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Centers for Disease Control

You can lose the mask if you’re fully vaxxed

Do your part, reap the reward.

Federal health officials reversed course Thursday and advised that people who are fully vaccinated can stop wearing masks and observing social distancing in most indoor and outdoor settings.

It’s welcome news for many who have grown weary of the safety precautions more than 14 months into the global public health crisis and is a significant milestone in returning to pre-pandemic life. But the announcement will likely give new life to the debate about requiring vaccinations that has been playing out in Texas and across the nation — and it comes as less than a third of Texans are fully vaccinated.

“We have all longed for this moment,” Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, said from the White House on Thursday. “If you are fully vaccinated, you can start doing the things that you had stopped doing because of the pandemic.”

But Walensky cautioned that the CDC’s guidance comes with exceptions. Vaccinated people should continue to wear masks and distance themselves from others in medical settings and around high-risk populations, such as doctor’s offices, hospitals and long-term care facilities, and while traveling aboard airplanes, busses and trains. Incarcerated people and people in homeless shelters should also continue to observe safety precautions.

[…]

More than 11 million Texans had received at least one dose of the COVID-19 vaccine as of Tuesday, according to state data. Nearly 31% of the state’s residents are fully vaccinated. But the rate at which Texas is vaccinating its residents has slowed despite ample supply. An April poll by the University of Texas at Austin and The Texas Tribune found that 36% of Texans said they were either reluctant to receive the vaccine or would refuse to get it, including nearly half of the state’s Republicans.

Peter Hotez, a preeminent infectious disease expert and dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, said on Twitter that he supported the announcement, but that it carries a risk in places like Texas.

“COVID19 immunization rates in my part of the country, TX + South, are still lagging the rest of the nation, so I worry about a 5th wave this summer in the South like last summer,” he said.

As noted in the story, this comes on the heels of the approval of the vaccine for 12 to 15 year olds. I’ve already seen pictures of a bunch of my friends’ kids getting their first shot; ours will do so later today. Our vaccination numbers in Texas can certainly be better, but that’s one part helping people overcome the obstacles in their path to getting a shot, and one part giving whatever answers or reassurances the hesitant folks have. Not much you can do about the flat-out resisters, but if we can limit the damage to just them we’ll be all right. I also suspect that over time we’ll see higher vax numbers in the urban areas than elsewhere, or at least we will if we do the job of making it as accessible as possible. In the meantime, those of us who have gotten our shots can show our faces again, and just in time for summer. That’s gonna feel good.

(To be sure, some number of unmasked people are the same chuckleheads who refuse to be vaccinated, and they’ve been walking around unmasked for a long time now. There is an argument that the CDC’s new guidance isn’t a good idea. And of course, individual retailers and restaurants and what have you may continue to require masks in their establishments for the time being, since there’s no way to tell who is and isn’t vaccinated. You can take your mask off where you can if you’re vaxxed, just as always be thoughtful and considerate about it.)

Pfizer shot approved for younger kids

Yes!

The Food and Drug Administration cleared the first coronavirus vaccine for emergency use in children as young as 12 on Monday, expanding access to the Pfizer-BioNTech shot to adolescents ahead of the next school year and marking another milestone in the nation’s battle with the virus.

The decision that the two-shot regimen is safe and effective for younger adolescents had been highly anticipated by many parents and pediatricians, particularly with the growing gap between what vaccinated and unvaccinated people may do safely. Evidence suggests that schools can function at low risk with prevention measures, such as masks and social distancing. But vaccines are poised to increase confidence in resuming in-person activities and are regarded as pivotal to returning to normalcy.

“Adolescents, especially, have suffered tremendously from the covid pandemic. Even though they’re less likely than adults to be hospitalized or have severe illness, their lives really have been curtailed in many parts of the country,” said Kawsar R. Talaat, an assistant professor of international health at the Johns Hopkins Bloomberg School of Public Health. “A vaccine gives them an extra layer of protection and allows them to go back to being kids.”

Expert advisers to the Centers for Disease Control and Prevention are scheduled to meet Wednesday to recommend how the vaccine should be used in that age group, and the vaccine can be administered as soon as the CDC director signs off on the recommendation.

In a news briefing Monday evening after the announcement, FDA officials said the Pfizer authorization for 12- to 15-year-olds was a straightforward decision because the data showed that the vaccine was safe and that the response to the vaccine was even better than among the 18- to 25-year-olds who got the shots.

Our almost-17-year-old has had her shots. We’ll be getting the 14-year-old signed up as soon as we can. “Herd immunity” may never be a thing we achieve with COVID, but having a greater share of the population vaxed is a good thing, and adding this group to the eligible list moves towards that goal. I’m ready for this.

Now it gets harder to vaccinate people

We reached this point pretty quickly. The hill gets steeper from here.

After months of not having enough COVID-19 vaccines to meet demand, Texas suddenly appears to have plenty of shots but not as many people lining up to receive them, even though more than three quarters of the state still isn’t fully vaccinated.

Almost 7 million Texans have been vaccinated against COVID-19 — more than 23% of the state’s population — and health officials say they are starting to see lower demand at public vaccination sites. Recent data show reported vaccine doses have decreased: The number of people who have gotten at least one shot in Texas grew by over 1 million during the week ending April 14; the following week the number dropped to about 660,000.

Across Texas, local leaders are trying to ramp up outreach efforts and fill more appointments. Houston’s FEMA hub at NRG Park is now offering walk-in slots, a shift from prior appointment-only requirements that kept some residents from getting early doses. The state will also be rolling out a TV campaign to boost vaccinations, Department of State Health Services spokesperson Chris Van Deusen told the Wall Street Journal.

Local health officials say efforts to vaccinate older Texans have been successful: As of April 21, nearly 60% of Texans age 65 and older have been fully vaccinated. Since the state opened vaccinations to all adults on March 29, around one-fifth of Texans between 16 to 49 years old — who make up the biggest proportion of eligible adults — have been fully vaccinated.

“It seems we’re getting to the point that most people eager to get vaccinated have gotten at least their first dose,” Imelda Garcia, associate commissioner of laboratory and infectious disease services for DSHS, said during a Thursday press conference. “The next phase will be about helping ensure that vaccine is more easily available to those folks who are not going to go as far out of their way.”

Nationally, vaccine supply may outpace demand within the next month, according to the Kaiser Family Foundation, a health nonprofit.

Vaccination rates vary across Texas: most large urban and suburban counties, except for Tarrant County, are above the overall state rate in terms of the percentage of people who have received at least one dose. Along the border, a region that has been particularly hard hit by the pandemic, more than 40% of the population in many counties, including El Paso, Starr and Cameron, have gotten a dose — compared with 36% statewide.

[…]

Texas’ vaccination efforts are still missing people who have faced obstacles for months, said Catherine Troisi, an infectious disease epidemiologist with UTHealth School of Public Health in Houston. Some lack internet access or the computer skills to make an online appointment, while others lack transportation to reach a vaccine provider.

And Black and Hispanic Texans continue to be vaccinated at lower rates than whites, even as appointments become more available across the state.

According to the embedded map in the story, Harris County has fully vaccinated 22.8% of its residents, which is a bit below the statewide average of 23.6%. However, more than twice as many people have had at least one shot, which by my calculation is 56.7% of the Harris population, and that’s pretty darn good. In theory, in a month’s time our baseline number should be close to sixty percent. The one-shot Johnson and Johnson vaccine has been resumed, and that should help with some of the harder-to-reach folks as well, since it only requires the one appointment.

There’s a lot of effort going on now to reach the people who have obstacles to getting vaccinated, and while that will take more time I believe they will get there. That leaves the anti-vax zealots, and I have no more idea how to reach them than you do. That said, there is one obvious strategy to maybe draw some of the more resistant folks out of the woodwork:

There are public policy “interventions” that can encourage further adoption: publicizing how safe the vaccine has been so far for people who’ve gotten it, stocking doctors’ offices and mobile clinics to make the shots more convenient, tying access to public spaces to being fully vaxxed, promising to eliminate mask mandates and other societywide restrictions once a certain percentage of the population has gotten its doses, and so forth.

Those are among the suggestions you’ll find being made by individuals arguing against the one really obvious way to get people to do something: paying them. Economist Robert Litan, former Democratic presidential long shot John Delaney, and an Oxford professor named Julian Savulescu are among those who’ve proposed such cash-for-vax payments; Litan would make them $1,000 and Delaney $1,500. In response, ethicists affiliated with the University of Washington and the Cornell and University of Pennsylvania medical schools have written, in the Journal of Medical Ethics and Journal of the American Medical Association, that it would be a bad idea.

The arguments against payment are reasonable ones: It’s crude and coercive to put proportionally huge pressure on lower-wealth citizens to do something that they might not want to; the idea that you get something like “hazard pay” for taking a vaccine might convince people it is risky; and setting a precedent of paying people to protect their health might make them less likely to take vaccines and follow guidelines in the future if there’s no money in it. Localized and incentive-driven initiatives like the ones described above, ethicists say, are more likely to build the long-term trust between officials and residents that will be crucial to ending this pandemic and preventing future ones.

The problem with this case is that it exists for the most part in an abstracted, theorized version of the United States that is populated by individuals making good-faith decisions based on credible public information and conversations with medical professionals. Our actual country, however, is one in which one of the two major parties sees an advantage in the weaponized misunderstanding of medical science, celebrity influencers build followings by pretending to uncover sinister threats everywhere, and media outlets spam every speciously correlated story about someone having a health problem after getting a shot into millions of pockets multiple times a day. Informational and incentive-based campaigns to reach people who have genuine, medically oriented hesitations about the vaccine are good ideas that should definitely be pursued. Does anyone honestly think they’re going to be enough? This is a fractured polity we’re dealing with here, folks!

Contemporary Americans self-evidently do not share a common trust in any government or media institution. On the other hand, almost all of us still appreciate and believe in the institution of the United States dollar, and the ways it can be earned and spent.

Maybe most of these people are die-hard Trumpers. As the author notes, those folks happily cashed their Biden stimulus checks. Money talks. It sticks in my craw to reward this kind of selfish and self-destructive behavior, too, but in the end the more vaccinated people the better off we all are, especially those who have legitimate medical reasons for not getting vaxxed. There is an inverse to this approach, which I’ll get to in another post. Put me down as being in favor of all reasonable strategies for getting as many shots in arms as we can.

The Hobby poll on ending COVID restrictions

A little while ago I blogged about the recent UH Hobby Center poll regarding the winter freeze and blackouts and responses to them. At the time I mentioned the poll had a separate section about Greg Abbott lifting the COVID restrictions on mask wearing and business capacity. I thought there might be another story that referenced those results, but if there was I never saw it. So, let’s go back and look at that part of the poll ourselves. Here’s the relevant data, and as before the landing page for the poll is here. From the poll data for the questions on the restrictions:

On March 2, 2021, Texas Governor Greg Abbott issued Executive Order GA-34, which lifted statewide COVID-19 restrictions. The order rescinded, beginning on March 10, the governor’s previous mandate (GA-29) that Texans wear face coverings (masks) and allowed all businesses to operate at 100% capacity as long as the area in which the businesses are located does not surpass a high hospitalization threshold. This threshold is defined by an area where COVID-19 patients as a percentage of total hospital capacity exceeds 15% for seven consecutive days.

The survey respondents were asked five questions related to Governor Abbott’s executive order regarding the lifting of COVID-19 restrictions, and the responses were cross-tabulated with ethnicity/race, age, gender, education, and partisanship.

37% of Texans support Governor Abbott’s decision to end the statewide mask mandate while 56% oppose the decision. The remaining 7% neither support nor oppose the decision.

42% of Texans support Governor Abbott’s decision to allow all businesses to operate at 100% capacity and 49% oppose it. The remaining 9% neither support nor oppose the decision.

When provided with the following information, “According to recent data, the daily counts of COVID-19 hospitalizations and deaths in Texas are trending downward, although the rates remain relatively high. The head of the federal Centers for Disease Control and Prevention and other medical experts say that while caseloads are flattening out, variants of the coronavirus could bring another wave of the pandemic and that mask and business capacity restrictions should stay in place at this point in time,” 37% support Governor Abbott’s decision to end Texas’s statewide mask mandate and to allow businesses to operate at 100% capacity in light of the recommendations of medical experts while 51% oppose the decision. The remaining 12% neither support nor oppose the decision.

[…]

When asked whether they agree or disagree with the statement that Governor Abbott’s ending the mask mandate and allowing businesses to operate at 100% capacity will help restore jobs and return a sense of normalcy to Texans’ lives, 44% of Texans agree with the statement and 37% disagree. The remaining one-fifth (19%) neither agrees nor disagrees with the statement.

[…]

When asked whether they agree or disagree with the statement that Governor Abbott’s ending the statewide mask mandate and allowing businesses to operate at 100% capacity will result in an increase in the number of COVID-19 infections, hospitalizations and fatalities in Texas, a slight majority (51%) of the respondents agree with the statement compared to slightly less than a third (30%) who disagree with it. The remaining one-fifth (19%) neither agrees nor disagrees with the statement.

I’ve noted the partisan numbers in the sample before, so go review my previous post for that discussion. I’d love to see more polling on the lifting of the mask mandate, and I’d be very interested to see if it changes over time, but I’m not expecting much on that front. We know that Texas’ COVID case rate has remained fairly low despite the dropping of the mandates, a result I mostly attribute to people continuing to wear masks anyway. It may well be that people wind up disagreeing less with Abbott’s actions if this continues, or it may mostly be a proxy for partisan feelings. I’m noting it here in case we do get more data down the line.

No flu

I would never say that there was any such thing as a silver lining to the COVID pandemic, but it is true that basically nobody died from the flu this year because of masking and social distancing.

What medical officials worried would be a “twindemic” at the end of last year — the concurrence of influenza and COVID-19 sicknesses overwhelming Houston’s hospitals — turned out surprisingly well.

At Memorial Hermann, just three patients tested positive for influenza during the 2020-2021 flu season, compared to 983 patients during the 2019-2020 flu season. Doctors test for both flu and COVID-19 as a precaution.

The same public health measures that prevent SARS-CoV-2 from spreading — masks, social distancing and regular hand-washing — kept influenza strains from sickening people.

“When we were looking internally, we just weren’t seeing flu,” said Dr. James McCarthy, chief executive physician at Memorial Hermann.

Flu infections are down nationwide, with a hospitalization rate of 0.7 per 100,000 people, according to the Centers for Disease Control and Prevention. During the last flu season, the rate was nearly 100 times higher — 66.1 per 100,000 patients. Pediatric deaths also decreased, from 189 last year to one this year.

[…]

Researchers wondered whether being infected with the coronavirus would wipe out the chances of getting the flu, and say it may be a factor that contributed equally to declining flu rates.

“Part of it is because we had a worse virus that was spreading faster,” McCarthy said.

Knowing to wear masks and get a flu vaccine could be a huge step toward eradicating deadly flu seasons. But will people continue to practice those public health measures? Doctors don’t know.

“We’re recognizing that not only can we protect our friends and loved ones from COVID, but we can also do it from influenza with precautions for medically vulnerable folks,” McCarthy said.

I’ve gotten a flu shot every year for as long as I can remember, and as far as I know I’ve never gotten the flu. I will certainly continue to get those vaccines as before, and I’d strongly consider wearing a mask during the flu season going forward when doing things like grocery shopping. Hard to see any reason why not to at this point.

What to expect when you’re fully vaccinated

The CDC has released some guidance that will help people understand what is safe to do and what precautions they will still need to take once they are fully vaccinated.

Fully vaccinated Americans can gather with other vaccinated people indoors without wearing a mask or social distancing, according to long-awaited guidance from federal health officials.

The recommendations also say that vaccinated people can come together in the same way — in a single household — with people considered at low-risk for severe disease, such as in the case of vaccinated grandparents visiting healthy children and grandchildren.

The Centers for Disease Control and Prevention announced the guidance Monday.

The guidance is designed to address a growing demand, as more adults have been getting vaccinated and wondering if it gives them greater freedom to visit family members, travel, or do other things like they did before the COVID-19 pandemic swept the world last year.

“With more and more people vaccinated each day, we are starting to turn a corner,” said CDC Director Dr. Rochelle Walensky.

During a press briefing Monday, she called the guidance a “first step” toward restoring normalcy in how people come together. She said more activities would be ok’d for vaccinated individuals once caseloads and deaths decline, more Americans are vaccinated, and as more science emerges on the ability of those who have been vaccinated to get and spread the virus.

You can see their guidance here. Among other things, this should make a lot of grandparents happy:

A lot more people will get those vaccines in the coming weeks. The need for continued mask-wearing is simply because you can still get and carry the SARS-CoV2 virus after being vaccinated, you are just much less likely to become sick if you do. Basically, you can still be an asymptomatic carrier, and so for the safety of the not-yet-vaccinated, especially in public places, your mask is still needed at this time. But that will eventually decrease, as the vaccination numbers swell. We just had to wait a little longer. We can and must still do the right thing in the meantime. Vox, the Chron, and Daily Kos have more.

What can we expect from the maskless mandate?

More COVID, obviously.

The Centers for Disease Control is increasing pressure on Republican leaders in states like Texas that have eased COVID restrictions, publishing a study on Friday showing evidence that the measures — such as the mask requirement that Gov. Greg Abbott rescinded this week — clearly decrease COVID cases and deaths, while opening up restaurants causes them to spike.

“We have seen this movie before: When prevention measures like mask mandates are rolled back, cases go up,” CDC Director Rochelle Walensky said. “I know the idea of relaxing mask wearing and getting back to everyday activities is appealing, but we’re not there yet.”

[…]

On Friday, Walensky continued to sound the alarm. She said that COVID cases and deaths have started to plateau for more than a week at levels similar to the late summer surge — just as some states are easing restrictions that helped drive those cases down.

White House officials said Friday the trend is concerning, especially as progress has been made on vaccinations. Nearly 55 percent of people 65 and older have received at least one vaccine dose, up from just 8 percent six weeks ago, senior White House COVID-19 adviser Andy Slavitt said.

More than 3.5 million Texans have received at least one dose of the vaccine, and nearly 2 million have been fully vaccinated, out of a population of 29 million. Still, the state ranks among the lowest for the percentage of people vaccinated, at 13 percent.

“It’s better to spike the football once you’re safely in the end zone, not once you’ve made a couple of completions,” Slavitt said.

The CDC released a new report on Friday that showed COVID cases and death rates decreased within 20 days of the implementation of state mask mandates. That progress was quickly reversed with the opening of restaurants, however, the report said. COVID cases rose between 41 and 100 days after states allowed dining in restaurants and daily death rates rose between 61 and 100 days after.

“Policies that require universal mask use and restrict any on-premises restaurant dining are important components of a comprehensive strategy to reduce exposure to and transmission of SARS-CoV-2,” the study said. “Such efforts are increasingly important given the emergence of highly transmissible SARS-CoV-2 variants in the United States.”

I think what’s so infuriating about this is that we really are in the home stretch now. Texas is at the back of the pack in terms of vaccination rate (though Harris County is doing reasonably well), but we are making steady progress. Anecdotally, I know so many more people now who have gotten at least their first shot compared to just a month ago. It would have been so easy to say that we just need to hold on until (say) Memorial Day or something like that, when we can expect to have a significant number of people who have been vaccinated, then we can really begin to ease up. We can emphasize outdoor events first, and be clear about when masks aren’t needed (when everyone involved has been vaccinated) versus when they should still be worn. We’ve come this far, we can see where we want to be, we just need to finish the job. Why was that so hard?

You may say, as Abbott was quoted in the story, that we haven’t actually enforced the mask mandate in Texas that just urging people to wear them while explicitly not requiring it isn’t all that different. I’d say first that the reason we haven’t enforced it is because Greg Abbott was so frightened by the likes of Shelley Luther that he cowardly backed down from any kind of official enforcement. What that has meant in practice is that responsibility for mask requirements falls squarely on the shoulders of frontline workers, who at least had the backup of an executive order when confronting some maskhole. But now even that is going away, which means we’ll have a lot more of this:

Fidel Minor, a Houston Metro bus driver, said Gov. Greg Abbott’s mask rollback will incite “mass chaos” on city buses as drivers like him try to enforce federal mask requirements for transit.

“It’s already a hard enough job as it is without having conflicting directives,” said Minor, a driver for Houston Metro.

Abbott relaxed requirements on businesses Tuesday, lifting statewide mask mandates and reducing capacity restrictions on restaurants and retailers. The order, effective March 10, sent chills through frontline workers across the region who say they still face risks on the job.

Asking customers to wear masks means being met with a daily dose of attitude, said Stacy Brown, bakery manager at Phoenicia Specialty Foods, a grocery store on the ground floor of One Park Place downtown. Now she fears that attitude will spread.

“We’re gonna have people come into the store, not wanting to comply just because of what (Abbott) says,” she said, noting she feels it’s especially important that her customers wear masks because as a diabetic she’s in a high-risk group.

[…]

David Lee, a deli manager at Kroger in Galveston who got sick with the virus in December, said it’s scary to know he and his colleagues will be surrounded by more of the maskless customers he believes exposed him to the virus in the first place. “I think (Abbott) should wait at least two more months,” he said. “It’s going to be scary now.”

For its part, the family-run Phoenicia will keep its mask mandate at its two Houston stores and restaurants, said owner Haig Tcholakian. Requiring masks inside his stores is about health and safety for staff and customers, first and foremost, he said. But also because when workers get sick or exposed, it affects business, too.

“It disrupts operations quite a bit, and if there are multiple (illnesses) across all businesses that would probably limit us and make us scramble to make up for that,” he said.

Tcholakian said he and his employees have to ask people to leave a handful of times a week. Like Brown, his bakery manager, he’s concerned that enforcement will get more difficult now. “We’ll have to prepare for it.”

For Teresa McClatchie, an escalator monitor at Bush Intercontinental Airport, the governor’s policy change seems at odds with the facts on the ground. She said her coworkers are still ill with the virus — one may need to stay on oxygen on an ongoing basis because of damage the virus did to her lungs.

“We still have some employees out,” she said, “and some, they may not be back.”

The number of restaurants and other businesses that will continue to require masks is inspiring and may just help blunt the effect of Abbott’s foolishness, but it still shouldn’t fall on these people to ensure that the jackasses out there don’t endanger them or others.

And for those of you who may be mad at HEB for urging but not requiring masks at their stores, it’s exactly with this in mind that they made this call.

H-E-B President Scott McClelland has the explanation why the store won’t require customers to wear masks in light of Gov. Greg Abbott’s Tuesday announcement.

While it has the power to require customers to wear masks before entering, McClelland said H-E-B won’t take that step – in part because of belligerent customers who have caused nearly 2,000 in-store incidents surrounding masks at Houston stores alone.

If a customer walks into the store without a mask, a worker will ask them to put one on, McClelland said. If they don’t have one, they will be offered a mask.

If they still refuse to put one on, McClelland said “we are not going to escalate.”

“What’s important to me is, I’ve got to ensure for the physical safety of both my employees and customers in the store,” McClelland said. “That’s what we have been doing, and frankly it’s the same thing we’ll continue to do.”

I confess, I recently yelled at one dipshit at HEB who was walking around with his mask on his chin. It wasn’t smart, and it wasn’t considerate of the other customers in the yogurt aisle who had to be wondering if something was about to go down, but I was so mad and I felt like someone needed to do something. McClelland is right about not escalating, and I will just have to keep that in mind. And I have already spent more time and energy thinking about this than Greg Abbott ever will.

President Biden disagrees with the maskless mandate

I mean, duh.

President Joe Biden

President Joe Biden said Wednesday that Texas made a “big mistake” by removing its statewide mask mandate and suggested the decision reflected “Neanderthal thinking.”

The comments by the Democratic president came a day after Republican Gov. Greg Abbott announced he was not only ending the mask requirement but also allowing businesses to reopen at full capacity. A small fraction of Texans have been fully vaccinated, and while coronavirus numbers have been generally declining in the state, they remain substantial.

“Texas — I think it’s a big mistake,” Biden said at the White House. “We are on the cusp of being able to fundamentally change the nature of this disease because the way in which are are able to get vaccines in people’s arms. The last thing — the last thing — we need is Neanderthal thinking in the meantime.”

Biden’s administration has urged states not to let up on restrictions as vaccinations pick up. Rochelle Walensky, Biden’s director of the Centers for Disease Control and Prevention, reiterated that earlier Wednesday during a White House coronavirus briefing when asked about Abbott’s announcement.

“I think we at the CDC have been very clear that now is not the time to release all restrictions,” Walensky said.

Asked about the Texas news a short time later, White House press secretary Jen Psaki did not directly address Abbott’s actions but said “the entire country has paid the price for political leaders who ignored the science when it comes to the pandemic.”

Abbott’s announcement came four days after he joined Biden for a tour of Houston that was partly about the state’s vaccination efforts. In remarks at the end of the trip, Biden stressed it was “not the time to relax” practices to curb the spread of the virus.

“We have to keep washing our hands, staying socially distanced,” Biden said. “And for God’s sake, wear your mask.”

See here and here for the background. I’m sure we can all surmise what Abbott’s opinion of Biden’s opinion is, but then Abbott only cares about what a few people think. He won’t be unhappy if Biden gets mad at him.

Please don’t take your mask off yet

Seriously, what’s the rush?

Gov. Greg Abbott said Thursday that Texas is looking at when it will be able to lift all statewide orders related to the coronavirus pandemic and that an announcement is forthcoming.

Abbott made the comments at a Corpus Christi news conference where he was asked when the statewide mask mandate would end as Texans continue to get vaccinated. That requirement has been in effect since July.

Abbott called it a “great question.”

“We’re working right now on evaluating when we’re gonna be able to remove all statewide orders, and we will be making announcements about that pretty soon,” Abbott said, without giving a specific time frame.

[…]

The Centers for Disease Control recommends that people who have received two doses of the vaccine continue to avoid crowds, stay at least 6 feet away from people who live outside their households, and wear masks to cover their nose and mouth.

Dr. Anthony Fauci, the nation’s top infectious-disease doctor, has repeatedly said that he does not know when Americans will be able to return to normal, but that they may still need to continue wearing face masks into 2022.

Note that at this point about five percent of Texans total have been fully vaccinated. We need to get to over 70% to achieve something like herd immunity. Maybe Abbott is speaking of some hypothetical date well into the future to lift the mask mandate, but he deserves no benefit of the doubt. Why do we always have to learn these lessons the hard way? There’s absolutely no reason to rush this. The Chron and the San Antonio Report have more.

We should be vaccinating grocery workers

The only disagreement I have with this is that we should have more broadly classified “essential workers” from the beginning, and it should include more people who do not have the ability to work from home.

Nearly a year into the pandemic, Ryan’s experience that day reflects the challenges that grocery store workers across Texas are facing in their stores every day. For months, workers have risked their health to keep shorthanded grocery stores open, all while dealing with increased hours and customers refusing to wear masks.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices urged states to include front-line essential workers in Phase 1B of vaccine allocation. But Texas decided not to include any essential employees like grocery store workers in the state’s current vaccine priority groups. Without any guarantee of vaccine prioritization, grocery workers now find themselves overwhelmed and continually exposed to the virus with no end in sight.

[…]

Back in April, when people made a rush for essential supplies like toilet paper and soap, Gov. Greg Abbott tweeted a message of support for grocery store workers, saying that “everyone across our state appreciates your hard work to help Texans respond to the #coronavirus.” Since then, workers say they have felt forgotten and abandoned by the state government.

In December, the Texas Expert Vaccine Allocation Panel, in charge of designating each population currently eligible to receive vaccinations, decided against including front-line essential workers in Phase 1B. The Department of State Health Services said that the panel wanted to reserve vaccine doses for those at the highest risk of death, which includes people over 65 and anyone over 16 with a chronic medical condition that puts them at higher risk.

At least 8 million Texans currently qualify for Phase 1A or 1B of vaccine allocation, but the state has received fewer than 4 million doses thus far. The panel is currently considering potential priority groups for Phase 1C of vaccine rollout, and its decision will depend on epidemiological data about virus transmission, according to DSHS Director of Media Relations Chris Van Deusen.

However, at least 11 states and the District of Columbia followed CDC recommendations by deciding to put front-line essential workers, including grocery store employees, in the their latest rounds of vaccine allocation, according to The Washington Post. New York allowed grocery workers to start getting the vaccine last month. Arkansas has also started vaccinating teachers and educators in the first round of essential workers to receive doses, and the state plans to expand distribution to other essential workers later this month.

“You feel like you don’t matter when your own state goes against every recommendation that there is out there,” said Dawn Hand, who works at a Kroger in Houston. “Why don’t we matter? What’s your answer to that?”

I personally feel that prioritizing people who had to do in-person work, as some states have done, was the better choice than making group 1B open to the over 65 crowd, and I say that even knowing quite a few people who have gotten their vaccine as a result of that choice. Big employers, like grocery stores and big-box retail – plus all of their delivery workers – could have been brought in to help distribute and administer the shots. This would target people who are clearly at risk, and as the story notes would also have helped with the equity problem. Another group of essential workers that should have been prioritized are meatpacking plant employees, who have not only been extremely hard-hit by COVID (due in large part to the inhumane practices of their employers) but are also lower-income, often non-English-speaking people who are harder to reach for the vaccine. In their case, I’d want to send clinicians to their locations, and use whatever threats and incentives are needed to make sure their bosses give them the time and space to get vaccinated. We could still do all of this in round 3, but I don’t blame any one of these folks for thinking that they were left behind.

As the COVID mutates

Just another reminder that we need to continue trying not to spread the virus while we wait for everyone to get vaccinated.

A more contagious variant of the coronavirus first found in Britain is spreading rapidly in the United States, doubling roughly every 10 days, according to a new study.

Analyzing half a million coronavirus tests and hundreds of genomes, a team of researchers predicted that in a month this variant could become predominant in the United States, potentially bringing a surge of new cases and increased risk of death.

The new research offers the first nationwide look at the history of the variant, known as B.1.1.7, since it arrived in the United States in late 2020. Last month, the Centers for Disease Control and Prevention warned that B.1.1.7 could become predominant by March if it behaved the way it did in Britain. The new study confirms that projected path.

“Nothing in this paper is surprising, but people need to see it,” said Kristian Andersen, a co-author of the study and a virologist at the Scripps Research Institute in La Jolla, Calif. “We should probably prepare for this being the predominant lineage in most places in the United States by March.”

Dr. Andersen’s team estimated that the transmission rate of B.1.1.7 in the United States is 30 percent to 40 percent higher than that of more common variants, although those figures may rise as more data comes in, he said. The variant has already been implicated in surges in other countries, including Ireland, Portugal and Jordan.

“There could indeed be a very serious situation developing in a matter of months or weeks,” said Nicholas Davies, an epidemiologist at the London School of Hygiene and Tropical Medicine who was not involved in the study. “These may be early signals warranting urgent investigation by public health authorities.”

[…]

“There’s still a lot that we have to learn,” said Nathan Grubaugh, a virologist at Yale University who was not involved in the study. “But these things are important enough that we have to start doing things now.”

It’s possible that chains of B.1.1.7 transmission are spreading faster than other viruses. Or it might be that B.1.1.7 was more common among incoming travelers starting new outbreaks.

“I still think that we are weeks away from really knowing how this will turn out,” Dr. Grubaugh said.

The contagiousness of B.1.1.7 makes it a threat to take seriously. Public health measures that work on other variants may not be enough to stop B.1.1.7. More cases in the United States would mean more hospitalizations, potentially straining hospitals that are only now recovering from record high numbers of patients last month.

Making matters worse, Dr. Davies and his colleagues at the London School of Hygiene and Tropical Medicine posted a study online on Wednesday suggesting that the risk of dying of B.1.1.7 is 35 percent higher than it is for other variants. The study has yet to be published in a scientific journal.

And if you’re worried about that, you can also be worried about this.

The likely more transmissible variant of COVID-19 first detected in South Africa has arrived in the Houston area, according to Houston Methodist Hospital.

The hospital system said it found the region’s first case of the new, faster-spreading variant on Saturday while sequencing the genomes of positive test results. It also found two cases of the variant first discovered in the United Kingdom. The UK variant first was confirmed in the Houston area in early January.

The infected person is a Fort Bend County man, who tested positive weeks ago and has recovered from the illness, said Dr. Jacquelyn Johnson Minter, Fort Bend County Health & Human Services Director. The patient had traveled domestically before his diagnosis. His household members have tested negative, and he did not work while infected so there was no exposure at his job, Minter said.

Still, Minter said she would not be surprised to learn the South Africa variant was spreading through the community.

[…]

Dr. Wesley Long, who works with the Methodist sequencing effort, said there is no evidence from the clinical trials of Pfizer and Moderna vaccines that they are less effective against the variants, especially the U.K. strain. He said there is limited evidence that certain other vaccines and therapies that target the spike protein of COVID-19 may be less effective against the South African variant, though they still should provide benefits to most people.

The U.S. Centers for Disease Control says “rigorous and increased compliance” with mitigation strategies like social distancing and wearing masks is needed to combat the spread of the virus.

Yes, the same basic techniques to avoid spreading the disease are still effective – masking, social distancing, washing hands, avoiding indoor gatherings – but they have to be strictly followed, because the newer versions of the virus are easier to transmit. So far there’s no evidence that these mutations are resistant to the vaccine, but the risk there is that the more infections, the greater the chances of further mutation, and thus the greater the chances that such a variant could emerge. All of this is to say, stay vigilant. Infection numbers are finally starting to drop, and with that comes the temptation to ease up. It’s still way too early for that.

The second shot portal

People are going to need this, too.

Houston officials plan to launch a website this week that will let people schedule appointments for their second doses of the COVID-19 vaccine.

Health Director Stephen Williams on Monday said officials plan to send out that link to people who got their first shot from the city “later this week, and maybe even as soon as tomorrow.”

The new process would be welcome news to people waiting on their second doses, many of whom have grown uneasy as their windows for the booster shot approach. Currently, city health workers call vaccinees to schedule their shots in the week before the 28-day window when the second dose is recommended.

The city has cited new guidance from the U.S. Centers for Disease Control that the second Moderna dose should be given as close to 28 days as possible after the first, but can be given as far out as 42 days. The Health Department has said it anticipates everyone who gets a shot from the city should be able to get their second one within 28 days. The city has asked residents to avoid calling the city unless they are less than 48 hours from their 28-day window.

Mayor Sylvester Turner said the city has given out more than 2,300 second shots already and has scheduled another 11,971. He said the city has received 18,600 doses for second shots. That is in addition to 41,950 doses for first shots, of which the city has administered 33,839 — about 80 percent of its supply.

The city closed its senior wait list — operated by the Harris County Area Agency on Aging — on Friday after more than 70,000 people called to enroll. Williams said it is “hard to discern” when the city will reopen that portal. It is separate from Harris County’s wait list, which launched last week, and has grown to more than 165,000 people.

I’ve seen chatter on Twitter and Facebook from people who have gotten the first shot (or helped a family member get it) and been confused about how to schedule the second one. Hopefully this will help with that, because obviously people will need to get that in a timely and orderly manner. And, not to put too fine a point on it, the volume of second shots will need to ramp up to meet the volume of first shots in short order. The first shot volume is starting to accelerate, but it will need to increase well beyond that. Help is coming, we’ve got to do the best we can until then.

Nowhere to go but up with COVID vaccines

Starting from scratch.

Newly sworn in President Joe Biden and his advisers are inheriting no coronavirus vaccine distribution plan to speak of from the Trump administration, sources tell CNN, posing a significant challenge for the new White House.

The Biden administration has promised to try to turn the Covid-19 pandemic around and drastically speed up the pace of vaccinating Americans against the virus. But in the immediate hours following Biden being sworn into office on Wednesday, sources with direct knowledge of the new administration’s Covid-related work told CNN one of the biggest shocks that the Biden team had to digest during the transition period was what they saw as a complete lack of a vaccine distribution strategy under former President Donald Trump, even weeks after multiple vaccines were approved for use in the United States.

“There is nothing for us to rework. We are going to have to build everything from scratch,” one source said.

Another source described the moment that it became clear the Biden administration would have to essentially start from “square one” because there simply was no plan as: “Wow, just further affirmation of complete incompetence.”

The new administration has asked some of the key players who worked on Covid and vaccines under Trump to resign from their roles, including Operation Warp Speed chief scientific adviser Moncef Slaoui and Surgeon General Jerome Adams. It has kept on others such as Dr. Anthony Fauci, who is now serving as Biden’s chief medical adviser on Covid-19. Adams was asked to stay on as an adviser.

Prior to Inauguration Day, some of Biden’s Covid-19 advisers had wanted to be careful not to be overly critical in public of the Trump administration’s handling of the virus and vaccine, given that the Biden transition team was already having a hard time getting critical information and cooperation from the outgoing administration, the source said.

Now that the transition of power has taken place, the Biden administration is hoping that they can quickly start to get a clearer picture of where things actually stand with vaccine distribution and administration across the country, going through something of a “fact-checking” exercise on what exactly the Trump administration had and had not done, they added.

I trust none of this comes as a surprise. This would be a big challenge even if Team Biden were getting a handoff from a competent, caring, and diligent administration. And remember, right now we’re still experiencing over four thousand COVID deaths per day, with hospitals coast to coast full to bursting. We’re likely still not at the peak from the Christmas-celebration phase of the pandemic.

To be fair, it’s in the Biden administration’s political interests to emphasize what a crappy job Trump did with pandemic response, so that any blame they place on their predecessor for the inevitable bump or stumble sounds credible. And for all the justified criticism, the US is not doing all that badly when compared to other countries when it comes to getting people vaccinated. I’ve said before, the single most important thing that Biden can do to give Dems a fighting chance in the 2022 midterm election is to put the country back on a good track, and the two things he can do to make that happen are get the economy humming again and get everyone vaccinated. The incentives are lined up with the plan of action, the rest is all about getting it done. TPM and Daily Kos have more.

Can we get enough people vaccinated?

It’s going to take a lot of work.

In poll after poll, alarming numbers say they don’t plan to be inoculated with the vaccine, whose 95 percent efficacy rate in trials exceeded everyone’s expectations. It’s scientists’ nightmare: create one of medicine’s landmark achievements only to have large numbers of people not bother to get it.

But that appears to be the reality. Although the numbers appear to have improved since drugmakers Pfizer and Moderna reported their impressive trial results last month, about 40 percent of Americans tell poll takers they don’t plan to get a COVID-19 vaccine. In Texas, only 42 percent say they will.

Public health officials fear such numbers will hinder the campaign to shut down the greatest scourge since the 1918 Spanish influenza.

At stake is a possible squandering of the chance to get COVID-19 under control by late summer, to save countless lives that will be lost the longer it takes to stop the spread of the virus. Also at stake is an increased potential for a more lethal or contagious strain of the virus to emerge, always a threat as long as an infection continues to circulate.

“The hesitancy is bad for getting the population vaccinated to obtain herd or community immunity, which would allow for activities to become normal again,” said Kirstin Matthews, a fellow in science and technology policy at Rice University’s Baker Institute. “The Biden administration will need to find ways to gain public trust in the Centers for Disease Control and Prevention and FDA to ensure communities take the vaccine.”

A national task force led by Johns Hopkins Center for Health Security and Texas State University’s anthropology department added that “if poorly designed and executed, a COVID-19 vaccine campaign in the U.S. could undermine the increasingly tenuous belief in vaccines and public health authorities who recommend them, especially among people most at risk of COVID-19 impacts.”

[…]

Vaccine mistrust has been building for years, fueled by a small but growing movement that works to exempt children for “reasons of conscience” from school-required inoculations. But the COVID-19 vaccine has brought a new audience to such groups, like Texans for Vaccine Choice. Its leader told publications this summer that its phones were ringing off the hook with calls from people who said they’d gotten other vaccines but don’t want this one.

Neil Johnson, a physicist at George Washington University who studies anti-vaccine groups on social media, has estimated that in recent months, 10 percent of people on Facebook asking questions about vaccines have switched to anti-vaccine views.

“It’s going to be a bumpy road,” said Peter Hotez, a vaccine scientist at Baylor College of Medicine. “Given media scrutiny and an aggressive anti-vaxxer movement, particularly in Texas, any adverse vaccine events are going to be amplified.”

The story cites this Texas Tribune poll from October. I feel like things are probably a bit better now, mostly because it’s clear we will now have a competent administration that takes the pandemic seriously in charge of getting the vaccine out. For sure, messaging is going to be key to this, and all of us will need to play a part to make sure our family and friends have good information and make good choices. This Twitter thread has some good advice.

There will no doubt be significant resistance no matter what, and we may have to reach a point where we impose sanctions on people who could get the vaccine but haven’t. I don’t know what that might look like, and honestly I’m not sure if there’s a practical way to do what I’m suggesting. It’s way premature at this point anyway, but it’s best to be prepared for all possibilities. And as much as anything, we need to be prepared to fight off any effort in the Lege to coddle the anti-vaxxers, who already have had way too much influence, and success. If we can just avoid not making things worse, that will be a big win.

UPDATE: See this NPR story for evidence of growing confidence in the COVID vaccine.

Bar owners still mad at Abbott

Can’t blame them, but the situation is complicated.

As Gov. Greg Abbott outlined his latest reopening plan this week, bar owner Greg Barrineau watched in disbelief. Abbott, who announced that Texas restaurants could expand dine-in service to 75% capacity, said bars must remain closed.

“Some bars and their associations have offered some very helpful ideas,” Abbott said of reopening, “and we will continue to work with them on that process.”

But Barrineau, who has laid off his 12 staff members and suffered hundreds of thousands of dollars in losses at Drink Texas, a bar with locations in San Antonio and Boerne, said that assertion of collaboration is “insanity — he doesn’t care about small businesses.”

Michael Klein, the head of Texas Bar and Nightclub Alliance, which represents thousands of bars, said that Abbott’s statement about working together was “incorrect,” carefully choosing his words. The TBNA laid out a six-point plan to reopen in August, but Klein said the governor, whom he referred to strictly as “anti-business Abbott,” has not responded to the plan.

“We’ve never heard back from them,” Klein said. “We believe that he is disingenuous.”

Abbott’s office did not respond to requests for comment.

While restaurant owners applauded Abbott’s move to allow them to increase operations, Klein said Thursday’s ruling was “completely unacceptable” for many bars and other facilities where alcohol sales make up more than half of the revenue. It could leave 30% of Texas bars and 39% of distilleries permanently closed within six months, industry leaders said.

[…]

Spread from conventional bars and nightclubs has been widely documented throughout the U.S., and infectious disease experts caution going inside establishments that don’t follow social distancing protocols.

Kristin Mondy, chief of the infectious disease division in the University of Texas at Austin’s medical school, said there is increased risk in spreading the virus if strangers mingle in a tight, closed space, especially as drinking could cause bar customers to loosen their inhibitions.

Klein said the industry’s plan would reduce those issues by complying with Centers for Disease Control and Prevention requirements.

Some of the requirements in TBNA’s plan include ensuring all patrons are seated at their own tables, barring dance floors and mingling among groups, requiring face masks for all servers and customers when not at their tables, and conducting temperature checks upon entry. Mondy said these procedures could help as long as mask-wearing and social distancing are enforced.

[…]

Cord Switzer, who has helped run Fredericksburg Winery for almost 25 years with his family, said he has been able to technically and legally become a food server — but no one that comes is actually eating the food. That’s not why they go to a winery, he said.

“It makes no sense to me,” Switzer said. “We have never been interested in being in the food service business. We have no intent of doing that in the future, but it was our only choice.”

Switzer started wine tastings on Saturday for the first time in two months and hopes to begin recouping his losses after making 30% of last year’s revenue. But he doesn’t understand the governor’s categorization, and industry advocates share Switzer’s confusion.

“Texas winery owners continue to be perplexed by Governor Abbott’s steadfast refusal to recognize that the lion’s share of Texas alcohol manufacturer’s tasting rooms have little, if anything, in common with bars and nightclubs,” said Patrick Whitehead, the president of the Texas Wine and Grape Growers Association, in an email. “Governor Abbott’s arbitrary, and frankly unfair, act of lumping our tasting rooms into the category of bars is like a surgeon operating with a chainsaw rather [than] a scalpel.”

Switzer’s money troubles are not unique; nearly half of distilleries surveyed by the Texas Whiskey Association have experienced revenue losses greater than 60%. Spence Whelan, the head of the association, which represents distilleries across Texas, said continued restrictions could be disastrous for the industry, which normally relies on a big fourth quarter in holiday sales to stay afloat. This fall, with little or no visitors, that could be wiped out. Under Texas law, whiskey distilleries cannot ship or deliver whiskey directly to customers, nor can they sell more than two bottles of whiskey per person.

At the very least, Whelan said, those rules should be relaxed. Many places don’t want to open yet anyway, and there are other ways to bring in money. He said the industry has sent more than 15,000 letters to the governor’s office asking to waive those restrictions and has received no response.

Let’s acknowledge that bars are a high-risk environment for COVID-19, and the reopening of bars in May was a significant contributor to the subsequent outbreaks that swept the state in June and July. We should also acknowledge that there’s evidence that the reopening of restaurants, even at lower capacities, is also a risk factor in spreading COVID-19. The bar owners’ complaint – and wineries’, and distilleries’, and craft breweries’ – is that Abbott has been particularly rigid about how these risks are categorized, and has been unresponsive to any input that would allow these entities to operate in a lower-risk fashion.

I have a lot of sympathy for these complaints. Some bars have been able to reopen by creative interpretation of the 51% rule, by incorporating to-go service, and by a recent rule change that lets them have food trucks on their premises. But this doesn’t work for every bar, it imposes extra costs on them, and it doesn’t change the fundamental nature of their business. The only good thing that may come out of it is the expanded allowance for to-go service, and maybe if we’re very lucky a broader rethinking of our antiquated regulatory scheme for alcohol. I don’t know how effective the risk-mitigation strategies that have been proposed by the various industry groups would be, but we could study them and try the ones that comply with known best practices. We could surely let the places that have ample outdoor space like wineries and craft breweries with beer gardens take advantage of those spaces (to some extent we already are permitting this), and we could make allowances for those that have large and well-ventilated indoor spaces where social distancing would work. And, you know, Abbott and Dan Patrick could put a little pressure on the two Republican Senators to support a relief bill in Congress that included funds for bars and other places that rely heavily on alcohol sales (such as music halls) that just can’t be allowed to reopen right now. Abbott has done none of this, and as noted in the story has been repeatedly unwilling to engage in any discussion about it.

So this is both a legitimate set of concerns by members of a significant sector of the Texas economy, and a real opportunity for Democrats going forward. Dems don’t need to pander or reverse course on their properly-held principles about minimizing COVID risk. They just need to be willing to consider the various risk-mitigation strategies that have been proposed, and to continue to push for a response from Congress that truly addresses the broad economic pain that much of the country is still experiencing. Good policy is so often good politics, and the opportunity to do both here is enormous.

Time for another COVID roundup

Let’s start with some good news, which comes wrapped in a warning.

The number of coronavirus patients crowding hospital wards in the Houston area is now in its sixth week of steady decline, a welcome reversal of the virus’ alarming surge in June and July.

The headcount of COVID-19 patients has fallen by half since its mid-July peak in hospitals affiliated with the seven systems based in the Texas Medical Center. And the number of intensive care patients at those facilities has dropped by a third.

The subsiding wave has merely shifted civic leaders’ concerns, however — and not only because hospital headcounts, new cases, and other metrics remain well above their levels before the spike.

Worried that Houstonians will invite another crisis by concluding it is safe to attend cookouts or crowd onto restaurant patios, public officials and medical leaders are stressing that the best measures of success are not empty intensive care beds but an absence of widespread infections.

“I do worry about people listening to this news and taking it the wrong way, saying, ‘Whew that’s over, now let’s go back to life as normal,’” said Dr. Esmaeil Porsa, CEO of Harris Health, the county’s public hospital district. “This is not the time.”

[…]

In every case, these metrics suggest the Houston region remains well short of containing the virus. The testing positivity rate, for instance, is about 15 percent in the city and county, and 10 percent among TMC institutions.

What about case counts? Harris County over the last week has averaged more than two and a half times as many daily cases as the 400 it would take to step down from Hidalgo’s top threat level. And the nine-county Houston region is averaging almost nine times as many new daily cases as the TMC goal of 200.

Another of Hidalgo’s metrics calls for the share of intensive care patients who have COVID-19 to not exceed 15 percent; the share of ICU patients in the county who have COVID-19 remains more than double that.

We’re headed in the right direction, but we’ve still got a long way to go. Stay home. Maintain social distancing. Wear a mask. Wash your hands.

And while case numbers may be coming down, fatality numbers are higher than we’ve counted.

Since the start of the COVID-19 pandemic in Texas, the state’s death toll from all causes has soared by thousands above historical averages — a sobering spike that experts say reveals the true toll of the disease.

Between the beginning of the local pandemic and the end of July, 95,000 deaths were reported in Texas, according to U.S. Centers for Disease Control data. Based on historical mortality records and predictive modeling, government epidemiologists would have expected to see about 82,500 deaths during that time.

The CDC attributed more than 7,100 deaths to COVID-19, but that leaves roughly 5,500 more than expected and with no identified tie to the pandemic. The CDC’s chief of mortality, Dr. Bob Anderson, said these “excess deaths” are likely from a range of pandemic-related problems, including misclassifications because doctors did not initially understand the many ways that COVID-19 affects the circulatory system and results in a stroke or a heart attack.

“It can cause all sorts of havoc in the body,” he said.

The CDC data offers an opaque but important estimate of how deadly the virus has been in Texas, which suffered from testing shortages for weeks as COVID-19 case counts climbed.

“It has shocked me to see people think that there’s overcounts of the COVID deaths, because I can’t even imagine that that’d be the case,” said Mark Hayward, a professor at the University of Texas who studies mortality trends. “The undercount is so dramatic.”

And there is a clear racial disparity in the undercounts. Between March and the end of July, Texas recorded more than 21,000 deaths of Latinos — more than 5,000 higher than epidemiologists predicted. Of those, about 2,100 were attributed to COVID-19. That leaves more than 3,000 deaths in excess of the expected number, many of them in border counties that lack resources for testing.

This is a phenomenon we’ve seen literally around the world. We’ve certainly known that it’s happening in Texas. The expert opinion is that we’ve already passed 200K deaths nationally, or about 25% more than the official count. If you could read one of the names of those 200K dead Americans every second, it would take you over 55 hours, nonstop, to read them all. Think about that for a minute. Or for 55 hours.

Also, too, we still suck at testing.

After plummeting for days, the number of COVID-19 tests reported in Texas suddenly jumped by 124,693 on Thursday, which state health officials said was a result of coding errors and a system upgrade.

Backlogs at a hospital lab and a commercial lab accounted for most of the tests, which could not be added to the state’s official tally until the coding errors had been fixed, said Lara Anton, spokesperson for the Texas Department of State Health Services.

Of the 124,000 tests reported on Thursday, approximately 95,000 were from a lab that served several hospitals, Anton said, adding that the lab sent files containing an error in one of the data fields, which DSHS’ electronic system could not read.

DSHS doesn’t know when the tests were actually conducted and is working with local health departments to find out, she said.

[…]

Whether because of human error, shifting benchmarks or bureaucratic changes, it’s not the first time that Texas officials have corrected their data since the beginning of the pandemic. Almost every major data point has come with caveats, sometimes blurring for days the big picture of the pandemic in Texas.

It is what it is. I don’t know what else to say.

Finally, the coin shortage is real, y’all.

Some retailers have started posting signs notifying customers that they might not be able to provide exact change for their purchases, and instead ask for them to pay with a credit or debit card or exact payment.

“It’s not like coins are not there,” said Venky Shankar, professor and director of research at the Center for Retailing Studies in Texas A&M University’s Mays Business School. The coins are just being used less as business has slowed and more people stay home.

Another hurdle for coin usage, Shankar said, is the fear that money could carry the novel coronavirus, even though experts don’t know definitively whether cash actually poses a threat.

In order to keep coins circulating, the U.S. Mint has asked people to pay with exact change. “We ask that the American public start spending their coins, depositing them, or exchanging them for currency at financial institutions or taking them to a coin redemption kiosk,” the mint said in a news release. A new task force — the U.S. Coin Task Force — has also been charged with determining how to reinvigorate the supply chain.

[…]

According to Shankar, roughly 45 to 50 percent of sales in smaller stores — places such as convenience stores — are made in cash. But big grocers such as H-E-B, Kroger and Walmart have also faced a shortage of coins.

In response to the shortage, some retailers and restaurants have started to pay or reward customers for their coins.

The U.S. Mint has also increased production from 1.2 billion coins in June to 1.35 billion coins per month for the rest of 2020, according to a Statista review.

But that doesn’t solve everything.

“That still will not unlock the coins that are already in the drawers and the banks,” Shankar said.

Laundromats, which rely heavily on coins to function, are among the businesses directly impacted by the coin shortage.

Yeah, that would suck if no one has any damn quarters. This is a problem all over, and offhand I have no idea what to do about it. I normally like paying for things in cash, but have barely used any since March. This is a teeny tiny reason for saying this, but we live in very strange times.

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.

The hidden toll

Another reason why the reported death count from COVID-19 is too low: People who didn’t know they were infected and die at home may never be tested or counted.

As coronavirus cases surge, inundating hospitals and leading to testing shortages, a rapidly growing number of Houston area residents are dying at home, according to an NBC News and ProPublica review of Houston Fire Department data. An increasing number of these at-home deaths have been confirmed to be the result of COVID-19, Harris County medical examiner data shows.

The previously unreported jump in people dying at home is the latest indicator of a mounting crisis in a region beset by one of the nation’s worst and fastest-growing coronavirus outbreaks. On Tuesday, a record 3,851 people were hospitalized for the coronavirus in the Houston region, exceeding normal intensive care capacity and sending some hospitals scrambling to find additional staff and space.

The uptick in the number of people dying before they can even reach a hospital in Houston draws parallels to what happened in New York City in March and April, when there was a spike in the number of times firefighters responded to medical calls, only to discover that the person in need of help had already died. These increases also echo those reported during outbreaks in Detroit and Boston, when the number of people dying at home jumped as coronavirus cases surged.

While far more people died of COVID-19 in those cities than have died so far in Houston, researchers and paramedics say that the trend of sudden at-home deaths in Texas’ largest city is concerning because it shows that the virus’s toll may be deeper than what appears in official death tallies and daily hospitalization reports.

Many people who die at home are not tested for COVID-19, said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston. In New York City, for example, only 16 percent of the 11,475 at-home deaths between February and June have been attributed to COVID-19, according to data from the U.S. Centers for Disease Control and Prevention.

“There’s no reflexive testing,” Faust said, noting that medical examiners are selective about the cases they take. “There’s no pressure to call it a COVID death.”

The rise in at-home deaths may also reflect people who are afraid to go to the hospital because of COVID-19, and who die of heart attacks, strokes, diabetes and other conditions not tied to the coronavirus, Faust said.

Ultimately, Faust said, public health experts trying to assess the toll from COVID will need to study how many excess deaths there are in a particular region and whether the demographics of those who died are different from what one might expect. “If there’s a huge spike in at-home deaths but no real spike in overall deaths, it’s just sort of rearranging deck chairs.”

There’s more, so go read the rest. I don’t have anything to add other than the usual disclaimer that none of this had to happen. We could have had a federal government that actually prepared for COVID-19. We could have had a state government that cared about reopening in a safe and scientifically-driven manner. We have neither of those things – yet – and so here we are. Keep that in mind, today and every day, not just through this November, but through November of 2022.

We need to understand what we did wrong

So yeah, we need this.

Two of the nation’s most influential experts on the coronavirus pandemic, both based in Texas, are calling for an independent, nonpartisan investigation of the U.S. response to the novel coronavirus.

“We must prevent this from happening again,” said Gerald Parker, who directs the pandemic and biosecurity program at Texas A&M’s Bush School of Public Service. “This is not going to be our last pandemic.”

Peter Hotez, a Houston-based vaccine researcher and frequent commentator on cable news, noted that the current virus, SARS-CoV-2, is the third coronavirus to pose a major health threat in the last 20 years. And given that outbreaks had already wreaked havoc in China and Europe, U.S. public health systems were notably slow to respond.

“What hurt Wuhan was what hurt New York City,” said Hotez, “which is that virus transmission went on for six weeks before there was any public health intervention.”

In a videotaped interview with John Sharp, chancellor of The Texas A&M University System, Parker suggested an investigation modeled on the nonpartisan 9/11 Commission.

[…]

Hotez, who also participated in the interview with Sharp, said later that he feared a congressional panel would become “a political circus.” Instead he proposed a review by the National Academies of Sciences, Engineering and Medicine.

Among the questions Hotez wants answered: How, for the whole month of February, did the U.S. miss evidence that the virus was already here? Given the crowding and high number of underlying conditions in low-income neighborhoods, what was done to prepare African-American and Hispanic communities in the early days? Why didn’t the CDC have a centralized epidemiological model, including models of cities and metropolitan areas? And how can the U.S. prepare for future epidemics?

For those who are fans of comparing government to business, this is a very standard business thing to do. Call it an after-action review, or a root cause analysis, or just a plain old audit, it really is vital to learn from experiences, good and bad, so that you can understand what happened and why it happened, and what you can do better next time. I think we can all agree that there is plenty to be learned from this saga, and we all owe it to ourselves to do that. I would hope that much is non-controversial.

But let’s be real, there’s no way to do this that won’t involve politics. You can put together the bluest of blue ribbon panels, staff it with the bona fidiest of experts, and stick entirely to a just-the-facts narrative, it’s still going to be political. That’s because the single biggest actor in this drama was Donald Trump, and his influence on the decisions made at the state and local level was entirely political. Any review that doesn’t do a thorough accounting of this isn’t worth the effort. If Republicans haven’t figured out that Trump’s mishandling of this is what’s killing them in the polls right now, I can’t help them, but I would think they’d want to help themselves. If we manage to get an all-Democratic government next year (please, please), I won’t really expect Republicans to like anything such a report would say. That’s shouldn’t be the point, or anyone’s concern. Do a thorough review, get all the facts out into the open, learn everything there is to be learned, and let the chips fall where they may.

Please wear a mask

Don’t be that person. Seriously.

Kara McIntyre remembers the day she likely contracted COVID-19 — she wasn’t wearing a face mask.

She was at Target and began to feel dizzy. Later she checked her temperature and had a fever. So she got tested for the novel coronavirus, and a few days later her results came back positive.

The 39-year-old radio deejay did not wear a face mask before she was infected in March, something she said she feels guilty about now.

“I know I came in contact with a person who tested positive for it,” McIntyre said. “I wasn’t going out much, but I put gas in my car, went to the grocery store. Knowing I went through that and may have gotten other people sick, that’s terrifying.”

As the state reopens restaurants, shopping malls, gyms and salons, whether or not to wear a mask has become a hot-button issue. To some, it’s a way to signal one has their neighbor’s health and well-being in mind. To others, it’s an inconvenience or an attack on American freedoms.

[…]

The Centers for Disease Control and Prevention recommends everyone wear a face mask in public, in addition to practicing social distancing and frequent hand washing. But the president and vice president are often photographed without them.

Face masks have become a divisive issue even in Houston, where residents are known for coming together during times of crisis like Hurricane Harvey, said Cathy Power, 51.

“What I gather is that there is a narrative out there that masks are for the weak. This is wrong — masks are worn to protect others; they are not for protecting yourself,” said Power, who lives in the East End, and suffers chronic health issues. “They reduce the risk by keeping droplets from traveling as far as they would if you were not wearing a mask. It works best if we all wear them.”

People wear masks to protect others around them as studies have shown it has little to do with our own ability to not be infected, said Dr. David Persse, Houston’s health authority.

“Take a mirror, breathe on it and see the mist that forms. If you’re ill, the mist is full of virus,” Persse said. “Do the same thing with the mask in front of you; you’ll see far less of any mist on that mirror at all. That’s how it works.”

This is the sort of assumption that drives post-reopening models that predict a large increase in COVID-19 infections. If people are literally and figuratively letting their guard down, we’re going to be right back where we were in early March before all the shutdowns. We don’t want that, right?

So that leaves two viable options. One is to continue to stay home as much as possible and be relentless about social distancing and avoiding crowds. If you’re doing that, then for the most part you don’t need to wear a mask. But when you are out in public, in places where you are interacting with or just in close contact with other people, then you really do need to wear one. Grocery shopping? Wear a mask. Getting your hair cut? Wear a mask. They do make a difference.

More to the point, if we all agree that the cost of keeping the economy on ice is very high, the key to reopening is to find ways to reduce risk while out in public. Wearing a mask is a low-cost method of risk mitigation. The more we do it, the more free we can be with our movements and interactions.

That’s really all there is to it. If we do this together, we can get that curve down to zero, which is the best-case scenario short of a vaccine. (Which an astonishingly large percentage of people say they won’t take, but that’s a rant for a different day.) Remember, lots of people have no choice about this – health care workers and people in all kids of retail and service jobs have been wearing masks all day every day for a long time now. It’s not that often that you can do a fairly small thing and make a big difference. This is one of those times. Wear your mask. Thank you.

Hollywood’s plans to come back

I’ve posted a few times about how sports leagues like MLB are making plans to return to action from coronavirus shutdowns. The larger entertainment industry, including TV and movie making, are in a similar position as the sports leagues, and they too are starting to game out how they can (safely) return to doing what they do. This story gives a good outline of where that stands.

We are still months away from cameras rolling — studios’ most optimistic projections are for July-August production restarts, and the more realistic ones are aiming to be up and running by September. California is still under a stay-at-home order, which currently expires on May 15.

There are many different issues we will cover, starting today with the resumption of location and soundstage shoots.

Getting up and running again in this brave new world is going to be very difficult to navigate. For one thing, insurers are unlikely to cover productions for COVID-19 cases when business resumes, according to multiple sources in the know. Producers all over filed multimillion-dollar claims triggered when civil authorities — governments — prevented filming from continuing and forcing production shutdowns. When the business starts up, that will now be considered an identified risk, and insurers will not cover it, sources said, just as CDC is warning of a second coronavirus wave.

What does that mean? Most likely, everyone on a film or TV production will be required to sign a rider, similar to ones they sign covering behavior codes in areas like sexual harassment, to indemnify the productions. “You acknowledge you are going into a high-density area, and while we will do our best effort to protect you, nothing is failsafe and if you contract COVID-19, we are not liable,” said a source involved drawing up these guidelines. “There is no other way we can think of to address this. If you don’t want to sign, don’t take the job.”

Conversations about how to return to production began ramping up late last week amid stabilizing levels of new COVID-19 cases and deaths in Los Angeles County, boosted by an encouraging drop in new infections over the weekend. Unfortunately, the optimism was short lived — Tuesday and Wednesday brought record spikes in deaths– but discussions continue because the business cannot begin to recover until an industry goes back to work.

So far, there are no protocols on which studios have settled, but active discussions continue, including with the film commissions in New York and Los Angeles, we hear. AMPTP and IATSE are leaning in hardest here to map lists of safety concerns and solutions, and every major studio in Hollywood has top people trying to figure out every scenario that needs to be addressed before shows can get up and running. The same conversations are taking place in other areas that touch the business, from the offices where people work and congregate, to hotspot eateries and movie theaters.

A lot of this starts with the state of California’s plan to gradually ease up on restrictions. Studios will still need to contend with any remaining local restrictions. There’s a lot in here, from catering to heavier use of green screens to avoid filming crowds to extra special handling of topline stars, and some of the items listed will likely be similar to the steps other businesses will have to take to reopen their own offices. Check it out.

Mask up

Time for the next step in virus mitigation.

Judge Lina Hidalgo

Harris County Judge Lina Hidalgo on Wednesday ordered residents to cover their faces in public, the latest effort by local governments to slow the spread of the novel coronavirus.

The new rules, which require residents 10 and older to cover their nose and mouth when outside the home, take effect Monday and last 30 days. Acceptable garments include a homemade mask, scarf, bandana or handkerchief. Medical masks or N-95 respirators are not recommended as they are most needed by first responders and health workers.

Under the order, the county’s 4.7 million residents must cover their faces at all times except when exercising, eating or drinking; the exemptions also include when individuals are alone in a separate single space, at home with roommates or family, or when wearing a mask poses a greater risk to security, mental or physical health. Violating the mask rules is punishable by a fine of up to $1,000, though Hidalgo urged police to use discretion.

Unlike previous restrictions announced by the city and county executives, Hidalgo’s mask order drew fierce, partisan rebuke, highlighting what has become a national political divide over coronavirus restrictions.

[…]

Employers at businesses deemed essential under Harris County’s stay-at-home order must provide face coverings and training to workers whose jobs require them to come into contact with colleagues or the public. Hidalgo has yet to determine whether to extend the stay-at-home rules, which expire April 30.

Hospitalization data suggests the curve of new cases is flattening here, Hidalgo said at a news conference Wednesday. The region still is susceptible to another wave of infections, she warned.

“If we get cocky, we get sloppy, we get right back to where we started, and all of the sacrifices people have been making have been in vain,” Hidalgo said while wearing a homemade mask. “Let’s not get complacent. Let’s remember that we still have work to do.”

Hidalgo said the mask rules were spurred by her team’s realization the outbreak would require a long-term health response that extends beyond the end of stay-home rules.

Houston Mayor Sylvester Turner endorsed Hidalgo’s plan. He thanked residents for their sacrifices to date and said he would announce a plan Thursday to distribute 70,000 masks to vulnerable residents.

Masks are a crucial tool to prevent a surge in cases as businesses and public spaces reopen, said Firas Zabaneh, an infectious disease expert at Houston Methodist. He said they also serve as a visual reminder to maintain social distancing.

“The public will be safer with masks on,” Zabaneh said. “As we ease the restrictions, more and more people are going to be interacting with each other.”

The Centers for Disease Control recommends wearing masks when social distancing is not possible, such as at a grocery store. Many people who have coronavirus do not show symptoms, and the disease can be spread through speaking, coughing or sneezing.

I omitted all the partisan criticism, which included a particularly whiny response from the police union president, because sniveling is pathetic and life is short. As the story notes, Laredo and Dallas and San Antonio have issued similar orders without any of the fuss; I’ll leave it to you to decide why the same thing from Judge Lina Hidalgo inspired such vitriol. The police guy went running to AG Ken Paxton to ask if she was allowed to do that, and he demurred, while reminding the cops that they do have the discretion to not issue citations.

Anyway, look. The way forward with this pandemic, certainly until we have an effective treatment regimen and eventually a vaccine, is going to include things like masks, plus continued social distancing and universal testing and a whole lot more hand sanitizer and bleach wipes. This is the new normal, whether we like it or not. It would be nice if everyone went along with this willingly, but we’ve already seen that a significant portion of the population doesn’t take any of this seriously. This is where we are.

Galveston and Montgomery Counties have not followed suit. For what it’s worth, they were behind the curve in issuing stay-at-home orders, too. With Greg Abbott’s forthcoming order to “reopen” the economy, it’s possible that Hidalgo’s order will be quite short-lived, since Abbott seems to have remembered that he doesn’t like letting local governments do things. As is so often the case lately, I have no idea what happens next. Buckle up, it’s gonna be bumpy. The Press has more.

Ridiculous Hotze lawsuit now in district court

We are all dumber by the mere existence of this.

The Texas Supreme Court has dismissed a lawsuit challenging the constitutionality of Harris County’s stay-at-home order, though the legal fight is set to continue in state district court.

The Wednesday ruling came at the request of the suit’s plaintiffs, including longtime conservative activist Steve Hotze and the pastors of three Houston-area churches.

Earlier this week, Jared Woodfill, the group’s attorney, filed a new case in Harris County that similarly claims County Judge Lina Hidalgo’s stay-at-home order violates the plaintiffs’ First Amendment rights because it allegedly continues to restrict church services even after Hidalgo revised it to align with Gov. Greg Abbott’s executive order deeming churches “essential businesses.”

The governor’s March 31 directive, akin to the stay-at-home orders issued by counties across Texas, came one day after anti-LGBTQ Republican activist Hotze and pastors Juan Bustamante, George Garcia and David Valdez filed a petition arguing that Harris County’s order violates the Constitution by ordering the closure of churches and failing to define gun shops as “essential” businesses.

The four original plaintiffs remain on the new lawsuit, and they are joined by Tom DeLay, the former House Majority Leader who represented a district in the Houston area until 2006. The plaintiffs also have challenged Montgomery County’s stay-at-home order in a different state district court.

[…]

Last Friday, Hidalgo revised her order to “permit in-person religious services that comply with the CDC’s guidelines,” according to a court filing by the county attorney’s office. The plaintiffs are continuing to challenge Hidalgo’s order in state district court, Woodfill said, in part because it imposes penalties — up to 180 days in jail and a $1,000 fine — that Abbott’s does not.

Hidalgo’s amended order says: “Per the Texas Attorney General’s guidance on this topic, if religious services cannot be conducted from home or through remote services, then religious services may be conducted in churches, congregations and houses of worship.”

Woodfill said he interprets that language to bar most churches from meeting in person, because most are capable of holding services remotely.

“Just about every church has the ability to do that,” Woodfill said. “Maybe there are some small churches that don’t. That doesn’t mean your parishioners have internet or the ability to access the service. We think that’s clearly government coming in to the church and issuing edicts and mandates that are an infringement on religious liberties.”

See here for the background. All this and Tom DeLay, too, because you can’t spell “stupid, evil, and corrupt” without Tom DeLay. Bear in mind, Hotze got what he wanted from Abbott’s executive order. It’s just that he’s special, so very special, and the rules of law and man don’t apply to him. I could sit here and spew invective at him all day, but what’s the point? He’s a sociopath, and this is what he does. If you get hurt as a result, that’s not his problem.

The Republican death wish

It would be one thing if they were just putting their own lives at risk, but that’s not how viruses work.

After Dallas County Judge Clay Jenkins became the first to announce a mandatory stay-at-home rule, conservative groups including Empower Texans began ringing alarms in opposition to Jenkins and to Republican Gov. Greg Abbott, who they say paved the way for the move.

Abbott had said he would applaud local leaders who felt they should issue stay-at-home orders for their communities.

“I’m extremely concerned about what Dallas Co just did, and Abbott’s apparent sanctioning of it,” Empower Texans president Ross Kecseg wrote on Twitter.

So far, Lt. Gov. Dan Patrick is the highest-ranking state official to echo those concerns.

“What I’m living in fear of is what is happening to this country,” Patrick said in a Fox News interview. “I don’t want the whole country to be sacrificed.”

Patrick, who turns 70 next week, went on to say he’d be willing to risk his own life and well-being to help preserve the way of life for other Americans — a statement that drew harsh rebukes on social media and inspired hashtags such as #DieForTheDow.

[…]

Critics of the stay-at-home orders are contradicting the advice of public health authorities at every level of government, from the World Health Organization to the national Centers for Disease Control and Prevention to local health officials. Epidemiologists have stressed that keeping people apart is the best way to fight back against a new virus for which there is no vaccine, and that aggressive early steps are the only way to get ahead of COVID-19.

The discord in Texas mirrors what’s going on at the national level with Republican governors showing more reluctance than Democratic ones, like Cuomo, to shutting down their states, said Timothy Callaghan, assistant professor of health policy and politics at the Texas A&M School of Public Health.

“On the one hand, they certainly want to protect the public health, but they are also afraid about hindering the freedoms of their citizens and they’re also concerned about the economic impact of having society in many ways shut down,” Callaghan said. “It’s a tricky balancing act for many politicians on the conservative side.”

Not only does that send Texans a mixed message but Callaghan said it could also reduce the effectiveness of the orders.

“If you want to see a true impact of flattening the curve throughout the state of Texas, it’s important for it to be a statewide policy,” Callaghan said. “Certainly in those areas that choose to enact some sort of shelter in place policy, you’re going to see some effect, but we don’t know if it’s going to be a smaller effect than if the entire state had chosen to do something.”

See here for the background. It’s not actually clear that they want to protect public health, since everyone who knows anything about public health and epidemiology is practically shouting from the rooftops that these shutdowns are necessary and we risk having literally millions of people die without them. Indeed, rightwing magazines are touting the virtues of deliberately spreading coronavirus, in a ridiculous and dangerous belief that it’s preferable to social distancing. I suspect there’s a certain amount of cognitive dissonance going on, since the one thing that can mitigate the economic impact of the stay-at-home orders is massive government action to put money in people’s pockets to replace the income they’d be losing, and that would seem to be the thing that Dan Patrick fears more than his own death. It’s clear that they’re taking their direction from Donald Trump, because that’s what they do these days and Trump is getting tired of the whole pandemic thing. It will be interesting to see if actual elected Republicans turn on Greg Abbott if he however reluctantly orders a statewide shutdown. In the meantime, I don’t know what there is to say other than there’s one way to get through this without a lot of people dying, and what these Republicans are agitating about is not it.

Further delay for Opening Day

Mid-May at the most optimistic, and that’s very likely too soon.

Major League Baseball pushed back opening day until mid-May at the earliest on Monday because of the new coronavirus after the federal government recommended restricting events of more than 50 people for the next eight weeks.

Baseball Commissioner Rob Manfred made the announcement following a conference call with executives of the 30 teams.

“The clubs remain committed to playing as many games as possible when the season begins,” the commissioner’s office said in a statement.

The Centers for Disease Control and Prevention recommended Sunday that gatherings of 50 people or more be canceled or postponed across the country for the next eight weeks.

“The opening of the 2020 regular season will be pushed back in accordance with that guidance,” Manfred said.

No telling at this point when games will start. The All-Star Game at Dodger Stadium in Los Angeles on July 14 could be in jeopardy.

“We’re not going to announce an alternate opening day at this point. We’re going to have to see how things develop,” Manfred told the St. Louis Post-Dispatch at Cardinals camp in Jupiter, Florida. He didn’t want to speculate about the possibility of playing in empty stadiums, saying part of that decision would depend on timing.

See here for the background. This assumes that after eight weeks we will not be under a general directive to greatly limit public gatherings, and that MLB players will be more or less ready to go as soon as that happens. I’ll take the over on this best and assume that sometime in June is a more realistic target. The NBA is currently aiming for mid-to-late June, and if that is how it works out for MLB as well, I’ll be reasonably satisfied. That could yield an MLB season of between 90 and 120 games, depending on when in June things could start and whether the end of the season could be pushed back and/or whether there might be more doubleheaders. I’m sure there will be plenty of discussions between the league and the union, as there are now about pay and service time and what have you. Three months seems like forever now, but if we’re at a point of normality again where sports have returned, I for one will be pretty damn happy. I mean, there are plenty of worse alternatives at this time.

The Houston healthcare community is preparing for COVID-19

I sure hope it’s enough.

With last week’s new certainty that the novel coronavirus is loose and being transmitted in Houston, the region’s medical providers are bracing for the current handful of known cases to blaze into an outbreak like nothing in modern memory.

“We had been saying, ‘It’s not a matter of if, it’s a matter of when,’” said Umair Shah, executive director of Harris County Public Health. “That’s not the case anymore. It’s now.”

By shutting down events and closing schools, officials aim to “flatten the curve” — to stop too many people from getting sick at the same time and overwhelming the region’s hospitals and medical providers.

Much about the highly contagious new virus remains unknown, and projections of its future behavior vary wildly.

Based on scenarios from the Centers for Disease Control and Prevention, the New York Times estimated that anywhere from 2.4 million to 21 million people in the United States could require hospitalization, “potentially crushing the nation’s medical system, which has only about 925,000 staffed hospital beds.”

For most people, the virus is expected to be mild. But up to 20 percent of cases — mostly people over 60 or with underlying medical conditions — may require hospitalization.

If everyone gets sick more or less at once, area hospitals almost certainly would not have enough rooms, critical care or ventilators. In Italy, where officials waited to control the outbreak, an extraordinary surge of cases has left the medical system on the verge of collapse.

Based on Harris County estimates, County Judge Lina Hidalgo said recently that if 30 percent of Harris County residents were to become sick at the same time and 20 percent of those people needed hospital care, medical infrastructure would be overloaded.

“We simply do not have enough hospital capacity to assume all of those people,” Hidalgo said. “We can’t afford to have a sudden spike in cases.”

Even the best case — a slowed outbreak that continues for months — is almost certain to pose significant challenges to the area’s hospitals, clinics and doctor’s offices.

[…]

The virus poses particular threats to hospital personnel, who will be working long hours under stressful conditions — and facing coronavirus-related personal problems such as a lack of child care due to school closures. In the worst scenario, seen in China, medical personnel become ill themselves, and their colleagues have to take care of them.

Testifying before Congress earlier this month, Dr. Peter Hotez, a Baylor College of Medicine vaccine researcher and infectious disease specialist, urged that special attention be paid to hospital workers.

“If health care professionals are out of work because they’re sick, or if they’re being taken care of by other health care professionals in ICUs, that’s a disaster,” he said.

And just this weekend, two ER doctors, one in New Jersey and one in Kirkland, Washington, have tested positive for coronavirus. Even with the best preventative measures, this thing is going to spread. All we can do – all that we must do – is take every action we can to try to limit how quickly it spreads. That’s our best hope.

The state responds to coronavirus

Like it or not, we need to be prepared.

Texas officials are scrambling to remain prepared for a major outbreak of a pneumonia-like disease whose global spread one expert says is now moving into “the next phase.”

From the governor’s office to hospitals to state agencies, Texas officials are intensifying efforts to plan for scenarios that could unfold now that the coronavirus is no longer relatively contained to China and surrounding countries and the number of cases is soaring in countries in Europe and the Middle East.

“I think we need to call an audible,” said Peter Hotez, an infectious disease specialist at Baylor College of Medicine and Texas Children’s Hospital. “We need to refresh the algorithms about who’s at risk and when we should suspect someone has the virus. We’re not calling it an epidemic yet, but we should start operating as if it were.”

Hotez said the disease’s spread — the number of cases in Italy and Iran, now about 900, more than doubled in two days, for instance — has made basing screening on the individual’s travel history less relevant. He also noted some recent cases have been characterized by gastrointestinal symptoms rather than respiratory symptoms.

[…]

There are 10 patients with the coronavirus in Texas, including six confirmed by the CDC and four who tested positively in Japan but whose results have not yet been confirmed by the U.S. agency. Of the 10, two came from Wuhan on a State Department-chartered flight and eight came from the Diamond Princess cruise.

There are 15 cases in the U.S. — none in Texas — that weren’t imported.

But CDC officials warned this week that it’s a matter of “when, not if” the virus arrives in the U.S. in larger numbers. The officials said people should start preparing for significant disruptions to daily life.

Noting the alarm that caused in some people who rushed out to buy water or face masks, Dr. Umair Shah, executive director of the Harris County Public Health Authority, said the remarks glossed over the timeline at which the U.S. cases are likely to significantly ramp up. He said that likely won’t be soon.

“The containment strategy in China was effective for giving everyone more time to prepare for the virus,” said Shah, noting the realistic hope was always to delay the virus’ spread, not stop it. “Governments were able to get information out and alert people to be on guard, just as they should be for the everyday flu.”

Three basic things: One, don’t panic. Two, be extra careful about what you read and especially what you share regarding coronavirus. Don’t be one of those idiots who passes along rumors and lies because you couldn’t be bothered to do a little vetting first. And three, practice good hygiene. Cough and sneeze into your elbow, wash your hands frequently, and if you do get sick, stay home. We can all do our part to make a difference.

The extraordinary danger of being pregnant and uninsured in Texas

So utterly appalling.

Right there with them

From 2012 through 2015, at least 382 pregnant women and new mothers died in Texas from causes related to pregnancy and childbirth, according to the most recent data available from the Department of State Health Services; since then, hundreds more have likely perished. While their cases reflect the problems that contribute to maternal mortality across the United States — gross medical errors, deeply entrenched racism, structural deficiencies in how care is delivered — another Texas-size factor often plays a significant role: the state’s vast, and growing, problem with health insurance access.

About one in six Texans — just over 5 million people — had no health insurance last year. That’s almost a sixth of all uninsured Americans, more than the entire population of neighboring Louisiana. After trending lower for several years, the Texas rate has been rising again — to 17.7% in 2018, or about twice the national average.

The numbers for women are even worse. Texas has the highest rate of uninsured women of reproductive age in the country; a third were without health coverage in 2018, according to a DSHS survey. In some counties, mainly along the Mexico border, that estimate approaches 40%.

Public health experts have long warned that such gaps can have profound consequences for women’s health across their lifespans and are a critical factor in why the U.S. has the highest rate of maternal deaths in the developed world. Texas’ maternal mortality numbers have been notably troubling, even as errors in key data have complicated efforts to understand what’s going on and led skeptics, including the governorto question whether there’s really a crisis.

Hardly anyone outside the policy world has taken a deep look at how these insurance gaps play out for women in the second-largest state in the U.S. — at how, in the worst-case scenarios, lack of access to medical care endangers the lives of pregnant women, new mothers and babies.

ProPublica and Vox have spent the last eight months doing just that — combing through government data and reports, medical records and research studies, and talking with scores of women, health care providers, policymakers and families of lost mothers around the state. We learned about Rosa Diaz and dozens of others, mostly women of color, by scouring medical examiner’s databases for sudden, “natural” deaths, then inspecting investigator and autopsy reports for clues about what went wrong.

The picture that emerges is of a system of staggering complexity, riddled with obstacles and cracks, that prioritizes babies over mothers, thwarts women at every turn, frustrates doctors and midwives, and incentivizes substandard care. It’s “the extreme example of a fragmented system that cares about women much more in the context of delivering a healthy baby than the mother’s health in and of itself,” said Eugene Declercq, professor of community health sciences at Boston University School of Public Health.

Most of the mothers whose cases we examined were covered by Medicaid for low-income pregnant women, a state-federal health insurance program that pays for 53% of the births in Texas, more than 200,000 a year, and 43% of all births nationwide. In Texas, the program covers OB-GYN visits, medications, testing and nonobstetric care, from endocrinologists to eye exams.

But the application process is so cumbersome that women in the state have the latest entry to prenatal care in the country, ProPublica and Vox found. It can take months to be seen by regular providers and even longer to access specialists. This poses the greatest danger for high-risk mothers-to-be — as many women on Medicaid are, having had no medical care for significant parts of their lives. Then, roughly two months after delivery, pregnancy Medicaid comes to an end, and the safety net gives way to a cliff. For many new mothers, the result is a medical, emotional and financial disaster.

More than half of all maternal deaths in the U.S. now occur following delivery, according to the Centers for Disease Control and Prevention, with as many as 24% happening six or more weeks after a woman gives birth. In Texas, the proportion of late-postpartum deaths is closer to 40%, with black women bearing the greatest risk. “To lose health care coverage really has a tremendous potential to worsen outcomes,” said Dr. Lisa Hollier, chief medical officer for obstetrics and gynecology for Texas Children’s Health Plan and chair of the state’s maternal mortality review committee.

This is a long excerpt, but there’s a lot more to the story, so please read the whole thing. There are numerous policy decisions at fault here – not expanding Medicaid, low Medicaid reimbursements, cutting off Planned Parenthood and substituting in wholly inadequate alternatives, and more – and all of them can be laid at the feet of the state’s Republican leadership. Whoever runs against Greg Abbott and Dan Patrick and Ken Paxton in 2022 should loudly and repeatedly assert that every maternal death in Texas is their fault. I keep saying this, and it keeps being true: Nothing will change until we have different, and better, government in this state. There’s no other way to do it.

Another look at scooter mayhem

From the Associated Press:

Photo: Josie Norris /San Antonio Express-News

As stand-up electric scooters have rolled into more than 100 cities worldwide, many of the people riding them are ending up in the emergency room with serious injuries. Others have been killed. There are no comprehensive statistics available but a rough count by The Associated Press of media reports turned up at least 11 electric scooter rider deaths in the U.S. since the beginning of 2018. Nine were on rented scooters and two on ones the victims owned.

With summer fast approaching, the numbers will undoubtedly grow as more riders take to the streets. Despite the risks, demand for the two-wheeled scooters continues to soar, popularized by companies like Lime and Bird. In the U.S. alone, riders took 38.5 million trips on rentable scooters in 2018, according to the National Association of City Transportation Officials.

[..]

Data on injuries or fatalities linked to scooters is hard to come by because the industry is so new. In Austin, Texas, public health officials working with the Centers for Disease Control counted 192 scooter-related injuries in three months in 2018. Nearly half were head injuries, including 15% that were traumatic brain injuries like concussions and bleeding of the brain. Less than 1% of the injured riders wore a helmet.

Bird, one of the largest scooter-sharing companies, dropped its scooters on the streets of Santa Monica, California, in September 2017 and within a few months riders were showing up at the emergency room, according to Dr. Tarak Trivedi, an emergency room physician in Los Angeles and co-author of one of the first peer-reviewed studies of scooter injuries. The following year, Trivedi and his colleagues counted 249 scooter injuries, and more than 40% were head injuries. Just 4% were wearing a helmet.

“I don’t think our roads are ready for this,” Trivedi said.

Bird and Lime both recommend that riders wear helmets, and they’ve handed out tens of thousands for free. But last year, Bird successfully fought a California proposal that would have required helmets for adults, maintaining that scooters should follow the same laws as electric bikes that don’t require adult helmets.

Bird says helmet requirements are off-putting to riders and could lead to fewer scooters on the road. Almost counterintuitively, the company argues that it’s better to have more riders than less because it forces drivers to pay attention to them.

“There’s a safety in numbers effect, where the motorists know that there’s people out on the street, so they act accordingly,” said Paul Steely White, director of safety policy and advocacy for Bird.

Getting people to wear helmets is a challenge. Riders don’t want exposure to lice or germs that could be found in shared helmets, and many make a spontaneous decision to scoot while they’re already out and about.

You can add this to the Austin study, which is now beginning to paint a consistent picture. Here’s the problem as I see it: Scooters on sidewalks are a danger to pedestrians, while scooters on roads are a danger to themselves, with worse potential consequences. They’re all right on bike paths and bike trails, as long as those are not used by pedestrians, but there aren’t enough of them to support the scooter business model. I don’t know how they’re supposed to fit into an urban street system. There’s something to be said for the “safety in numbers” effect – the same is known to be true for bicycles – but how many scooters will there need to be to get to that effect, and how long might that take? I just hope that we can figure out some better strategies to minimize the damage until we get there.

(That definitely means making helmets mandatory. I mean, come on.)

Austin’s scooter study

Be careful riding these things, and for crying out loud wear a helmet.

A first-of-its-kind study on injuries related to dockless electric scooters found that most incidents were preventable, and now Austin city officials are hoping to use their findings to inform future policy.

The city’s health and transportation departments collaborated with the Centers for Disease Control and Prevention to review 271 reports of possible scooter related injuries filed from Sept. 5 to Nov. 30, 2018. The study, however, only confirmed 190 cases involved scooter riders, one involved a pedestrian and one involved a cyclist. The rest were determined to be hurt while riding a gas-powered scooter, moped or device that uses three wheels, or didn’t involve a device at all, said Jeff Taylor, an Austin Public Health epidemiologist.

“If anything, this study also helped prove out that, that we need to be more precise in our language when we’re recording data that a scooter is not just a scooter. We mean something very specific,” Austin Transportation Department Director Robert Spillar said Thursday.

The CDC said the study found “a high proportion of e-scooter related injuries involved potentially preventable risk factors, such as lack of helmet use or motor vehicle interaction.” City officials also said almost half the head injuries documented could have been prevented.

The study drew data from Austin-Travis County EMS incident reports and information from nine area hospitals, as well as from interviews with some who were injured. Taylor said it was important to interview the injured so the data could be more specific.

Among the findings:

• 20 people for every 100,000 scooter trips taken were injured, and most were first-time riders.

• 48% were between 18 and 29 years old. Researchers recommend targeting educational materials to that age group going forward.

• 39% of injuries happened between the hours of 6 p.m. and 6 a.m.

• 29% told researchers they had been drinking before they rode.

• Only one person of the 190 riders hurt was wearing a helmet.

• More than half of the riders were injured in the street and a third were hurt while riding on the sidewalk.

• More than a third said speed contributed to them crashing.

Having more accurate data about the scooters and how they’re affecting Austin residents could help inform policy discussions in the future, said Dr. Christopher Ziebell, emergency department medical director for Dell Seton Medical Center. The hospital does not have a uniform way to record the number and type of scooter injuries coming into the emergency room, he said.

[…]

During a period comparable to the one the CDC studied — four months in 2018, between May 7 and Sept. 6 — the Texas Department of Transportation found that in Austin 1,945 people were injured in a vehicle and eight were killed; 105 were injured on motorcycles and five were killed; 60 were hurt using bicycles. Scooter injuries during that time tallied 28, according to the city of Austin.

Lessening the number of injuries related to scooters could start with messaging and education, Ziebell said. Patients have told him they thought hopping on a scooter would be a quick, fun thing, but they end up hitting a pebble and crashing.

“I still hear patients who come in and say, ‘I had no idea,’ ” he said. His patients range in age from their 20s to 70s.

See here for the background. I don’t know why there’s such a wide disparity between the CDC and TxDOT studies in terms of the number of scooter-related injuries over similar time spans. My guess is that only a fraction of scooter injuries in the latter period were reported to TxDOT. Be that as it may, while the scooters caused their share of (I daresay mostly preventable) mayhem, they’re a drop in the bucket next to motor vehicles. Let’s do what we can to make scooters safer, but let’s not lose sight of the bigger picture. Mother Jones has more.

Measles, schmeasles

Eh, no biggie.

With U.S. measles cases this year reaching historic levels since being practically eradicated nearly 20 years ago, a host of bills targeting vaccination policies in Texas don’t appear to be gaining traction in the Legislature.

The U.S. Centers for Disease Control and Prevention has confirmed 704 cases of the measles in 22 states so far this year, the most of any year since 1994. Fifteen of those cases have been in Texas, the Texas Department of State Health Services said.

Considering the scope of the crisis, Rekha Lakshmanan, policy director for the Immunization Partnership, a group devoted to eradicating vaccine-preventable diseases, said lawmakers this session are missing an important opportunity to pass what she called “common-sense immunization laws,” among them bills aimed at increasing data transparency.

Notable among those measures are Senate Bill 329, filed by Sen. Kel Seliger, R-Amarillo, which would require the Department of State Health Services to publish the immunization opt-out rates for individual public schools. Currently, the health department is only required to post this information for districts as a whole and private schools. Another, House Bill 1966 by Rep. Gene Wu, D-Houston, would empower child care facilities to list their immunization opt-out rates for parents who are interested.

Vaccine advocates say making this data available would help parents choose the best place to send their children, particularly if the children have compromised immune systems and can’t be vaccinated.

“If you cannot vaccinate your child, then you need to place them in a child care facility with children who are vaccinated, I think, for the obvious reason that you know those children would not spread it to your child if there is a contagion that goes through the population,” Wu said of his legislation.

Opponents say the information does not reflect the overall health of a facility and could lead to kids being discriminated against for not being vaccinated, even though names would not be published.

Lawmakers heard testimony on both bills in committee hearings last week but did not vote on either. Next week is the deadline for the House to advance bills. The Senate has until May 22.

See here, here, and here for some background. This story was from the weekend, so please note that the House deadline for voting out bills is tonight at midnight. After that, it’s Senate bills or attaching amendments if your bill died in committee. The anti-vaxxers complaints do not move me. I see this as a matter of giving parents the information they need to make good choices. If that means that preschools and child care facilities are less inclined to take kids whose parents chose not to vaccinate them because it’s bad for their business, well, that should tell you something.

Also, too:

Amid a record-breaking national outbreak of measles, the number of Texans who exempt their children from vaccination for non-medical reasons took another big leap this past school year.

The number increased 14 percent in 2018-2019, continuing a 15-year-long trend that public health officials worry is leaving communities vulnerable to the resurgence of preventable diseases such as measles, which has been confirmed this year in 23 states, including Texas. The number of measles cases this year is the largest since 1994.

“Seeing non-medical exemptions increase again on a double-digit scale should create outrage for everyone,” Allison Winnike, president and CEO of the Houston-based Immunization Partnership, said in a statement. “It’s time for Texans to take action.”

Porfirio Villarreal, public information officer for the Houston health department, added that it’s “disappointing to see yet another rise in the number of parents opting out of life-saving vaccines, mostly due to the vast amount of misinformation on the internet and social media channels.”

The number of exemptions are still small, 64,176, but they represent a roughly 2,000 percent increase since 2003, when the state began allowing parents to decline immunization requirements for reasons of conscience. There were about 3,000 in 2003-2004, and a little under 57,000 in 2017-2018.

[…]

Texas is one of 17 states that allow waivers of school vaccine requirements based on parents’ conscience or personal beliefs. Only three states — California, Mississippi and West Virginia — don’t grant exemptions on religious grants. All 50 states allow exemptions for medical conditions, such as a compromised immune system.

Of course, tightening up the rules for exemptions is not on the table at all. The report that produced this data breaks it down by school district but – as we know – not by individual school. I don’t even know what else to say.

Another scooter casualty study

To be done in Austin.

As many as 14,000 dockless electric scooters are on the streets of Austin, whose 326 square miles are home to almost 1 million people. That likely makes Austin one of the cities with the highest scooter-to-citizen ratio in the nation — though the electric vehicles are also rapidly multiplying on the streets and sidewalks of Atlanta, San Diego, Nashville and Washington. At least 1,200 more are poised to appear in Austin whenever already-licensed operators deploy them. Ten companies have licenses to operate now.

Austin city leaders, worried about injuries for both users and pedestrians, asked the Centers for Disease Control and Prevention to investigate scooter-related crashes and injuries. The first-ever CDC scooter study will also look at how accidents could be prevented.

“We’re totally paranoid,” said Forrest Preece, a retired advertising executive who lives in a downtown condo and leads a largely pedestrian life.

“I’m 72 and my wife is 70. It would be easy to knock us over,” he said. “My wife actually went online and found a little mirror to attach to her wrist to look behind her so she’s not constantly turning around. We go single file so she can see that mirror and see what’s behind us.”

These scooters are everywhere — speeding by or strewn on sidewalks — and are likely to overwhelm the city this spring as Austin readies for an onslaught of scooter-riding visitors during the annual SXSW Conference & Festivals, running March 8-17. Last year’s SXSW drew 432,500 people.

The scooter study was launched in December when three CDC epidemiologists spent two weeks in Austin reviewing incidents and scooter-related injuries during a 60-day period from September to November. They began contacting the 258 individuals identified through EMS calls or who visited emergency rooms with a scooter-related injury. Findings from this study will likely be released in March and could have far-reaching effects as cities across the country grapple with reports of injuries from these e-scooters.

“We don’t know if there’s something unique about Austin or the population there that may be different from other parts of the United States or globally,” said Eric Pevzner, chief of the Atlanta-based CDC Epidemic Intelligence Service, which is conducting the probe. “The rate of scooter injuries in Austin may be consistent with what’s being noticed in other places, or it may be much higher.”

[…]

The CDC Austin study will calculate injuries per number of scooters ridden and per mile traveled. As researchers speak with those hurt, they’ll ask about road conditions, street types, weather, helmet use and behaviors, including alcohol use while riding.

While the study continues, Austin’s transportation department announced a “pause” in issuing new licenses to dockless mobility operators to assess the level of demand for those currently licensed and to ensure safety. The city is also reviewing its current rules and expects to revise the scooter rider ordinance this spring.

This story references the earlier study that was done in California, whose methodology was slightly different. The city of Austin just witnessed its first fatality involving a scooter, which would make it the third nationally. I look forward to seeing the results, and even more the recommendations for how cities should try to make these things safer to operate.

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.

We’re going to be fighting about vaccinations for a while

I wish it weren’t so, but it is.

Texas is one of 18 states that allow non-medical exemptions to the vaccines required for school attendance. California had a similar law allowing non-medical exemptions, until last year when it enacted a law that has one of the strictest requirements in the country after a 2014 outbreak of measles traced to the Disneyland theme park infected more than 100 people around the country.

Many of the parents opting out of the immunizations, which are widely recommended by doctors, say they fear a link between the vaccines and health problems such as autism. But studies that they cite have been widely debunked by public health officials.

“Year after year we’ve seen a steady increase in the number of students with a conscientious exemption from vaccination in Texas,” said Christine Mann, a spokeswoman for the Texas Department of State Health Services. “But overall, the numbers are small.”

Even though statewide levels of vaccinations remain high, at over 98 percent, what concerns public health officials are the growing clusters of geographic areas with high rates of unvaccinated children. Texas went from just 2,314 “conscientious exemptions” in 2003 to 44,716 this year, according to the Texas Department of State Health Services.

Some parents are pressing state officials to let them know how many of their children’s peers are unvaccinated. Jinny Suh, who has a 4-year-old son, is helping spearhead a petition drive asking legislators to change state law so that the number of school exemptions is public. Currently, exemption rates are available for individual private and charter schools, but only district-wide for public schools.

State Rep. César Blanco, a Democrat from El Paso, introduced a bill during the last legislative session that would have required schools to notify parents about vaccination rates at the school level, but the bill was stalled in committee.

“As a parent, there are lots of things that people get very passionate about,” Suh said, “but for some reason, in my experience, vaccinations remains an almost taboo topic besides a few passionate people.”

Yes, the anti-vaxxers are a minority, but they are a vocal and organized minority, which is a recipe for political success. Unfortunately, the end result of that political success is a growing public health problem, which is compounded by a lack of leadership in our state government. Honestly, what we need here is for an organized pushback against the anti-vaxxers, a pro-vaccine Moms Demand Action kind of thing. The main difference here isn’t that there is an anti-vaccination legislative faction that needs to be countered. I doubt there are that many legislators who are truly anti-vaccination, though there are a decent number who are in favor of “conscience” objections to some extent. It’s more that there isn’t a vocal and active pro-vaccination legislative force that can advance the cause and/or defend against attempts to weaken vaccination requirements. People who want to see more kids get vaccinated and fewer kids get exempted from vaccinations need to elect a few of their own. Until that happens, we’re going to see more stories like this one.