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COVID rate slows a bit, but ICUs still full

The good news.

So far, the delta variant has fueled a month of Houston-area COVID hospitalizations over 3,000, according to the Texas Department of State Health Services.

But Texas Medical Center records show positive case rates may be slowly declining. According to TMC’s daily report, 1,939 people tested positive Tuesday in the Greater Houston area, a decline that may be related to COVID testing site closures as a precaution before Hurricane Nicholas.

Also Tuesday, the medical center admitted 310 new COVID-19 patients compared to the average 328 per day last week. Hospitals in the TMC remain at 90 percent capacity.

Dr. Wesley Long, a microbiologist and medical director of diagnostic microbiology at Houston Methodist, has been tracking and analyzing the virus and its variants through the hospital’s COVID-19 genome sequencing operation.

While Long sees the increase slowing, he hesitates to say Houston is passed the peak of the surge.

“It’s like cresting the top of the wave, you don’t know what the backside of the wave is going to look like,” Long said. “In the beginning of this fourth wave, there were some people hopeful it would go up quickly and come down quickly. That’s not the case.”

The fourth wave’s peak has been broader than previous waves, which spiked and declined within about 25-30 days, Long explained. The big question with the delta wave is whether it will plateau at a high rate of hospitalizations or have a slow decline.

“It’s hard to know how other things like holidays and school will affect the case count,” he said. “It’s really important to keep masking, social distancing and staying home if you’re sick because it’s important to bring the fourth wave under control.”

Another way to look at it:

The not so good news.

COVID-19 hospitalizations have been declining across Texas and the Houston region, but the virus is still keeping a high number of people in ICUs, prolonging the strain on patients waiting for critical care beds.

Last week, the number of available adult ICU beds in Texas sunk below 300 for the first time in the pandemic, with 270 beds available on Sept. 8 and 279 available on Sept. 9, according to the Texas Department of State Health Services. There were 326 beds available this Wednesday, including 65 in the nine-county region surrounding Houston, the data show.

Texas Medical Center ICUs for weeks have been hovering around 90 percent full with “Phase 2” surge plans — which add 373 ICU beds to the 1,330 available in Phase 1 — activated.

[…]

ICU data is a lagging indicator of the virus’s impact, [Dr. Syed Raza, vice president of medical operations at CHI St. Luke’s Health-The Woodlands Hospital] said, because the sickest patients need care for a longer period of time. He said it is the “natural course of the pandemic” for ICUs to remain high after hospitalizations decline.

Dr. James McDeavitt, executive vice president and dean of clinical affairs at Baylor College of Medicine, said the hospital strain appears to be easing overall. The number of COVID patients in ICU beds likely peaked at the end of August, when they took up 49 percent of all critical care beds, he said. As of Wednesday, that number dropped to 45 percent.

He said he is cautiously optimistic that “we’ll continue to see this trend move in right direction.” He compared the current ICU situation to flooding during hurricane.

“We are no longer stuffing towels under the door” to stop the water, he said. “But the water is still over our threshold.”

I mean, it could be worse. It’s still not good, and it’s going to continue to not be good for awhile, but it could be worse. Keep up with the precautions, they’re our best hope in the short term as more people get vaccinated.

Hospital systems have no excuse for not mandating COVID vaccines now

So get on with it already.

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

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

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

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

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

[…]

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

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

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

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

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

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

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

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

A bit of good news in the wastewater

I’ll take it where I can get it.

Community spread of coronavirus is on the decline from its recent summertime high, but experts warn that Labor Day gatherings and kids’ return to classrooms could bring a rash of new infections in the coming weeks.

The latest samples of Houston’s wastewater — a highly sensitive method for tracking coronavirus — show diminishing traces of the virus across the region, said Loren Hopkins, the Houston Health Department’s chief environmental science officer. The results indicate a slight drop in person-to-person spread.

“The positivity rates are still alarmingly high, the wastewater rates are still alarmingly high, but it may be trending down,” Hopkins said Wednesday.

The decline could be short-lived.

The holiday weekend and the start of school, which spurred record infections among children, will likely keep the Houston area in “plateau mode” for the foreseeable future, said Bill McKeon, CEO of the Texas Medical Center.

On Tuesday, the Texas Medical Center reported that the rate of transmission across the Houston area was 0.87; the average for the previous week was 0.99. Both figures landing below 1.0 is a good sign; any number above 1.0 means the virus is spreading through the community.

Still, McKeon urged caution. Tuesday’s low daily transmission rate of 0.87 could be artificially deflated due to low testing rates, he said, which commonly occur over holiday weekends.

“We are just coming out of the Labor Day weekend and we typically do not see the impact of holidays for one to two weeks,” McKeon said.

[…]

Houston’s coronavirus hospitalizations slowed by 2.3 percent in the past week, but remained only slightly lower than August’s record peak. As of Tuesday, 3,370 people were in area hospitals for COVID-19, down from the record high of 3,500 on Aug. 24, according to the Texas Department of State Health Services.

Ballooning school transmissions are another concern, experts said, especially in districts that do not have mask mandates. Student infections are rapidly rising across the state, with the total number of positive cases among public school students surging by 90 percent just a few weeks into the new school year.

“We need mask mandates to protect our school children from getting infected and bringing it home to Mom and Dad,” said Catherine Troisi, an epidemiologist at Texas Medical Center’s School of Public Health.

The wastewater had documented to surge, and it will be the leading indicator when there is a real decline. I hope people were cautious over the Labor Day weekend, but we’ll know soon enough what if any effect that had. As for mask mandates in the schools, it seems to be working pretty well for HISD. I keep saying, none of this is a mystery, we know what we need to do, we just have to do it.

The contract health worker surge

Don’t know how sustainable this is.

Dr. Esmaeil Porsa, president and CEO of Harris Health System, said the hospitals in the system were at a breaking point when he learned that 100 temporary medical workers were being sent to help.

As cases surged, the hospitals were admitting more children and pregnant women with complications from COVID-19, and patients who needed intensive care waited in emergency rooms for ICU beds to become available.

The nurses, respiratory therapists and other contract staff “definitely arrived here at a pivotal moment,” Porsa said. “They did exactly what I had hoped that they would do, which is allowing us the opportunity of a couple of things: to provide a little bit of relief for front-line staff who have been running around ragged, but also created an opportunity for us to expand our capacity.”

[…]

Gov. Greg Abbott announced the Texas Department of State Health Services would deploy state-funded relief workers to hospitals, and 8,100 have either arrived from other states or are expected soon.

It’s the second time the state has taken such action. At the height of the state’s winter surge, almost 14,000 medical workers were deployed across the state, according to DSHS. From July 2020 to early August of this year, the state spent more than $5 billion in federal disaster funds and coronavirus relief funds on medical personnel.

Abbott’s move came after hospitals and local health officials complained that they were having to outbid each other to hire contract nurses amid a statewide shortage of hospital staff.

W. Stephen Love, president and CEO of the Dallas-Fort Worth Hospital Council, said that competition among hospitals meant “they’re going to take from Peter to give to Paul, so to speak. That’s why using the state with their purchasing power [is important].”

The new push to bring more health workers to Texas comes as many have reached their limits, said Carrie Williams, spokesperson for the Texas Hospital Association.

“This surge has come faster and stronger than previous surges, and it comes at a time when the frontline [worker] is burned out,” Williams said in a statement. “We were already starting from behind when this surge hit.”

According to DSHS, the state’s hospitals requested more than 15,000 temporary staffers between Aug. 12 and Aug. 25. As of Aug. 25, almost 4,000 have been deployed, with most going to regions with the state’s most populous counties and metro areas.

[…]

Health officials continue to stress that the main way to reduce the need for additional staff is clear: more vaccinations. As of Aug. 25, about 47% of Texans were fully vaccinated.

Since Jan. 1, Porsa said, everyone who has died at LBJ Hospital and Ben Taub Hospital from COVID-19 has been unvaccinated.

“Space is not unlimited, resources are not unlimited,” Porsa said. “At some point it doesn’t matter how many nurses you throw at the problem, we are going to arrive at a situation where we’re not going to have enough clinicians, we’re not going to have enough doctors, we’re not going to have enough something else.

“We will run out of options at some point, and this is really really important for people to realize that this cannot go on forever, and they know what the solution is.”

It’s still not clear to me how there could even be that many not currently working medical staff out there to be brought in, but they do exist in some number, for which we are grateful and lucky. It’s also not clear at what point demand will outstrip supply, and as noted above, we may run into other limits even sooner than that.

How long can we last? There’s actually a tiny bit of cause for optimism in the most recent data.

The average number of daily COVID hospitalizations in the Texas Medical Center dropped for the first time since early July from a record 390 patients to 388, the medical center reported Monday.

The metric reflects the daily average of hospitalized patients over the previous week. The drop comes amid declining COVID hospitalizations both nationally and statewide.
A three-day decline in total COVID hospitalizations in Texas brought the number to 13,557 on Saturday, the most recent day for which data is available. The Centers for Disease Control and Prevention also reported a drop in the average number of new daily hospitalizations nationwide, from 12,354 on Thursday to 12,051 on Friday. More recent national data is not yet available.

Dr. James McDeavitt, executive vice president and dean of clinical affairs at Baylor College of Medicine, said the decline is part of the natural course of the pandemic.

“When you see an outbreak like this, the virus kind of runs through the population until it gets to the point where it starts running out of people to infect,” he said, adding, “That does not mean herd immunity.”

He warned that the virus still has room to spread, especially as schools reopen. In an interview last week, McDeavitt said hospitals will continue to feel the strain of the current surge as cases decline.

Burnout among nurses, lingering staffing shortages and the record number of hospitalizations all factor into a longer recovery period.

“From the peak, we’re probably still a month-and-a-half to getting to something that feels like business as usual,” he said last week. “So best case, we’re into October now before we start to get some relief.”

So don’t get too cocky. It’s good that maybe we’ve peaked and will start to see a decline, but we’re still a long way out from where we were in May and June, and we could easily reverse course again. We need to keep getting people vaccinated, because the alternative is more of what we’re going through now.

Readin’ and writin’ and gettin’ COVID

Welcome back to school, kids.

Positive COVID-19 cases among Texas public school students rose by more than 9,000 last week, the highest number ever recorded in a seven-day period, state data shows.

As of Aug. 22, there were 14,033 reports of positive COVID cases in students across the state, according to data released by Texas Health and Human Services on Friday. The number represents a 182 percent increase from the 4,976 student cases reported through Aug. 15.

There were another 3,425 positive cases reported in school staff across the state, an increase of 712 from the previous week.

In some districts, more than half the new infections are among elementary school students, who are not eligible for any of the available vaccines.

“This school year is gonna look a whole lot different than last year,” said Dr. Katelyn Jetelina, an assistant professor of epidemiology at UTHealth School of Public Health in Dallas. “We have a whole lot more transmission now in the community and we have the delta variant.”

The cumulative number of cases in students since the 2021-2022 school year began is 20,256. The total staff cases so far this school year is 7,488.

In case you were wondering why so many parents are pissed about the fight against mask mandates. Now that all schools are open I would hope we won’t see any more big jumps like that, but we are going to see the case levels rise for now. I hope that at some point, when there’s enough data to be reasonably confident in the results, we can get a comparison of COVID rates in districts that have mandated masks versus those that have not.

On a related note:

People under 50 are being admitted to hospitals with COVID-19 in larger numbers than at any point during the pandemic as the latest surge of the coronavirus continues to tighten its grip on Texas.

According to data released by the Texas Department of State Health Services, as of Aug. 22, adults 30 to 49 now account for roughly 29% of all COVID-19 hospital admissions in Texas, up from 15% on Jan. 11 during the height of the winter surge.

The data shows that people in the 18-29 age group increased their share of admissions during that period from 5% to 7%, while the percentage of children under 18 admitted to hospitals with COVID-19 increased by 1 percentage point — an average of 46 children each day were hospitalized during the week ending Aug 22.

Meanwhile, fewer people over 70 are landing in hospitals with COVID-19. During the winter peak, about 41% of hospitalized COVID patients were over 70. As of Aug. 22, that dropped by almost half, to 23%.

The data confirmed what many doctors have been saying in recent weeks about the delta variant sending younger people into hospitals at a higher rate than earlier in the pandemic.

“We are seeing certainly younger patients hospitalized and younger patients on ventilators where we haven’t seen that before,” said Dr. Ron Cook, chief health officer at the Texas Tech University Health Sciences Center.

This variant has spread faster among unvaccinated Texans of all ages. As of last week, between 93% and 98% of hospitalizations have been unvaccinated people, depending on the area of Texas, officials said.

More than 70% of Texans over the age of 50 are fully vaccinated, compared to only about half of Texans between the ages of 16 and 49 and one-third of those ages 12-15. Children under age 12 are not eligible for vaccination.

And as the hospitals fill up with COVID patients, people who have other serious but treatable conditions are put in jeopardy. No amount of horse de-wormer is gonna fix that.

Other things the Lege has been up to

A brief roundup, to clear some tabs…

Bad Bail Bill 2.0 moves forward.

A sweeping revision of the process for releasing accused criminals on bail won initial approval from the Texas House on Friday night, nearly three months after the GOP-priority legislation stalled in the regular legislative session.

Senate Bill 6, which would require people accused of violent crimes to put up cash to get out of jail, tentatively passed the House on an 82-37 party line vote. The Senate passed the legislation earlier this month on a 27-2 vote.

A House committee advanced the bill Monday after taking out a controversial provision that would have restricted charitable groups from posting bail for defendants, a practice that gained popularity last summer when groups posted bail to release people arrested while protesting the death of George Floyd, a Black man murdered by a white Minneapolis police officer.

On Friday, House members added a related provision back into the bill that does not limit the ability of such groups to post bail. Instead, the amendment would require charitable bail funds to be certified by county officials as nonprofit organizations and file reports on who they bond out of jail.

“The original bill that came over [from the Senate] was essentially going to outlaw … the charitable bail process,” said state Rep. Travis Clardy, R-Nacogdoches, on his amendment. “We made it very clear to the other side of the building that this would not stand.”

The bill still needs to pass the House a final time before it is sent back to the Senate, which can either accept the House changes or enter into closed-door negotiations. State Sen. Joan Huffman, the Houston Republican who authored the bill, did not respond to questions about House changes this week.

See here and here for some background. This is bad, and there’s a decent chance parts if not all of it will eventually be found unconstitutional, but in the short term it will do some damage. Go read Grits for Breakfast or follow him on Twitter for a deeper dive.

Some virtual learning gets funded.

After months in limbo, Texas lawmakers took a step toward expanding and funding virtual learning as the pandemic still proves a threat to families not yet comfortable sending their children back to classrooms.

The Texas House approved Senate Bill 15 on Friday night in a 115-3 vote. The bill will go to a final reading and vote in the House before making its way to Gov. Greg Abbott’s desk.

The House’s initial approval of the bill will give some parents a measure of relief that there could be more virtual learning options as the pandemic once again strains the state’s resources. Hospitalizations and cases are surging due to the more transmissible delta variant of the coronavirus.

Necessary, albeit regrettable. We wouldn’t be revisiting this topic if we had a better handle on COVID, but given that we are not we need to acknowledge reality where we can. This is one reasonable place to do so.

More border boondoggling.

The Texas House approved nearly $2 billion in additional funding for border security operations, giving Gov. Greg Abbott more state dollars to implement his plans to build a border wall and incarcerate migrants for state criminal offenses in an effort to deter migrants from coming to the state.

Lawmakers gave initial approval Friday to a funding bill by a vote of 81-38 that would triple what the state allocated for border security during the last biennium. The $1.88 billion appropriated by House Bill 9 is in addition to the $1.05 billion lawmakers approved for border security this spring.

“There’s a crisis on our southern border with serious consequences extending throughout our state,” said Rep. Greg Bonnen, R-Friendswood, who authored the bill. “Texas must respond to the crisis that has been brought to our doorstep.”

In June, Abbott announced Texas would build a state-funded border wall to decrease the number of migrants entering through its border with Mexico. Earlier this year, the two-term Republican governor launched Operation Lone Star, an effort that directed state military and police resources to the border to aid local and federal authorities fighting the smuggling of people and drugs across the border.

Abbott, who is seeking reelection next year, had previously said he expects the state to build hundreds of miles of wall along the state’s 1,254-mile border with Mexico, but had not specified where the wall would be or how much it would cost.

This message has been paid for by the Greg Abbott campaign.

More money for “temporary” hospital workers.

Gov. Greg Abbott announced Thursday that for the second time amid a recent surge in COVID-19 hospitalizations that Texas will increase the number of state-funded relief workers it will be sending to Texas hospitals, bringing the total to 8,100.

The Texas Department of State Health Services had previously authorized contracting 5,600 medical personnel, and Thursday’s announcement adds 2,500 more.

During the state’s winter COVID-19 surge, more than 13,500 temporary medical workers were deployed across the state, according to DSHS. Those numbers began to dwindle once cases started to decrease and vaccinations became more widely available.

Now, the highly-contagious delta variant has pushed the state to reverse course and again take the lead in alleviating staffing shortages as hospitals are inundated with COVID-19 patients and intensive care unit beds are becoming scarce. On Aug. 9, Abbott directed DSHS to use staffing agencies to secure out-of-state medical personnel for Texas hospitals and asked hospitals to voluntarily halt elective medical procedures.

The state will fully fund the temporary health workers through Sept. 30.

Not technically a Lege thing, but Lege-adjacent. See my previous point about things we wouldn’t need to be doing if we had handled COVID better. I have no idea where we will find all these relief workers, but that’s yet another mess Greg Abbott will have to clean up for himself.

And finally, one thing the Lege hasn’t been doing:

And yet here we are. Still not too late, I suppose, but with every passing day this becomes more and more true.

Yes, the wastewater is also pointing to a COVID surge

In case you were wondering.

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

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

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

[…]

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

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

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

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

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

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

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

A few words from the CEO of the Medical Center

From an interview he did with Lisa Gray.

What we’re seeing, sadly, is more of the same, only with more intense numbers. The number of people who are testing positive in our community continues to escalate month over month. The test positivity rate is now at 15.1 percent.

But probably the most accurate reflection is our hospitalizations. We just reached an all-time high: 421 people were admitted to our hospitals for COVID yesterday.

Step back for a second and look at that relative to the entire pandemic. Back in June and July, we had two weeks where the average number of hospital admissions was over 300. That was in the second wave.

Fast forward to wave three: We had four weeks that averaged over 300.

Now we are into our second week with no slowing the pace. At 421 today, we are seeing the highest peak of all of the pandemic going back 18 months now.

It’s largely a pandemic of the unwilling — people unwilling to be vaccinated. Now 44% of Houstonians are unvaccinated. Those are the vast majority of the people that are showing up in our emergency rooms and and in our ICUs. They’re very sick.

Many people thought that they were young, and therefore their immune system would be strong enough to protect them. That is not the case with this deadly delta variant, which is three times more transmissible than the earlier alpha variant.

Our hospitals’ staffs are 18 months into this. They’re exhausted.

And we have far fewer nurses than we used to have. They’re being recruited to other states, like Florida, that are even worse off than Texas.

The saddest fact is, 18 percent of all the new cases so far in August are children.

With the alpha variant, everyone thought, “OK, it’s 65 and older.” So we went after the nursing homes, and we did a brilliant job at protecting the elderly population and those who are immunocompromised.

But now, that vulnerable population is children under 12, who are not able to be vaccinated. We are predicting a mess in our schools. With nearly 20 percent of new cases being children, now we’re going to huddle them together in schools? Some may have masks. Some may not. It’s a recipe for disaster.

You can read the rest or give it a listen, but his answer to the first question tells you most of what you need to know. Hospitals around the state have been facing a similar crisis. I keep harping on this because it needs to be harped on, as we have a governor who can’t follow his own dictum about “responsible behavior”, a felonious Attorney General who’s soliciting snitches so he can go after rogue mask mandates, and a Legislature that wants to ban mask mandates forever. This is what we’re up against.

I don’t know if I’d call this “good news”, but the projections say we can see the beginning of the end from here.

While hospitalization numbers are nearing the heights they reached during the state’s most fatal surge in January, public health projections indicate that the latest wave will result in fewer deaths — mostly because senior citizens are widely vaccinated and hospital patients are now much younger. Still, state health officials are preparing for the worst, preemptively ordering a fleet of five mortuary trailers from the federal government in case infections spiral.

Public health experts still expect at least some increase in coronavirus deaths over the coming weeks, as fatalities are a lagging indicator — cases rise first, then hospitalizations, then intensive care usage, then deaths.

Now, the state is averaging about 100 daily deaths, a number not expected to exceed 150 over the next month before tapering off. That’s nowhere near the 350 COVID deaths per day that the state saw in January.

“We’ll go up some, but again, not to the levels that we saw back in January,” said Dr. David Lakey, the vice chancellor for health affairs and chief medical officer at the University of Texas system, referencing the forecasts.

Still, the precipitous rise in hospitalizations is a cause for concern. More than 12,000 Texans were in the hospital with the virus on Wednesday, with dozens of Texas hospitals running out of ICU beds (during the winter surge, hospitalizations peaked at just over 14,000). Patients are younger than they were in the first two waves of the virus, and almost everyone facing severe illness is unvaccinated.

[…]

Projection models following Texas’ daily COVID case and hospitalization counts anticipate a rise in deaths in the near future. By mid-September, a model offered by the U.S. Centers for Disease Control and Prevention estimates that the Lone Star State will see about 790 deaths per week, or roughly 113 per day.

Another model, produced by researchers at the Institute for Health Metrics and Evaluation at the University of Washington, projects about 125 deaths per day by mid-September in a worst-case scenario. In both forecasts, it appears that the state has already seen the brunt of its COVID deaths.

That’s largely because the vast majority of Texas’ over-65 population — those most vulnerable to the coronavirus — have received at least one dose of the vaccine, experts said.

“Those that were most at risk of having severe disease have some protection, and that’s good protection because of the vaccine,” Lakey said.

While a spike in hospitalizations and ICU bed usage does portend fatalities, the relationship between those data points will be less “linear” during the third wave, he said. It remains to be seen whether young patients will have other, long-term side effects of the virus — what some are calling “long COVID.”

Deaths will also decrease as more people become vaccinated or recover from the illness, said Dr. Ali Mokdad, a professor of health metric science at the University of Washington’s Institute for Health Metrics and Evaluation. The institute’s researchers estimate that about 74 percent of Texans will be immune to the delta variant, either through infection or vaccination, by Dec. 1.

“The virus is running out of people to infect,” he said.

The forecasts should not be interpreted as an assured outcome, though. Public buy-in on safety precautions, including mask-wearing, will ultimately determine the trajectory of the third wave.

In other words, don’t expect a best-case outcome, because we’re not allowed to do the things we need to do to make this less awful. Note also that while extensive vaccinations among older folks will help to limit fatalities, there will still be an excess of deaths in the coming weeks because of the overfilled hospitals – people with other serious conditions will die as a result, as was the case in the previous waves. Now is a very bad time to have a heart attack or be in a car crash.

At least there is a rise in the rate of people getting vaccinated, now that the threat is so much higher. Some of that is the result of mandates and restrictions on unvaccinated people, some is due to pressures and enticements from employers, and some is due to straight up financial rewards. Whatever it takes, whatever it takes.

It’s a bad time to go to a rural hospital

Only gonna get worse, too, at least in the short term.

For the past week, Brooke Hale has been told “no” about 80 times a day. The executive assistant at Altus Lumberton Hospital has spent her shifts on the phone in a windowless office, repeatedly asking other facilities within an 800-mile radius the same question: Can you take one of our critical COVID-19 patients?

On Thursday, there were three. They needed intensive care, and without it they could die. Hale tried hospitals in Texarkana and Tyler, Lubbock and Lufkin, Oklahoma, Louisiana and Mississippi. None had room.

“I feel helpless,” Hale said through her green N95 mask. “I feel like I can’t help patients like I need to.”

The same scene is being repeated throughout Southeast Texas, as rural hospitals and freestanding emergency rooms are scrambling to send critical patients to other regions and states because Houston medical centers, full with COVID-19 patients, refuse to accept transfers.

For small facilities, what once was a routine transport to local hospitals has become a frantic process of cold calling and cajoling health care providers in hopes of securing an open bed. In the meantime, patients who must receive intensive care languish in places that are unable to provide it.

By Thursday afternoon, 543 patients in the 25-county hospital region anchored by Houston were waiting for staffed hospital beds, according to the SouthEast Texas Regional Advisory Council; 62 more waited to be admitted to an ICU. The gridlock also extends to ambulance crews, who wait longer outside of crowded ERs to admit patients.

And health officials predict the region’s COVID-19 hospitalizations, which have grown for three straight weeks to more than 2,500, will swell further through August.

The result is a strained health care system that is more dangerous for anyone in need of acute care, from a critically ill COVID-19 patient to a car accident victim who requires surgery. And like last summer’s surge, researchers fear this wave will bring an increase in non-COVID deaths, attributable to delays in care caused by the pandemic.

“Typically, it takes less than an hour to find a bed,” said Dr. Swapan Dubey, chief medical officer at Texas Emergency Care Center, which has two Houston-area freestanding ERs. “Nowadays in my own centers, we’re hearing cases that are taking 30 to even 50 hours.”

I mean, this is the same song we’ve been singing for the past few weeks. We experienced this before, in previous COVID waves, and at least at some level the lesson never took, because here we are again. We know exactly what we need to do to make this better, and we have a much better tool available to us this time with the vaccines, and yet here we are again. I don’t know what else to say, but I do know who to blame, and that’s Greg Abbott. Even in this part of the state, which includes some of the reddest counties around, we need to make more people see it that way, too.

Abbott flails about on the COVID surge

He remains committed to the bit.

Gov. Greg Abbott announced new moves Monday to fight the coronavirus pandemic as it rages again in Texas, including asking hospitals to again put off certain elective procedures to free up space for COVID-19 patients.

Still, the governor did not back down on his refusal to institute any new statewide restrictions on businesses or to let local governments and schools mandate masks or vaccines.

Instead, Abbott announced he had written to the Texas Hospital Association asking hospitals to “voluntarily postpone medical procedures for which delay will not result in loss of life or a deterioration in the patient’s condition.” As coronavirus was consuming the state last summer, Abbott took a more restrictive approach and banned elective surgeries in over 100 counties before ending the prohibition in September.

Abbott also announced Monday he was asking state agencies to open additional COVID-19 antibody infusion centers that aim to treat COVID-19 patients with therapeutic drugs and keep them from requiring hospitalization. And he said the Department of State Health Services “will be utilizing staffing agencies to provide medical personnel from out-of-state to Texas health care facilities to assist in COVID-19 operations.”

That is a reversal for the state. In July, the state told cities and counties it would not send additional health care workers to aid hospitals with the latest surge of COVID-19 patients, like it had earlier in the pandemic. Instead, state officials said, city and county leaders should dip into $10.5 billion worth of federal stimulus dollars to pay for those workers should hospitals need them.

[…]

As part of Monday’s announcement, Abbott’s office said he was directing state agencies to “increase vaccination availability across the state” but did not provide further details.

“Texans can help bolster our efforts by getting vaccinated against COVID-19,” Abbott said in the news release. “The COVID-19 vaccine is safe and effective, and it is our best defense against this virus.”

Well, some hospitals had already taken the step of halting elective procedures, so way to be out in front on that, bro. Part of this “plan” includes recruiting more nurses from out of state to help us with the shortage we are now experiencing. I presume this means he’ll be trying to lure them from states that have COVID under a greater degree of control, probably places where the Governors in question made an actual effort to get people vaccinated and didn’t kneecap local leaders’ attempts to keep their people safe. I have no idea why any of them would want to come here now, but God bless ’em if they do. I guess we should be thankful that Abbott is doing something other than literally fiddling while the state burns, but color me a little too grumpy to care about such crumbs.

Overflow COVID tents

This is fine.

Harris Health System’s intensive care units are nearly full as the delta variant sends more COVID-19 patients into hospitals, prompting the safety-net health system for the county’s indigent communities to construct tents for triaging patients.

As of Monday afternoon, Lyndon B. Johnson Hospital’s ICU was 100 percent full, and 63 percent of patients were being treated for COVID-19 complications. Ben Taub Hospital’s ICU was 95 percent full, with 27 percent of patients sickened by the virus.

“The trend line is vertical,” said Bryan McLeod, a spokesperson for Harris Health.

The tents apparent outside the hospital in northeast Houston could be used for COVID-19 overflow patients, but officials may also choose to use it for patients who come in with other illnesses. Last summer, they were used to diagnose coronavirus cases, McLeod said.

This year, they may just be used to treat non-COVID patients, or those with less severe infections. Staff are still installing operational and diagnostic equipment in the overflow area, which will take patients from the emergency room.

While LBJ is the only hospital currently using such tents, Memorial Hermann is creating additional space for overflow patients by converting beds in their pre- and post-anesthesia units into ICU beds.

[…]

Statewide, hospitalizations have been increasing rapidly; on Saturday 9,462 people were hospitalized, an increase of 30 percent over the previous Saturday, according to the Texas Department of State Health Services. This weekend’s hospitalization figures were the highest Texas has seen since Feb. 6.

Not just in Houston.

Dozens of Texas hospitals have run out of intensive care unit beds as COVID-19 surges faster than any other time during the pandemic, propelled by the new delta variant.

The state is divided into 22 trauma service areas, and half of them reported 10 or fewer available ICU beds on Sunday. As more than 9,400 COVID-19 patients fill the state’s ICUs, which are reserved for the patients who are the sickest or most injured, the trauma service area that includes Laredo reported no available ICU beds, while the area that includes Abilene reported having one.

At least 53 Texas hospitals have no available ICU capacity, according to numbers reported to the federal government during the week ending Aug. 5. In Austin, five hospitals were at or above 90% of their ICU capacity during the same period, with two reporting no available ICU beds.

“This surge is by far the fastest and most aggressive that we’ve seen. Almost all of our hospitalizations are due to unvaccinated patients developing severe illness,” Dr. Desmar Walkes, Austin-Travis County’s health authority, told reporters last week. “ICU staff are seeing a younger population in our hospitals. Patients in the ICU are sicker and stay in the hospital longer than with prior surges, putting more strain on hospital resources.”

Around 87.1% of all hospital beds in Texas are in use — the highest level since the start of the pandemic — with 14.1% of those beds occupied by COVID-19 patients. When Gov. Greg Abbott began to relax some COVID-19 restrictions on businesses in October, his order maintained reduced restaurant capacity and kept bars closed in regions in which 15% or more of hospital beds were filled with COVID-19 patients.

This week, COVID-19 hospitalizations reached higher levels across the state than when Abbott imposed a statewide mask mandate in July 2020. Abbott has maintained that he will not be reviving the mask mandate and has barred local authorities from issuing their own.

No, really, NBD.

More than 10,000 Texans are hospitalized for COVID-19, according to data released by the Texas Department of State Health Services Tuesday afternoon.

According to Tuesday’s report, 10,041 people were hospitalized with COVID-19 across the state of Texas on Monday, the highest rate since Feb. 4, as the delta variant continues to dominate new COVID-19 infections.

[…]

Monday’s figure represents a 37 percent increase over the number of hospitalizations one week prior.

But don’t worry, Abbott has asked for more nurses to move to Texas, so we’re going to be fine. Really, what more do you need him to do?

There needs to be more defiance of Greg Abbott and his no-mandates mandate

I find a bit of a pattern in this story and wonder if there may be something to it.

School districts, local officials and hospitals are pushing back on Gov. Greg Abbott’s executive order barring mask and vaccine mandates, setting the stage for legal showdowns over coronavirus safety measures just as cases are surging in Texas and hospitals are filling up.

Houston ISD signaled its intention to require face coverings when students return this month. The University of Texas Medical Branch in Galveston requested an exemption to mandate COVID-19 vaccinations for staff, but was denied. Dallas County Judge Clay Jenkins required face masks at a meeting this week; he’s now being sued.

[…]

Dr. Mark McClellan, who advised Abbott earlier in the pandemic, said local officials need flexibility based on conditions in their area.

“There is evidence that wearing a mask, especially at times of high community transmission which Texas has right now, does help significantly,” said McClellan, former commissioner of the U.S. Food and Drug Administration and director of the Duke-Margolis Center for Health Policy at Duke University.

“I appreciate that wearing a mask is inconvenient, I would rather not do it,” he said. “But if there are high rates of transmission in the community I think it’s important for local authorities to have the ability to make a decision that works best for their students and their population.”

Early last year, Abbott said he would rely on data and doctors in making decisions to promote public health. McClellan was one of Abbott’s four original medical advisors, but is no longer playing that role.

Abbott has remained in regular contact with one of the original advisors, Department of State Health Services head Dr. John Hellerstedt, since the beginning of the pandemic, according to spokeswoman Renae Eze. Hellerstedt did not answer questions about whether he agreed with Abbott’s executive order.

[…]

It remains to be seen whether other school districts follow suit in defying Abbott’s order. El Paso officials wrote to Abbott this week urging him to give school districts a choice in whether to require masks or not. Dallas ISD did not respond to a request for comment.

Violations of Abbott’s order can result in a fine of up to $1,000. Georgina Pérez, a State Board of Education member from El Paso, volunteered to raise money to help pay fines for school districts that defy the governor’s order by mandating masks.

“Knowingly not protecting children from harm goes against everything that teachers stand for,” she said.

Abbott’s office did not immediately respond to questions about whether any fines have been levied to date. Houston Mayor Sylvester Turner has faced no pushback since he told the city’s roughly 20,000 workers on Monday to resume wearing masks at work, according to a spokesperson.

[…]

Some institutions that sought exemptions from Abbott’s order have been rejected. The latest version blocks a wide swath of government entities, including cities, counties, universities and publicly funded hospitals, from requiring staff get the vaccine while full FDA approval is pending.

The University of Texas Medical Branch would want to require vaccination of its frontline clinical staff and requested an exemption, but was told to abide by the governor’s order, according to Dr. Janak A. Patel, director of the Department of Infection Control & Healthcare Epidemiology.

Dr. John Zerwas, the UT system’s vice chancellor for health affairs, raised the exemption request with Abbott recently, who was not willing to change his position, he said.

Parkland Hospital, a publicly funded organization that falls under Abbott’s order, plans to require its employees get vaccinated as soon as the FDA fully approves the shot. In anticipation, Parkland alerted staff this week that the first dose will be required by Sept. 24 and the second — or single Johnson & Johnson dose — by Oct. 15. Approximately 71% of staff are already vaccinated against COVID-19.

“These steps are necessary to protect Parkland’s complex patient population who, due to their socio-economic status, often have no choice in where they receive care,” said Michael Malaise, senior vice president of communications and external relations for Parkland, in an email.

The main thing I notice is that for the most part, the entities that have just gone ahead and done the thing they wanted to do that was in violation of Abbott’s executive orders have – so far – not received any pushback for doing so. The exception is Dallas County Commissioners Court, which got a stern letter from Ken Paxton after barring one of the commissioners from entering without a mask, but even that letter didn’t spell out any particular actions Paxton would take. The difference between UT Medical Branch hospital and Parkland Hospital is particularly instructive. Moreover, even if a cease-and-desist letter or some other legal action comes down on Parkland, by the time the dust settles they probably will have gotten some number of previously unvaxxed employees to get their shots, and that’s all that matters.

So, my advice to El Paso ISD and austin ISD, which may be considering its own mask mandate, is to just do it. Mask mandates are something that a lot of parents want, especially parents of medically fragile children or who have immunocompromised family members at home, and especially given the limited remote learning opportunities that exist now. The thousand-dollar fine, which doesn’t appear to have a clear mechanism for enforcement, isn’t very much even if it’s a thousand dollars a day, and that may be challenged in court on the grounds that it is discriminatory against students with health issues. But really, it’s the right thing to do, and maybe – just maybe – Abbott has gotten out a bit over his skis here. For sure, asking is going to get you nowhere. Take action and take it now, if all else fails it should be something that can be taken back. Do what you must to protect the kids.

UPDATE: Someone agrees with me:

The nursing shortage

Just gonna leave this here.

A nursing shortage and a high volume of patients prompted Lyndon B. Johnson Hospital on Sunday night to declare an “internal disaster” in the emergency room, where wait times swelled to 24 hours, Harris Health System officials said Tuesday.

Internal disasters limit the flow of ambulance traffic to the hospital and are usually triggered by infrastructure problems, such as fires or diagnostic machine failures.

On Sunday, however, the hospital could only staff 16 of its 24 ICU beds. At one point, about 130 people were in the ER waiting room from an “onslaught” of patients with a variety of health problems, said Dr. Esmaeil Porsa, president and CEO at Harris Health System. The rise in patients came as the state of Texas is dealing with an acute surge of COVID-19 hospitalizations; on Tuesday, the state reported 7,305 hospitalized patients, an increase of 38 percent over last Tuesday.

The system needs about 250 more nurses to fully staff both LBJ and Ben Taub Hospital, said Porsa.

“It got a point where it was actually unsafe for us to accept more patients because we just did not have enough staff,” he said.

Porsa said the 215-bed hospital is no longer under an internal disaster but remains at capacity. It has since added staff for two ICU beds.

The disaster designation was first brought to light by an emergency room doctor who emailed State Sen. John Whitmire Sunday night about the “untenable” situation there. The email, obtained by the Houston Chronicle, pleaded for more nurses.

Just a reminder, a lot of doctors and nurses are thoroughly burned out from the earlier COVID waves. They had every reason to believe that things were finally better and they could get back to their regular, normal jobs, but that was not to be. And now we’re asking them do it all again, for an even bigger surge with no help at all from state government in sight. It’s just going to get worse from here.

Back to Code Red

Pretty much inevitable at this point.

Harris County Judge Lina Hidalgo on Thursday returned the county to the highest COVID-19 threat level and urged unvaccinated residents to stay home and avoid unnecessary contact with others.

At a news conference, Hidalgo and Mayor Sylvester Turner pleaded with residents to get vaccinated, wear masks in public settings, and avoid hospitals except for life-threatening conditions.

“We find ourselves retracing our steps toward the edge of a cliff,” Hidalgo said. “It’s very conceivable that we can once again be heading toward a public health catastrophe.”

[…]

The county’s data report Wednesday evening showed how far and fast the situation has deteriorated: an explosion of new cases and a positivity rate of 16 percent. Hospitalizations in the Houston area have increased for 20 straight days and show no signs of slowing; they are on pace to set a pandemic record in about a week.

At its heart, the stay-home request of unvaccinated residents is toothless. Hidalgo lacks the authority to enforce it, let alone issue less restrictive edicts, such as mandatory mask wearing. As one of the most popular local elected officials, however, she hopes to shake residents from a sense of complacency that the pandemic is over.

“I know there’s a lot of conflicting messages, there’s a lot of confusion, so I don’t want to talk about what I don’t have the ability to do,” Hidalgo said of the state pre-emptions. “The truth of the matter is, the best we can do right now, the most we have the authority to do right now, is what we’re doing. So, we’re going to continue to make the most of that and really be direct about what we want the community to do.”

The mayor, who bucked the governor in requiring city workers to wear masks this week, said the numbers would dictate the city’s response to the virus. As of Thursday, 197 city employees had active cases of COVID-19.

“The numbers will dictate my response, and then we’ll deal with whatever happens after that. But I’m not going to be constrained by some order,” Turner said. “Wherever this virus goes, and whatever we need to do to check it and to save lives, is what I’m prepared to do.”

As the story notes, several other big counties have taken this step already, and more will surely follow. For those of you who like visuals, here you go:

Not a pretty picture at all. There’s nothing more Judge Hidalgo can do, since Greg Abbott has cut off any power that local officials had once had. I note that as of this writing, Mayor Turner’s employee mask mandate has not yet drawn a response from Abbott or Paxton. Makes me wonder if there’s more room to push the envelope a little, or if further provocation will draw their wrath.

While we can count on Judge Hidalgo to do everything she can to mitigate the spread of the virus, we can also count on her colleague to the north to do nothing.

COVID-19 cases and hospitalizations are continuing to increase dramatically in Montgomery County and around the region as the delta variant surges in unvaccinated residents.

While the Department of State Health Services recently started tracking cases in vaccinated people and specific data is not yet available, county health officials are reporting most new cases in unvaccinated residents.

“We can say that the vast majority of new cases, hospitalizations and deaths have not been vaccinated,” said Misti Willingham with the Montgomery County Hospital District. “Vaccines help reduce the risk of severe illness, hospitalization and death. Being vaccinated does a great job prepping your immune system should you encounter the virus.”

[…]

According to data from the health district since July 7, total hospitalizations in Montgomery County increased from 42 to 238 with 48 of those patients in critical care beds. MCPHD noted 157 of those 238 are Montgomery County residents.

The county’s active cases jumped 767 to 4,219. Since July 7, active cases in the county have surged by 3,624. The county’s total number of cases is now 60,941, increasing from 55,838 since July 7. Additionally, the county added three more reinfections bringing that number to 26.

However, health officials did not report any additional deaths from the virus. The total number of deaths remained at 354.

The county’s testing positive rate has climbed from 4 percent in early July to 19 percent. To date, 30,742 people have fully recovered.

Note there’s no comment from Montgomery County Judge Mark Keough in that story. Which is just as well, because when he does talk, this is the sort of thing he says. I have no words.

Since it’s all up to us to keep ourselves safe, we may as well remind ourselves of what we can do. Or at least, what we could do with just a little cooperation from our state government.

With COVID-19 cases and hospitalizations growing exponentially in Houston and Texas, responsibility for blunting the surge is still largely a matter of personal choices, leaving medical and public-health professionals pleading with Texans to be vaccinated, mask up and maintain social distancing.

On Wednesday, Texas reported 8,130 hospitalizations, a 44 percent increase since last Wednesday. At Texas Medical Center hospitals, 311 patients were hospitalized for COVID, up from 61 only a month before.

“When all the indicators head in the same direction, that gives you a good idea,” said epidemiologist Catherine Troisi, who teaches at UT School of Public Health. “Right now everything is looking bad.”

[…]

“Delta is so transmissible, it’s picking off anyone who’s unvaccinated,” said Peter Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development and dean of the National School of Tropical Medicine at Baylor. “That’s what’s been happening in Louisiana and Mississippi, and now it’s starting here.”

Of the three main strategies to blunt the effect of the coming surge — vaccinating, masking and social distancing — Hotez favors vaccinations, and says it’s crucial to administer as many as possible immediately.

“If we wait until mid-surge, a vaccine campaign will be much less effective,” he said. “If ever there were a time to vaccinate, it’s now.”

He continued: “The single best thing we could do is mandate vaccinations for schools, but in Texas we’re not even talking about that. We can’t even mandate masks.”

Troisi agreed that urging individuals to act responsibly isn’t enough.

“From a public health standpoint,” she said, “we need to get people vaccinated, and we need to increase testing. Maybe we don’t have to mandate vaccines. But you shouldn’t be able to go into Target or eat at McDonald’s if you’re not vaccinated. There have to be consequences for not getting the vaccine. You can’t just put other people at risk.”

The delta variant moves faster than previous coronavirus strains, notes Spencer Fox, associate director of the UT COVID-19 Modeling Consortium.

“With the traditional coronavirus, if someone is infected, on average they’re infectious starting two-and-a-half days after infection and show symptoms at five days,” he said. “But with delta, a key difference is that the time between exposure and being infectious is shorter by a day.”

A percentage of people infected today are almost certain to need hospitalization within one to two weeks. So preventive measures taken today, he said, “will help reduce hospitalizations a week from now, and will have major impacts two weeks from now.”

In other words, all of the same risk-minimization techniques we had before, back when we didn’t have an amazingly effective vaccine that was free and available to everyone over the age of 12 to really truly minimize the risk. I’m going to boil it all down to “get you and everyone in your family who is eligible vaccinated, and do everything you can to avoid any contact with unvaccinated people”.

For sure, stay the hell away from this.

Texans for Vaccine Choice will host a rally on the steps of the Texas Capitol later this month, protesting “the current state of medical mandates” as the state grapples with a surge in COVID-19 cases and stagnating vaccination rates.

The rally is scheduled for Aug. 21 at 11:30 a.m. A panel discussion will address the state’s current COVID protocols and vaccine requirements.

“I’m speechless,” Dr. Peter Hotez said Thursday morning. “To do that when there’s a public health crisis, with COVID rates going up — it’s terrible.”

As someone once said, terrible is as terrible does. If the COVID they will spread could be limited to just them it would be one thing. But it’s not, and so here we are.

The data for the “fourth wave” looks so, so bad

Yikes.

Fueled by the delta variant, a surge in Houston COVID-19 hospitalizations is growing as fast as at any time during the pandemic so far, and is projected to pass previous records by mid-August — even though roughly half of all eligible Houstonians are fully vaccinated.

“We’re heading into dark times,” said Texas Medical Center CEO Bill McKeon. Already, he said, “our ICUs are filled with unvaccinated people.”

On Tuesday, Texas Medical Center hospitals listed 1,372 people in intensive care — more than the number of regular ICU beds. The hospitals are now in Phase II of the medical center’s surge plan, opening unused wards to accommodate the gravely ill patients expected to need them.

The Texas Department of State Health Services reported 7,305 people were hospitalized statewide for COVID-19 as of Tuesday — more than four times as many as on July 1, and a 38 percent increase over last Tuesday’s figure.

Estimates by the UT-Austin COVID-19 Modeling Consortium suggest that all regions across Texas will face surges larger than anything seen so far.

In the Houston area, the previous record for COVID hospitalizations was 2,927 people on Jan. 8. The consortium’s latest model predicts that record will be broken Aug. 8. The previous record for ICU patients — 947, set July 18, 2020 — is predicted to be broken Aug. 15.

Even more alarmingly, the surge isn’t predicted to level off there, but to keep climbing sharply. By the end of August, the consortium forecasts that roughly 2,000 people will be in Houston ICUs — double the previous high.

“It’s really scary,” said Spencer Fox, associate director of the modeling project. “I’m worried about the next few weeks. It’s so clear in the data: We’re in the midst of a very severe surge.”

Houston Methodist CEO Marc Boom described “a perfect storm”: the combination of Texas’ large number of unvaccinated people, the rampaging delta variant, and the recent relaxation of preventive measures such as masking and social distancing.

I’m at a loss for words and have wrung out just about all of my outrage. So I’m just going to leave this here:

If only Greg Abbott would listen to his own Department of State Health Services. I wonder what it’s like to live in a state that has a Governor that isn’t actively trying to harm its residents.

One more thing:

White Linen Night is back — well, sort of.

In lieu of official festivities, a group of Heights business owners have gotten together to host “Late Night on 19th Street” this Saturday. The good news is there will still be plenty of live music, pop-up vendors, artisans and white linen. The bad news is there will not be street closures, so plan accordingly.

Celebrations — geared toward supporting small, local businesses — are slated to run Aug. 7 from 5-7 p.m. between the 200-300 on Heights’ historic 19th Street.

Manready Mercantile owner Travis Weaver suggests bringing water, sunscreen, a bandana, portable cooler and potentially an umbrella.

“It never hurts to be prepared,” he said via statement. “If you don’t have any white linen, anything white will do. Don’t forget comfy shoes!”

How about “And don’t forget a mask! And for Christ’s sake don’t bother to show up if you and your entire party aren’t fully vaccinated!” I’m just saying.

We’re #2!

More people have died of COVID in Texas than any other state except California, as Texas surpasses New York’s total.

Texas has passed New York to become the state with the second-most COVID-19 deaths, a feat experts say was driven by an inability to control transmission of the virus here.

Texas reached the milestone Wednesday, hitting 53,275 deaths, despite trailing New York by more than 29,000 fatalities last summer. Since then, though Texas is 54 percent more populous, more than twice as many Texans as New Yorkers have succumbed to COVID-19. California, the most populous state, leads the nation with 64,372 virus deaths.

Spencer Fox, associate director of the University of Texas COVID-19 Modeling Consortium, said he was surprised Texas had not passed New York in mortality sooner, since the northeastern state did a far better job limiting the spread of virus after it endured a horrific surge last spring.

“They enacted really strong, precautionary measures that overall are well based in the available science,” Fox said. “It seems that many of the Texas policies were put in place to try and prevent health care collapse rather than trying to prevent transmission.”

By June 30 of last year, as the first wave of the COVID-19 pandemic swept through the United States, New York tallied 31,775 virus deaths. Texas had just 2,481.

While New York City hospitals were pushed to the brink in the spring and the region became a global epicenter of the virus, Texas had kept the virus at bay and begun to ease restrictions.

Over next 13 months, however, the states reversed roles. New York kept restrictions and mask rules in place longer and consistently maintained a lower positivity rate than Texas. In contrast, Texas endured two surges of the virus and is in the early stages of a third, as the Delta variant now sweeps the country as a fourth wave of the virus.

During that time, Texas steadily closed in on New York’s death tally, a Chronicle analysis found.

Another way to put it is this: Since June 30 of last year, 13 months ago, there have been about 51,000 COVID deaths in Texas. (That’s the official count, which as we know is too low for a variety of factors, but it’s what we’re using for comparison purposes.) In that same time period, there have been about 22,000 COVID deaths in New York. Texas, with 54% more people than New York, has had 131% more COVID deaths than New York in that time period. It’s mind-boggling, enraging, tragic, devastating, and all of it can be laid at the doorstep of Greg Abbott.

The rest of the story is a timeline of those past 13 months, the various things that governments in New York and Texas did and didn’t do to deal with the changing infection rates, and so on. New York has been far more restrictive than Texas has, sometimes to the point where its residents complained and experts questioned the risk calculation involved, but the numbers are what they are. New York also has a higher vaccination rate than Texas, so this trend is going to continue, and probably accelerate, in the foreseeable future. Indeed, given how much more vaccinated California is than Texas, we could conceivably catch up to them as well. Not a goal we should want to achieve.

But we’re well on the way, and Texas’ hospitals are bracing for impact.

When Terry Scoggin left work at Titus Regional Medical Center in Mount Pleasant on Tuesday evening, there were five patients at the facility being treated for COVID.

Overnight, six more people suffering severe coronavirus infections were admitted to the rural Northeast Texas hospital — pushing the facility to its capacity limit and putting Scoggin, the hospital’s chief executive, on high alert for what he’s calling “a fourth surge.”

“We’re at it again,” Scoggin said.

That same night, hospitalizations in Bexar County rose by nearly 8%. Almost 100 people were admitted with severe COVID to local facilities on Tuesday alone, Bexar County officials said on Wednesday.

“These numbers are staggering and frightening,” said Eric Epley, CEO of the Southwest Texas Regional Advisory Council for Trauma in San Antonio.

Hospital and health officials across Texas are seeing similar dramatic jumps, straining an already decimated health care system that is starving for workers in the aftermath of previous coronavirus surges.

[…]

Fueled by the highly contagious delta variant of the coronavirus, which is contributing to skyrocketing cases not just in Texas but across the nation, the rising hospitalizations rates have spread outside of the heavily populated metro areas that first began to report increases a few weeks ago. Now they are being seen in all corners of the state, triggering pleas from hospitals for state-backed staffing help to handle the increasing pressure.

Trend forecasters at the University of Texas at Austin’s COVID-19 Modeling Consortium said Wednesday that most regions of the state could see a return within a couple of weeks to the capacity-busting hospitalization rate facilities were experiencing in January — the height of the pandemic — if people don’t resume masking up and social distancing.

In Florida, hospitals are already seeing the numbers of COVID patients exceeding levels they saw during the worst of the pandemic, and consortium researchers told The Texas Tribune that Texas is not far behind.

“We are absolutely on a path to hit a surge as large, if not bigger, than the previous surges right now” said Spencer Fox, associate director at the consortium. “If nothing is done, we’re on a crash course for a very large third wave.”

The situation has caused health officials from both rural and metro areas to plead for more resources from the state.

“On behalf of the 157 rural hospitals across Texas, I am writing to ask you immediately take steps to provide additional medical staffing which we anticipate will be needed in our rural hospitals in short order because of the new COVID surge,” John Henderson, president and CEO of the Texas Organization of Rural and Community Hospitals, wrote in a July 26 letter to Gov. Greg Abbott.

And what was Abbott’s eventual response?

The story is behind their paywall, but the basics of it that I could glean were that the state of Texas is declining to use any COVID stimulus funds to pay for more hospital staff. Instead, the state is directing cities and counties to use their own COVID funds for that. Because we’re all in this together you’re on your own, Jack. And remember, it’s all your fault and will be your fault when more people have died of COVID in Texas than anywhere else in the country.

Greg Abbott will blame you if you get sick

He will take no responsibility at all.

With COVID-19 hospitalizations soaring past 5,000 statewide for the first time in nearly five months, state officials are stepping up vaccination outreach programs and promotional campaigns but Gov. Greg Abbott insists that the state won’t impose any new mandates on Texans.

State officials announced Wednesday that Texas has 5,292 people hospitalized with lab-confirmed COVID-19 — the highest number since March 2, the day Abbott announced he was ending all state mask mandates and restrictions on businesses.

At that time, Abbott called for “personal diligence” and said statewide mandates are no longer needed.

Though 10,000 new COVID infections were reported statewide on Wednesday, the most since February, he has not changed his messaging.

“The time for government mask mandates is over — now is the time for personal responsibility,” Abbott wrote on Twitter on Tuesday. “Every Texan has the right to choose whether they will wear a mask or have their children wear masks.”

His latest comments came as the president of the Texas State Teachers Association publicly called on Abbott to allow schools to require masks, particularly since vaccines have not been approved for children under 12.

“If Gov. Abbott really cares about the health and safety of Texas students, educators and their communities, he will give local school officials and health experts the option of requiring masks in their schools,” Texas State Teachers Association President Ovidia Molina said on Tuesday.

I mean, I think we know the answer to that hypothetical.

Meanwhile, statewide hospitalizations from the virus have doubled in the last two weeks and more than tripled since the start of July, when Abbott re-issued a disaster declaration to deal with COVID-19.

“COVID-19 hospitalizations are rising and new variants of the virus are spreading quickly in our communities,” said Dr. John Hellerstedt, commissioner of the Texas Department of State Health Services in a statement Wednesday.

While Texas still appears to have more 9,100 available hospital beds statewide, there are areas around Beaumont, College Station and Killeen reporting that few intensive care beds are available for additional chronic patients.

The College Station region reported no more available ICU beds on Wednesday and Laredo officials were down to just 1 available ICU bed.

Killeen is a city in Bell County, which has one of the worst vaccination rates in the state, according to state data. Just 33.5 percent of that county’s population over 12 years of age have been fully vaccinated compared to over 54 percent in Harris County and 56 percent in Bexar.

“It is clear that increasing vaccinations is still our best strategy to navigate through this pandemic and get to closure,” Bell County Judge David Blackburn said in a recent news release.

Statewide, just 52 percent of Texans 12 and older have been vaccinated.

Here’s the Thursday update.

Across Texas, 5,662 people were hospitalized for the virus as of Thursday, the highest number recorded by DSHS since Feb. 28 and a massive increase since its low point of 1,428 on June 27.

It’s bad, y’all. And it’s getting worse. There’s a bit of a vaccination push now, but as you know it takes time to get fully protected, and we don’t have any. Abbott’s lifting of the mask mandate when he did was premature, and his mulish resistance to any possible leeway for local officials is harmful in the extreme, but let’s be clear that his biggest sin is not doing everything he could to get more Texans vaccinated. Masks at least would do something now, and even if it is too late for this surge to ramp up vaccinations, that’s still by far the best thing to do. So what is Abbott doing?

Vaccinations > masks, but thanks to Abbott’s utter lack of leadership, we have neither. And so thousands more people are getting sick, and some number of them – more than it should be – will end up in the hospital or a grave. And all of that is on Greg Abbott.

On the reaction by some people to the new mask recommendations

I have one thing to say to this.

Texas Republicans in Congress are fuming over new mask requirements on Capitol Hill and recommendations from the CDC that even vaccinated Americans begin masking again as an extra precaution in parts of the country where the Delta variant is spreading, including Texas.

“Which is it, vaccines or masks?” said U.S. Rep. Chip Roy, a San Antonio Republican, in an impassioned speech on the House floor on Wednesday. “Do the vaccines work or they don’t work? Do the masks work or they don’t work? I’d like to know which it is.”

Health officials have been clear that the vaccines remain effective at preventing the worst outcomes of COVID, including hospitalization and death. The vast majority of breakthrough cases have been mild.

But COVID infections continue to climb throughout much of the U.S. — including Texas — and the Centers for Disease Control and Prevention this week revised its recommendations to urge even fully vaccinated Americans in those areas to wear masks indoors again.

That led to new mask mandates in the U.S. House and the White House, but Texas Gov. Greg Abbott has made clear he doesn’t not plan to require face coverings again in Texas.

Still, Republicans were outraged at the new guidance. U.S. Sen. Ted Cruz called mask-wearing “a virtue signal of submissiveness” as he referred to Democrats wearing face coverings again as “kabuki theater.”

If you are not fully vaccinated, have not made your vaccinated status known to others, and have not been a vocal advocate of vaccination, then you can take any and all complaints you may have about these new recommendations and go fuck yourself. Seriously.

I say again, with all the feeling I can muster: Go fuck yourself.

More masking

In Travis County.

Public health officials in Austin and Travis County are now encouraging vaccinated people to wear masks both indoors and outdoors, and for those unvaccinated to stay at home except for essential needs — the first major city in Texas to take such a step.

This comes as the highly contagious delta variant continues to spread across the state, pushing the county’s seven-day average of new hospitalizations to 35 — the threshold for Stage 4 of the area’s COVID-19 risk-based guidelines.

County officials made the announcement in a virtual news conference Friday morning. Under Stage 4, officials want residents — vaccinated and unvaccinated — to wear masks at all times in public, and for unvaccinated people to only leave their homes for essential trips.

The city can’t enforce the restrictions, however, because Gov. Greg Abbott banned all local pandemic-related mandates in May. The recommendations differ from those of the U.S. Centers for Disease Control and Prevention, which says it safe for people who are fully vaccinated to “resume activities that you did before the pandemic without wearing a mask or physically distancing.”

It was just last week that Austin had gone to Stage 3. Of course as noted they can’t make anyone do any of this. They can just ask nicely and recommend as hard as they can.

Fort Bend is doing likewise.

Fort Bend County officials highly encourage people to wear masks indoors and get vaccinated as the highly contagious Delta variant spreads through the community.

A month after confirming the presence of the Delta variant in Fort Bend, health officials have detected an increase in the COVID-19 test positivity rate and in the number of cases, hospitalizations and ICU admissions, said Dr. Jacquelyn Minter, director of the county’s health and human services department.

In the past week, roughly 77 percent of the reported cases were the Delta variant, Minter said. The vast majority of cases of severe illness involve people who are unvaccinated. There has been a spike in the number of infected young adults.

“We are finding that this variant is especially adept at spreading in close groups of unvaccinated people,” Minter said.

Officials recommend that people who are vaccinated and unvaccinated wear masks indoors, practice physical distancing and wash their hands. County staff will post signs recommending that people mask up.

“This is a preventive action that is being asked,” said County Judge KP George. “This is not a mandate. But it is strongly advised to reduce the number of infected people.”

Harris County has gone up a notch as well, and it won’t surprise me if they take the next step. Just as a reminder, masking and social distancing did a pretty good job of keeping things under control when there was no vaccine. If we could at least do that, we could get this back under control pretty quickly. I think we all know that the overlap between “won’t get vaxxed” and “won’t wear a mask” is pretty high, so keep your expectations in check. If only there were some way to do more than encourage and recommend…

The fourth wave

We’re not ready.

One local hospital is reinstating visitor limits and Harris County Judge Lina Hidalgo is mulling a change to the county’s threat level amid a wave of COVID-19 variant cases that medical leaders warned Tuesday could overwhelm area hospitals and wreak further havoc as schools reopen next month.

The warning came amid massive spikes in hospitalizations across the Houston region, which Hidalgo’s office is closely monitoring to decide if the county needs to raise its emergency threat level from yellow to orange — or moderate to significant.

“We’re watching this very, very closely,” Hidalgo spokesperson Rafael Lemaitre wrote in an email. “The trends are moving in the wrong direction again and we are in a high-stakes race against the delta variant of this virus. Our message to the community is simple and clear: If you haven’t been vaccinated, take action now.”

In May, Hidalgo lowered the threat level from red — where it had been for nearly a year — to orange, then yellow a few weeks later, as COVID cases waned statewide.

But this month, hospitalizations across the state have more than doubled, ballooning from 1,591 on July 1 to 3,319 as of Tuesday, according to the Texas Department of State Health Services. The state’s hospitalization count peaked in January at 14,000.

Texas Medical Center CEO William McKeon said he fears the closing of many testing centers will make it more difficult to gauge the extent of COVID’s spread in the coming weeks.

“As this fourth wave begins in force, our radar is down,” Texas Medical Center CEO William McKeon said in a Tuesday conference call with reporters. “We have only a fraction of the testing…. We’re going to be running much more blind to the spread of delta variant in our community.”

[…]

Memorial-Hermann Health System plans to readopt visitor restrictions this week, and will test all patients for COVID, regardless of their vaccination status, said Dr. Annamaria Macaluso Davidson, vice president of employee health medical operations.

The hospital system had about 100 confirmed COVID cases on July 4; by Tuesday, there were more than 250.

We’ve been discussing this, and you know how I feel. The hospitalization numbers are still relatively low, but that’s a sharp increase, and there’s no reason to think there won’t be more. And I hadn’t even thought about the drastic reduction in testing facilities – I don’t know how big an effect that may have, but it’s not going to help.

I drafted this a couple of days ago, and before I knew it, Judge Hidalgo had already taken action.

Harris County’s emergency threat level was raised to orange — or “significant” — on Thursday and County Judge Lina Hidalgo called for resumed mask wearing amid a fourth wave of COVID-19 that has already caused hospitalizations to spike across the region.

“It’s not too late,” Hidalgo said. “But if we don’t act now, it will be too late for many people…. We are at the beginning of a potentially very dangerous fourth wave of this pandemic.”

The guidelines for the orange threat level are voluntary, and urge residents — namely those who are not vaccinated — to avoid large gatherings and businesses with poor safety procedures.

Hidalgo also said “everyone” should resume wearing masks to protect the County’s population who are not fully vaccinated. Currently, about 2.1 million county residents are fully vaccinated — 44 percent of Harris County’s total population.

She noted the county’s positivity rate is now doubling about every 17 days, quicker than any other point in the pandemic.

Get your masks back on, and hope for the best. I trust Judge Hidalgo to do everything she can to ameliorate this situation, but as we know, there’s not a lot she can do. Greg Abbott has seen to that.

One thing that could help is if more places of business begin putting in their own vaccination requirements, mostly for employees but also possibly for customers or business partners, depending on the situation. Putting some limits on what one can do as an unvaccinated person is one of the few effective ways to compel people to get their shots. That will have to come from the private sector, because it sure won’t come from the state. The FDA giving final approval to the Pfizer and Moderna shots will help, too. I just don’t know how long we can wait.

Abbott affirms he will take no action to mitigate future COVID waves

He’s on brand, that much is for sure.

Gov. Greg Abbott says he will not impose another statewide mask mandate, despite COVID-19 cases being on the rise again.

“There will be no mask mandate imposed, and the reasons for that are very clear,” Abbott told KPRC-TV in Houston on Tuesday. “There are so many people who have immunities to COVID, whether it be through the vaccination, whether it be through their own exposure and their recovery from it, which would be acquired immunity.”

It would be “inappropriate to require people who already have immunity to wear a mask,” Abbott said.

During a news conference Wednesday in Houston, Abbott went further and expressed blanket resistance to any new restrictions to fight the virus. He said Texas is “past the time of government mandates” and “into the time for personal responsibility.”

[…]

Abbott reiterated Tuesday that Texas schoolchildren will not face mask requirements as they return to school later this summer.

“Kids will not be forced by government or by schools to wear masks in school,” Abbott said. “They can by parental choice wear a mask, but there will be no government mandate requiring masks.”

Well, he answered my question, and that answer is “You’re on your own, it’s not my problem if you get sick”. What happens when and if hospitals begin to get overrun remains a mystery. The most charitable explanation of this stance is “Look, we all know that the idiots who haven’t gotten vaccinated are the same idiots who refuse to wear masks, so what’s even the point?” If only he as Governor had some power to enforce compliance, or to be a voice of persuasion to those who have refused to bear any responsibility. But at least he cleared that up for us, so thanks for that. The Chron and Reform Austin have more.

What will Harris County do about rising case numbers?

I’m afraid we’ll find out soon enough.

The Harris Health System’s COVID-19 ward was down to just one patient at the beginning of July.

Anxious to hit zero COVID-19 patients, Dr. Esmaeil Porsa, the hospital system’s CEO, purchased and stored a bottle of Martinelli’s sparkling grape juice — “fake champagne” — in his refrigerator. If the COVID ward emptied out, he would drive to Lyndon B. Johnson Hospital, one of the system’s two medical centers, to celebrate with doctors and nurses.

Instead, the numbers went the opposite direction. As of Friday morning, nurses were treating 14 COVID patients at LBJ Hospital.

“We really had the opportunity to have this darn thing beaten,” Porsa said.

COVID-19 infections are climbing upward again in Houston and Texas as vaccine rates lag, the delta variant spreads and people return to their normal lives.

Most of the patients admitted to hospitals for COVID-19 are unvaccinated or have received just one dose of the Pfizer or Moderna vaccines, Porsa said. None of the 119 people who have died from COVID-19 at Harris Health since January were fully vaccinated.

“If that is not reason enough for us to change our attitudes toward a simple, accessible, proven safe and proven effective prevention … I’m just losing my mind,” Porsa said.

Hospitalizations across the state have increased by more than 75 percent in recent weeks: On June 27, 1,428 hospital beds were filled; by July 15, the number had reached 2,519.

According to KHOU, “Almost every county in the area is seeing an increase in new cases”, and “Daily new cases in the Greater Houston area have jumped about 65% in the last two weeks”. (Cases and hospitalizations are rising nationally, too.) They show data from Harris and its surrounding counties except for Liberty and Waller. Harris has the lowest percentage increase, but it’s the biggest county so its sheer numbers are the highest.

We know how Travis County is responding to its increase in cases. Harris County had dropped its threat level to Yellow in May. Are we looking at a step up again?

Harris County Judge Lina Hidalgo has yet to announce any rollbacks for the region.

“There is no conceivable reason why a single additional hospital bed in our healthcare system should be filled with someone who is sick from COVID-19 when vaccines are readily available and free,” said Rafael Lemaitre, a spokesperson for Hidalgo’s office.

Vaccination rates plateaued in late April amid high hesitancy rates and difficulty accessing immunization sites. In recent months, health officials piloted financial incentives such as scholarships to encourage younger people to sign up for an appointment.

Stay tuned on that. Maybe there’s some headway to be made with younger people, whose vax rates are the lowest among age groups. Better happen quickly, that’s all I can say.

Kids still get COVID, too

And they need to get vaccinated if at all possible.

Since the Food and Drug Administration approved emergency use of the Pfizer vaccine for 12 to15 year olds on May 10, more than 300,000 Texas adolescents and teenagers have received at least one dose. Girls in this age range are receiving the vaccine at a higher rate (153,000) than boys (149,000), according to Texas Health and Human Services. Nationwide, more than 626,000 12 to 15 year olds have received two doses, according to the CDC.

Though young people can now receive shots, the number of children and adolescents being hospitalized is increasing. The Centers for Disease Control and Prevention released data from the first half of 2021 that shows nearly one-third of adolescents who are hospitalized with COVID-19 require intensive care. Five percent of those patients need to be put on ventilators with supplemental oxygen, as well.

The CDC reports that nearly 400 children and adolescents are currently in hospitals across the country with COVID or complications from the virus. More than 16,000 under the age of 18 have been hospitalized from COVID since the start of the pandemic, and more than 300 of them have died from it, said Dr. Jim Versalovic, interim pediatrician-in-chief at Texas Children’s Hospital.

“This is a huge setback for a child or adolescent with time spent out of school or activities,” Versalovic said. “There’s a long recovery time even if the infection is mild initially.”

He attributes the increase to fewer masks and stagnating vaccination rates.

More than half of all Texans are vaccinated with at least one dose, but that doesn’t mean Houston is free of several coronavirus variants that are more transmissible and deadlier than the original virus.

In the last month, fewer people are masking up in public outdoors and indoors after the CDC said it was safe for vaccinated people to go masklessThree-day holiday weekends and the onslaught of summer weather has turned Houston into the partying swamp city it was before the pandemic, too.

[…]

Versalovic said about 10 percent of children diagnosed with the virus at his hospital require hospitalization. This rate is nearly three times greater than the seasonal flu, which the CDC reported killed nearly 600 children between 2017 and 2018.

Child survivors sometimes have a whole new set of problems when the initial infection clears. Several weeks after other symptoms have gone away, children who had mild COVID develop other symptoms that typically require hospitalization. This is called Multisystem Inflammatory Syndrome in Children, or MIS-C.

MIS-C symptoms include fever, stomach pain, diarrhea, vomiting, neck pain, random rashes and bloodshot eyes. Extreme fatigue is also a symptom, but it’s usually blamed on other problems.

Texas Children’s has vaccinated more than 18,500 12 to 15 year olds since early May. Any person age 12 and older is eligible for a free Pfizer vaccine from the hospital, regardless of whether they are currently a patient. Vaccines are available at six Texas Children’s sites across Houston Monday through Saturday.

The hospital is partnering with Houston-area school districts now to immunize their students, so middle and high schools can open safely for the fall semester, he added.

“We are going to be very busy during the summer months as we seek to immunize as many children as possible,” Versalovic said. “It’s important to protect adolescents to stop the spread of COVID as they get ready for summer activities, camps, sports and the school year in August.”

Not much to say here that we haven’t said already, many times. Get your kids vaccinated. As long as there are unvaccinated and/or immunocompromised members of your household, you should continue with pre-vaccination safety protocols as much as possible, which I know is vastly more difficult now that masks are being removed all over the place. It is true that the health risks to kids from COVID are lower than they are with adults, but they are not zero and they can be serious. For all the progress we’ve made, we’re not out of danger yet.

Study claims Uber has reduced drunk driving in Houston

Of interest.

Paid rides have saved lives and lessened drunk driving convictions in Houston, according to a new study released Wednesday by local researchers that claimed a direct link between more folks hailing an Uber and fewer wheeled into emergency rooms.

“The data shows that ridesharing companies can decrease these incidents because they give young people an alternative to driving drunk,” said Dr. Christopher Conner, a neurosurgery resident at McGovern Medical School at UTHealth in Houston and lead author of the report, published in the Journal of the American Medical Association’s surgery periodical.

Conner and the other researchers compared trip information from Uber — which supplied the data — in Houston between 2014 and 2018 to emergency room visits to Houston’s two Level I trauma centers during the same period and four years prior to Uber’s debut.

Vehicle-crash visits to the ERs at Ben Taub and Memorial Hermann-Texas Medical Center dropped 23.8 percent after Uber arrived in February 2014 during the peak Friday and Saturday night periods, researchers found. The decline was even more pronounced among people below age 30, where researchers reported a 38.9 percent drop in hospital visits as a result of wrecks.

The authors also found a decrease in drinking and driving convictions in Harris County during the same period.

Back in the early days of Uber and Lyft, when they were trying to get licensed to operate in all the cities (and seeking to pass a bill in the Lege to mandate their approval), there were studies conducted that showed similar results in other locations, and at least one study that disputed such effects. What we have now that we didn’t have then is a lot more data. I thought at the time that the connection between ridesharing services and a reduction in DWI made intuitive sense, and I still think that now even as I find the overall case for Uber and Lyft to be less compelling. I do think it’s easier, and more the societal norm, to get a drunken friend or colleague or whoever into an Uber or Lyft than it was in the older days to persuade them to call a cab. More work should be done to better quantify that, but that such a trend is visible is no surprise to me.

Threat level down again

Nice.

Harris County Judge Lina Hidalgo on Friday downgraded the county to the yellow COVID-19 threat level, citing improving metrics for the virus here coupled with increasing vaccinations.

“This is an important and encouraging, but still fragile, milestone in our fight against COVID-19,” Hidalgo said. “Our community is doing what it needs to do to move the needle in the right direction, but the threat of stalling or moving backwards remains very real.”

Hidalgo urged unvaccinated residents to avoid gatherings over Memorial Day weekend and implored them to get inoculated.

Friday’s move was the second downgrade in two weeks, following months of criticism the threat level had become meaningless as COVID numbers improved and the governor opened the entire state for business.

See here for the previous update. You can complain if you want, but Judge Hidalgo was just following the data and not screwing around with the agreed-upon metrics for the sake of politics. If you want to keep this moving along, go convince your unvaccinated friends and family to get the shot or stay masked up. The path forward has always been simple, the problem has been the unwillingness of too many people to follow it.

Hospitalizations are down

Very good news.

The number of Texans hospitalized for COVID-19 this week hit its lowest mark in nearly a year, the latest sign that the state is turning a corner.

According to the state Department of State Health Services figures released Wednesday, fewer than 2,000 people were hospitalized for COVID-19 for the first time since June, 2020. Wednesday’s data showed 1,962 people were in the hospital due to the virus; by Thursday, the number had dropped again — to 1,899.

It’s the first time the hospitalization rate has dipped below 2,000 since June 2020, and a massive drop from its January peak of more than 14,000.

The news was welcomed by public health officials and experts, though they also warned against complacency until more people are vaccinated.

“We are at this point where the virus is basically in an arm-wrestling match with vaccines, and vaccines are winning,” said Dr. David Persse, Houston’s chief medical officer. “Things are absolutely getting better, but I don’t want us to completely take our foot off the brake.”

He said the drop in hospitalizations is likely due to the elderly — who are more at-risk of serious symptoms — being initially prioritized for inoculations. Nearly 70 percent of all Texans older than 65 have been fully vaccinated as of Thursday, according to DSHS.

Persse remains worried about the number of people who have not been vaccinated.

“There’s still a risk,” he said.

As of Thursday, about 52 percent of all eligible Texans — those aged 12 and older — have received at least one vaccine dose, a number that puts the state near the bottom of all states for vaccines per capita.

Like I said, this is all very good, but there’s no question it could be better. We could have more people vaccinated, and we could be vaccinating the rest at a faster clip. We could have more unvaccinated people wearing masks and exercising caution about being around other people. We could have fewer people who don’t intend to get vaccinated. Our numbers are better than they’ve been in a year – basically, since the start of last year’s summer surge – and they’re going in the right direction, but we’re still vulnerable to an uptick. If we make it through without that happening, at least some of that will be pure dumb luck.

Threat level down

Been waiting for this for some time.

Harris County finally will downgrade from its highest COVID-19 threat level, County Judge Lina Hidalgo said Monday evening, after 47 weeks of urging residents to stay home.

Hidalgo said the effectiveness of the COVID-19 vaccines and improving local metrics were among several factors that convinced her to revise the threat level system the county debuted last summer. The U.S. Centers From Disease Control also told fully vaccinated Americans last week they may resume their pre-pandemic lives.

“We’re very much at a turning point,” Hidalgo said. “We don’t want to claim victory because there certainly there’s a possibility that amongst the unvaccinated, the virus gets out of control. But we do have reason for celebration.

Hidalgo said she would make a formal announcement Tuesday. Remaining guidelines would only apply to unvaccinated residents.

The two Republican county commissioners had urged the Democratic leader for weeks to abandon Level Red, which states that virus outbreaks are uncontrolled and worsening; data show the opposite is true.

The pair, Jack Cagle and Tom Ramsey, have said that while COVID-19 still must be taken seriously, the Level Red designation obscures the progress the county has made in containing the virus.

[…]

Currently, Harris County meets four of five criteria to downgrade to the next-highest threat level, including 14-day averages of new cases below 400 and share of ICU beds occupied by virus patients below 15 percent.

The remaining barrier is a test positivity rate below 5 percent; currently that metric stands at 9.4 percent. That result differs greatly than the positivity rate recorded by the Texas Medical Center system, which currently is 3.7 percent.

The TMC rate comes from tests conducted on patients at member hospitals in the Houston region; the county rate comes from tests taken by the Houston and Harris County health departments, as well as local pharmacies.

Hidalgo said experts she consulted said since few residents were being tested, Harris County’s rate likely was artificially high. She said her team would revise the metrics so positivity rate and new cases are secondary criteria.

See here for the previous update, which was a month ago. We’re a lot farther along on vaccinations, and all of the numbers have moved in accordance with that. I like the fact that we’re being true to the metrics, and that we are making adjustments to them based on new facts on the ground. I commend Judge Hidalgo for consistently doing the right thing, which would have been a lot easier to do if we didn’t have Threat Level Super Duper Bright Red stupidity and malevolence from other parts of our government. The later story also notes that government buildings would reopen to 50 percent capacity, and the county is reviewing that dumb anti-mask mandate order. The Press and the Trib have more.

Houston’s hospitals are still busy

Interesting.

While local hospital leaders aren’t sounding the alarm about capacity concerns, we heard a similar story from leaders at St. Luke’s and Houston Methodist: hospital beds and emergency rooms are regularly filling up as both health systems continue to manage coronavirus patients on top of all the folks finally heading to the hospital for care they may have delayed due to the pandemic, all while the number of patients coming into local emergency rooms is already hitting pre-COVID levels.

Roberta Schwartz, Executive VP of Houston Methodist Hospital in the Texas Medical Center, told the Press that it wasn’t surprising to hear that the Houston Methodist ER in Sugar Land was recently so busy it had to turn away ambulances temporarily.

“The emergency rooms and the hospitals are very full,” Schwartz said.

When we asked Dr. Brad Lembcke — Chief Medical Officer at St. Luke’s — about the current status of his hospital system’s bed count and ER capacity, he said “We’re full, I guess is probably the two-second version.”

[…]

Lots of Schwartz’s colleagues around the country have told her their hospitals are seeing lower numbers of emergency room visits than they did before COVID. “That is not the case at Houston Methodist,” Schwartz said, “and seems not to be the case in Houston.”

St. Luke’s is also seeing a similar trend of ERs packed with more patients than in other parts of the United States, Lembcke said. While “a lot of places report only recovering to about 80 percent of what their prior volumes were,” he said, St. Luke’s main downtown hospital is now seeing ER numbers that have “just about reached the pre-COVID states.”

Even though coronavirus hospitalizations have fallen after the winter surge, local hospitals continue to deal with steady numbers of COVID-19 patients. At Houston Methodist, the number of coronavirus hospitalizations has plateaued in recent weeks, and at a level higher than where that patient count leveled-off at after the first two surges in the spring and summer of 2020.

Schwartz said that after the first surge last spring, coronavirus hospitalizations at Houston Methodist fell to around 50. Following the summer surge, they averaged “about 100 COVID patients on a daily basis.”

“When we came down from this latest surge in December and January, we’re settling in at about 180 to 200,” Schwartz said.

“If you had a normal load of patients, and you add on 200, that would put some stressors to the system, and I think that you’re seeing that across Houston. And this comment on saturation is not just us, it’s lots of hospitals,” she said.

Lembcke said that St. Luke’s average number of coronavirus hospitalizations these days is “maybe a little higher” than what they saw right after the summer surge. “But it’s more consistent. It’s been pretty stable over the last month or so.”

When asked about why Houston’s hospitals are still so full, Schwartz said she and her colleagues have a few educated guesses.

“We do know for sure — 100 percent, this is documented in many papers — that people have delayed their care in many cases, and are coming in with later stage illnesses,” many of whom whose conditions got bad enough that they needed emergency care, Schwartz said. Some of those patients “were people who said ‘I don’t want to get COVID from going to the hospital or to the doctor.’ We know that.”

They note also that a lot of nurses have retired or left the industry due to burnout from the previous high volume of COVID cases, and that they are seeing a lot more younger patients with serious COVID issues, as is “needing a lung transplant”-level of seriousness. I certainly hope we’ll get back on a downward trajectory as more people get vaccinated, but this is a reminder both that we really need to get as many people vaxxed as we can, and that even as the overall numbers have dropped we’re still not out of the red yet.

Medicaid expansion by any means necessary

Whatever it takes. But I’ll believe it when I see it, and I have a very hard time believing that the current cast of characters will do anything to make it happen.

It’s constitutional – deal with it

Texas Republicans have been swift to condemn the Biden administration for rescinding early approval of a multibillion dollar Medicaid program that would help fund emergency care for the state’s booming uninsured population through 2030.

Gov. Greg Abbott said the federal government was “deliberately betraying Texans.”

Attorney General Ken Paxton vowed to “use every legal tool available to regain the assistance Texans need.”

But the decision federal health officials announced Friday could end up being one of the biggest steps yet to extend government health coverage to low-income people in Texas since the Affordable Care Act, according to health advocates and political observers. That’s true even if it doesn’t spur immediate change.

“The Biden administration has all the cards here,” said Brandon Rottinghaus, who teaches political science at the University of Houston. “They aren’t playing nice anymore with health care expansion. They’ve got the money, so they have the leverage.”

Pressure is also coming from inside the state. On Tuesday, a group of more than 150 organizations, including chambers of commerce, trade associations and local officials signed a letter calling on lawmakers to “support increased health coverage for Texans.”

“We specifically support a coverage initiative that is bipartisan, funded through available federal dollars, structured to be neutral for the state’s budget, and designed to meet Texas’ specific needs, values and circumstances,” it said.

The letter notably did not include the Texas Hospital Association, which criticized Friday’s decision. It has supported expanded coverage in the past.

[…]

Health care advocates have been quick to downplay Friday’s announcement, saying there is still plenty of time for the state to apply again for the waiver before next year. Texas was originally approved for the extension as part of a flurry of eleventh-hour orders by Trump health officials. In doing so, it allowed the state to forgo the normal comment period.

“I think of it in terms of, Texas didn’t follow the rules, and now it’s being told to follow the rules,” said Elena Marks, president of Episcopal Health Foundation in Houston. “It’s not being told, ‘you can’t have an uncompensated care pool.’ In fact, we need an uncompensated care pool, we ought to have one. But we have to follow the rules.”

See here for the background. Rescinding the 1115 waiver extension and making Texas follow the process to re-apply for it is a shot across the bow, but a limited one. If Texas does re-apply correctly, that extension will almost certainly be granted, though perhaps for a shorter period of time or with more strings attached. The current position of the Texas Hospital Association, which is on the sharp end of the stick right now, gives Abbott et al some cover. And as the story notes, Abbott has a primary election coming up, and the very last thing he will want to do before he wins that is anything that will make it look like he capitulated to Joe Biden and the Democrats. Maybe something happens after that, but politically speaking the incentives are all wrong.

This Trib story from Wednesday afternoon appears to offer a bit of hope, but don’t be fooled into thinking it’s more than that.

Among several bills filed in the conservative Texas Legislature is a Medicaid expansion plan with bipartisan support that is similar to those adopted in some Republican-led states.

Nine House Republicans and all 67 House Democrats have publicly signed on to House Bill 3871, which would give it enough votes to pass the 150-member chamber. Although none of the proposals have gotten a hearing this session, Medicaid expansion is expected to be introduced in some form as a floor amendment Thursday when the House debates the state budget.

[…]

“The time to do this is now,” said state Rep. Julie Johnson, D-Carrollton, the author of House Bill 3871. “The deal on the table that the [federal] government offered to us is, in my opinion, irresponsible not to accept.”

Conservative lawmakers are weighing their historic opposition to Medicaid expansion against the potential of billions in federal incentives coming to Texas during a tight budget cycle.

“There is a bipartisan desire to see the cost of health care decrease. The unsustainable increase in prices, whether at the hospital, the doctor, or in health insurance premiums hits all Texans,” GOP state Rep. James Frank, chair of the House Human Services Committee, said in emailed comments to the Tribune. “But there is also concern that when Medicaid expands, that adds pressure to the private insurance market to make up the difference in reimbursements. Hence, expansion is a hidden tax on those who have private insurance, driving up the cost of care for everyone.”

[…]

Lt. Gov. Dan Patrick’s and Gov. Greg Abbott’s offices did not respond to requests for comment, but both have opposed expanding Medicaid in the past. In January, House Speaker Dade Phelan expressed doubt that Medicaid expansion would happen this session.

Among other arguments, opponents say it would crowd out current Medicaid patients who are already getting a low quality of care due to the limited number of physicians who accept Medicaid patients because of low reimbursements.

It’s nice that there are 76 votes for a bill that hasn’t gotten a hearing and would still have to get through the Senate and be signed by Greg Abbott, but it’s still vaporware for now. (Rep. Frank, the House Human Services Committee Chair, is not among the nine Republican co-authors.) The same old tired arguments against Medicaid expansion, by people who don’t like Medicaid but claim to want to “protect” it, continue to have sway. Honestly, about 95% of this story could have been written in 2019, or 2017, or 2015, or 2013. It’s a tale as old as time at this point. The urge among Republicans to stick it to Obamacare at all costs has not abated. I don’t see anything to suggest to me that something has changed in this dynamic. I will be delighted to be wrong, but until I am proven wrong I say it ain’t gonna happen until we elect enough Democrats to make it happen.

Vaccine progress

Good news.

Texas will surpass more than 7 million COVID-19 vaccination doses administered today, top public health officials told the Texas Senate as Gov. Greg Abbott lifted all capacity limits for businesses and ended government-imposed mask mandates in the state.

At the same time, the health officials also offered a strong defense of the previous mask mandates, saying they reduced the chance of asymptomatic people spreading the virus and resulted in a record low year for influenza in Texas.

The speed with which vaccinations are being distributed is one of the keys to Abbott’s new order removing all mask mandates and allowing all businesses to re-open to 100 percent of their occupancy. Still, Texas has one of the lowest vaccination rates in the country, with 15.8 percent of residents having received at least one shot.

“We have come a long way in a very short period of time,” said Imelda Garcia, a top official with the Department of State Health Services, as she testified before a committee in the Texas Senate on Wednesday morning.

Garcia reminded lawmakers that Texas didn’t get its first vaccine shipments until Dec. 14. She lauded vaccine providers around the state for stepping up to administer so many shots in such a small window.

“They have been busting their butts in order to get shots in arms as fast as they physically and possibly can,” Garcia said.

Harris County alone topped 1 million doses on Tuesday.

Because the majority of vaccines in Texas require two doses, the number of people fully vaccinated is just over 2 million statewide.

Yes, there has been a lot of great work done, and everyone involved should be praised and thanked for it. There have been plenty of obstacles to overcome, that’s for sure. Because I’m a numbers nerd, I feel like I have to say something about the totals and percentages cited in this story, because as is they’re making me twitch. Seven million people would represent about 23% of the total state population. Given that the vaccines are only being given to those 16 and up, that makes the denominator in that fraction smaller, and thus would make the percentage higher. The only way this works if that total of “seven million doses administered” counts all shots given, both first and second. That would put the number of people that have had at least one shot at almost five million, which is closer to that 15.8% (it’s now higher on that NYT page, as it updates in real time). I’m just a little annoyed that I had to think it through like this to make sense of it all.

Not so good news.

The Texas Medical Center, in partnership with the city, is now administering 232,000 COVID-19 vaccine doses per week, and experts expect that number to ramp up as more vaccines are shipped to the state.

While vaccination rates are increasing and COVID-19 cases are trending downward again, medical officials said the public shouldn’t get too comfortable. Texas Medical Center leaders said there is currently no strong correlation between vaccination and hospitalization rates.

Experts are anxious that there could be another surge as students go on spring break this month. There’s more virus in Houston, and it’s spreading faster as more infectious variants circulate in the area.

“We’re not seeing the rapid decline we want to see,” Bill McKeon, president of the Texas Medical Center, said at a Wednesday webinar on the state of COVID-19 in Houston.

Part of the reason for this is that it takes time for the vaccine to take full effect – this is true of both the one-shot J&J vaccine and the two-dose Pfizer and Moderna vaccines – and it is eminently possible to continue to carry the disease after getting your shots. You will be much less likely to get sick, but you can pass it on to others, who may not be so lucky. This is why everyone who cares about keeping people alive and healthy are continuing to urge everyone to wear masks and maintain social distancing. We are approaching a point where those things will not be vital, but we are not there yet.

Good news for some, just news for others.

Texans ages 50 and older will be eligible for the COVID-19 vaccine starting March 15, state health officials announced Wednesday.

“We’ve seen a remarkable decrease in the number of hospitalizations and deaths since people 65 and older started becoming fully vaccinated in January,” said Imelda Garcia, the chair of the state’s Expert Vaccine Allocation Panel. “Expanding to ages 50 to 64 will continue the state’s priorities of protecting those at the greatest risk of severe outcomes and preserving the state’s health care system.”

Currently, the state is vaccinating members of priority groups 1A and 1B, which include health care workers, Texans 65 and older, and anyone over age 15 who has a pre-existing condition. Last week, state officials also made educators and child care employees eligible for a dose.

Those 50 and older will be included in priority group 1C. More than 93 percent of Texans who have died from the virus have been at least 50 years old, health officials said in a press release.

One can certainly argue that some other folks should have been next in line, but this is where we are. On the plus side, thanks to President Biden, everyone will be eligible for the shot in a few weeks. Until then, get yourself signed up at your first opportunity. And keep that mask on until someone other than Greg Abbott tells you to take it off. The Trib has more.

Reactions to the maskless mandate

Let’s start with the doctors, since clearly they weren’t consulted.

Houston-area doctors and medical professionals reacted with dismay to Gov. Greg Abbott’s Tuesday decision to roll back the state’s mask mandate and other precautions against COVID-19.

“I had a pretty strong visceral reaction — like PTSD,” said Dr. Matt Dacso, an internist at the University of Texas Medical Branch. “I can think of no other word but incomprehensible… Everybody is hurting, but gosh, man. The masks were doing a lot for us.”

Dacso said the order was a huge hit to morale, coming almost exactly one year after the first recorded case in New York. His team had been celebrating the progress made since then — until they heard about Abbott’s order.

[…]

“It’s true that Texas has been vaccinating people,” said Peter Hotez, vaccine researcher at Texas Children’s Hospital Center for Vaccine Development. “But after the recent freeze, we rank at the bottom of states in the percentage of people we’ve vaccinated: Only 13 percent of Texans have had their first dose.

“I would have preferred to wait a couple of weeks to reopen while we see how these new variants play out here, and so that we could catch up to the rest of the country in terms of vaccinations,” Hotez continued.

While people who have been vaccinated may feel tempted to go out without their masks, they shouldn’t, said Dr. Diana Fite, president of the Texas Medical Association.

A vaccination means they’re less likely to face severe complications from COVID-19, not that they’re less likely to catch it and infect others. COVID-19 vaccine manufacturers are still studying the rate of transmission and infection in people who have been immunized, and trial data may not be available until the spring.

“Fully vaccinating 1.8 million people is still a huge number, but it’s far from getting anywhere near where we say things are going to be contained,” Fite said.

Local hospitals say they are not planning to change their masking requirements.

“The COVID-19 virus and its effects will be with us for a long time,” St. Luke’s Health officials said in a Tuesday afternoon statement. To ensure the safety and health of our communities, we urge people to continue to wear masks and practice other precautions like hand washing and social distancing, in addition to getting vaccinated. Wearing a mask is one of the most effective ways to limit the spread of the virus, which is why masks are still required at all St Luke’s Health facilities.”

See here for the background. Local health officials were equally vehement.

Keep wearing your mask and taking COVID-19 safety precautions, local health experts said Tuesday, after Gov. Greg Abbott announced he was lifting the statewide mask mandate and restrictions on businesses.

“Despite the impending removal of the state mask mandate, we must continue our vigilance with masking, distancing, and hand washing,” said Dr. Mark Escott, Travis County Interim Health Authority. “These remain critical in our ongoing fight against COVID-19.”

Expressing concerns about highly contagious variants of the virus and the need for local health officials to maintain some authority over their local situations — which vary widely from county to county — doctors and health officials cautioned that Texans should not take Abbott’s announcement as a signal to relax the behavior that has lead to a recent decrease in coronavirus case rates and hospitalizations.

[…]

Dr. Ivan Melendez, Hidalgo County Health Authority, said it’s premature to abandon safety precautions and hopes Texans can stay patient even in the absence of statewide rules.

“I think that people have a lot more common sense than we give them credit for, but … it’s very hard for human beings not to start socializing and to stop wearing masks,” he said.”I understand they are looking for any sign they can go back to the old ways, but I would just remind them that we’re in the bottom of the ninth, two runs out, and we’re almost there. This isn’t the time to put the bench in. This is the time to continue with the A-Team. Very soon, we’ll be there.”

Others said that while they’re glad Abbott did stress that Texans should stay cautious, the mandate provided an important function that the state may not be ready for yet.

“I think it’s a little bit early, in my opinion, to be removing the masking requirement,” said Dr. James McDeavitt, senior vice president and dean of clinical affairs at Baylor College of Medicine. “I would have preferred to see our numbers lower, and I would have preferred to see more people vaccinated before we took that leap.”

Dr. John Carlo, CEO of Prism Health North Texas and a member of the state medical association’s COVID-19 task force, agreed it was too soon for Texans to relax their safety practices, adding he is especially concerned about the increasing spread of the U.K. variant of COVID-19, which is thought to be more contagious and perhaps more deadly.

None of this should be a surprise. I’m sure there are some doctors out there who are Team No Mask, but as a group this is obvious. The Texas Medical Association took a diplomatic path:

Restaurants were also cautious, though they have clear reasons to be happy about the full reopening stuff.

Operators wondered if they would be ready to return so quickly to full service; if they could hire workers fast enough to accommodate full capacity; if their purveyors would be ready to service increased orders for food and other goods. And, most crucially, how mask wearing would be handled by workers and a dining public no longer required to cover up.

There were no clear answers Tuesday.

“Personally, I didn’t expect him to say that today. I thought we wouldn’t see it until sometime in the summertime,” said [Levi] Goode, whose restaurant portfolio also includes Goode Co. Seafood, Goode Co. Kitchen & Cantina and Armadillo Palace. “We’ve adopted some great practice from the safety standpoint during the pandemic, and many of those will remain intact until we feel comfortable we can move in another direction.”

But without a state mandate that masks are required, next Wednesday will bring uncertainty.

Ricardo Molina, president and co-owner of Molina’s Cantina restaurants, said that he probably will not enforce masks for his servers, but that those who choose to wear one will be able to do so. He added that customers will ultimately dictate how the staff will come down on masks.

“We’re probably going to find the vast majority (of customers) are ready to see masks go away,” Molina said. “If people are ready to go all-out business as usual, we’re ready to do that as well.”

Paul Miller, owner of Gr8 Plate Hospitality which includes The Union Kitchen and Jax Grill restaurants, anticipates a gradual return to practices that existed before COVID-19.

“Our primary concern is for our staff and our guests, and while we certainly appreciate the opportunity to go back to 100 percent and the governor has removed the mask mandate, we are going to continue to uphold our safety and sanitation protocols as we slowly but surely move into this new phase of our business,” he said.

How the restaurant industry will negotiate that new phase wasn’t clear on Tuesday. While the Texas Restaurant Association celebrated Abbott’s announcement, it was quick to say that Texas restaurants must “remain vigilant so we do not slide backward.”

“Consumers will only go where they feel safe, and so restaurants must continue to be very thoughtful and implement the safety protocols that will enable them to maintain and build trust with their consumers and employees,” the association stated.

Yeah, that. It’s a thing I’ve been saying for months – you have to beat the virus if you really want to reopen. People will not want to patronize businesses if they don’t feel safe doing so. That as much as anything is why I would have expected a more gradual reopening, one that takes into account the fact that we still have a lot of vaccinations to administer, and still have a lot of people getting sick and going to the hospital. Just declare your intention to take the victory lap. What was the rush?

Personally, I’ve been eating at a couple of places that have outdoor seating, and also doing takeout. I will continue to do that for at least the next few months. The Chron’s Alison Cook is surveying restaurants around town to see what their response is; her initial story on that is here. Quite a few are currently planning to stay with what they’re doing now, which surprises me a little, but in a good way. I’ll be very interested to see how the wider public reacts. For the record, the subset of barbecue joint owners and brewery owners were not impressed and seem to be determined to keep doing what they’ve been doing for now.

School districts have a choice to make.

Local school boards will have the authority to decide whether to require students over the age of 10 to wear masks under current Texas Education Agency health guidance, after Gov. Greg Abbott announced Tuesday he was lifting the state’s mask mandate and reopening businesses at 100 percent capacity.

In the governor’s executive order, which takes effect March 10, he wrote that public schools “may operate” under minimum health protocols found in Texas Education Agency guidance, and that private schools and colleges are “encouraged to establish similar standards.”

Under the previous mask mandate, all students older than 10 were required to wear masks on school property.

TEA’s most recent guidance, issued in December, says that outside the soon-to-expire mask mandate, school systems “may require the use of masks or face shields for adults or students for whom it is developmentally appropriate.”

Houston and Fort Bend ISDs issued statements Tuesday afternoon saying they would continue to require masks and face coverings at all schools and district facilities.

“This requirement is consistent with the advice of health professional and guidelines from the Centers for Disease Control and Prevention,” HISD officials said in a statement.

We got a robocall from HISD Tuesday afternoon informing us of this. It’s the clear and obviously correct call, and as someone whose kids are attending school in person, I’d have been massively pissed if they had done otherwise.

Metro riders will need to keep their masks on.

Despite state officials loosening restrictions related to COVID, Metropolitan Transit Authority officials said requirements for face coverings on riders and employees will continue.

“Metro has no plans at this time to drop the mask requirement for people riding our system,” transit agency spokesman Jerome Gray said.

Since June, Metro has required masks for anyone using the system. Last month, the Federal Transit Administration issued guidance that all transportation providers — buses, trains, ferries and planes — prohibit anyone from riding without a mask.

For those who do not have a face covering and want to hop on a bus, Metro drivers will offer them a mask. Bus drivers and others have handed out 2 million masks along the Metro system, agency officials said.

Good call. This, not so much.

H-E-B will urge, but not require, customers to wear masks inside its grocery stores in Texas after Gov. Greg Abbott rescinded his statewide mask mandate Tuesday, the company said.

The grocer and retailer, however, will still require employees and vendors to wear masks in the stores.

“Although there is no longer a statewide mask order, H-E-B believes it is important that masks be worn in public spaces until more Texans and our Partners have access to the Covid-19 vaccine,” Lisa Helfman, the retailer’s local public affairs director, said in a statement.

I’ve already seen a few people react negatively to this on Twitter. I try to do my HEB shopping early in the morning, to avoid larger crowds. I may need to push it a little earlier now. Yes, we could order curbside – we have done it a couple of times – but I like the in store experience. Or at least, I have liked it. Don’t make me regret my choices, HEB.

What are your expectations? Will you avoid or patronize places that lift their mask requirements? The Texas Signal and Dos Centavos have more.

Abbott lifts statewide mask mandate

Unbelievable.

Gov. Greg Abbott announced Tuesday that he is ending Texas’ statewide mask mandate next week and will allow all businesses to operate at full capacity.

“It is now time to open Texas 100%,” Abbott said from a Mexican restaurant in Lubbock, arguing that Texas has fought the coronavirus pandemic to the point that “people and businesses don’t need the state telling them how to operate” any longer.

Abbott said he was rescinding “most of the earlier executive orders” he has issued over the past year to stem the spread of the virus. He said starting next Wednesday, “all businesses of any type are allowed to open 100%” and masks will no longer be required in public. The mask requirement has been in effect since last summer.

Meanwhile, the spread of the virus remains substantial across the state, with Texas averaging over 200 reported deaths a day over the last week. And while Abbott has voiced optimism that vaccinations will accelerate soon, less than 7% of Texans had been fully vaccinated as of this weekend.

Texas will become the most populous state in the country not to have a mask mandate. More than 30 states currently have one in place.

Abbott urged Texans to still exercise “personal vigilance” in navigating the pandemic. “It’s just that now state mandates are no longer needed,” he said.

Currently, most businesses are permitted to operate at 75% capacity unless their region is seeing a jump in COVID-19 hospitalizations. While he was allowing businesses to fully reopen, Abbott said that people still have the right to operate how they want and can “limit capacity or implement additional safety protocols.” Abbott’s executive order said there was nothing stopping businesses from requiring employees or customers to wear masks.

[…]

Texans have been under a statewide mask mandate since July of last year — and they have grown widely comfortable with it, according to polling. The latest survey from the University of Texas and Texas Tribune found that 88% of the state’s voters wear masks when they’re in close contact with people outside of their households. That group includes 98% of Democrats and 81% of Republicans.

The absence of statewide restrictions should not be a signal to Texans to stop wearing masks, social distancing, washing their hands or doing other things to keep the virus from spreading, said Dr. John Carlo, CEO of Prism Health North Texas and a member of the Texas Medical Association’s COVID-19 task force.

Carlo declined to react specifically to Abbott’s order, saying he had not had a chance to read it. He also expressed concern that new virus variants, specifically the U.K. variant, could still turn back the positive trends cited by Abbott.

“We’re facing unacceptably high rates, and we still hear every day about more and more people becoming sick. And it may be less than before, but it’s still too many,” Carlo said. “Even if businesses open up and even if we loosen restrictions, that does not mean we should stop what we’re doing because we’re not there yet.”

It was clear from what Abbott said during President Biden’s visit that he was planning to take action to loosen restrictions. I was prepared for him to announce a step-down or a schedule or something more gradual. I did not expect him to just rip the bandage right off. I don’t know what to say, but Judge Hidalgo does, so let’s listen to her.

Harris County Judge Lina Hidalgo and Mayor Sylvester Turner slammed Gov. Greg Abbott Tuesday for allowing all businesses in Texas to fully reopen next week and lifting his statewide mask mandate, suggesting the governor timed the move to distract angry Texans from the widespread power outages during the recent winter storm.

“At best, today’s decision is wishful thinking,” Hidalgo said. “At worst, it is a cynical attempt to distract Texans from the failures of state oversight of our power grid.”

Turner said Abbott’s decision to rescind the COVID measures marked “the third time the governor has stepped in when things were going in the right direction,” a reference to the surges in cases, hospitalizations and deaths that ensued after Abbott implemented reopening guidelines last year.

“It makes no sense,” Turner said. “Unless the governor is trying to deflect from what happened a little less than two weeks ago with the winter storm.”

[…]

Before Abbott’s announcement, Hidalgo and Turner sent the governor a letter urging him not to lift his statewide mask mandate.

“Supported by our public health professionals, we believe it would be premature and harmful to do anything to lose widespread adoption of this preventative measure,” Hidalgo and Turner wrote, arguing the mandate has allowed small businesses to remain open by keeping cases down.

The disparity between Hidalgo and Turner’s concerns — that Abbott would simply lift the mask order but keep other restrictions intact — and his decision to fully reopen the state puts on full display the diverging messages Houstonians are receiving from their local Democratic leaders and the Republicans who run the state. While Hidalgo is telling residents to stay home and buckle down, Abbott is giving the green light for a return to normal life, albeit one where Texans govern themselves using “personal responsibility,” he said Tuesday.

We know how well that’s worked so far. The irony is that other parts of state government still understand what’s at stake:

I’d love to say that Abbott will suffer political blowback for this, but polling data is mixed and inconsistent.

Texas voters’ concerns about the spread of coronavirus are higher now than they were in October, before a winter surge in caseloads and hospitalizations, according to the latest University of Texas/Texas Tribune Poll.

Almost half of Texas voters (49%) said that they are either extremely or very concerned about the spread of the pandemic in their communities — up from 40% in October. Their apprehension matches the spread of the coronavirus. As cases were rising in June, 47% had high levels of concern.

Caseloads were at a low point in October, as was voter concern about spread. And sharp increases through the holidays and into the new year were matched by a rise in public unease.

Voters’ concern about “you or someone you know” getting infected followed that pattern, too. In the current poll, 50% said they were extremely or very concerned, up from 44% in October, and close to the 48% who responded that way in the June poll.

“The second, bigger surge seems to have had an impact on people’s attitudes,” said James Henson, co-director of the poll and head of the Texas Politics Project at the University of Texas at Austin. “In October, there was a trend of Republicans being less concerned, but this does reflect what a hard period the state went through from October to February.”

While their personal concerns have risen, voters’ overall assessment of the pandemic hasn’t changed much. In the latest survey, 53% called it “a significant crisis,” while 32% called it “a serious problem but not a crisis.” In October, 53% called it significant and 29% called it serious.

Economic concerns during the pandemic remain high. Asked whether it’s more important to help control the spread of the coronavirus or to help the economy, 47% pointed to the coronavirus and 43% said it’s more important to help the economy. In a June poll, 53% of Texans wanted to control the spread and 38% wanted to focus on the economy.

“The economy/COVID number is 2-to-1 in other parts of the country. Here, it’s almost even,” said Daron Shaw, a UT-Austin government professor and co-director of the poll. “What was a 15-point spread is now a 4-point spread.

So people are concerned about the pandemic, but also about the economy. Some of that may just be a reflection of the partisan split, but I have no doubt that Abbott thinks the politics of this are good for him, and that’s even before we take into account the distraction from the freeze. The scenario where he’s most likely to take a hit is one in which the numbers spike and a lot more people die. Nobody wants that to happen, yet here we are at a higher risk of it because of Abbott’s actions. It’s just enraging. So please keep wearing your damn mask, even after you get your shots. Wait for someone with more credibility than Greg Abbott to tell you it’s safe to do otherwise.

One more thing:

We both know how plausible that is. Texas Monthly, Reform Austin, the San Antonio Report, the Texas Signal, and the Chron has more.

Vaccine roundup

Just a few news stories (and a Twitter thread) of interest from recent days.

How do you get a COVID-19 vaccine? In Texas’ rollout, it’s a game of luck and chance

Still, the contrast shows just how sharp and seemingly random the divide has emerged between those who are able to get the vaccine easily and those who cannot. In the fourth week of Texas’ vaccine rollout, a dermatology practice in Bellaire got 300 doses while Hope Clinic, which serves Houston’s poor and immigrant communities, got 100, according to the state’s most current list.

County registration hotlines have crashed under the volume of applicants while some doctors reported fielding calls from friends asking how to move to the front of the line.

In the month since the vaccines got federal approval, getting them into arms of the most vulnerable has been anything but smooth. Distribution has lagged. Demand has far outstripped supply. Critics call it yet another chapter in the failed government response to a virus that arrived nearly a year ago.

“There does seem to be no discernible distinction between those who are getting the vaccine and those who aren’t,” said Elena Marks, CEO of Houston’s Episcopal Health Foundation, an organization that works to improve health care access for poor.

Such unevenness is happening not just among the public but also within the medical community. At some small and midsize private practices, access to the vaccine remains elusive for front-line health care workers who regularly treat COVID patients, doctors say. Yet employees of large medical practices and big-name facilities are vaccinating staff that is not in direct contact with patients and in some cases working from home.

Clogged phone lines and ethical dilemmas: Texas health providers scramble to roll out vaccine with little state guidance

Texas has largely left the vaccine rollout process in the hands of local providers like Tarrytown Pharmacy, one of more than 1,000 providers approved to vaccinate Texans. And outside of dictating the first two groups allowed to receive it, providers say the state has given little instruction or information on when allotments will arrive, how immunization operations should be organized and what principles ought to be followed in prioritizing within groups 1A and 1B.

As they spearhead vaccination in a state of 29 million people, hospitals, pharmacies and community health centers alike across Texas built new scheduling systems from scratch, struggled to sync their patient information systems with the state’s and answered to an increasingly anxious public wondering when their turn for the shot will come — all while helping fight the COVID-19 pandemic during its highest peak in Texas.

“Every space I have is booked. I have phones going off the hook saying, ‘Where’s mine?’” said Dr. James McCarthy, chief physician executive for the Memorial Hermann Health System in Houston. “The demand is insatiable right now. Everybody wants it today, and we just don’t have enough vaccines. It will take months.”

The state’s initial allocation of 1.2 million doses had been shipped by Jan. 3, according to state health officials, and another January shipment was expected to bring the state’s total allotment to 1.7 million. That’s still hundreds of thousands of doses short of the roughly 1.9 million necessary to provide just a first dose of vaccine to those Texas health care workers and residents of long-term care facilities eligible in group 1A.

But before many of those first in line had received a dose, the state allowed providers to start administering the vaccine to the second group — about 8 million people older than 65 or at least 16 with certain medical conditions. A Department of State Health Services official said there is some overlap between groups 1A and 1B (doctors and other health care workers over age 65, for example).

The sudden announcement to open vaccinations to the second group — just a week after the first distribution of vaccines for the first group — caught many providers off guard.

“It was in response to all of the chatter and angst to ‘Oh my God, they haven’t given all their vaccines out,’ and it’s been five days,” said McCarthy of Memorial Hermann. “I thought we would get all the health care workers done, and then we would move on. I didn’t think we’d be doing them simultaneously.”

Greg Abbott’s Politics Create a Vaccine Stampede

But Texas decided to do things differently than the CDC. While the state’s designated first tier matched that of the feds, its second tier included all Texans age 65 and older, as well as those with preexisting health conditions that make them vulnerable to severe cases of COVID-19. This approach put lower priority on police and younger essential workers, like grocery clerks or restaurant servers, many of whom were bitter about the state’s decision. Then, just before the new year, Governor Greg Abbott and his state health department changed the game further. On December 29, state health commissioner John Hellerstedt ordered providers to start vaccinating those in the second tier immediately, even though many in the first tier remained unvaccinated. Abbott backed him up in a tweet: “The state urges vaccine providers to quickly provide all shots.”

In an instant, I effectively had been moved to the front of the vaccination line. The problem was finding where that line began. Abbott had started a stampede.

There were too many eligible people chasing too little vaccine. The Texas Department of State Health Services reported that it had received 1.3 million doses. But Abbott had authorized another 8 million people to receive the vaccine even though providers weren’t anywhere near finished inoculating the 1.9 million Texans in what was supposed to be the first-tier priority group. Abbott’s declaration got too many in the state (even those under 65 and without any severe health conditions) thinking vaccines were more widely available. With few providers actually offering shots to the general public, the Hunger Games of vaccination had begun.

Advocates worry vaccines will be out of reach for Black and Hispanic neighborhoods devastated by COVID-19

COVID-19 has been disproportionately deadly for communities of color in Texas. And advocates for those communities are worried that they will have more trouble accessing vaccinations than the white population because of where vaccination sites are located.

“We already saw huge disparities in death rates and people getting [coronavirus] infections, and there wasn’t availability of resources like health care for brown and Black communities suffering tremendously,” said Kazique Prince, interim executive director for the Central Texas Collective for Racial Equity, a nonprofit association based in Austin. “I’m very nervous and anxious that this [vaccination effort] is not going to work out for us.”

According to the Texas Department of State Health Services data, more than half of the fatalities in Texas due to COVID-19 have been Hispanic individuals and almost 10% have been Black people. Yet the state’s designated vaccination sites — mostly hospitals, clinics, nursing homes and pharmacies — are concentrated in more affluent areas where those facilities tend to be located.

And, just as a reminder:

Health officials in Austin are considering opening a makeshift hospital as its intensive care units fill up. Patients in North Texas are being treated in lobbies or in hallways. And hospitals around Laredo, Abilene and College Station have three or fewer intensive care unit beds open, according to state data.

A week into the new year, hospitalizations in Texas have well-surpassed a deadly summer wave that overwhelmed health care workers in the Rio Grande Valley. Health experts have long warned of a dark winter — with a public tired of following safety precautions, a raging pandemic and cold weather drawing people indoors where the virus can more easily spread. Add to that holiday gatherings and increased levels of travel, which health officials say are already being reflected in the growing numbers of hospitalized coronavirus patients.

New year, same story. We deserve so much better. We’ll get better soon from the federal government. When will we get it from our state government?

More COVID restrictions are about to happen in Harris County

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

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

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

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

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

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

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

More here.

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

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

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

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

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

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

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

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

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

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

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

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