman, president of Baylor. “That’s needed to better understand how infections impact different Houston communities, the variations in those communities and the numbers in certain high-risk environments, like prisons and nursing homes.”

Klotman said he anticipates Baylor will partner with local health departments to determine optimal resource allocation — such as where to focus testing and contact tracing — based on the prevalence the studies find in communities.

A Baylor prevalence study based on antibody testing would put the Houston region among a handful of U.S. communities to conduct such research, which has found that more than 20 percent of people in New York City but only 4 percent of those in Los Angeles County have been infected. Klotman said he thinks Houston’s rate will be closer to the California number.

Such antibody testing, repeated over time, also would show the area’s progress toward herd immunity, the protection from a contagious disease that occurs when a high percentage of the population has either had the infection or been vaccinated. Experts say that percentage — there is no vaccine for the coronavirus yet — needs to reach at least 60 to 70.

There’s more, and you should read the rest. As a reminder, viral tests are to see who has the virus now, and antibody tests are to see who has had it in the past. Do not mix the two if you want to know the current case count. I would note that the Texas Tribune case tracker showed 10,921 infections in Harris County as of May 25. If that four percent guess is accurate, then given a county population of 4.7 million, the actual number of cases would be more like 188,000. That’s consistent, even a bit under, the typical antibody test experience, which winds up estimating the real infection count at about ten times the “official” count. And note that we’d have to have more than ten times that number to get close to the minimum threshold for herd immunity.

Anyway. I look forward to seeing what this can tell us. In conjunction with the wastewater testing, maybe we can finally get a clear local picture of this pandemic.

Typhus in Texas

One more thing to worry about, in case you needed it.

Strickland spent four days in a hospital receiving treatment and needed about a year to fully recover from the potentially fatal disease transmitted by fleas believed nowadays to be carried most abundantly by opossums and other backyard mammals that spread them to cats and dogs.

Between 2003 and 2013, typhus increased tenfold in Texas and spread from nine counties to 41, according to Baylor College of Medicine researchers

The numbers have increased since then.

Harris County, which reported no cases before 2007, had 32 cases in 2016, double the previous years’ numbers.

Researchers do not know why the numbers are increasing.

In any case, the infection is severe enough that 60 percent of people who contracted the infection during the 10-year period had to be hospitalized. Four died, one in Houston.

“We can now add typhus to the growing list of tropical infections striking Texas,” said Dr. Peter Hotez, founding dean of the National School of Tropical Medicine at Baylor and Texas Children’s Hospital, “Chagas, dengue fever, Zika, chikungunya and now typhus – tropical diseases have become the new normal in south and southeast Texas.”

[…]

It was Strickland’s bout with the disease, in 2009, that first got the attention of Dr. Kristy Murray, a Baylor associate professor of infectious disease who had taught about typhus in the Valley but had not heard of it in modern-day urban centers, despite a focus on the tropical diseases that have emerged in Texas in recent times.

In the ensuing years, Murray heard enough anecdotal evidence of an increase in cases from local doctors that she decided to look at state data, combing through case histories to document the numbers and spot trends.

Murray was struck by the results, published recently in the journal Emerging Infectious Diseases, which showed 222 cases in Texas in 2013, many in Houston, Austin and San Antonio. That was up from just 30 reported cases in 2003, all in the southern part of the state, in counties such as Hidalgo and Nueces where the disease has remained an issue over the decades.

Unlike many tropical diseases, which predominate in poor areas, the new cases of typhus were just as likely to be reported in more affluent areas, such as Bellaire and West University.

The highest rate of attack was in kids, 5 to 19 years old.

In 2016, according to the most recent state data, the number of Texas cases had risen to 364.

The study in question is here. Typhus, it should be noted, is not the same as typhoid fever, of Typhoid Mary fame. The study in question was published a couple of months ago, and there were a few stories on the same topic at the time. Country musician Bruce Robison had to cancel a few shows recently after he came down with typhus. It can be spread by fleas, so make sure your pets are getting treated. Common symptoms include fever, headache, and a rash, so be aware and take care.

No Rice-BCM merger

The longstanding merger talks between Rice University and Baylor College of Medicine have been terminated.

Rice President David Leebron and Baylor College of Medicine President Dr. William Butler gave no reason for the talks ending in their statement.

“Since we signed a memorandum of understanding in March of 2009, we have been in extensive discussions in an attempt to meet several conditions that both institutions considered to be essential for a successful merger,” said the statement, which was e-mailed to campus faculty, staffs and students. “We joined in a thorough and deliberate process that explored the many benefits and challenges a merger would entail. With the MOU due to expire this month, the leadership of both institutions decided it is in the best interests of both BCM and Rice University to strengthen the existing relationship without a formal merger.”

The announcement came just four months after Leebron and Butler hinted a deal might by in place by the end of January. In a joint statement in September, they said that the negotiating period had been extended through Jan. 31 and pledged “to work hard to bring our discussions to a successful conclusion over the next four months.”

But Baylor was never able to resolve Rice’s two big concerns — the medical school’s shaky finances and lack of a private adult hospital for its clinical faculty. Butler announced in December that talks had fallen through to make St. Luke’s Episcopal Hospital its partner again, some eight months after financial concerns prompted the school to shelve construction of its own hospital.

Given the tough budget situation at Rice this year, I’m sure those financial concerns loomed ever larger. For what it’s worth, most of the Rice students and alums I know were not favorable to the merger idea, and the initial reaction I’ve seen to its collapse is relief. Reaction on the Rice fan forum is a bit more varied. I think it would have been a plus for Rice to be affiliated with a medical school if it could have been made to work, but this is probably for the best. If the two schools do strengthen their existing relationship, perhaps most of the good that would have come out of a merger can still happen with less risk and disruption for all.

Senate panel approves budget

As you know, the Lege has one task they absolutely must do every biennium, and that’s pass a budget. The Senate Finance Committee has taken its first step towards doing that.

A two-year state budget that accepts federal stimulus money and increases spending by 7.3 percent, but hoards cash reserves, was approved by Senate budget writers today.

Counting federal funds, the Senate Finance Committee’s budget would spend $182.2 billion, up $12.5 billion over the current two year cycle.

“It’s a fairly significant increase in the overall budget,” said Finance Committee Chairman Steve Ogden, R-Bryan. “The committee worked hard to try and address many, many legitimate needs in state government, and we wouldn’t have been able to do it without the federal stimulus money.”

The panel approved the budget, 14-0. The full Senate is expected to act on it later this week.

A key goal of Senate budget writers was to protect the state’s “rainy day fund,” so that 2 1/2 -year old school property tax cuts won’t vanish after 2011. The committee left untouched some $9.1 billion expected in the rainy day fund by September 2011.

The reserve is expected to be used next session, when lawmakers will confront a yawning gap between the 2006 property tax cuts and offsetting new revenues from a revamped business tax and higher taxes on cigarettes and private transfers of used cars.

A 24-percent increase in federal funds helped the Senate panel balance the budget for 2010-2011.

So, thanks to stimulus funding, we can keep those irresponsible property tax cuts and not only not dip into the Rainy Day Fund, but also put aside enough money to pay for a further continuation of those cuts in the next session, when the piper was fixing to hand us a sizable bill for his services. My head is spinning.

In a brief discussion by the Finance Committee, Sens. Judith Zaffirini, D-Laredo, and Eddie Lucio, D-Brownsville, said they were voting for the budget with reservations.

Zaffirini said the panel should have heard testimony from experts before adopting a last-minute provision that would bar using any funds in the budget for embryonic stem cell research.

There’s a longer story on that here. Most of the arguments are familiar to people, since it’s basically the abortion issue one step removed, so I’ll just note this bit and move on:

Proponents of using embryos, who say they are obtained from fertility clinics and would be discarded anyway, said Texas stands to lose billions from a burgeoning biotech industry if it continues to create a hostile legal and regulatory climate.

A recent study by University of North Texas economists Bernard Weinstein and Terry Clower said the state could lose out on as many as 100,000 new jobs in the next five years if the state restricts embryonic research.

Yeah, no one’s ever really explained to me what’s supposed to happen to all those unused embryos at fertility clinics. Stay in the freezer forever, I guess. The Chron has a story on this as well, noting that researchers from Baylor College of Medicine, three University of Texas Health System academic health institutions and Rice University, including Norbel laureates Robert Curl and Ferid Murad, signed a letter to the Senate asking them to remove the Ogden rider. Anyway, moving on as noted to the House, where the Appropriations Committee was dealing with a different kind of kerfuffle.

House budget writers, spurred by a chairman angered by how Gov. Rick Perry helped steer a $50 million grant to the Texas A&M University System, voted Friday to strip Perry of one of the powers he used to make the grant happen.

The House Appropriations Committee put language in its proposed budget saying any transfers between the Texas Enterprise Fund and the Emerging Technology Fund must be approved by the 10-member Legislative Budget Board. The panel also said the budget board, made up of the lieutenant governor, House speaker and members of the House and Senate, must approve any grants from the two funds.

Perry uses the Enterprise Fund to attract businesses to the state and the Emerging Technology Fund to launch tech projects at universities working with the private sector. Current law says grants from those accounts must be approved by the governor, lieutenant governor and House speaker.

Friday’s move was a response to Perry’s announcement this week that he had transferred $50 million from the Enterprise Fund to the Emerging Technology Fund to pay for a grant to the Texas A&M University System for a new pharmaceutical manufacturing center.

But House Appropriations Committee Chairman Jim Pitts, R-Waxahachie , says that’s not how the state usually pays for buildings at universities.

Several members of the Appropriations Committee, including Pitts, praised the Texas A&M center, saying they were more concerned with the process than the result.

“We have a legitimate concern that funds (that) were dedicated for one purpose were moved to a fund with a completely different purpose with little or no input from the Legislature,” Pitts said.

There’s a reason a lot of us have called this a slush fund for the Governor. I suppose I should thank him for making that a little more obvious to some folks. This may well be a fine use of that money, but it sure would be nice to have something other than just Rick Perry’s say so.

One more thing:

The Appropriations panel also proposed putting $136 million into the Enterprise Fund and $77 million into the Emerging Technology Fund over the next two years — combined, more than $200 million less than Perry requested.

“Now is not the time to cut back on job creation programs,” Perry spokeswoman Allison Castle said.

Because Rick Perry’s priorities are sacrosanct. Other priorities can go hang, but what Rick Perry wants is untouchable. Got it.