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A more general look at ransomware attacks

This WaPo story, which I found by googling around for more news on the Dallas ransomware attack, has some great general information on this recent plague, which I thought you’d find useful as well.

The ransomware attacks that pose a risk to life and health

Investigators weren’t able to get information on the history of police calls to the home of a mass killing suspect due to a ransomware attack that knocked Dallas government computers down, law enforcement officials told Rebecca Lopez of news channel WFAA in a story this weekend.

Police and fire leaders in the same city, meanwhile, said that response times had slowed. Officers are relying on backup plans like resorting to using pen and paper during system outages, Kelli Smith reported for the Dallas Morning News. That comes amid assurances from a city leader that “key public safety functions continue as usual.”

The cyberattack on the Dallas government illustrates ransomware’s potential, if not actual, risks to public health and safety. Some details about the Dallas cyberattack are still unknown; a city official is expected to discuss the hack when he appears before a Dallas City Council panel today.< The economic impacts of ransomware have long been established as concrete. This weekend brought the two-year anniversary of the attack on Colonial Pipeline, which prompted a fuel panic on the East Coast.

But ransomware attacks on government agencies and hospitals present the danger of a more physical kind of harm.

“All of these things create a very obvious potential for lives to be lost,” Brett Callow, a threat analyst at the cybersecurity firm Emsisoft, told me.

[…]

The state of the attacks

While there has been a reported slowdown in ransomware attacks from 2021 to 2022, overall attacks on U.S. hospitals doubled between 2016 and 2021, according to one study. Emsisoft has tracked nearly 200 ransomware attacks on the public sector since the start of last year.

Attacks on local government agencies and hospital systems are among the most worrying in the current battle against ransomware, Megan Stifel, a co-chair of the joint public-private Ransomware Task Force, told me last week.

And federal officials say many ransomware attacks go unreported, so the accuracy of any tallies are lacking. A bill signed into law last year would require critical infrastructure owners and operators to report to the federal government when they suffer major cyber incidents or make ransomware payments. The law’s definition of covered entities required to report would include critical government facilities owned by state, local and federal governments, but the Cybersecurity and Infrastructure and Security Agency is still writing the regulations that fill out more details.

And while there’s evidence that ransomware victims are growing less willing to pay to unlock their systems, some still do. San Bernardino County, Calif., officials acknowledged last week that the county paid ransomware operators $1.1 million to free up sheriff’s department computers. A county spokesperson, David Wert, told KCAL News that “insurance covers most of the payment.”

The fact that ransomware gangs are still getting paid is “why these attacks keep on happening,” Callow said.

“All of these incidents, whether involving health care, police or other emergency services, do put lives at risk,” Callow said. “If lives haven’t already been lost because of ransomware attacks, it’s inevitably only a matter of time until they will be.”

There’s more in there about the effect of ransomware attacks on police and hospitals, so go read the rest. This is the sort of thing for which there ought to be a large pile of federal money made available, to local and state governments, to school districts, to hospitals, to utilities and waste management sites, all for the purpose of upgrading their cybersecurity capabilities. Mostly because a lot of these entities are overworked and under-resourced, they often make easy and enticing targets for ransomware gangs. The potential harms are great, and we’re just not doing enough to mitigate them.

More than just money is needed, of course – you need people who know how to implement the software and manage the systems and deal with alerts and incidents and so forth. Believe me, it’s a big undertaking and we need a lot more people doing this kind of work. Which raises a whole ‘nother set of issues, about school curricula and how we bring women and people of color and other under-represented groups into this profession and them keep them there, as well as immigration because we’re going to need to import some of these people, but all that is beyond my scope here. Point is, you ought to check and see how your city or county or school district is doing with its cybersecurity. Better to ask now than find out the hard way later.

More plaintiffs join lawsuit against Texas over abortion restrictions

Good.

One woman had to carry her baby, missing much of her skull, for months knowing she’d bury her daughter soon after she was born. Another started mirroring the life-threatening symptoms that her baby was displaying while in the womb. An OB-GYN found herself secretly traveling to Colorado to abort her wanted pregnancy, marred by the diagnosis of a fatal fetal anomaly.

All of the women were told they could not end their pregnancies in Texas, a state that has enacted some of the nation’s most restrictive abortion laws.

Now, they’re asking a Texas court to put an emergency hold on some abortion restrictions, joining a lawsuit launched earlier this year by five other women who were denied abortions in the state, despite pregnancies they say endangered their health or lives.

More than a dozen Texas women in total have joined the Center for Reproductive Rights’ lawsuit against the state’s law, which prohibits abortions unless a mother’s life is at risk — an exception that is not clearly defined. Texas doctors who perform abortions risk life in prison and fines of up to $100,000, leaving many women with providers who are unwilling to even discuss terminating a pregnancy.

“Our hope is that it will allow physicians at least a little more comfort when it comes to patients in obstetrical emergencies who really need an abortion where it’s going to effect their health, fertility or life going forward,” Molly Duane, the lead attorney on the case, told The Associated Press. “Almost all of the plaintiffs in the lawsuit tell similar stories about their doctors saying, if not for this law, I’d give you an abortion right now.”

The lawsuit serves as a nationwide model for abortion rights advocates to challenge strict new abortion laws states that have rolled out since the Supreme Court overturned Roe v. Wade last year. Sixteen states, including Texas, do not allow abortions when a fatal fetal anomaly is detected while six do not allow exceptions for the mother’s health, according to an analysis by KFF, a health research organization.

Duane said the Center for Reproductive Rights is looking at filing similar lawsuits in other states, noting that they’ve heard from women across the country. Roughly 25 Texas women have contacted the organization about their own experiences since the initial lawsuit was filed in March.

See here and here for more on the original lawsuit. A copy of the amended suit, which will be heard in Travis County, is here. The story has details about several of the new plaintiffs – as we have seen, too many times before, these were wanted pregnancies that ran into deadly complications, and the effect on these women because of the strict restrictions on what doctors can do now is harrowing – with more about them here. I haven’t seen any further coverage of this yet, which annoys me. There was a brief moment, in the 2022 campaign and at the beginning of the legislative session, when there were a few words spoken by Republicans about maybe softening the super-strict bans just a little, to include rape and incest exceptions and clarify the “life/health of the mother” situation. That got shot down by the usual suspects, and instead we get some more anti-abortion crap, this time being slipped into a bill to extend Medicaid coverage to 12 months for new mothers. So yeah, I’m very invested in this litigation. The press release from the Center for Reproductive Rights is here, and they have more in their Twitter thread.

FDA approves RSV vaccine

Good.

After a 60-year scientific quest, the world has its first vaccine to protect against respiratory syncytial virus, or RSV – and more are on the way.

On Wednesday, the US Food and Drug Administration approved Arexvy, made by GSK, which is designed to be given as a single shot to adults 60 and older.

It could be available for seniors as soon as this fall, pending a recommendation for its use from the US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, which next meets in June.

“Older adults, in particular those with underlying health conditions, such as heart or lung disease or weakened immune systems, are at high risk for severe disease caused by RSV,” said Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, in a statement. “Today’s approval of the first RSV vaccine is an important public health achievement to prevent a disease which can be life-threatening and reflects the FDA’s continued commitment to facilitating the development of safe and effective vaccines for use in the United States.”

Although RSV is a disease that’s often associated with babies and young children, it can also be dangerous for seniors. In the US, an estimated 159,000 adults 65 and older are hospitalized each year with RSV, and an estimated 10,000 to 13,000 die as a result of their infection.

“RSV certainly is an important disease in the elderly. In some years, the burden of RSV disease comes close to the burden of flu in the elderly. And this is really a wonderful development,” said Dr. Ruth Karron, a professor of international health at Johns Hopkins Bloomberg School of Public Health, who was not involved in the development of the vaccine.

[…]

Three other RSV vaccines for older adults are also in the final phases of testing.

The FDA is expected to make a decision on Pfizer’s RSV vaccine for older adults by the end of May. The agency is also reviewing Pfizer’s maternal vaccine to protect infants and is expected to make a call on that one by the end of August.

Moderna is finishing its Phase 3 trial of an mRNA vaccine for RSV in older adults and expects to submit the results to the FDA for approval within the next few months.

Bavarian Nordic, maker of the Jynneos mpox vaccine, says it will report results from a Phase 3 trial of its RSV vaccine for older adults this year.

Paul Chaplin, president and CEO of Bavarian Nordic, says there’s a saying in Britain that you’ll wait a long time for a bus, and then four will show up at once. The race to the finish line for an RSV vaccine is a little bit like that, he says.

“We’ve been waiting decades for a safe effective RSV vaccine, and there’s been numerous attempts that have failed,” Chaplin said.

“And I know GSK will likely get the first approval, but there are others coming through, including us. And I just think it’s fantastic, because RSV is a huge unmet medical need that a lot of people underestimate the importance of, and we will hopefully now have a number of effective vaccines that will help protect people.”

We’ve discussed RSV before, often in the context of other viruses. I’m a few years away from being in the group of people for whom this vaccine is recommended, but who knows, that could change any time. I’m glad we’ll have this option. The story of how we got to where we are, and the disastrous first attempt at an RSV vaccine in the 60s, is worth your time to read. And if you are in that group that ought to get this shot, please do yourself the favor and do it.

Feds rebuke hospitals that didn’t do emergency abortions

Relevant to our interests.

Two hospitals that refused to provide an emergency abortion to a pregnant woman who was experiencing premature labor put her life in jeopardy and violated federal law, a first-of-its-kind investigation by the federal government has found.

The findings, revealed in documents obtained by The Associated Press, are a warning to hospitals around the country as they struggle to reconcile dozens of new state laws that ban or severely restrict abortion with a federal mandate for doctors to provide abortions when a woman’s health is at risk. The competing edicts have been rolled out since the Supreme Court overturned the constitutional right to an abortion last year.

But federal law, which requires doctors to treat patients in emergency situations, trumps those state laws, the nation’s top health official said in a statement.

“Fortunately, this patient survived. But she never should have gone through the terrifying ordeal she experienced in the first place,” Health and Human Services Secretary Xavier Becerra said. “We want her, and every patient out there like her, to know that we will do everything we can to protect their lives and health, and to investigate and enforce the law to the fullest extent of our legal authority, in accordance with orders from the courts.”

The federal agency’s investigation centers on two hospitals — Freeman Health System in Joplin, Missouri, and University of Kansas Hospital in Kansas City, Kansas — that in August refused to provide an abortion to a Missouri woman whose water broke early at 17 weeks of pregnancy. Doctors at both hospitals told Mylissa Farmer that her fetus would not survive, that her amniotic fluid had emptied and that she was at risk for serious infection or losing her uterus, but they would not terminate the pregnancy because a fetal heartbeat was still detectable.

Ultimately, Farmer had to travel to an abortion clinic in Illinois.

“It was dehumanizing. It was terrifying. It was horrible not to get the care to save your life,” Farmer, who lives in Joplin, said of her experience. “I felt like I was responsible to do something, to say something, to not have this happen again to another woman. It was bad enough to be so powerless.”

Farmer’s complaints launched the first investigations that the Centers for Medicare & Medicaid Services, or CMS, has publicly acknowledged since Roe v. Wade was overturned last year. Across the country, women have reported being turned away from hospitals for abortions, despite doctors telling them that this puts them at further risk for infection or even death.

[…]

Nationwide, doctors have reported uncertainty around how to provide care to pregnant women, especially in the nearly 20 states where new laws have banned or limited the care. Doctors face criminal and civil penalties in some states for aborting a pregnancy.

But in a letter sent Monday to hospital and doctors associations that highlights the investigations, Becerra said he hopes the investigations clarify that the organizations must follow the federal law, the Emergency Medical Treatment and Labor Act, or EMTALA.

As you may recall, EMTALA has been the subject of contradictory court rulings, which likely gives it an eventual date before SCOTUS. The status of that federal law, which now depends on where you are, and its inherent conflict with various draconian state laws, surely contributes to confusion over what is and is now allowed, but it’s not just about confusion. It’s also about the very understandable reluctance of doctors and hospitals to put themselves on the line for a potential murder charge and life in prison when they’re not 100% sure they’re in the clear. As we have said many times, the vagueness and broadness of many state laws is intentional. We have that lawsuit in Texas that seeks clarity on these matters, and that will be of great importance when it comes to a courtroom. In the meantime, a strong push by the CMS to ensure access where it can is appreciated. We need much more than that, but as of right now that’s about the best we can hope for.

Harris Health seeks bond issue

Probably on your ballot this November.

Harris Health board members on Thursday unanimously agreed to move forward with a $2.5 billion bond proposal to build a new Lyndon B. Johnson Hospital and make what they say are sorely needed upgrades throughout the county’s public health care system, which treats the region’s poor and uninsured.

The board next will seek approval from Harris County commissioners, who will have the final say on the bond amount and whether the proposal will be placed on the November ballot. The proposed bond would finance the project over 10 years, with an additional $300 million in county funds and $100 million in grants and philanthropy.

The health system has struggled to keep up with population growth, officials say, and the major expansion is necessary to handle the projected increase in uninsured patients who rely on Harris Health for care. During Thursday’s board meeting, Harris Health CEO Dr. Esmaeil Porsa choked up as he recounted seeing patients being treated in hallways during his regular walks around LBJ hospital.

“That should not be happening,” he said. “That is not equitable health. We should not expose our patients and our employees to this situation on a daily basis.”

Both Harris Health hospitals — LBJ and Ben Taub — opened more than 30 years ago at their current locations. Since then, the county’s population has increased from roughly 2.7 million to 4.7 million, with a quarter of those residents lacking insurance. In addition to a new, larger hospital on the existing LBJ campus in northeast Houston, the project would include a major expansion of the current facilities and three new outpatient centers.

Located at 5656 Kelley St., just north of Kashmere Gardens, LBJ hospital is the busiest Level III trauma center in the state with more than 80,000 annual patient visits, according to the health system.

The new hospital would become the county’s third Level I adult trauma center and the first outside the Texas Medical Center. A Level I designation provides the most comprehensive care for injuries, including 24-hour coverage by general surgeons and a broader availability of specialty services. The American College of Surgeons recommends at least one Level 1 trauma center for every million people.

The new LBJ would expand the number of inpatient beds from 215 to 390, with room to add another 60, and allow for the beds to be used for interchangeable needs, according to planning documents. The building adds capacity for patients under observation and includes a helipad for those who need to be transported by air. Additional parking garages will be built on the campus.

The current LBJ would undergo $433 million in renovations “to address critical service gaps” and provide more outpatient services, planning documents say. A renovation at Ben Taub would add a new inpatient tower with 120 patient rooms and extend the facility’s life span by 15 years. Low-volume outpatient centers would be expanded, and three new outpatient centers would be built in east, northwest and southwest Harris County.

Seems like some long overdue business to me. This does still need to be approved by Commissioners Court before it can be placed on the ballot, but I would expect that to be a formality. As is often the case with these things, I’ll be interested to see if there’s any organized opposition to it.

Another “future doctor shortage” article

Third in the series. This one covers our future nurse shortage, too.

More than a year and a half after Texas implemented its six-week abortion ban, and months after Dobbs, medical providers say they are facing impossible situations that pit their ethical obligation to patients who are dealing with traumatic and dangerous pregnancy complications against the fear of lawsuits, loss of their medical licenses, and incarceration. The problem is encapsulated by a lawsuit filed this month in Texas, in which five women and two OB-GYNs sued the state over the abortion bans that they say have created so much confusion and fear among providers that it has affected women’s health and even threatened their lives. Unsure of how to comply with the new rules, hospitals have interpreted them differently, with some requiring approval from attorneys or ethics boards for physicians to provide abortion care in medical emergencies, and others leaving it up to individual doctors, with little guidance or support. This has meant that some physicians wait until patients are near death to intervene in medical emergencies, according to recent research, court filings, news reports, and interviews. “I’ll get consults from another doctor asking me what to do in a particular case—a mother bleeding, or a pregnancy where there’s an infection in the womb before the baby can survive outside the womb. I have doctors calling me, hesitating, not quite knowing what to do because the baby has a heartbeat, when clearly the mother’s life is at risk,” John Visintine, a maternal fetal medicine specialist in McAllen, Texas, told me. “These are things that I haven’t seen in, you know, 20 years of practicing OB, 14 years of practicing high-risk OB—I’ve never run into these situations where people are wondering what to do.”

The inability to provide what they say is the standard of care to pregnant patients is taking a toll, personally and professionally, according to interviews with more than a dozen doctors and nurses across Texas. And it’s causing many, like Wilson, to reconsider the future of their career in the state. Almost every provider I spoke with for this story has thought about leaving their practice or leaving Texas in the wake of S.B. 8 and Dobbs. Several have already moved or stopped seeing patients here, at least in large part because of the abortion bans. “If I was ever touch a patient again, it won’t be in the state of Texas,” said Charles Brown, chair of ​​the Texas district of the American College of Obstetricians and Gynecologists (ACOG), who stopped seeing patients last year after decades working as a maternal fetal medicine specialist. Many asked that their hospital affiliation not be included in this story, in some cases because they feared consequences from their employer or the public for speaking out about these laws, even though they’re not breaking them. Some worry about what will happen to their own kids if they are targeted. Several cried through the interviews. Many of those I spoke with who haven’t left yet are still thinking about it regularly—people who have family and homes and lives in Texas and would not otherwise have considered moving.

Brown put the stakes bluntly: “Are people quitting? … The answer is yes,” he said. “I hope I’m 100 percent wrong about this, but I think it’s a much bigger trend that’s going to become obvious pretty quickly.”

[…]

This is all happening as Texans can’t afford to lose more access to medical care. In 2022, 15 percent of the state’s 254 counties had no doctor, according to data from the state health department, and about two-thirds had no OB-GYN. Texas has one of the most significant physician shortages in the country, with a shortfall that is expected to increase by more than 50 percent over the next decade, according to the state’s projections. The shortage of registered nurses, around 30,000, is expected to nearly double over the same period. Already, Texans in large swaths of the state must drive hours for medical careincluding to give birth. According to recent research from the nonprofit March of Dimes, it is among the worst states for maternity care access, which has decreased in a dozen Texas counties in the past two years, mostly due to a loss of obstetrics providers.

This doesn’t yet take into account the effects of increased criminalization of abortion care, which is further compounded by dramatic pandemic-induced burnout among clinicians. As physicians retire, hospitals are struggling to replace them; as nurses burn out or leave for more lucrative travel nursing roles, their positions are sitting open. There have been a string of policies and factors that have stretched providers in Texas for many years, from having the highest uninsured rate in the country to low Medicaid reimbursement rates to the demonization of science to attacks on transgender health care, and now the abortion bans, according to Tom Banning, the CEO of the Texas Academy of Family Physicians. “The first rule of holes, when you’re trying to get out of the hole, is to stop digging,” he said. “We just continue to dig the hole that we’re in deeper.”

This is an issue for both urban and rural areas, but it’s felt most acutely outside major metros, where one retirement or move can be the difference between having access to medical care near home or having to drive an extra several hours. The state has experienced the most rural hospital closures in the country in recent years. Less than half of rural hospitals nationwide still have labor and delivery services, according to recent research from the Chartis Center for Rural Health; in Texas, that number is just 40 percent. John Henderson, the president and CEO of the Texas Organization of Rural and Community Hospitals, said he gave a presentation this fall for a group of representatives from about 100 rural Texas hospitals where he asked them to raise their hand if they don’t currently have openings for registered nurses. “There were three out of 100 that were fully staffed, and I was actually surprised that there were three,” he said. “It’s crisis-level staffing for the majority of rural Texas hospitals.” Maternity wards have long been the sacrificial lamb for cash-strapped rural hospitals trying to save money and keep their doors open, but more recently, it’s short staffing that has forced closures and cuts to services in Texas and across the country.

See here and here for the previous entries. The problems with rural hospitals and the general unavailability of maternity care are separate but related phenomena. I realize that the plural of “anecdote” isn’t “data”, but there sure are a lot of anecdotes, and some of them do come with data, so.

It is of course possible that none of this gets beyond the anecdote stage. Some of the people quoted in the story admit that it’s tough to leave even as they get pushed past what they thought their point of tolerance was. Maybe the effect will only be truly felt in rural areas where they keep on voting for the Republicans that create and exacerbate these problems for them. Maybe it’s dumb to expect Republicans to feel the consequences for any of their actions, given that they haven’t felt them for the freeze or for the continued epidemic of mass shootings. I don’t know what’s going to happen. But as long as these stories keep getting written, I’ll keep pointing them out.

More on the lawsuit that seeks to clarify exceptions to Texas’ forced birth laws

A couple of interesting articles to read to enhance our understanding of the lawsuit filed by five women who claim that Texas’ anti-abortion laws have harmed them.

From Vox:

In theory, even after the Supreme Court’s anti-abortion decision in Dobbs v. Jackson Women’s Health Organization (2022), medically necessary abortions remain legal in all 50 states. Texas law, for example, is supposed to permit abortions when a patient is “at risk of death” or if they face “a serious risk of substantial impairment of a major bodily function.”

There’s also a federal law, the Emergency Medical Treatment and Labor Act (EMTALA), which requires most hospitals to perform emergency abortions to prevent “serious impairment to bodily functions” or “serious dysfunction of any bodily organ or part.” (Though, notably, Texas’s GOP attorney general, Ken Paxton, convinced a Trump-appointed judge to issue an opinion claiming that this federal abortion protection does not exist.)

But in practice, the new lawsuit claims, Texas physicians are often too terrified to perform likely legal abortions because the consequences of performing an abortion that the courts later deem to be illegal are catastrophic. The maximum penalty for performing an illegal abortion in Texas is life in prison.

This lawsuit, known as Zurawski v. Texas, asks the state courts to clarify when medically necessary abortions are legal within the state so that doctors can know when they can treat their patients without risking a prison sentence or a lawsuit.

[…]

These plaintiffs argue in their complaint that one reason why Texas doctors are unwilling to perform abortions, even when delaying an abortion risks a patient’s life, is that Texas law is a hodgepodge of multiple abortion bans, each with inconsistent provisions permitting abortions when a patient’s life or health is in danger, and none of which use medical terminology that doctors can rely upon to know exactly what they are and are not permitted to do.

Texas’s primary criminal ban on abortions, for example, provides that abortions are permitted when “in the exercise of reasonable medical judgment” a physician determines that their patient “has a life-threatening physical condition” or faces a “serious risk of substantial impairment of a major bodily function” that relates to their pregnancy.

Meanwhile, a separate statute, enacted before Roe v. Wade was decided in 1973, also bans abortions. And it does so with a much narrower exception for abortions performed “for the purpose of saving the life of the mother.” But it’s unclear whether, now that the Supreme Court has overturned Roe, this law remains in effect or not. While a federal appeals court determined in 2004 that this pre-Roe ban on abortions was “repealed by implication,” Attorney General Paxton claimed that the law is still enforceable after Roe was overruled.

And then there’s SB 8, the state’s bounty hunter law, which permits private citizens to sue doctors who perform abortions after the sixth week of pregnancy. That statute uses completely different language to describe when an abortion is allowed, permitting abortions “if a physician believes a medical emergency exists that prevents compliance” with SB 8.

Most of these statutes, moreover, were enacted when Roe was still good law. So there are few, if any, court decisions interpreting them, explaining how the multiple conflicting exceptions to the multiple different abortion bans interact with each other, or resolving disputes about which laws are actually in effect.

Typically, lawyers rely on past court decisions to predict how courts are likely to apply a statute to their clients. But, without many (or any) such decisions to rely upon, lawyers advising doctors and hospitals cannot provide reliable advice to those clients. And, again, if a doctor and their attorneys guess wrong about whether a particular abortion is legal, that doctor could wind up spending the rest of their life behind bars.

See here, here, and here for more on EMTALA, which is likely to end up before SCOTUS eventually. Author Ian Millhiser speculates about the possibility that the Zurawski case could clarify state law, but he has his doubts. Which leads us to this Slate story.

Make no mistake about it: Texas’ law has unique problems. The state’s conservative lawmakers kept the pre-Roe criminal ban passed in 1925; to circumvent Roe v. Wade, they passed S.B. 8. In 2021, after Donald Trump reshaped the Supreme Court, they passed a trigger law. Inconsistencies crept in, and the result is a mess that frightens doctors away from addressing real emergencies.

But the problems with Texas’ exceptions are broader, and they tell a story about why abortion exceptions as a general matter fail to protect patients. From the time of previous eras’ abortion bans, exceptions were tailored more to prevent free access to the procedure than to address real problems in pregnancy, and state abortion laws today are no exception.

When abortion reform efforts got underway in the 1960s, the American Law Institute proposed what amounted to a menu of exceptions to criminal abortion bans for patients seen to be innocent enough to deserve abortion (the ALI included exceptions for rape and incest, fetal abnormality, and certain health threats). Pushback from anti-abortion lawyers was immediate. They argued not just that abortion was immoral and unconstitutional, but also that the exceptions were an open invitation for fraud. Decades before Todd Akin’s comments about “legitimate rape,” they argued that pregnancy after sexual assault was all but impossible—and that rape exceptions were an excuse for promiscuous women. They framed health exceptions as universally unnecessary, arguing that virtually no pregnancies were life-threatening.

After Roe, anti-abortion suspicion of patients invoking exceptions only deepened. They pointed to Roe’s companion case, Doe v. Bolton, that defined health to include physical and mental well-being. For abortion opponents, that looked like an exception that could swallow the rule: wouldn’t anyone forced to remain pregnant suffer mental distress?

So after Congress passed the Hyde Amendment, a ban on Medicaid reimbursement for abortion in 1976, anti-abortion legislators worked to make it harder for patients to invoke exceptions or to eliminate them altogether. Sexual assault victims, for example, had to report to law enforcement within a certain time frame, and some Hyde proponents voted to eliminate all rape and incest exceptions.

Anti-abortion activists began using a similar strategy in model laws designed to chip away at Roe. For example, in the Pennsylvania law considered by the Supreme Court in Planned Parenthood of Pennsylvania v. Casey, anti-abortion groups proposed a medical emergency exception only to save a patient’s life or “create serious risk of substantial and irreversible impairment of major bodily function.”

The similarity to Texas’ law is no accident. For the anti-abortion movement, the narrow and ambiguous language adopted by Pennsylvania in the 1980s, and by Texas more recently, reflects the same beliefs: The most important issue is preventing abortion, and exceptions serve primarily to discourage what Republicans see as unjustified procedures. But the justifications of many plaintiffs are all too obvious. One patient diagnosed with “preterm prelabor rupture of membranes” was denied care, developed sepsis, nearly died, and suffered lasting impacts to her future fertility; another, pregnant with twins, was forced to travel out of state to maximize the chances of survival for herself and one of the twins when the second received a devastating diagnosis. These stories will almost certainly continue in Texas and states like it.

In other words, to borrow from a bit of wisdom that has been applied to the Trump regime, the lack of clarity is the point. We don’t know what the courts will make of this, but we can expect that Ken Paxton and the rest of the forced birth machinery will do everything in their power to keep threatening everyone who might try to get an abortion for any reason. You know what I’m going to say here, so say it with me: Nothing will change until we start winning more elections.

Five women harmed by Texas’ anti-abortion law file a lawsuit over it

Well, this ought to be interesting.

Five women who say they were denied abortions despite grave risks to their lives or their fetuses sued the state of Texas on Monday, apparently the first time that pregnant women themselves have taken legal action against the bans that have shut down access to abortion across the country since the U.S. Supreme Court overturned Roe v. Wademe.

The women — two visibly pregnant — plan to tell their stories on the steps of the Texas Capitol on Tuesday. Their often harrowing experiences will put faces to what their 91-page complaint calls “catastrophic harms” to women since the court’s decision in June, which eliminated the constitutional right to abortion after five decades.

Their accounts may resonate with public opinion, which generally supports legalized abortion and does so overwhelmingly when a pregnancy endangers the woman’s life. The lawsuit, backed by the Center for Reproductive Rights, comes as the country grapples with the fallout from overturning Roe, with abortion banned in at least 13 states.

Texas, like most states with bans, allows exceptions when a physician determines there is risk of “substantial” harm to the mother, or in cases of rape or incest, or if the fetus has a fatal diagnosis. Yet the potential for prison sentences of up to 99 years, $100,000 fines and the loss of medical licenses has scared doctors into not providing abortions even in cases where the law would seem to allow them.

The suit asks the court to affirm that physicians can make exceptions, and to clarify under what conditions. But its greater power may be in appealing to public opinion on abortion. Similar lawsuits over exceptions, focusing public attention on stories of women who were denied abortions despite medical dangers, helped build momentum for legalized abortion in heavily Catholic Ireland and in South America.

The women bringing the suit contradict stereotypes about who receives abortions and why. Married, and some with children already, the women rejoiced at their pregnancies, only to discover that their fetuses had no chance of survival — two had no skulls, and two others were threatening the lives of their twins.

Though they faced the risk of hemorrhage or life-threatening infection from carrying those fetuses, the women were told they could not have abortions, the suit says. Some doctors refused even to suggest the option, or to forward medical records to another provider.

The women found themselves furtively crossing state borders to seek medical treatment outside Texas, worried that family and neighbors might report them to state authorities. In some cases, the women became so ill that they were hospitalized. One plaintiff, Amanda Zurawski, was told she was not yet sick enough to receive an abortion, then twice became septic, and was left with so much scar tissue that one of her fallopian tubes is permanently closed.

“You don’t think you’re somebody who’s going to need an abortion, let alone an abortion to save my life,” Zurawski, 35, said. “If anybody reads my story, I don’t care where they are on the political spectrum, very few people would agree there is anything pro-life about this.”

[…]

Unlike other suits from abortion rights groups, the Texas suit does not seek to overturn the state bans on abortion. Instead, it asks the court to confirm that Texas law allows physicians to offer abortion if, in their good-faith judgment, the procedure is necessary because the woman has a “physical emergent medical condition” that cannot be treated during pregnancy or that makes continuing the pregnancy unsafe, or the fetus has a condition “where the pregnancy is unlikely to result in the birth of a living child with sustained life.”

The women are not suing the medical providers who denied abortions, and the providers are not named in the suit; in most cases, the women say the providers were doing the best they could, but had their hands tied.

The Texas Medical Association has appealed to state authorities to offer more clarity on what exceptions are allowed. The author of one of the bans wrote to the state medical board in August, concerned that hospitals “may be wrongfully prohibiting or seriously delaying physicians from providing medically appropriate and possibly lifesaving services to patients who have various pregnancy complications.” He underscored that under the exceptions, hospitals had to protect the “mother’s life and major bodily function.”

The lawsuit says the five plaintiffs “represent only the tip of the iceberg,” and that “millions” of people across the country have been “denied dignified treatment as equal human beings.”

As the story notes, it is a reprint of a New York Times article. I don’t know who has what stereotypes about who gets abortions, but none of this surprises me. I’ve been saying all along that it’s just a matter of time before some nice white married lady, like one of these plaintiffs, dies from being unable to get timely medical care as a result of Texas’ anti-abortion law. One of these plaintiffs spent three days in intensive care with sepsis because abortion care was denied to her. No one should have to go through that.

I’m wondering what the state’s defense will be. My best guess is that they will claim that the law is clear as written and that if these women were unlucky enough to have incompetent doctors that’s their problem. The Republicans really don’t want there to be any clear lines about when an abortion is allowed, because the lack of clarity serves their purpose of forcing women to give birth.

Also, these women are going to get smeared, doxxed, threatened, harassed, and so on. Can’t be having them speaking out about their experiences, that’s just not allowed.

I’m not going to be foolish enough to make any predictions here. I will say that if these plaintiffs win, it will have only a marginal effect, in that their situations are relatively rare. The total number of abortions that would be allowed if they win will be minimal – basically, this is a “life/health of the mother” exception. Rape and incest are still not acceptable reasons for an abortion, and of course elective abortions are still criminalized. It would be significant in that the risk of death or serious health consequences would be mitigated, and that’s a big deal, but it will be limited. For now, that’s the best we can do. Axios, NPR, the Trib, Daily Kos, The 19th, the Current, and Slate have more.

Emergency miscarriage care

Here’s another thing most of us have not had to think much about in the past when abortion was generally legal.

[A uterine aspiration (also commonly known as a D&C) or the removal of tissue from the uterus via suction] is a standard method for treatment of miscarriage and can be a life-saving intervention if a woman is hemorrhaging. But uterine aspiration is also routinely used to perform early abortions, and that’s one reason many emergency departments have historically resisted efforts to make the option available to patients who come in for miscarriage-related care.

That care already accounts for more than 900,000 emergency room visits every year, according to the most recent estimates. Now, as states move to restrict access to abortion in the wake of the Supreme Court’s decision in June to overturn Roe v. Wade, experts say that number is likely to surge even higher.

Fewer abortions will mean more pregnancies, and more pregnancies will mean more miscarriages,” said Dr. Sarah Prager, a professor of obstetrics and gynecology at the University of Washington and a co-author of the guidelines on miscarriage management for the American College of Obstetricians and Gynecologists.

Around 15% of known pregnancies end in miscarriage, and the first medical professional many of those patients see will be in an emergency room. Yet, by and large, she says, “emergency medicine physicians aren’t trained in managing miscarriage and don’t see it as something they should own.”

For more than a decade, Prager has been trying to change that through her work with the TEAMM Project, the nonprofit she co-founded on the premise that “many people experience miscarriage before they’re established with an OB-GYN.” Short for Training, Education and Advocacy in Miscarriage Management, TEAMM has conducted in-person workshops for clinicians at more than 100 sites in 19 states on all aspects of miscarriage care — everything from the use of ultrasound to diagnose fetal death to the three treatment options miscarrying patients should be offered when they come in for care.

A uterine aspiration is recommended when patients are bleeding heavily, are anemic, or are medically fragile, and many patients prefer the procedure because it can resolve a miscarriage most quickly. Another option is medication — usually mifepristone followed by misoprostol — which can help the body expel pregnancy tissue in a matter of hours. And the third is “expectant management”: waiting for the tissue to pass on its own. The latter can take several weeks and is unsuccessful for about 20% of patients, who remain at risk for hemorrhage and have to return to the hospital for surgery or medication.

In many emergency departments, expectant management has long been the only option made available. But now, amid the legal uncertainty unleashed by the fall of Roe, Prager and colleagues say they’ve been inundated with inquiries from emergency departments across the country. Doctors in states that have since criminalized abortion face stiff penalties, including felony charges, prison time, and the loss of their medical license and livelihoods.

“I think they’re scared,” says Prager. “They want to be able to know, with 100% certainty, that a pregnancy is no longer viable.”

This is why I say it’s just a matter of time before some nice white suburban lady who already has kids dies because she isn’t treated for a pregnancy-related emergency in a timely fashion. The corollary to this is that some doctor who performs a life-saving D&C on a patient will be arrested and charged with murder for it. I don’t want to see these things happen. It’s just that the conditions in our state, and in too many other states, are absolutely ripe for it. I really hope I’m wrong.

New year, new omicron variant

Stay safe out there.

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

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

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

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

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

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

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

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

It’s winter surge time again

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


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

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

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

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

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

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

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

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

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

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

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

Beware of RSV

Worrying.

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

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

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

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

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

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

[…]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[…]

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

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

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

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

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

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

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

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

Is this just the calm before the next COVID wave?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The wastewater is looking good now

In terms of COVID levels, anyway.

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

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

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

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

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

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

The new county COVID risk assessment system

We’ll see how it works.

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

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

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

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

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

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

[…]

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

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

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

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

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

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

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

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

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

“Safe haven” laws are also not a replacement for abortion

Continuing a theme.

What are safe haven laws?

flurry of Houston baby abandonments in the ’90s led Texas to become the first state to enact a safe haven law in 1999.

Created as an incentive for parents in crisis who are unable to care for their newborns, the law allow parents to drop off babies 60 days or younger at any hospital, fire station or EMS station in the state, no questions asked.

The baby will then be protected and given medical care until a permanent home is found. Provided the baby arrives unharmed and safe, the parents avoid prosecution for abandonment or neglect.

Do people actually use the laws?

Roughly 400,000 babies are born in Texas each year, but data shows that a small fraction of people actually utilize the option.

Just 172 infants have been relinquished under the state’s safe haven law since 2009, according to data from the Department of Family and Protective Services.

Why?

Most families have likely never heard of it, said Sheila M. Katz, a sociology professor at the University of Houston.

This is especially true for middle- and low-income families who may not have the “extra bandwidth” to explore something until they’re in the situation, Katz said.

[…]

Katz said safe haven laws are “very good” at doing what they’re designed to do, but weren’t created to be an option for people unwilling to continue pregnancies.

“It’s taking a law and trying to make it look like a band-aid for bigger issues,” she said.

“If a woman is in an unhealthy relationship and decides to get an abortion to sever ties,” Katz added, “a safe haven law will not help in this situation.”

Or, to put it another way, people who choose to get abortions do so because they don’t want to be pregnant. There’s a separate decision made about what to do after giving birth once that one has been made. The impression I get is that the kind of person who would dump a baby at a fire station is someone who felt truly desperate and trapped and without any other option. While it is very likely that the post-Dobbs criminalization of abortion in Texas will increase that population, the availability of abortion pills and the still-robust abortion access network may mitigate that. I could be wrong, of course – we may in fact see enough of an increase in that population to drive an equivalent increase in the number of babies getting deposited at these locations. If you think that’s something to cheer about, well, you know what I think of you.

A different EMTALA ruling in Idaho

As expected. You know where this goes from here.

A federal judge on Wednesday blocked Idaho from enforcing a ban on abortions when pregnant women require emergency care, a day after a judge in Texas ruled against President Joe Biden’s administration on the same issue.

The conflicting rulings came in two of the first lawsuits over Biden’s attempts to keep abortion legal after the conservative majority U.S. Supreme Court in June overturned the 1973 Roe v. Wade decision that legalized the procedure nationwide.

Legal experts said the dueling rulings in Idaho and Texas could, if upheld on appeal, force the Supreme Court to wade back into the debate.

[…]

In Idaho, U.S. District Judge B. Lynn Winmill agreed with the U.S. Department of Justice that the abortion ban taking effect Thursday conflicts with a federal law that ensures patients can receive emergency “stabilizing care.”

Winmill, who was appointed to the court by former Democratic President Bill Clinton, issued a preliminary injunction blocking Idaho from enforcing its ban to the extent it conflicts with federal law, citing the threat to patients.

“One cannot imagine the anxiety and fear (a pregnant woman) will experience if her doctors feel hobbled by an Idaho law that does not allow them to provide the medical care necessary to preserve her health and life,” Winmill wrote.

The Justice Department has said the federal Emergency Medical Treatment and Labor Act requires abortion care in emergency situations.

“Today’s decision by the District Court for the District of Idaho ensures that women in the State of Idaho can obtain the emergency medical treatment to which they are entitled under federal law,” U.S. Attorney General Merrick Garland said in a written statement.

“The Department of Justice will continue to use every tool at its disposal to defend the reproductive rights protected by federal law,” Garland said. The DOJ has said that it disagrees with the Texas ruling and is considering next legal steps.

See here for the background. TPM goes deeper into the two rulings and also provides copies of them, but the bottom line is that the Texas judge said that the federal guidance went too far, didn’t go through the formal rule-change process (even though it was guidance on an existing rule and not a change), didn’t take the rights of the fetus into account, and could only apply when the mother’s life was in danger, not just when her health was threatened. The Idaho judge didn’t do any of that.

Both rulings will be appealed, and as Idaho is in the more liberal Ninth Circuit, there’s a very good chance that this ruling will be upheld. The same is true for Texas, where the radical and lawless Fifth Circuit will get its paws on it. While it is usually the case that a split in the appellate courts means that SCOTUS will weigh in, it seems possible to me that they will duck the issue, perhaps on the grounds that this is really a dispute over state laws, and since the Texas case applies only to Texas, there’s no need for them to step in. I’m just guessing, I could easily be wrong. We’ll know soon enough. DAily Kos has more.

Restraining order granted in Paxton’s EMTALA lawsuit

Ugh.

Texas hospitals will not be required to provide emergency abortions after a federal judge ruled the Biden administration was unauthorized to enforce such a rule.

U.S. District Judge James Wesley Hendrix in Lubbock ruled that the guidance by the U.S. Department of Health and Human Services went beyond the text of a related federal law, Reuters reported. The judge’s ruling agreed with Republican Texas Attorney General Ken Paxton.

Hendrix, who was appointed by former President Donald Trump, only barred federal regulators from enforcing the guidance and its interpretation of the Emergency Medical Treatment and Active Labor Act in Texas, and against two anti-abortion groups of doctors. The judge declined to enjoin the guidance nationwide.

[…]

The Biden administration’s guidance was an attempted response to concerns about the health of pregnant patients being turned away or delayed care by hospitals worried about abortion bans. The Texas Medical Association wrote a letter asking state regulators to “prevent any wrongful intrusion into the practice of medicine.”

See here for the background. At least this time it’s just limited to the state and not nationwide, though of course it’s our effed-up state that needed this to be decided differently. As TPM notes, there’s a similar case in Idaho that may have a ruling by the time you read this, so we’re going to be fighting this out in the appeals courts and then very likely SCOTUS. Joy.

I often say that I Am Not A Lawyer in posts about legal things. I say that in part to make it clear that my analysis is that of a layperson, and one should be wary of accepting my acumen of the finer points of legal theory. But that also frees me to an extent of the concern about the technicalities and lets me just focus on the things that should matter, whether they actually will in a real courtroom or not. As a prime example of this, let’s look at a bit of the judge’s ruling. I’m quoting from that TPM story now:

“That Guidance goes well beyond EMTALA’s text, which protects both mothers and unborn children, is silent as to abortion, and preempts state law only when the two directly conflict,” Hendrix writes.

Siding with the two groups of anti-abortion physicians as well as the state of Texas, Hendrix writes that the HHS guidance requiring physicians to act when the woman’s health is at risk is too generous.

“The Guidance states that EMTALA may require an abortion when the health of the pregnant woman is in serious jeopardy,” he says. “Texas law, on the other hand, limits abortions to when the medical condition is life-threatening, and HLPA goes further to expressly limit the condition to a physical condition,” he adds, referring to Texas’ trigger law that outlaws abortions in most cases.

He argues that the guidance also does away with consideration for the embryo or fetus. The government contends that, when the wellbeing of the woman and embryo or fetus are in conflict, it should be the pregnant patient who decides whether or not to go forth with an abortion. Hendrix says that the decision should be taken out of the woman’s hands and put into the doctor’s — who has to then comply with state law.

He also dips into agency power arguments to hack back the guidance, claiming that Congress has not resolved the specific question at play.

“Specifically, the question at issue here is whether Congress has directly addressed whether physicians must perform abortions when they believe that it would resolve a pregnant woman’s emergency medical condition, irrespective of the unborn child’s health and state law,” he writes. “Congress has not.”

In other words, unless you the doctor who may get prosecuted for murder are sure the pregnant person is going to die, you have to let them suffer. I don’t care about the legal technicalities, I’m here to say that if you’re capable of committing these words to a document, you’re a goddamned sociopath and you have no business having power of any kind. That of course also applies to Ken Paxton and Greg Abbott and every single member of the Legislature who voted for these barbaric laws. It’s what this election is about. And I should note that Slate’s Mark Joseph Stern, who is an actual lawyer, sees this the same way I do. So there. Daily Kos and CNN have more.

At least you’re (probably) not giving birth in West Texas

This is a long story about the lack of prenatal and obstetric care in West Texas. It’s mostly set in Alpine, Presidio, and Big Bend, which are the “big cities” in the area that actually have doctors and medical facilities in them. The one hospital in the area is in Big Bend, and its labor and delivery unit is now closed much of the time, for a variety of reasons. This is a small taste of what it’s like to be pregnant in this part of the state.

Big Bend is the only hospital in a 12,000-square-mile area that delivers babies. If Billings’s patient goes into labor when the maternity ward is closed, she’ll have to make a difficult choice. She can drive to the next nearest hospital, in Fort Stockton, yet another hour away. Or, if her labor is too far along and she’s unlikely to make it, she can deliver in Big Bend’s emergency room. But the ER doesn’t have a fetal heart monitor or nurses who know how to use one. It also doesn’t keep patients overnight. When a woman gives birth there, she’s either transferred to Fort Stockton—enduring the long drive after having just had a baby—or discharged and sent home.

This situation is stressful and dangerous for pregnant women. Uterine hemorrhages, postpartum preeclampsia (a potentially deadly spike in blood pressure), and other life-threatening complications are most likely to occur in the first few days after childbirth. This is why hospitals usually keep new mothers under observation for 24 hours to 48 hours. “This is not the ‘standard of care’ that women should receive,” Billings says. “You’re not supposed to discharge patients and leave it up to chance.”

Big Bend doesn’t really have a choice. In the past two years, almost all its labor and delivery nurses quit. The hospital has tried to replace them, but the national nursing shortage caused by the pandemic has made that impossible. When Big Bend is too short-staffed to deliver a baby safely, its labor and delivery unit has to close.

[…]

Medicaid pays for 42 percent of all hospital births, but it doesn’t reimburse hospitals for the full cost of care. (In most states it pays between 50 cents and 70 cents on the dollar, which means a hospital loses money when it cares for someone on the program.) To offset its losses, a hospital often charges its privately insured patients significantly higher fees. But if it’s in a poor neighborhood and doesn’t have enough privately insured patients, it can’t recoup the money. So most pre-pandemic maternity ward closures were in low-income areas and disproportionately affected pregnant women of color. Pandemic-related nursing shortages have only made the situation worse. Nowhere is this problem more evident than in Texas.

The state is the national leader in maternity ward closures. In the past decade, more than twenty rural hospitals have stopped delivering babies. More than half the state’s rural counties don’t even have a gynecologist. Texas has some of the lowest income eligibility limits for Medicaid and has declined to expand them, as allowed by the Affordable Care Act. (Childless adults don’t qualify for the program unless they’re disabled.) As a result, more than 18 percent of Texans don’t have health insurance, the highest percentage of uninsured residents in the U.S. Income eligibility limits jump for pregnant women—$36,200 for single mothers, $45,600 for married ones—but the application process takes at least a month. According to the March of Dimes, a fifth of all pregnant women in Texas don’t get prenatal care until they’re five months along. In other words, when a poor woman gets pregnant in Texas, it’s hard for her to find a doctor or even a hospital.

“What we’re seeing in terms of health outcomes, it’s not good,” says John Henderson, chief executive officer and president of the Texas Organization of Rural & Community Hospitals. “We have lower birth weights, more preterm births. When it comes to caring for pregnant women and their babies, Texas does not compare favorably to other states.”

Like I said, this is a long story and it’s worth your time to read. I’m old enough to remember when tort “reform”, in particular putting a cap on damage awards that can be given in medical malpractice lawsuits, was supposed to usher in a new era of doctor abundance in Texas. I don’t think that has worked out in the way we were promised. Towards the end, one of the doctors the author spoke to for the story notes that since abortion was already impossible to get in their region, the new state ban on abortion likely won’t result in more babies being born there. These docs will still deal with miscarriages and ectopic pregnancies and other life-threatening situations – they tell some amazing stories – despite the threat to their own safety. Click over and read on for more.

The latest COVID wave may be peaking in Houston

Hopefully

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

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

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

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

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

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

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

[…]

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

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

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

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

[…]

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

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

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

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

We need more monkeypox vaccines

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

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

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

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

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

[…]

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

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

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

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

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

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

The current state of the hospitals

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

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

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

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

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

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

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

[…]

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

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

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

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

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

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

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

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

When abortion is outlawed, pregnant people will be denied health care

It’s already happening.

The Texas Medical Association is asking state regulators to step in after it says several hospitals afraid of violating the state’s abortion ban have turned away pregnant patients or delayed care leading to complications, The Dallas Morning News reported.

In a letter to the Texas Medical Board — the state agency that regulates the practice of medicine — TMA officials on Wednesday said they have received complaints that hospital administrators and their legal teams are stopping doctors from providing medically appropriate care to patients with some pregnancy complications. They ask the board to “swiftly act to prevent any wrongful intrusion into the practice of medicine.”

TMA is a professional nonprofit that represents over 55,000 medical professionals in the state.

The request comes as confusion and concerns abound among Texas medical professionals over what they can and cannot do under Texas’ abortion ban.

Beyond elective abortions, there are several situations in which a doctor might advise an abortion for the safety of the patient — including ectopic pregnancies, in which a fertilized egg grows outside of the uterus, making it unviable — or provide other stabilizing treatments during hypertension and preeclampsia. Delays in treatment can cause serious health complications.

But in a post-Roe world, physicians in states where abortion has been banned have to weigh the legal implications of their actions, instead of making decisions based on what prevailing medical literature recommends. In Texas, doctors can face six-figure fines and be put in jail for any disallowed abortions.

According to the Morning News, the TMA included in its letter examples of some cases in which treatment was denied or delayed but did not name specific hospitals. In Central Texas, a physician was allegedly instructed to not treat an ectopic pregnancy until a rupture occurred, which puts patient health at serious risk, the letter says.

“Delayed or prevented care in this scenario creates a substantial risk for the patient’s future reproductive ability and poses serious risk to the patient’s immediate physical wellbeing,” the letter says.

The TMA letter also accused two other hospitals of telling doctors to turn away pregnant patients and send them home to “expel the fetus” if their water broke too soon, which can put them at risk of infection.

Not only are patients being put at risk of serious injury, but doctors could face lawsuits or the loss of their medical licenses for not providing adequate care, the TMA letter says. Failing to do so might violate the state’s prohibition on the corporate practice of medicine, which generally prohibits corporations or nonphysicians from practicing medicine.

The TMA’s plea comes one day after Texas sued the Biden administration to block new federal guidance reiterating to the nation’s doctors that they’re protected by federal law to terminate a pregnancy as part of emergency treatment.

Yeah, that. Look, I’m sure that was a splendid and appropriately stern letter that the TMA sent to those hospitals and pharmacies. I can’t find a copy of it online, but I believe it said all the right things. You know what would be even better than those words? Some action in the form of supporting candidates that will not sue to stop hospitals and doctors from giving needed treatment to their patients, and will not support the surely forthcoming legislation that will aim to put doctors and nurses and other healthcare workers in jail for providing needed health care to patients. I can think of a few, and I’m sure you can, too. What do you say, Texas Medical Association?

Paxton sues over emergency guidance to doctors

This is what “leaving it to the states” looks like.

Best mugshot ever

Texas is suing the Biden administration over guidance released Monday telling the nation’s doctors they’re protected by federal law to terminate a pregnancy as part of emergency treatment — and threatening to defund hospitals that don’t perform these procedures.

The Biden administration’s guidance states that federal law requires doctors to perform abortions for pregnant people in emergency rooms when it is “the stabilizing treatment necessary” to resolve a medical emergency, including treatments for ectopic pregnancy, hypertension and preeclampsia.

On Wednesday, the Biden administration also warned retail pharmacies that they must fill prescriptions for pills that can induce abortion or risk violating federal civil rights law.

These two recent actions pit the federal executive branch against state governments after the U.S. Supreme Court undid a nearly half-century-old precedent that had affirmed access to abortion as a constitutional right.

Texas Attorney General Ken Paxton’s office filed the suit challenging the guidance in federal court on Thursday, saying the Biden administration’s guidance violates the state’s “sovereign interest in the power to create and enforce a legal code.”

[…]

The Biden administration reassured the nation’s doctors that they don’t need to wait until a patient’s health deteriorates before acting and that they can act in cases where nontreatment would result in serious impairment, guidance that comes as medical professionals in Texas and other states where abortion is banned are trying to figure out what kind of women’s health care is allowed under new restrictions. The guidance isn’t seeking to update existing law but is said to clarify a hospital’s duties under the Emergency Medical Treatment and Active Labor Act.

I thought it was federal law that was sovereign, but what do I know? I know that if Paxton gets his way women are going to die because doctors won’t be able to treat them properly and in a timely fashion. That’s what’s really at stake here. And I expect Paxton to get his way, at least at first. The Chron points out the obvious:

The case underscores the dominant position that conservative Republicans hold in the federal judicial system: Paxton filed the case in Lubbock, in the U.S. Northern District of Texas, where there are 12 judges, 10 of whom were appointed by Republican presidents and six of whom were named by former President Donald J. Trump.

If Paxton were to lose, the case would go to the Fifth Circuit Court in New Orleans, widely recognized as one of the most conservative federal appellate courts in the country, and the final step would be the Supreme Court, which ruled last month to overturn Roe v Wade in the first place.

I guarantee you, whatever the district court judge does, the Fifth Circuit will give Ken Paxton what he wants because that’s what they do. And then SCOTUS gets to make another abortion ruling. Great system we have here, isn’t it?

I had drafted a post about the imminent threat to EMTALA that the Biden administration’s guidance had queued up, and then made the mistake of not publishing it in time to keep up with the news cycle. My bad. The original post is beneath the fold. I stand by what I said in this post. Now let’s bring the fight that this requires. Daily Kos and Mother Jones have more.

(more…)

COVID hospitalizations up in Houston

Welp.

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

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

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

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

[…]

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

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

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

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

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

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

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

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

The empty “mental health” promise

What’s going on in Uvalde these days.

Days after the May 24 shooting, Texas Gov. Greg Abbott promised an “abundance of mental health services” to help “anyone in the community who needs it … the totality of anyone who lives in this community.” He said the services would be free. “We just want you to ask for them,” he said, before giving out the 24/7 hotline number — 888-690-0799.

That’s a tall order for a community in an area with a shortage of mental health resources, in a state that ranks last for overall access to mental health care, according to a 2022 State of Mental Health in America report.

Mental health organizations are assembling a collection of services to assist those who seek help in Uvalde. But there have been hiccups and hitches along the way.

There is worry that what’s being offered is not coming together as fast or efficiently as it could be, and that it’s being assembled without keeping in mind the community it serves: Many residents are lower income, and some may have difficulties with transportation, or are mainly Hispanic. Many are not accustomed to seeking out therapy, or are distrustful of who is providing it.

Quintanilla-Taylor didn’t believe many would use the mental health services and had doubts about their long term availability.

“It’s not going be prevalent. … I don’t trust the resources, and that’s coming from an educated person,” said Quintanilla-Taylor, who’s pursuing a doctorate in philosophy and specializing in organizational leadership at the University of Texas at San Antonio.

[…]

Uvalde County Commissioners, the countywide government body, voted Thursday to purchase a building to create the Uvalde Together Resiliency Center to serve as a hub for long-term services, such as crisis counseling and behavioral health care for survivors.

Abbott set aside $5 million in funding for the center, which has been operating at the county fairgrounds.

Texas Sen. Roland Gutierrez, whose vast district includes Uvalde, said the community needs continuity of care and rather than create a new building the state could invest in the existing local community health clinic, in operation for 40 years and already serving 11,000 uninsured Uvalde residents.

“These are people who have behavioral health on the ground. They actually have the one psychiatrist in Uvalde right here,” Gutierrez said Friday referring to the clinic. “We needed to have the budget so that we can bring in therapists, which we would have been able to do with that money. Instead, they’re starting from whole cloth this promised center you’re going to have the district attorney run?”

Gutierrez, who has shifted a district office from Eagle Pass to Uvalde, said he met with 11 families whose children survived the shootings and were either wounded or sent to the hospital.

“What the families have been telling me is they don’t want to see one therapist one week, a different one the following and another one yet maybe the next week,” he said. “So, they are having trouble with appointments, with continuity and that’s very, very important, especially when we are talking about young children.”

Gutierrez said he sent a letter to Abbott asking for $2 million for the existing free community clinic to provide crisis care but has not heard back.

I’ve discussed this before, and this is another illustration of the problem. We can count on hearing two things whenever there’s a mass shooting in Texas. One is the usual blather about guns and why restricting access to guns isn’t the answer. The other is a rush to talk about mental health, both as a means of explaining the shooter’s actions and now more regularly as an alternate mitigation for gun violence that doesn’t restrict access to guns. It was a big component of the Cornyn bill, and may have been a key to its passage since there’s no question that more mental health services and funding for those services are badly needed. I’m happy to see that happen, it’s just that we all know this is only one piece of a much larger puzzle.

From the state perspective, any and all talk of mental health and services for mental health that comes from our state leaders is guaranteed to be little more than hot air. We have the longstanding issue of healthcare in general being out of reach for too many people because of lack of insurance, and the continued resistance to expanding Medicaid, which would be the single biggest step forward in that regard. We have the also longstanding issue of healthcare in rural areas, from hospitals closing for lack of funds to scarcity of doctors in rural areas, a problem that was supposed to have been solved by the passage of the tort “reform” constitutional amendment nearly 20 years ago. More recently there was Abbott’s redirection of over $200 million in funds from the Department of Health and Human Services to his never-ending border boondoggle. At every opportunity, the Republican leadership has made it clear that they don’t care about funding healthcare in general, and mental health services in particular. But they are willing to use the promise of mental health services as a distraction when the next crisis hits. That’s where we are now, and where we will be again if nothing changes.

Are we going to raise the COVID threat level again?

Maybe, but not yet.

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

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

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

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

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

[…]

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

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

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

That press release is worth a read:

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

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

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

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

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

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

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

Checking in again on the wastewater

COVID levels keep creeping up.

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

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

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

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

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

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

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

[…]

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

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

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

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

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

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

Time once again for Texas hospitals to struggle financially

I feel their pain, but…

More than $3 billion in federal money has flowed to Texas health care providers in recent months to help pay for COVID-19 treatments, tests and vaccines for patients without health insurance, according to national health officials.

Of that, a tiny fraction — some $2.2 million — went to the local independent hospital in rural Titus County for treating patients during wave after overwhelming wave of the devastating virus in an area where 1 in 3 residents are uninsured.

But the 174-bed Titus Regional Medical Center in northeast Texas needed every penny it could get as it struggled to cover the sudden, skyrocketing expenses of the pandemic: paying staff competitive wages to keep them on the job, keeping up with federal safety rules and managing record-breaking numbers of patients pouring into in the intensive care unit from a 150-mile radius, said CEO Terry Scoggin.

Now, after sending some $19 billion to hospitals and other health care providers nationwide, the fund known as the Health Resources and Services Administration COVID-19 Uninsured Program — created to help hospitals like Titus Regional pay for the care of uninsured COVID patients — has dried up.

While the halting of funds comes as Texas has seen infection numbers fall dramatically, the virus is still largely uncontrolled, causing surges and lockdowns in other countries. In the past, those surges abroad have always occurred before new cases rise again here in the United States, including Texas, which has more uninsured residents than any other state.

The failure to renew the program in time to continue reimbursing providers means that hospitals, clinics, private practices and others that don’t get public health funding from the state will have to “eat the cost” if they don’t charge for COVID-related services, Scoggin said.

“It’s a huge issue for us because we have so many adults who are uninsured,” Scoggin said. “And so it was kind of a kick in the gut for us when they shut that program off because I thought it was a good use of funds for the COVID piece.”

Refusing care to those patients who can’t pay is not an option, legally or morally, he said.

“We can’t turn people away, so we’re still going to pay for it,” Scoggin said. “It just shifted the expense of the uninsured from federal funds to individual hospitals.”

We’ve discussed the financial straits of rural hospitals in Texas before. I am once again pointing out that the locale in which this story is sited, Titus County, is yet another place that votes heavily Republican – Trump and Cornyn in 2020 and Abbott and Cruz in 2018 all topped 70% of the vote. I continue to have empathy for the employees of these hospitals, who for all I know may be habitually voting for politicians whose stated policy preferences are to help them. But I’m also saying it would be nice for these stories to include that easy-to-look-up data, because the simple fact is that if the likes of Greg Abbott or John Cornyn wanted to help the Titus Regional Medical Center, by expanding Medicaid or helping to push through more federal funds for the care of uninsured COVID payments, they could absolutely do so. The dots are just sitting there, waiting to be connected. We should do that.

Are we about to get more COVID in Houston?

We could be.

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

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

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

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

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

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

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

COVID hospitalizations at a low in the state

Good news (say it with me) for now.

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

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

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

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

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

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

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

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

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

And we’re back to yellow again

Let’s hope it lasts.

Harris County Judge Lina Hidalgo on Thursday lowered the county’s COVID threat level to yellow, signaling a controlled level of cases following the decline of the omicron wave.

The yellow level means COVID poses a “moderate threat” to the public and urges residents to continue to stay vigilant unless fully vaccinated.

Under the yellow or moderate level, unvaccinated residents are encouraged to continue masking and social distancing, while vaccinated residents are encouraged to do the same where required by law.

“My hope is that we are at a permanent turning point of this pandemic,” Hidalgo said in a statement. “But we’ve yet to have a wave where our hospitals don’t get overwhelmed, so we need to tread with caution before we declare victory over this virus.”

As noted, we dropped to the orange level two weeks ago. We were last in yellow in November, for less than a month before omicron moved in. I’m still wearing a mask for the grocery store and other indoor places with lots of people – I mean, I haven’t had a cold in over two years now, so why wouldn’t I? You do you, as long as that means getting vaxxed and/or boosted if you haven’t yet.

The Rodeo is back

Gonna be interesting to see how different it is, if it’s different at all.

And this year, after a one-year hiatus, the rodeo again will be focused on preventing the spread of COVID-19, the virus that abruptly brought the rodeo to a halt nearly two years ago. Masks will be required on public transit to the rodeo’s grounds, where an abundance of hand-washing and sanitizing stations will be positioned throughout. Many concession stands will only accept credit or debit cards instead of cash, and air-filtration systems have been updated to maximize the fresh air flowing inside NRG Stadium and NRG Center.

As the record-breaking omicron surge subsides, rodeo organizers encourage people to follow health and safety guidelines issued by the Centers for Disease Control and Prevention, which recommends that people stay up-to-date on vaccinations and take precaution such as wearing masks in areas of high transmission. People who are feeling ill are encouraged to stay home. More than 100 people a day continue to die of COVID-19 in Texas, with most of those fatalities among the unvaccinated, figures show.

Still, with the pandemic approaching the two-year mark and nearly 64 percent of Texans age 5 and older vaccinated, health experts agree that it’s time for people to return to large events such as the rodeo.

“We are going to have to live with COVID for a while, and I believe that people should be able to establish a new ‘normal’ and enjoy their lives,” said Dr. M. Kristen Peek, interim dean of the school of public and population health at the University of Texas Medical Branch in Galveston. “The Houston Livestock and Rodeo Show is an important part of Houston that people go and enjoy — just do it safely.”

After reviewing the rodeo’s eight-page document containing its COVID health protocols, Peek said the added precautions “look appropriate.” She said she is looking forward to attending the rodeo with her family.

“We will definitely be masked,” she said.

[…]

Now, 66 percent of Harris County is vaccinated with at least the primary series of Pfizer, Moderna and Johnson & Johnson, according to Harris County Public Health. The recent wave likely boosted natural immunity, and the community is equipped to handle the event without a major risk, said Dr. Paul Klotman, president and CEO of Baylor College of Medicine.

“The rodeo is in a big venue, so there’s a lot of ventilation and a big space,” he said. “Relative to other gatherings, this one ought to be safer than others. And if you look at some of the (recent) football games, there haven’t been a lot of big outbreaks.”

Klotman and other experts added a word of caution: the pandemic is not over. Vulnerable populations, such as immunocompromised people, still face a heightened risk of severe illness if infected.

“I wouldn’t be going if I lived with somebody who is going through cancer chemotherapy,” stressed Dr. James McDeavitt, executive vice president and dean of clinical affairs at Baylor.

See here for some background. I’m mostly okay with this, especially for the outdoor parts of the rodeo. We don’t currently have any plans to go to the fairgrounds, but we’re all vaxxed and boosted, we don’t have any immunocompromised people in our daily lives, and the risk being outdoors is fairly low. Honestly, taking the train to and from the event, which is the only way to go for me, feels a lot more risky just because the trains are always super full during Rodeo times. I’d feel more apprehensive about attending indoor events and the concerts, but if we did we’d be wearing our KN-95s, so it’s no more risky than some other things we’ve been doing. I don’t expect this to become a vector for infection, but by all means exercise as much caution as you want. Don’t go if you don’t feel good about it.

Orange is the new threat level

New again, anyway.

Harris County Judge Lina Hidalgo lowered Harris County’s COVID-19 threat level to “significant” Thursday, signaling the city is emerging from the worst of the omicron wave as infection rates plummet.

Harris County has met all four metrics needed to lower its threat level from red, its highest level indicating “severe risk,” to orange, the second-highest possible threat level. Under orange, officials still recommend that residents minimize all unnecessary contact and avoid large gatherings to stem the spread of the virus.

“The omicron wave hit Harris County very, very hard,” Hidalgo said in a statement. “In fact, only now have our hospitalization rates dropped to levels that don’t immediately threaten the capacity of our healthcare system.”

[…]

The two other metrics that were keeping the county in red — ICU capacity and new cases per 100,000 — have improved in recent days, leading to the downgrade Thursday. The overall percentage of COVID patients in the ICU fell to the county’s threshold of 15 percent, and the seven-day rate of new cases per 100,000 people declined to 83, well below the county’s goal of 100.

Hidalgo encouraged residents to get vaccinated to avoid another “dangerous” COVID spike.

“While we’re moving in the right direction, there are no guarantees we won’t see another wave in the future,” Hidalgo said.

We were last at orange in December, on the way to red a couple of weeks later. At this rate, we’ll likely be back to yellow soon, and after that who knows. The good news is that between our vaccination level and the sheer number of people who contracted omicron, our overall immunity level for the short term is as good as it’s ever been. The bad news is that our vax level is still way too low, far too few kids have been vaxxed, and the waning omicron wave is causing fewer people to get vaxxed now because the threat is receding. It really is just a matter of time before we’re back in a crisis situation again. If we’re lucky, and we make a strong effort to get a lot more people vaccinated in countries that have not had nearly enough vaccine supply, then maybe that next wave is farther off. If not, well, I probably don’t have to tell you what that means. Stace has more.