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Texas Department of State Health Services

Could we get an expansion of medical marijuana?

Apr 12th, 2023
by Charles Kuffner.
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Maybe, but I have my usual doubts for the usual reasons.

Rep. Stephanie Klick

Texans who suffer from chronic pain and potentially other debilitating conditions would be able to access the state’s medical marijuana program under a bill advanced by the Texas House on Tuesday.

The bipartisan legislation, sponsored by House Public Health chair Stephanie Klick, is an expansion on the state’s 2015 “Compassionate Use” law — which has, in a number of legislative changes since it was created, allowed a growing number of patients in Texas to legally use cannabis to treat debilitating symptoms of conditions such as epilepsy, autism, cancer and post-traumatic stress disorder, or PTSD.

House Bill 1805 passed the chamber Tuesday on a preliminary vote of 121-23 and is expected to get final approval on Wednesday before heading to a Senate committee.

The bill would allow doctors to prescribe 10 milligram doses of cannabis for chronic pain cases that might normally call for an opioid pain management prescription. Some conditions that could cause such pain would include Crohn’s disease and rheumatoid arthritis.

The bill also authorizes the Texas Department of State Health Services to further expand the list of conditions that it could be used for in the future, without needing to change state law anymore.

Klick’s bill also changes the way the legal level of tetrahydrocannabinol, or THC — the active psychoactive agent in cannabis — is measured, from a concentration to a set volume of 10 milligrams per dose, which supporters say allows it to be delivered more efficiently and in a wider variety of ways. The THC found in cannabis has been found by some patients and doctors to be effective against pain, depression, anxiety, appetite problems and nausea.

There was no debate on the House floor, nor any vocal opposition in a committee hearing on the bill last month.

As research has expanded in the area of low-THC medical marijuana, currently delivered to patients in mostly tincture oils and gummies, Texas lawmakers have been in favor of expanding access to the program, Klick said.

“My intent then and still is to have a truly medical program that follows the scientific data,” said Klick, R-Fort Worth, who sponsored the legislation creating the original program.

The Compassionate Use Program in Texas has registered some 45,000 patients since it first began, with about 10,000 to 12,000 active participants, said Nico Richardson, the interim chief executive officer of Austin-based Texas Original, the state’s largest medical cannabis provider. By comparison, a similar but much more inclusive program in Florida has about 485,000 people currently enrolled in the program, Richardson said.

As noted before, I’m not following the Lege very closely this session, because it’s all a shitshow and I just don’t want to. But even in this cursed session there are a few good bills that will get real support, and so we may as well take note of it. Kudos to Rep. Klick, who as noted authored the original Compassionate Use bill, for getting this one this far.

The key question, as always, is what does Dan Patrick think. The story doesn’t say, and my default assumption in these matters is that he’s opposed to any increase in the allowable use of marijuana until proven otherwise. If he doesn’t support it, then this is as good as it gets. Even if he does support it, he could threaten to tank it if the House doesn’t play ball on his favorite things, like vouchers. Maybe I’m wrong and maybe this will be on a glide path to Greg Abbott’s desk. I’ll believe it when I see it. Until then, it’s Dan Patrick’s Senate and that’s how it will be until we are finally able to vote his ass out.

A closer look at the maternal mortality report

Dec 29th, 2022
by Charles Kuffner.
1 comment

I take no joy in predicting that the Legislature will take no action on this.

Nakeenya Wilson was at a meeting of Texas’ maternal mortality review committee when she got the call: Her sister, who had recently had a baby, was having a stroke.

Wilson raced to the hospital, leaving behind a stack of files documenting the stories of women who had died from pregnancy and childbirth complications. Many of the women in those files were Black, just like Wilson, who experienced a traumatic delivery herself.

“The whole thing just reminded me, if you change the name on those files, it could be me. It could be my sister,” said Wilson, who serves as the committee’s community representative.

A decade ago, when Texas first formed the Maternal Mortality and Morbidity Review Committee, Black women were twice as likely as white women, and four times as likely as Hispanic women, to die from pregnancy and childbirth.

Those disparities haven’t improved, according to the committee’s latest report, published Thursday.

In 2020, pregnant Black women were twice as likely to experience critical health issues like hemorrhage, preeclampsia and sepsis. While complications from obstetric hemorrhage declined overall in Texas in recent years, Black women saw an increase of nearly 10%.

Wilson said these statistics show the impact of a health care system that is biased against Black women.

“We’re still dying and being disproportionately impacted by hemorrhage when everybody else is getting better,” Wilson said. “Not only did it not improve, it didn’t stay the same — it got worse.”

The causes of these disparities aren’t always simple to identify, and they’re even harder to fix. It’s a combination of diminished health care access, systemic racism, and the impact of “social determinants of health” — the conditions in which someone is born, lives, works and grows up.

Wilson said she and her sister are prime examples. They grew up in poverty, without health insurance, routine doctor’s visits or consistent access to healthy food.

“We started behind the ball,” she said. “We’ve had so many hard things happen to us that have contributed to our health by the time we’re of childbearing age.”

Maternal health advocates in Texas say addressing these disparities will take more than fixing labor and delivery practices. It will require building a comprehensive health care system that addresses a community’s needs across the board, starting long before pregnancy.

In the end, Wilson’s sister survived her postpartum health scare. But the experience reminded Wilson why she volunteers her time to read, review and analyze stories of women who have died from pregnancy and childbirth.

“When you look at the work marginalized people do, they do it because they don’t feel like they have any choice,” she said. “If we want to see things change, and we want to be safe, we have to advocate for our own safety.”

See here for some background. There’s way too much for me to try to capture in an excerpt, so go read the whole thing. Rep. Shawn Thierry, who experienced some of these problems herself a few years ago when she was giving birth, is and has been working on getting legislation passed to address the issues, which includes things like expanding health care access, gathering better information, and strengthening the maternal mortality review process. See above for my assessment of the likelihood of passage. Rep. Thierry will need a lot more like-minded colleagues to make that happen, and we are very much not there yet. But the work is happening, and will continue to happen.

Here at last is that updated report on maternal mortality

Dec 18th, 2022
by Charles Kuffner.
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We’re still really bad at preventing it, especially for Black women.

At least 118 women dead and nearly 200 children left without a mother.

This was just a portion of the death toll from pregnancy and childbirth in Texas in 2019, according to a long-awaited state report published Thursday.

Severe medical complications from pregnancy and childbirth also increased significantly between 2018 and 2020, surging from 58.2 to 72.7 cases per 10,000 deliveries in Texas.

As in past years, the tragedy of maternal mortality unfolded unevenly across the state, impacting Black women worst of all.

This is the fifth biennial report from the state’s Maternal Mortality and Morbidity Review Committee since the Legislature formed it in 2013, and the first to review more timely cases; the previous report reviewed cases from nearly a decade ago.

In 2013, Black women were twice as likely as white women and four times as likely as Hispanic women to die from pregnancy-related causes. A preliminary assessment of 2019 data indicates those trends have persisted.

The report determined that discrimination contributed to 12% of pregnancy-related deaths in 2019. This was the first such report since the federal Centers for Disease Control and Prevention added discrimination, including structural and interpersonal racism, as a potential cause of maternal death. The specific nature of discrimination varied between the cases identified by the committee and did not show a specific trend, the report said.

In 2018, a subcommittee was created to address these continued disparities by helping design a tool to better determine when and if discrimination plays a role in maternal deaths.

The report also found that most of these deaths were preventable — in 90% of 2019 cases reviewed by the committee, there was at least some chance of saving the woman’s life.

See here and here for some background. Easy to see why there might have been political pressure to delay the release of this report until after the election, not that it likely would have mattered. The people who care about this already care, and the people who don’t already don’t. I’ve made my share of pointed observations about the gap between all of the anti-abortion rhetoric and the actual amount this state officially cares about human life; I don’t believe the people who are the problem here are capable of being shamed about it. But as long as we’re talking about abortion:

Obstetric hemorrhage was the leading cause of pregnancy-related death in Texas, accounting for a quarter of cases. While there were fewer severe complications from hemorrhage overall, Black women saw their rate of complications increase nearly 10%.

The most common cause of hemorrhage deaths was ectopic pregnancies, in which a fertilized egg implants outside the uterus. Left untreated, these nonviable pregnancies can rupture, causing life-threatening complications such as severe blood loss and sepsis.

You can expect those numbers to continue to go up. The Lege and Greg Abbott will do nothing about it. The Chron has more.

So why wasn’t that report on maternal mortality released when it was supposed to be?

Dec 10th, 2022
by Charles Kuffner.
1 comment

We’ll never really know, mostly because there’s no one with the power to compel an answer from those who do know that cares enough to use that power.

State health officials had completed a long-awaited report on maternal deaths and were preparing talking points about the findings just days before it was shelved until after the November midterms, according to emails obtained by Hearst Newspapers.

The messages suggest that the agency was moving toward a required Sept. 1 release of the state’s first updated count of pregnancy-related deaths in nearly a decade.

On Sept. 2, however, then-Commissioner John Hellerstedt, an appointee of Gov. Greg Abbott, said the agency needed more time to complete the analysis.

The last-minute delay infuriated maternal health experts who have spent years pressing the state to update its sluggish data review process. Members of the state’s Maternal Mortality and Morbidity Review Committee, which analyzes pregnancy-related deaths, said they were given no heads up about the announcement.

Advocates have since accused Gov. Abbott of instigating the delay in an effort to protect his re-election chances in the midterms.

Some of the strongest condemnation over the hold-up has come from the Black community, where women are three times more likely to die from childbirth than white women. This year’s report would be the state’s first to analyze the causes behind racial disparities among those who die during or after childbirth.

While it’s true that the agency had not completed a full count as of September, as Hellerstedt said, a draft preliminary report on the majority of 2019 deaths was finished and in the final stages of editing, according to the emails. It has been the agency’s practice for years to release findings even before a full analysis is completed, in an effort to speed up public health interventions.

Agency staff were sharing final versions of the draft as late as Aug. 24, according to the emails.

Earlier that month, the health agency had been preparing to brief Abbott’s office and state legislators about the report’s findings.

See here for the background. There are answers to this question – they may vary depending on who is being asked, but they do exist. The problem is that no one who is being asked cares to answer, and no one who wants that answer has the power to make them give one. The people who do have that power – certainly the Legislature and maybe the Attorney General – don’t care any more about it than Greg Abbott does. So, unless someone like former Commissioner Hellerstedt starts telling tales out of school, we’ll never know. In the meantime, we may finally get that report as soon as this coming week, so at least we have that going for us.

State delays report on maternal mortality until next year

Sep 16th, 2022
by Charles Kuffner.
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Sorry, didn’t get to it, other things to do, you know.

Texas health officials have missed a key window to complete the state’s first major updated count of pregnancy related deaths in nearly a decade, saying the findings will now be released next summer, most likely after the Legislature’s biennial session.

The delay, disclosed earlier this month by the Department of State Health Services, means lawmakers won’t likely be able to use the analysis, covering deaths from 2019, until the 2025 legislative cycle. The most recent state-level data available is nine years old.

In a hearing this month with the state’s Maternal Mortality and Morbidity Review Committee, DSHS commissioner Dr. John Hellerstedt said the agency wanted to better align its methodology with that of other states, and that there hadn’t been enough staff and money to finish the review for a scheduled Sept. 1 release.

“The information we provide is not easily understood, and not easily and readily comparable to what goes on in other states,” Hellerstedt told the committee. “And the fact it isn’t easily understood or easily comparable in my mind leaves room for a great deal of misunderstanding about what the data really means.”

In a statement, DSHS spokesman Chris Van Deusen said the agency is reviewing its “internal processes” to try to develop more timely data.

“I expect we’ll be having conversations with legislators about what could be done to speed up the lengthy review process,” he said.

The setback comes four months before the start of the legislative session and two months before the midterm election, which has been dominated in part by the state’s new Republican-led abortion ban. Those restrictions have placed more scrutiny on the state’s maternal mortality rate, which is among the 10 highest in the country, according to national estimates that track pregnancy-related complications while pregnant or within a year of giving birth.

“There are a lot of us that want to know whether or not pregnancy in Texas is a death sentence,” said state Rep. Ann Johnson, a Houston Democrat and member of the Texas Women’s Health Caucus. “If we’ve got a higher rate of maternal mortality, we sure want to figure it out. You can’t figure it out if somebody’s sitting on the numbers, and that’s my worry.”

Like in other states, maternal outcomes in Texas are worse for Black women, who have died at about three times the rate of non-black women. This year’s findings were expected to drill further into the causes behind those disparities.

Rep. Shawn Thierry, a Houston Democrat who has described going through her own dangerous birthing experience, said the data is critical for understanding the role cesarean sections play in maternal deaths and whether implicit bias is playing a factor in the quality of maternal care for Black women.

“There is so much to unpack from the data,” Thierry said, adding that “no woman who chooses life should have to do so in exchange for their own.”

Members of the state’s maternal mortality committee, which compiles the official report, said they were disappointed by the decision to hold the preliminary findings.

“(We) do the work to honor the lives of women who lost their lives, and families that are forever impacted by the loss of a mother,” said Dr. Carla Ortique, the committee chair. “So there’s disappointment on both fronts: that we’re not honoring those women and families, and that we may be negatively impacting efforts to improve maternal health outcomes in our state.”

Pathetic. And typical. But don’t worry, even if the Lege has no current data on maternal mortality to take action on in the next session, they will be fully prepared to make abortion more illegal, because that’s what they care about. Daily Kos has more.

Our overall vax level is down

Sep 13th, 2022
by Charles Kuffner.
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Not great!

The coverage rate for routine childhood vaccines – or the percentage of kids getting them – dropped during the COVID-19 pandemic and have yet to recover, according to statistics from the Texas Department of State Health Services.

Health care providers said many families skipped doctor’s visits during the pandemic to avoid exposure to the virus. But the drop is also due to a rise in “conscientious exemptions,” or parents and guardians who refuse to get their children vaccinated for religious, moral or philosophical reasons.

While anti-vaccine movements have existed since the smallpox vaccine debuted in the early 1800s, some worry the pushback against the COVID-19 vaccine may have a detrimental effect on the uptake for routine childhood immunizations, too.

“I think that, certainly, [the pandemic] is a good explanation for this,” said Terri Burke, the executive director of the Houston nonprofit The Immunization Partnership. “But there is no question that the vaccine hesitancy, skepticism, misinformation [and] disinformation that circulates around the COVID vaccine has bled over into childhood vaccines.”

A study published in the journal Vaccine found that from 2019 to 2020, immunization rates fell 47 percent among 5-month-olds and 58 percent among 16-month-olds.

Texas did see a slight increase in vaccination rates earlier this year, but they still remain below pre-pandemic levels, said Tasmiah Nuzhath, a Texas A&M School of Public Health doctoral candidate who led the study. That’s a concern because regardless of the reason, a lower percentage of vaccinated children means heightened for outbreaks of a disease like the measles, she said.

“Even a few-percentage dip in vaccination rates will put children at risk of getting sick, and could affect community protections against serious diseases,” Nuzhath said.

[…]

In the Houston area, there are some signs that coverage rates may be slowly recovering from the pandemic. The HOPE Clinic, for example, had a large demand for the shots before students returned to school this fall, Clinical Director Kara Green said.

The Immunization Clinic in Stafford has also seen more children coming in for their vaccines this year, but coverage rates are “still not where [they] should be,” Nursing Director Yvette Cheeks said.

During the 2011-12 school year, coverage rates were at least 97.4 percent for each of the routine vaccines required for kindergarten students, and at least 96.6 percent for each required for seventh grade.  By 2021-22, rates fell to a range of 93.5 percent to 95.9 percent for kindergarten, and 91.9 percent to 98 percent for seventh grade.

Some of the decline can be attributed to children who haven’t gotten their shots yet, but may do so later. Those “delinquency” rates topped 3 percent for the chickenpox, polio and DTaP (diphtheria, tetanus and acellular pertussis) vaccines for kindergarten and around 6 percent for the meningitis and DTaP vaccines for seventh grade.

It’s also due to a rise in conscientious exemptions. Ten years ago, the chickenpox vaccine for kindergarten had the highest rate of conscientious objections at 0.8 percent. By last year, rates hit at least 2.1 percent for each kindergarten vaccine and at least 1 percent for each seventh grade vaccine.

Those percentages may not seem like a lot, but they represent an increase from 28,432 conscientious objections across Texas in 2011-12 to 85,726 last year, according to TDSHS statistics.

Green and Cheeks believe coverage rates could increase through better access to the vaccines. Both the HOPE Clinic and the Immunization Clinic offer vaccines to lower-income and uninsured patients.

However, Green noted that the HOPE Clinic sees families cancel their child’s vaccine appointment due to issues such as a lack of transportation, or not having child care for their other children. Pop-up vaccination clinics at Houston schools or other community sites could help increase uptake, she said.

“I think if we make it easier for families to get these things done, then we really open up a lot of opportunities,” she said.

We need to do everything we can to make sure that all needed vaccines are easily available to all that want them. That’s a bigger problem that can be solved locally, but we have to try. Anyone can claim to be “pro-life”, but unless you’re pro-getting-lifesaving-shots-into-kids-arms, you’re just full of hot air.

Your omicron booster will be ready this week

Sep 5th, 2022
by Charles Kuffner.
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I’ll be getting mine.

Most Texans will be eligible in the coming days for a second round of Covid-19 booster shots after updated vaccines got final federal approval this week.

The new doses, from Pfizer-BioNTech and Moderna, are designed to fight off severe infection from the latest versions of the omicron variant, which have proven especially easy to spread. Federal health officials hope the new round of boosters can add a layer of immune protection heading into a potential uptick of infections this fall as people head back indoors.

The new boosters will be available to anyone 18 and older for Moderna’s, and anyone over the age of 12 for Pfizer-BioNTech’s. Older adults have been eligible for several months.

“If you are eligible, there is no bad time to get your COVID-19 booster and I strongly encourage you to receive it,” the Centers for Disease Control Director Rochelle Walensky said Thursday after endorsing an advisory committee’s recommendation to make the shots widely available.

The updated vaccines add spike protein components from the omicron subvariants BA.4 and BA.5, which helps restore protection that has waned since previous vaccine rounds. The CDC recommends waiting two months after your most recent COVID shot before getting the booster.

A spokesperson for the Texas Department of State Health Services said the doses are expected to ship out in the next few days, so Texans should be able to make appointments next week. Like previous boosters, these will be available at pharmacies, standalone health clinics and through local health departments, the agency said.

Both CVS and Walgreens were allowing patients to schedule the updated boosters as of Friday.

As the story notes, while COVID deaths in Texas are way down – about 100 a month statewide at this time – people are still getting infected. Plenty of people I know have been sidelined for a week or two in recent months. Long COVID and other risks remain as well. I’m still pretty vigilant about masking in indoor spaces, which usually puts me in a distinct minority, but it’s just a numbers game, and sooner or later that catches up to you. I’ll add on another layer of defense for that, thanks very much.

Get your kids vaccinated (I’m saying it again)

Jul 13th, 2022
by Charles Kuffner.
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We have a long way to go.

In the two weeks since the federal government allowed emergency use of COVID-19 vaccines for children younger than 5, nearly 32,000 Texas kids in that age group have been vaccinated.

That accounts for just over 1% of the state’s youngest residents, a lower rate than doctors had hoped, but faster than the national rate for kids that age — even as Texas deals with a lower-than-average vaccination rate across the state.

[…]

Vaccine acceptance by parents of Texas babies and toddlers is slower than the medical community had hoped it would be after COVID-19 vaccines were approved for use in children ages 6 months to 4 years old in late June.

On June 17, the U.S. Food and Drug Administration granted emergency use authorization, after frequent delays over several months, to Pfizer’s COVID-19 vaccine for children ages 6 months to 5 years, as well as to Moderna’s vaccine for kids ages 6 months to 6 years. The Centers for Disease Control and Prevention recommended their use the following day.

So far, just over 1% of the estimated 1.8 million Texans under 5 have gotten at least one dose. Nationwide, the number is slightly lower, with less than 1% of the country’s 29 million kids under 5 having their first doses.

Hesitancy with the vaccine rises among parents of younger kids because they tend to be more skeptical about the need for them, said Dr. Jaime E. Fergie, director of pediatric infectious diseases and hospital epidemiologist at Driscoll Children’s Hospital in Corpus Christi.

When the vaccine was made available to Texas kids ages 5 to 11 in November, nearly 6% of the population was vaccinated in the first two weeks. For children ages 12-15, when they were approved for the vaccine a year ago, more than 11% were vaccinated in the same time frame, according to the Texas Department of State Health Services.

During that time, the delta variant was making an alarming and devastating impact on the nation’s children, killing twice as many Texas kids in August through October 2021 than COVID-19 did the entire first year of the pandemic. That likely fueled early interest in the vaccine for children ages 5 and up, while recent months with lower community spread have likely bred what Fergie called “complacency” among the parents of the state’s tiniest residents.

“The uptake [for younger children] has been low; it’s been pathetic,” Fergie said. “I think the misconception is that COVID-19 in children is not important. But even though the impact on children is much less than on adults, there is still death for children, and hospitalizations are rising. There are still very powerful reasons to vaccinate children.”

Children accounted for nearly 20% of all COVID-19 cases reported in the U.S. throughout the pandemic. But they are less likely to develop serious illness or die than are patients who are decades older, and the mortality rate has been relatively low compared with adults.

Still, at least 155 Texans age 19 or younger have died from COVID-19 since the beginning of the pandemic, according to state health data. One-third of them were younger than 10.

Some 61% of Texans are fully vaccinated, compared with 67% nationwide.

See here for some background, and go read the rest, it’s a long story. I do think that the earlier authorizations came during the delta period made for a faster initial rollout, though the overall vax rate for kids remains bafflingly low. The fact that with current variants, the shots now are about preventing bad outcomes rather than preventing infection has probably changed the risk calculus for some folks. Add in the lack of any coordinated push for people to get the shots, the continued resistance by numerous Republican factions, and the general weariness with the pandemic, and this is what you get. I don’t know what else to say.

Monkeypox in the Houston area

Jun 24th, 2022
by Charles Kuffner.
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Was bound to happen sooner or later.

Two people in the region have tested positive for monkeypox, a viral disease with typically mild symptoms, public health officials with the City of Houston and Harris County announced Saturday.

The Houston Health Department said a Houston resident who had recently traveled internationally had a confirmed case of monkeypox. Hours later, Harris County Public Health said an out-of-state resident who had visited Harris County recently also had a confirmed case. The out-of-state resident is already out of the region and back in their home state.

The Centers for Disease Control and Prevention and the Texas Department of State Health Services have said the virus does not present a risk to the general public. The CDC’s website says monkeypox is “rarely fatal” and the risk of transmission in the United States is low.

Symptoms can include fever, headache, muscle aches, swollen lymph nodes, chills and exhaustion. It’s most notable symptom is a rash that can resemble pimples or blisters, the CDC said. It can spread from person-to-person through direct contact with the rash or body fluids. It can also spread by respiratory secretions during prolonged, face-to-face contact or during intimate physical contact.

As of Saturday afternoon, three cases had already been recorded in Texas — not including the two reported in Houston that day — and 114 have been logged nationwide since the first case this year was identified in mid-May.

See here for the background. As noted, it’s not something to freak out about, but do be aware of it and exercise reasonable caution. Mostly, if you have reason to think you might have been infected, contact your local public health department and do what they tell you to do.

Monkeypox? Really?

Jun 17th, 2022
by Charles Kuffner.
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Yeah, really.

Texas health officials said Tuesday they have identified the first case of monkeypox in the state this year, but noted the illness does not currently present a risk to the general public.

The case was identified in a Dallas County resident who recently traveled internationally, according to the Texas Department of State Health Services. The department is working with Dallas County Health and Human Services and the U.S. Centers for Disease Control and Prevention to investigate the case.

Health officials said they have also identified a “few” people who may have been exposed to the virus in Dallas. Those people are monitoring themselves for symptoms of infection, officials said.

In May, several cases of monkeypox were reported in countries that don’t regularly report the disease. This is not typical of past patterns of monkeypox, according to the World Health Organization. The organization is working with all affected countries, including the U.S., to investigate the outbreak and provide guidance on how to stop the spread and care for those infected.

The risk of this outbreak becoming widespread is low, according to WHO. Monkeypox is not typically considered to be very contagious because it requires close physical contact with someone who is infectious in order to spread.

[…]

Monkeypox is a viral zoonotic disease, meaning that it can spread from animals to humans and between humans, according to the World Health Organization. The disease is usually found in West and Central Africa, where the animals that may carry the virus typically live.

Symptoms usually include a fever, intense headache, muscle aches, back pain, low energy, swollen lymph nodes and a skin rash or lesions. The symptoms often resolve on their own without the need for treatment, according to WHO. Those infected should take care of the rash by letting it dry if possible, and they should avoid touching any sores in the mouth or eyes.

In most cases, monkeypox symptoms go away within a few weeks, but newborns, children and people with underlying immune deficiencies may be at risk of more serious symptoms and death from monkeypox, according to WHO.

The disease is commonly transmitted to humans through close contact with an infected person or animal, according to WHO. It can also be transmitted from person to person by inhaling large respiratory droplets or through close contact with body fluids and lesions or bedding and other contaminated materials.

So the good news is that it’s not very contagious – you’re not going to get it from some random person walking by you at Costco. You’ll probably be fine if you do get it. Just, you know, be careful when traveling, avoid contact with people who appear to have it, and for crying out loud if you do get infected please seek treatment and/or isolate yourself until you recover. We’ve got enough trouble already. The Chron has more.

When we had more deaths than births in Texas

Jun 10th, 2022
by Charles Kuffner.
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Seems like that would be a bad thing.

In the midst of the nation’s deadliest pandemic, Texas recorded more births than deaths every month since 2016 — with one exception.

Provisional data from the Texas Department of State Health Services shows that January 2021 was the only month when, statewide, the number of deaths was greater than the number of births.

Nine months before in April 2020, the world was one month into the COVID-19 pandemic. In January 2021, the seven-day average number of deaths from COVID-19 peaked in Texas, according to The New York Times, and vaccines had just become available to select groups of individuals.

Twenty counties — including Bexar County — recorded more births than deaths every month until the pandemic, when they began having months with more deaths than births.

The number of births for a county is determined by the mother’s residence.

Thirty one counties — including more populous ones like Harris, Dallas and Travis — always recorded more births than deaths, even during the pandemic.

Five counties — Bowie, Kerr, Potter, Smith, and Wichita — reported more deaths than births for all 22 months of pandemic data available.

There are charts and maps in the story, and they calculate the birth and death rates on a per 100K people basis to make everything more easily comparable. One thing the story doesn’t go into, which is a thing that has been widely reported on elsewhere, is differences in voting patterns across the counties. I’m not going to dive into all of the data here, but I will note this much about those five counties that had a net loss (not counting migrations) for each month:

Bowie – Trump 70.9%
Kerr – Trump 75.3%
Potter – Trump 68.5%
Smith – Trump 69.0%
Wichita – Trump 69.7%

You get the picture.

COVID hospitalizations at a low in the state

Apr 12th, 2022
by Charles Kuffner.
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Good news (say it with me) for now.

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

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

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

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

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

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

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

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

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

How low can COVID go?

Mar 16th, 2022
by Charles Kuffner.
1 comment

I feel like this is more a function of time and evolution than anything else, but we’ll see.

New coronavirus cases across the greater Houston area dropped to their lowest level in four months, new data showed Monday, just days after Harris County’s COVID threat level dropped to yellow, signaling the virus is not immediately threatening the capacity of the region’s healthcare system.

The demise of the omicron wave appeared all but complete in the latest numbers from the Texas Medical Center, which collectively admitted 77 new COVID-19 patients daily last week, down 63 percent since February.

Across the region, daily infection rates are now roughly equal to those recorded during the lull that followed the delta wave in late November, before the more contagious omicron variant swept the globe. The figures come as the remaining indoor mask mandates expire across the country and as Americans report feeling increasingly exhausted — or altogether fed up — with pandemic restrictions.

Around 430 people tested positive for COVID each day last week, down 80 percent from last month, Texas Medical Center reported Monday morning.

Houston-area deaths from COVID have plummeted in tandem with falling case counts in recent weeks. A total of 4,288 residents have died since the pandemic began.

The figures confirm Houston is in a period of low transmission. How long it will last is uncertain. Some experts, including Catherine Troisi, an infectious disease epidemiologist with UTHealth School of Public Health, consider omicron’s relatively milder disease a “lucky” happenstance that may not be repeated in future iterations of the virus.

Viral waves typically arrive about six months apart, meaning another surge could begin by summer.

Well, the next wave may already be underway in Europe, though at this point it remains to be seen if it will result in anything like what we have seen before. At some level, if we can get enough people vaxxed and boosted, then at least the next wave should not be as hard on the hospitals and the mortuaries. That’s the goal at this point, minimize the damage. You would hope that by now we’ve learned from our past experience.

You don’t want to go to the ICU right now

Jan 31st, 2022
by Charles Kuffner.
7 comments

And even if for some reason you did want to go to the intensive care unit, there probably wouldn’t be room for you.

The number of Texas intensive care unit beds available for adult patients is at an all-time low for the pandemic, with only 259 staffed beds open across the state as of Wednesday, as hospitals fight a historic staffing crisis and more unvaccinated people infected by the omicron variant pour into hospitals.

That’s 11 fewer beds than the previous record set in September during the deadly surge of the delta variant of COVID-19, according to the Texas Department of State Health Services. An average of 295 available beds has been reported in the last week, which is also lower than previous record averages.

The crunch on the state’s intensive care units comes as patient cases skyrocket and as hospitals themselves work to fill shifts left open by more workers home sick from COVID-19.

As of Wednesday, more than 13,300 hospitalized Texans have tested positive for the virus.

“Because of the high level of transmission and infectivity of the omicron variant, so many of our staff are getting positive,” said Bryan Alsip, chief medical officer for University Health in San Antonio. “We’ve been doing this a long time now — close to two years. We’re now experiencing our fourth large surge of those patients. It can get tiring.”

Alsip said University Health — the public hospital system for the San Antonio and the third largest of its kind in the state — is approaching numbers of hospitalized COVID-19 patients that the system has not seen since the last deadly surges in the early months of 2021 or the fall and summer of 2020.

[…]

But while omicron is putting fewer patients into the ICU than in previous surges, there are also fewer ICU beds that are able to be staffed due to a nursing shortage, officials say — and the sheer number of omicron cases is pushing patient counts higher.

The bottom line, they say, is that there are fewer beds for any Texas patient who may be suffering a serious medical event and need intensive care — whether they were put there by omicron or not.

So yeah, now when people tell you to drive safely, it’s more than just a bit of politeness. We might be reaching peak omicron, but as noted before hospitalization is a lagging indicator. There’s still a few weeks to go before we start seeing declines in those numbers.

While it would be nice to think that once this omicron wave recedes we’ll be in for a longer period of calm, but Dr. Peter Hotez says don’t count on it.

Q: There’s a lot of talk about omicron creating herd immunity and the transition from pandemic to endemic. Your thoughts?

A: The big picture, I’m still concerned about. There’s a lot of happy talk about omicron somehow acting as a weakened virus, herd immunity and the end of the pandemic. I do not think so yet. I think we’re in for another wave this summer across Texas and it could be just like 2020 and 2021. Here are the reasons why.

One: I’m not convinced the durability of the protection from omicron is going to be adequate. It may resemble the short-lived immunity you get from the upper respiratory virus. The population could still be vulnerable in the spring.

And vaccination rates are still not great in lower- and middle-income countries where these variants arose. I think we’re still very vulnerable to another variant arising in Africa or Asia.

Q: As you pointed out, that runs contrary to a lot of the hopeful buzz about omicron that I’m coming across.

A: Yeah, you hear that coming from the White House. And I’m hearing it from a lot of my talking head colleagues. But to me, right now, that rings hollow. I don’t think it’s wise. I think what we need most urgently right now is a national strategy for how we’re going to prevent another big variant in the summer from hitting Texas and the southern United States. Here’s what I think that strategy requires.

One: a strategy for global immunization against COVID-19, which just doesn’t exist now. The White House announced another 400 million doses, which is slightly more than what our Texas Children’s vaccine has done. We need 9 billion doses.

Second: We need a greater understanding about the durability and protection from the mRNA boosters. We’re getting conflicting results about the durability. That needs to be clarified. We need to understand that for a strategy for moving forward. Whether we keep the singular focus on the mRNA vaccine or broaden our COVID stockpiles to include additional technology.

And let me say, third: What’s our plan for global surveillance? So far we’ve been surprised by every major variant of concern. We need predictable surveillance models, but we don’t have them. That’s a need. What I’d like to see coming out of the White House is a national strategic task force to really dive into those three components. We need a realistic plan for the country. And I just don’t get the sense we have that right now. Nationally, we’re still in reactive mode every time.

As noted, Dr. Hotez and his colleague Dr. Maria Elena Bottazzi have done what they can to help with global vaccine supply. But we still need to get more shots in arms here – ESPECIALLY KIDS – and I don’t know what we can do to make that happen. Rewards and gimmicks might help a little around the margins, but not enough to really make a difference. The various federal mandates would have made a real difference, but well, you know. Your safety is officially in your hands. Don’t screw around with it.

I repeat: We need to get more kids vaccinated

Jan 29th, 2022
by Charles Kuffner.
Comments are off for this post

Come on, Houston.

In spite of the spread of the omicron variant, national COVID-19 vaccination rates for children ages 5-11 remain low. The same is true for children in Harris County, according to a Kaiser Health News analysis of CDC data.

Of Harris County’s children aged 5-11, only 18.2% of them are fully vaccinated; 22.2% have received one dose. Pharmaceutical company Pfizer announced the FDA authorization of their COVID-19 vaccine on October 29, 2021.

In Texas, most counties have low vaccination rates. Only 34 of Texas’ 254 counties have child vaccination rates above 10%.

When compared to other counties in the U.S. with child populations over 100,000 Harris County comes near the bottom of the list when ranked by vaccination rate.

At 13% fully vaccinated, Harris County’s child vaccination rate is barely higher than Dallas County’s (11%), lower than Bexar County’s (14%) and is about half of Travis County’s (26%).

That 18.2% cited appears to be a typo – according to both the embedded image in the story and the Kaiser Health News story, the actual figure is 12.8% for Harris. Half of what Travis County has done to this point, in other words. We have to do better than that.

And as a reminder why, there’s this.

Vaccines continued to provide strong protection against death from COVID-19 in December, even against the new omicron variant, according to state data released Friday.

Unvaccinated Texans were 16 times as likely to die from the virus in December, and were two times as likely to test positive for it. That gap has shrunk from the fall, likely due to omicron’s increased transmissibility.

The divide was most evident for Texans between 65 and 75 years old, who were 19 times more likely to die from COVID if they were unvaccinated. Nearly 80,000 COVID deaths have been reported in Texas since the pandemic began, the majority of them in 2021, when vaccines became available. Just under 1,600 deaths were reported to the state in December.

Yes, not being vaccinated is not the same risk for a 5-year-old as it is for a 75-year-old. But still, there are a lot more kids in the hospitals these days, and the little ones can certainly spread COVID to their elders. Get them their shots already.

Have I mentioned that we need to get more kids vaccinated?

Jan 21st, 2022
by Charles Kuffner.
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Seriously, y’all.

Since November, 693,345 Texas elementary-age children have received at least one dose of the vaccine, accounting for about 24% of the state’s 2.9 million children ages 5-11 — and a figure in line with the national rate. Nearly 390,000 of the 5-11 group are fully vaccinated, while more than half of Texans ages 12-15 are fully vaccinated.

Texas’ child vaccination rate is higher than in many other Southern states, where rates as low as 10% are being recorded. In the first two weeks after the shot was approved for emergency use in the younger age group, some 100,000 children showed up to Texas school clinics, pharmacies and pediatricians’ offices to get inoculated.

[…]

At Texas Children’s Hospital in Houston, positive cases among patients went from zero in early December to some 70 patients with COVID-19 a month later, mostly among unvaccinated children, said Dr. Jim Versalovic, pathologist-in-chief for the hospital. Their hospitalizations of children with COVID-19 broke all previous pandemic records, and at breakneck speed, he said. Just weeks after omicron was first detected in Texas, it was causing more than 90% of new cases showing up at his hospital — less than a month after the vaccine was approved for young kids.

“We have staggering numbers here during this omicron surge,” Versalovic said in a news conference in early January.

That same day, the state broke its own record of children hospitalized with COVID-19, reporting 350 — five more than the previous peak a few months before.

On Friday, the state health department released data on 3.8 million confirmed cases of COVID-19 in Texas in the first two years of the pandemic. Almost 19% of them — 722,393 — were diagnosed in residents under age 20. The demographics do not include cases reported in 2022.

During the first week of January, the Texas Department of State Health Services and the Texas Education Agency reported that about 26,500 students and 11,800 staff members had been infected with COVID, according to data released Friday.

While the numbers of student cases are nearing levels not seen since the start of school last fall, there are more cases of COVID-19 among staffers than at any other time in the pandemic. The numbers are likely to increase as more districts report their numbers to the state. The current numbers include only about half of all of the state’s 1,200 districts, and the number of districts reporting any numbers is inconsistent from week to week.

Meanwhile, on Wednesday, the state reported 471 children in Texas hospitals with COVID-19. Most of them are unvaccinated, hospital officials have said. But there is no state data detailing how many COVID-19 child patients are in Texas pediatric intensive care units.

Yes, I’ve said this before. The numbers have climbed a bit since then, but there’s so much farther to go. As was the case with previous iterations of the vaccine, there was a large initial burst of activity, as the folks who had been eagerly awaiting the day that it became available for that group rushed out to get it, then it leveled off. The difference is that this time that initial burst was much smaller. Gotta say, I have no idea why. Get your kids vaccinated. What are you waiting for?

The hospitals are getting slammed again

Jan 10th, 2022
by Charles Kuffner.
Comments are off for this post

Take precautions, y’all.

Pandemic forecasters in Texas say the state’s current surge of omicron infections and hospitalizations is likely to get much worse before it gets better, with hospitalizations expected to continue climbing for at least three weeks if social behaviors don’t change and slow the trend.

Across the nation, hospitalizations are already on the verge of breaking new pandemic records. In Texas on Thursday, according to state data, about 9,200 people were hospitalized with COVID-19 — far short of the record 14,218 hospitalizations from Jan. 11, 2021.

But with current numbers climbing exponentially each week, hospitalizations of Texans with COVID are likely to follow national trends and surpass previous levels in the state before they start to decline, said Anass Bouchnita, a researcher at the University of Texas COVID-19 Modeling Consortium, which uses data and research to project the path of the pandemic nationally.

The number of Texans testing positive for the virus every day is already at an all-time high, reaching a seven-day average of almost 44,000 confirmed cases on Friday. The seven-day average of new confirmed cases during the peak of the delta surge back in September was over 15,000.

That trend is likely to continue for at least another week, Bouchnita said.

“The situation in Texas is that it probably won’t reach the peak [for cases] until the second half of January,” he said.

Experts say the extremely high case count is why so many people are showing up in the hospital even as medical evidence suggests that the omicron variant — responsible for most new and active cases in Texas — is less severe than the previously dominant delta variant.

Bouchnita talked to The Texas Tribune on Friday, the same day the UT consortium released a report with the research team’s latest calculations about omicron’s projected path nationally. The report, which looked at eight scenarios in which omicron had varying degrees of severity, infectiousness and resistance to immunity, suggests the nation could see its new cases of this more contagious but less severe strain peak by mid-January before decreasing by half in early February.

The report called the current surge the largest COVID-19 wave in the United States to date.

[…]

Intensive care units at more than 50 hospitals are at 100% capacity, according to state reports, and some regions of the state, including El Paso, are reporting no ICU beds available in the area.

Already, the state’s children’s hospitals have more patients with COVID-19 in their beds than at any other time in the pandemic — 351 statewide on Thursday, which is higher than the last peak during the delta variant surge of 345 in early September.

“It’s pretty crazy,” said Frisco pediatrician Dr. Seth Kaplan, immediate past president of the Texas Pediatrics Society. “Our volume is way up.”

It’s mostly omicron now, very little delta in Texas, though there’s still a fair amount of delta in other parts of the US. It is true that omicron is less severe than delta, but it’s also true that it’s far more transmissible, and it’s affecting far more vaccinated people. Even with less severity, the sheer number of people being infected is driving the higher number of hospitalizations.

And while more vaccinated people are being infected by COVID, there’s still a big difference in outcomes between the vaxxed and the unvaxxed.

Omicron is sending a larger share of vaccinated people to the hospital that any previous COVID-19 variant, but unvaccinated people are still more likely to need critical care, according to Houston-area hospital officials.

Twenty-two of the 27 COVID patients in Harris Health System’s intensive care units are unvaccinated. At Houston Methodist, roughly 60 percent of the 80 COVID patients in the ICU are unvaccinated, and a high percentage of the remaining patients have underlying health conditions, said Dr. Faisal Masud, the hospital’s medical director of critical care.

It’s a similar story at St. Luke’s Health and Memorial Hermann Health System, both of which say 70 percent of ICU patients are unvaccinated.

“The vast majority of the people who are critically ill are either unvaccinated or have significant comorbidities,” said Dr. James McCarthy, chief physician executive at Memorial Hermann. “We are not seeing middle-aged, healthy, vaccinated individuals in the ICU like we did in the previous wave.”

[…]

Statewide, the number of patients in the ICU has been steadily rising since Christmas Eve, from 1,030 to 1,711 on Wednesday, according to the Texas Department of State Health Services. That’s about half of the patients in the ICU at the peak of the delta wave, but some Houston hospitals are already seeing ICU rates double over the last week.

The number of incoming ICU patients could exceed all previous peaks, said Dr. Esmaeil Porsa, president and CEO of Harris Health System. While the vaccines may not be as effective as they were initially, the current ICU population indicates that “they are still extremely effective against severe disease,” he said.

“More and more breakthrough infections are going to happen,” Porsa said. “We’re going to get a higher percentage of people who are vaccinated, but that number is never going to be a big number. It’s always going to be minority of people.”

Overall, doctors say omicron is not damaging the lungs as much as earlier strains. Fewer COVID patients in the Harris Health ICU require mechanical ventilation compared to delta, said Porsa, but other health issues like kidney and heart failure are becoming more common.

At Methodist, Masud has observed a similar pattern. A large portion of ICU patients Masud has treated ended up in the unit because the virus exacerbated an existing disease. The risk of facing such complications is higher for unvaccinated people, he said.

“This is eliciting an immune response, which is not only limited to lungs but which makes the patients sicker, with existing disease becoming much worse,” he said.

Masud said that now is a critical time to wear a well-fitted mask in public, especially for people who are not vaccinated.

It’s the same as before, in that the things you can do to mitigate your risk haven’t changed. Get vaxxed, and get your booster. Wear an N95 or KN95 mask when out with people. Avoid large indoor events and gatherings. Stay home if you’re not feeling well. This will pass, but how bad it gets before it passes is still up in the air. For more on the national picture, see TPM, Mother Jones, and Daily Kos.

The final official death toll from the big freeze

Jan 4th, 2022
by Charles Kuffner.
1 comment

It’s undoubtedly an underestimate.

Texas has added 36 more deaths to the official death toll from the February snow and ice storm, bringing the total to 246 in what was one of the worst natural disasters in the state’s history.

The Department of State Health Services disclosed the new total in a report on the storm that was released Friday and described as the “final report” in an analysis by the department’s Disaster Mortality Surveillance Unit. The deaths occurred between Feb. 11 and June 4. The figure includes people who were injured in the storm but did not die until later, and also people whose bodies were found after the storm, including during repairs of damaged homes.

The 246 deaths spanned 77 counties and included victims ranging from less than 1 year old to 102 years old, according to the report. Close to two-thirds of the deaths were due to hypothermia. Of the deaths, the report classified 148 as “direct,” 92 as “indirect” and six as “possible,” using criteria developed by the Centers for Disease Control and Prevention.

DSHS previously pegged the death toll at 210 in July. The agency said in the report that it identifies deaths through “mortality surveillance forms, death certificates, and verification of informally reported deaths.”

[…]

In addition to hypothermia, DSHS attributed the storm-related deaths to “exacerbation of pre-existing illness” (10%), motor vehicle accidents (9%), carbon monoxide poisoning (8%), fires (4%) and falls (4%). The Texas Tribune and NBC News reported in December that portable generators, which can cause carbon monoxide poisoning, are some of the deadliest consumer products.

There are other ways to approach this question. Last spring Buzzfeed used “excess mortality” – a comparison to the actual number of deaths at that time to the historic baseline – and estimated that as many as a thousand people may have died as a result of the freeze. That comes with large error bars, but even the low end of that range is almost twice as much as the official DSHS tally. However you look at it, it was a lot, and it was totally unnecessary. And it remains a big risk going forward because Greg Abbott and the Legislature and the Railroad Commission did basically nothing to mitigate it. That’s the real headline here.

Got to keep an eye on the hospitalizations

Dec 30th, 2021
by Charles Kuffner.
Comments are off for this post

They’re up, but for now we’re still in reasonably decent shape.

More than 1,200 people were hospitalized for COVID-19 in the Houston area on Monday, according to data released by the state Tuesday afternoon. The Department of State Health Services reported that 1,224 people were hospitalized for COVID-19 in the nine-county region around Houston.

The figure comes one day after the state reported topping 1,000 hospitalizations for the first time since October as the delta wave tapered off.

The hospitalization rate represents a 93 percent increase over last Monday, when DSHS recorded 636 COVID hospitalizations in the Houston area. The surge corresponds with the rapid spread of the highly-transmissible omicron variant, which first appeared in South Africa in late November, and has swelled to account for more than 90 percent of local cases in recent weeks.

Houston’s hospitalizations are still well below their delta peak, which reached 3,500 on Aug. 24. But less than a week after Houston  logged its 300,000th case of COVID, data from the Texas Medical Center shows that local transmission is increasing at a steady rate.

The current transmission rate is high – basically, on average everyone who gets the omicron variant will pass it on to another two people – and our vaccination rates remain pathetically mediocre. Harris County is better than the state overall, but not by much. There’s still a lot of room for this thing to find vulnerable people. Use rapid tests, isolate if you get a positive result, and wear good quality masks. We really can get through this if we’re not too dumb about it.

Simply having a COVIDful Christmastime

Dec 24th, 2021
by Charles Kuffner.
Comments are off for this post

Sorry not sorry.

Houston has surpassed 300,000 COVID-19 cases, just days after the highly contagious omicron variant leapfrogged delta to become the dominant viral strain circulating in the region and around the United States.

The staggering milestone reached Thursday, when the Houston Health Department reported 2,397 new cases for a cumulative total of 302,460, underscores the virus’s ability to evade all attempts at containment nearly two years into a global pandemic few predicted would be this persistent or deadly.

“Twenty-one months ago I never imagined our cases would get anywhere close to this big,” Houston’s Chief Medical Officer Dr. David Persse said. “If you had told me 300,000 I would have politely told you, ‘I think you’re crazy.”

Yet the easily transmitted omicron variant, first detected last month in South Africa, appears poised to sweep the Houston area and is already fueling outbreaks and scuttling holiday plans across the region.

The milestone is almost certainly an undercount, Persse said. Prevalence studies have found between 20 and 25 percent of Houston residents carry the antibodies that indicated a previous COVID infection. Accounting for those who contracted the virus but were never tested could put the city’s true COVID case count closer to half a million people.

“It’s a lot of suffering,” Persse said.

Extrapolating out to Harris County, that’s something like 1.2 million people who have had COVID, maybe a bit more. Obviously, for a lot of those people the consequences have been fairly small so far, but who knows what the longer term effect may be. And of course, we’re in the early stages of the omicron surge. So check back again later to see where these numbers go.

This says a lot, too.

As the omicron variant of COVID-19 threatens to fuel another surge of infections this winter, the state’s vaccination data shows demand for booster shots has outpaced the demand for first doses of the vaccine in the last few months — even as millions of Texans remain unvaccinated.

The average number of people getting boosters in Texas every day has surpassed those getting their first shots since late September, according to the state’s data. As of Dec. 21, the daily average of Texans who received their booster shots over the last week was about 52,000 — compared with the approximately 20,000 who received their first doses.

So far this month, at least 1.2 million Texans have gotten booster shots — nearly triple the number of people who received their first doses of the vaccine during the same time.

Meanwhile, the number of people getting their first shot of the vaccine over the last few months has remained far below people getting boosters, though the rate of first shots slightly increased in November and December.

[…]

Booster rates have gone up as the Food and Drug Administration has gradually authorized their use among different age groups. Adults 18 and older are allowed to get booster shots, and this month, the FDA authorized emergency use for 16- and 17-year-olds who had the Pfizer vaccine as their initial two-dose treatment, making them eligible to receive the same vaccine as a booster.

Meanwhile, the amount of people getting their first vaccine doses has waned in the last few months as vaccines have become more widely available and more people take the next steps in their vaccination regime. The state’s data shows a slight bump in first doses in November as Thanksgiving approached.

Even so, 10 million Texans remain unvaccinated.

And while there isn’t one specific reason why first-dose rates lag behind booster shots, Dr. Emily Briggs, who specializes in family medicine and has seen the split in the demand for the vaccine from a private practice in New Braunfels, largely credits ideology.

“We are at that point of anybody who believes in science acknowledges that we have had benefit from this vaccine. Those who are politically motivated or have been given fear and are focused on that fear are not vaccinated,” she said.

The people who have taken this pandemic seriously and have done what they can to minimize their risk and protect their communities are continuing to do so. The people who have not done so are still not doing so. Same as it ever was.

Same as it ever was.

As other states are mobilizing to respond to the rapidly spreading omicron variant, Gov. Greg Abbott is not budging on his hands-off approach to the coronavirus pandemic that was cemented months ago.

In March, Abbott ended the statewide mask mandate, marking the beginning of a sharp shift toward preaching “personal responsibility” and an outright rejection of any government mandate — whether state or local — to curb the pandemic. That philosophy carried the state through the delta variant this fall, even as hospitals were overrun and deaths climbed. Now as the state stares down the latest variant, Abbott remains unmoved, continuing to rule out any mask or vaccine mandates and business shutdowns.

“We’re moving forward with life as we know it,” Abbott said Tuesday in a radio interview when asked about omicron.

[…]

Asked Tuesday what the state is doing to address omicron, Abbott’s spokesperson Renae Eze said in a statement that the governor recently got a briefing on the state response to the variant by John Hellerstedt, the commissioner of the Department of State Health Services, and Nim Kidd, chief of the Texas Division of Emergency Management. Eze otherwise gave no indication the state was doing anything differently, saying it was continuing to respond to the pandemic by “setting up therapeutic infusion centers, ramping up COVID vaccination efforts, and providing surge staffing and medical equipment to hospitals and nursing homes.”

Eze ended by calling vaccination the “best defense” against COVID-19 and encouraging Texans to get immunized.

Even as Abbott’s office says it’s prioritizing vaccines as the best defense against COVID-19, the state’s vaccination rate lags nationally. As of Monday, 56% of Texans were fully vaccinated, placing Texas in the back half of the 50 states when ranked by vaccination rates.

Abbott got vaccinated on camera late last year and has encouraged Texans to get the shot. But he does not go out of his way to promote vaccinations and he has expended much more energy in recent months fighting vaccine requirements by local and federal officials.

Abbott has been virtually silent on the booster, which the U.S. Centers for Disease Control and Prevention said last month every qualifying adult should receive. The word “booster” has never appeared on Abbott’s personal Twitter account, and a spokesperson did not respond when asked whether the governor has received a booster.

I’m sure he has been boosted. Abbott is not an idiot. He’s a coward, but he’s not going to risk his own health and well-being. Same as it ever was.

Our year in COVID

Dec 23rd, 2021
by Charles Kuffner.
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It was bad. How it is next year is at least partially up to us.

Speaks for itself (Source: DSHS)

Texas recorded a 35 percent increase in COVID-19 deaths in 2021, compared to the first year of the pandemic, even though vaccines have been available for all adults since March.

The climbing toll, public health experts said, is almost entirely driven by people who are unvaccinated. From mid-January through October, just 8 percent of Texas virus deaths were among inoculated residents.

Memorial Hermann Chief Physician Dr. James McCarthy said it makes sense there would be more virus deaths in 2021, the first full year of the pandemic, though the highly transmissible delta variant coupled with a low vaccination rate and the decline of safe practices made fatalities worse than they otherwise would have been. And as the ultra-contagious omicron variant spreads rapidly in Houston, the pattern could continue.

“The real reason it’s worse this year is we stopped all the mask-wearing protection activities we had with a large portion of the population still unvaccinated and vulnerable to infection, hospitalization and death,” McCarthy said.

Texas this year had recorded 42,100 virus deaths through Dec. 13, according to data from the state health department, compared to 31,309 in 2020. The pandemic was declared in March 2020.

The share of fully vaccinated Texans is 56 percent, the 29th-highest rate in the country. Its large population means Texas has more unvaccinated residents — 12.8 million — than any state except California.

Four of the six deadliest months of the pandemic in Texas were in 2021. The most populous cities and counties have had the most virus deaths.

[…]

At this pace, Texas would not reach 70 percent until late May of 2022, the Centers For Disease Control and Prevention projects.

Harris County is outperforming the state average vaccine rate. Through Dec. 16, 59 percent of county residents were fully inoculated.

In other words, there’s still a lot of room for the next surge to rip through and infect, hospitalize, and kill unvaccinated people. Vaccinated people will also get sick, but they will be far less likely to get sick enough to be in danger.

We’re not going to get any help from the state government. The federal government is making more tests available and has ordered vaccine mandates, which really will do a lot to improve things, but of course our state leaders are fighting them as if they had stock in COVID itself. I don’t have anything original to say, but do go read the Department of State Health Services report that provided a lot of these numbers. And do what you need to do to protect yourself and your family.

Here comes omicron

Dec 7th, 2021
by Charles Kuffner.
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It was always just a matter of time.

Texas has identified its first case of the omicron COVID-19 variant, a strain flagged as potentially more infectious than any that has come before it, including the delta variant responsible for surges still happening across the country, state health officials said on Monday.

The variant was identified in Texas in a Harris County woman in her 40s, according to the Texas Department of State Health Services and county Judge Lina Hidalgo.

Many questions still surround omicron, even as it remains high on the radar of state and federal health officials.

While early indicators suggest the variant is very contagious, it’s still unknown whether it will infect people at a faster rate or cause more hospitalizations than the delta variant, which currently represents nearly all the active cases in Texas.

It could also take another month, experts say, to figure out how effective vaccines or natural immunity will be against the omicron variant.

Other unknowns include how sick it will make those infected and whether it will be milder or more aggressive than the delta variant.

Hidalgo said the woman in whom the variant was detected has no recent history of travel.

You can hear Dr. Peter Hotez talk about omicron and delta on CityCast Houston’s Monday podcast episode. I don’t have to tell you to get your shots and your booster, do I? There’s one way out of this, and that’s it.

UPDATE: Yeah, we detected it in the wastewater. A week ago. So, yeah.

Omicron may be coming, but delta is still here

Dec 5th, 2021
by Charles Kuffner.
1 comment

It’s still a big problem, in case we haven’t forgotten.

Omicron’s arrival in the U.S. came as no surprise to federal health officials and will be met with similar anticipation in Texas, where experts believe it could show up in state and local sequencing efforts as soon as this week.

“It’s almost certainly here,” said Dr. Benjamin Neuman, a Texas A&M University professor and chief virologist at its Global Health Research Complex, which does sequencing for COVID-19 variants.

On Monday, federal health officials concerned about omicron urged eligible vaccinated adults to get their booster shots to increase their protection from COVID-19, in whatever form it might take over the winter, and to keep masking, hand-washing and social distancing when possible.

In Texas, state health officials say they are ready to assist hospitals should another surge happen over the holidays and they are ramping up their own efforts to identify more variants in more parts of the state.

But their largest push, at least publicly, is for vaccination and booster shots. About 55% of Texans were fully vaccinated as of Dec. 1. Some 18.7% of fully vaccinated Texans have had boosters, according to state health numbers.

“Prevention is important, and vaccination remains our best prevention tool,” said Chris Van Deusen, spokesperson for the Texas Department of State Health Services.

[…]

Texas hospitals are still in the throes of a staffing shortage after almost two years of deadly surges and a summer wave of deaths and hospitalizations that saw record numbers of ICUs filled to capacity.

With more than 13 million Texans still not fully vaccinated, the fear of the medical community here is that another wave will further strain a health care system that is already exhausted and depleted.

At the moment, without more data about omicron, delta is still the variant likely to cause the most problems this winter, Neuman said.

“Today, it’s the delta wave that worries me. Not omicron yet,” Neuman said. “We’ve got to wait and see what omicron does, if anything. But with cases rising across the country — that’s entirely being driven by delta.”

There’s some interesting stuff in the article about how scientists in Texas are tracking different variants here – did you know there was such a thing as the Texas Variant Partnership? I didn’t – so read on. Everything I’ve read about omicron so far suggests it will be a couple of weeks before we have some real data on it, which will help us understand basic questions about how transmissible it is, how deadly it is, and so on. A huge question, especially in a still largely unvaccinated state like Texas is how much protection is natural immunity versus vaccination. I’m betting on the latter, but it’s certainly a possibility that another booster may need to be developed. Which, thanks to the nature of mRNA vaccines, can be done quickly, like three to four months. In the meantime, stay cautious and for crying out loud get your shots.

By the way, medical abortion is now more tightly restricted in Texas, too

Dec 3rd, 2021
by Charles Kuffner.
1 comment

Another piece of crap from the special session.

Misoprostol

A new law limiting the use of abortion-inducing medication in Texas goes into effect Thursday.

The law makes it a felony to provide the medication after seven weeks of pregnancy, putting Texas at odds with federal regulations. It also makes it a crime to send the medication through the mail.

Medical abortion is the most common way women in Texas terminate their pregnancies, according to state data.

These new restrictions reflect a growing concern among abortion opponents about the rise of “self-managed” abortions, in which pregnant people obtain the medications from out-of-state or international providers, with or without a prescription.

There’s evidence that more women turn to self-managed abortions when legal abortion is restricted. Texans have been unable to access abortions after about six weeks of pregnancy since Sept. 1, when a controversial new ban went into effect.

“Texas is looking at the ways that people are navigating around restrictions and trying to essentially make that as unsafe and as frightening for people as possible in order to deter them,” said Farah Diaz-Tello, senior legal counsel for If/When/How, a reproductive justice legal group.

Diaz-Tello and other advocates worry that the new criminal penalties may make pregnant Texans fearful of seeking medical care after a self-managed abortion.

[…]

Texas’ new law also specifies that no one may provide abortion medication “by courier, delivery or mail service.”

Texas already required the medication to be provided by a physician in person. But this specific clause addresses a growing concern among abortion opponents that patients are trying to circumvent the required doctor visit by getting the drugs by mail, especially with the state’s new restrictions that bans abortions after around six weeks.

Called a “self-managed abortion,” this usually entails ordering abortion-inducing drugs online, with or without a prescription, from doctors, pharmacies and other providers out of state or overseas.

The FDA has attempted to crack down on some providers, including AidAccess, a group founded in 2018 by Dr. Rebecca Gomperts, a European doctor. AidAccess provides abortion-inducing medications to women in areas that have restricted access to the procedure.

Gomperts has said she will continue prescribing to patients in Texas. She told CBS News in September that she believes she is on solid legal ground since it is legal to prescribe this medication where she is based.

See here for the backgroun; I didn’t blog it at the time for whatever the reason. A bit more than half of all abortions in Texas are medical abortions, which the FDA says are safe up to ten weeks. I suspect Dr. Gomperts and others like her if they exist will get more business now, despite the prohibition on sending the medication via mail. It’s really a matter of enforcement, and it’s not clear to me how Texas will be able to do that. That FDA action against her was from 2019, by the way. It would be nice for the current FDA to maybe revisit that now. I don’t have anything positive to end with. This is where we are right now.

COVID hospitalizations are (generally) down in (most of) Texas

Nov 28th, 2021
by Charles Kuffner.
Comments are off for this post

For now. I think you always have to add “for now” to this sort of thing.

As Texans head into the holiday season, there is much to celebrate when it comes to addressing the pandemic. But health experts say the state is not out of the woods just yet.

First, the good news. The number of residents here hospitalized with COVID-19 is at one of its lowest points since the beginning of the pandemic, while average daily deaths from the virus are also dropping and vaccines are finally — after a year of parents anxiously waiting for approval — flowing into the arms of the state’s elementary age children.

After a miserable summer when the delta variant caused a surge that rivaled the worst moments of the coronavirus pandemic, state health officials and experts say they are grateful for signs of relief. But they’re wary of being too optimistic about a pandemic that has, more than once, had this state in a stranglehold.

“People are just kind of happy or relieved that the most recent surge is done with, but I don’t think anybody’s celebrating anything yet,” said Dr. James Castillo, public health authority in Cameron County. In that county, the share of hospital beds occupied by COVID-19 patients has dropped to 3% percent, down from over 25% during the summer surge.

Still, health officials are now watching a recent increase in the number of new confirmed COVID-19 cases and a small uptick in the rate of COVID-19 tests coming back positive as potential warning signs.

They’re also keeping an eye on a troubling new surge in the nation’s Western states that has hit El Paso, a region that was spared the deadly delta surge that rocked the rest of the state in August and September.

“We’re certainly in a better place right now than we have been in quite a while,” said Chris Van Deusen, spokesperson for the Texas Department of State Health Services. “But we are sort of starting to see things change again. And you know, if there’s one thing we know about this pandemic, it’s that it’s going to keep changing.”

[…]

Every day of good news, it seems, carries with it a note of caution.

At highest risk, officials say, are the millions of Texans who have not been vaccinated. During the month of September, at the height of the surge when about half of Texans had been fully vaccinated, unvaccinated people were 20 times more likely to die from the virus than those who had been vaccinated.

What that means, scientists say, is that a surge among the unvaccinated could still happen.

“Overall, our projections right now are fairly optimistic for the state of Texas,” said Spencer Fox, associate director of the University of Texas COVID-19 Modeling Consortium. “But when we look at the winter, we’re still fairly concerned about what might happen in the future. … Our models suggest that there’s still enough susceptibility in our population to see another pandemic surge if we remove all precautions. I think Thanksgiving will be a lead indicator of what’s to come.”

As one of the graphics in this story shows, only 54.3% of the state’s population is fully vaccinated. So yeah, there’s a huge reservoir of vulnerable targets for the virus. And all of this is before we consider the possibility of new variants reaching our shores. If you’re fully vaxxed, you’re as safe as you’re going to be, but the old standbys of wearing masks and avoiding crowded indoor spaces are still in vogue. Don’t let your guard down.

Just a reminder, the COVID vaccine really will save your life

Nov 12th, 2021
by Charles Kuffner.
1 comment

Numbers don’t lie.

New data from the Texas health department released Monday proves what health officials have been trying to tell vaccine-hesitant Texans for months: The COVID-19 vaccine dramatically prevents death and is the best tool to prevent transmission of the deadly virus.

Out of nearly 29,000 Texans who have died from COVID-related illnesses since mid-January, only 8% of them were fully vaccinated against the virus, according to a report detailing the Texas Department of State Health Services’ findings.

And more than half of those deaths among vaccinated people were among Texans older than 75, the age group that is most vulnerable to the virus, the study shows.

“We’ve known for a while that vaccines were going to have a protective effect on a large segment of our population,” said Dr. Jennifer A. Shuford, state epidemiologist. “By looking at our own population and seeing what the impact of the vaccines have been on that population, we’re hoping just to be able to reach people here in Texas and show them the difference that being fully vaccinated can make in their lives and for their communities.”

The state health department study covers most of the positive cases and COVID-19 deaths reported in Texas among residents from Jan. 15 to Oct. 1. It’s the first time state officials have been able to statistically measure the true impact of the vaccine on the pandemic in Texas — which has one of the highest death tolls in the nation. The majority of Texans ages 16 and up didn’t become eligible for the vaccine until late March.

State health officials also found the vaccine greatly reduced the risk of virus transmission, including the highly contagious delta variant that ravaged the state over the summer.

Only 3% of 1.5 million positive COVID-19 tests examined since mid-January occurred in people who were already vaccinated.

Let’s be clear, these are the stakes when Greg Abbott and Ken Paxton do all the things they’ve been doing and are still doing to impede vaccination efforts. People have died, are dying, and will die because of them. We wouldn’t have needed the mandates if people like them hadn’t been feeding a steady diet of lies and grievances to the mostly gullible population that listens to them. I will never understand any of that.

The new report is particularly well-timed, officials say, because gatherings throughout the holiday season could touch off another surge as families get together — many of them for the first time since last year — and around 9 million Texans remain unvaccinated.

Texas saw its deadliest surge of the pandemic in January, when more than 400 deaths were reported daily at its peak, a trend health officials said was likely a direct result of the holidays.

The recent Texas Coronavirus Antibody Response Survey, commissioned by the state health department in partnership with the University of Texas System, estimated that about 75% of Texans — roughly 22 million people — likely have some level of protection against the virus, either by natural immunity from being infected or through vaccination.

But that doesn’t mean infected people are immune indefinitely or that they shouldn’t get the vaccine, health experts say.

In fact, doctors, scientists and health officials urge those who have been infected to get vaccinated anyway, saying the vaccine provides a strong boost in immunity even to those who have some level of natural protection.

The Texas CARES study found that fully vaccinated participants showed significantly higher antibody levels than those who were unvaccinated but had been infected.

A week ago, the CDC found that while both vaccination and natural infection provide about six months of protection from infection by the virus, the vaccine provides a “higher, more robust, and more consistent level of immunity” than natural infection does.

And while the fact that a solid majority of Texans are estimated to have some protection from the virus bodes well for the state in its fight against the pandemic, Shuford said, it still means that millions of Texans are vulnerable to severe illness or death from the highly contagious virus, without any vaccine or natural immunity.

The next frontier in COVID data reporting needs to focus on repeat infections, which I’m going to bet will also be overwhelmingly from the unvaccinated population. You get some immunity from having had the virus, but it’s not nearly as much as you might think. I don’t actually expect data to move a whole lot of opinion, but maybe it’ll help a little. And maybe those mandates plus vaxxes for kids will finally get us ahead of the curve. Here’s hoping, because winter is coming.

The Delta surge is killing younger people

Oct 7th, 2021
by Charles Kuffner.
4 comments

So many avoidable deaths.

About two weeks later, sometime in August, the [woman in the San Antonio intensive care bed] died. She was in her mid-40s.

She is among more than 9,000 Texans who have died from COVID-19 in August and September, nearly 40% of them under the age of 60, part of an alarming upswing in reported daily deaths that threatens to overtake last summer’s deadly surge in average weekly numbers.

The dramatic and sudden increase in deaths — which jumped nearly tenfold over two months this summer — comes in spite of tens of thousands of vaccine doses being administered to Texans every day.

[…]

Of the nearly 19,000 Texas deaths attributed to COVID-19 since early February, 119 were fully vaccinated according to preliminary data from the state health department.

Scientists are still researching whether the delta variant is more deadly than earlier versions of the virus, but it is known to be much more contagious, and some data suggest that it makes people much sicker, much faster than the previous versions. The COVID-19 vaccines are extremely effective in preventing serious illness or death, scientists say.

“We shouldn’t be surprised,” Dr. David Lakey, vice chancellor for health affairs, chief medical officer at the University of Texas System and a member of the Texas Medical Association’s COVID-19 task force, said of the death numbers. “The main reason the fatality rates are as high as they are is there’s a lot of COVID in a lot of people that have underlying conditions and are not immunized.”

[…]

The deadliest month of the pandemic so far was January — before vaccines were widely available — when 9,914 people died from COVID-19, according to state data. That month only 15% of the COVID-19 deaths were among Texans under age 60. Last month during the height of the delta surge, they accounted for 38% of deaths.

More Texans younger than 60 died in August than at any other point in the pandemic. Deaths of Texans in their 40s, for example, jumped to 679 — nearly double the previous peak for that age group in January 2021. For Texans in their 30s, deaths in August were 33% higher than the winter peak, while deaths of those younger than 30 — 124 in August — were 77% higher than the previous peak for that age group, which was 70 in July 2020.

Older people are still dying in the largest numbers, even as their vaccination rate has reached 98% in some areas and 79% of Texans ages 65 and older are fully vaccinated statewide. That’s because they are still more vulnerable to the illness and much more likely to die from an infection than their younger counterparts, said Spencer Fox, associate director of the University of Texas COVID-19 Modeling Consortium.

While deaths in that age group also increased in August, they were far below their peaks over the winter and last summer.

Hospitalizations peaked in August statewide — nearly reaching the record numbers from the January surge — and more hospitals reported ICUs at or over capacity than at any other time in the pandemic. Those numbers are starting to level off or decline, along with the positivity rate, which measures the percentage of COVID tests that are positive.

It’s an encouraging sign that the delta surge may finally be cresting, although that’s not a certainty, Fox said.

National models are saying the same thing, though everyone remains worried about the winter. That’s actually less of a concern here, at least for much of the state, because our winters tend to be mild, the occasional deadly freeze aside, and that means people can continue to be outdoors. Given how high our overall death rate has been, we can use all the help we can get. We’re sure not getting any from our state government.

El Paso is doing all right with Delta

Sep 22nd, 2021
by Charles Kuffner.
1 comment

Good for them, let’s hope it lasts.

While some other metro areas like Austin reported record high numbers of COVID-19 patients in their area hospitals just last month, and while statewide hospitalizations came close to eclipsing the January peak of 14,218, El Paso-area hospitals, which serve nearly a million West Texas residents, haven’t come close to their previous highs.

El Paso’s peak for COVID-19 hospitalizations was just over 1,100 in mid-November, said Wanda Helgesen, director of BorderRAC, the state’s regional advisory council for local hospitals.

On Thursday, the number of people hospitalized for COVID-19 in El Paso was 127.

In fact, the city’s daily hospitalization numbers haven’t broken 200 since March, according to the Texas Department of State Health Services. Hospitals are seeing an increase in patients, have occasionally seen their ICUs fill up and are having the same staffing problems as the rest of the state, she said, but have so far been able to handle the uptick.

Most of the pressure is related to non-COVID patients, many of whom had been waiting to get treatment for other problems, she said.

“We do have a surge of patients but not to the extent that other parts of Texas are having,” she said.

Helgesen and others say much of the credit can be attributed to the area’s high vaccination rate, widespread compliance with masking and social distancing, and a strong partnership among local community and health care leaders.

“It is amazing,” Helgesen said. “It is absolutely a credit to our community. I really think it was an all-out effort.”

The share of COVID-19 tests in El Paso that come back positive is hovering around 6%, while the statewide positivity rate is three times that at 18%.

And while COVID-19 patients, most of whom are unvaccinated, took up more than 30% of hospital capacity in some areas and more than 20% statewide last week, in El Paso they accounted for only 7% of patients in local hospitals.

For a city with one of the state’s highest per-capita COVID-19 death counts, the numbers present a rare glimmer of good news for the traumatized residents of this West Texas border city.

“Compared to the rest of Texas, we’re in heaven,” said Gabriel Ibarra-Mejia, assistant professor of public health at the University of Texas-El Paso. “That doesn’t mean we are free from COVID, but we’re doing much, much better than most of the rest of the state. The numbers don’t lie.”

Civic and health leaders say they aren’t ignoring one important fact: El Paso’s surges have been weeks behind the rest of the state throughout the pandemic, so it’s possible that the region’s own delta-fueled spike could still be ahead.

“We aren’t letting our guard down,” Helgesen said.

El Paso Mayor Oscar Leeser, who lost his mother and brother to COVID during the winter surge, said the reason the city and county have enacted recent mask mandates, in defiance of Gov. Greg Abbott’s ban on them and in spite of lower numbers, is because the potential for another surge is still real.

“We do worry and we want to make sure that we don’t have any spikes,” he said. “You always want to be proactive and you always want to be prepared.”

The story goes on to recount the huge spike in COVID cases that El Paso experienced last November, which put it in the national news. If you look at the included chart of COVID cases, which tracks El Paso and the state as a whole, the two were mostly in sync except for that giant surge in November, which came between the two big statewide surges, and now, when the statewide rate began to take off in May but El Paso’s stayed more or less where it had been. I’m sure the mask mandate and above-norm vaccination rates have helped with that, but it may also be that enough unvaccinated El Pasoans have had COVID that the overall rate of immunity is high enough to be something like herd immunity. Or maybe they’re just lucky right now, and the curve will begin to turn upward for them eventually. I very much hope that’s not the case, but I think we all know that this pandemic has been persistent and somewhat random about who gets it the worst at a given time. In the meantime, though, keep on keeping on, El Paso.

COVID rate slows a bit, but ICUs still full

Sep 19th, 2021
by Charles Kuffner.
Comments are off for this post

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.

We really need a mask mandate at every school district

Sep 9th, 2021
by Charles Kuffner.
1 comment

Or we can just accept a lot more hospitalized kids. Easy choice if you ask me.

The number of Texas children hospitalized with COVID-19 hit an all-time high over the weekend, with 345 on Saturday and 307 on Sunday, the highest two-day stretch recorded during the pandemic, according to data from the Texas Department of State Health Services.

The data follows a national trend of rising pediatric COVID hospitalization rates. A study from the Centers for Disease Control and Prevention released Friday shows the highest rate of increase among teenagers and children 0-4 years old. The study also found unvaccinated adolescents were 10 times more likely to need hospitalization compared to their vaccinated peers.

Children under 12 are ineligible for any of the available COVID-19 vaccines.

School reopenings and “pandemic fatigue” are two primary reasons for the statewide increase, said Dr. Katelyn Jetelina, an epidemiologist at UTHealth School of Public Health in Dallas and author of the popular blog “Your Local Epidemiologist.”

“The more that kids interact with each other, the more this is going to transmit,” she said, adding, “We really need to step up our mask game. Parents really need to invest in good masks to wear for their school.”

She urged parents to buy N95 masks for their children and to “lead by example” with their own mask-wearing habits.

Multiple studies have shown masks help reduce COVID transmission indoors. The CDC study also recommends universal masking in schools, where cases are soaring in Texas. The state health department on Aug. 29 recorded 51,904 COVID cases among Texas students since the 2021-22 school year began.

I mean, we’re a year and a half into this pandemic. We do know all this stuff already. I get that some people are tired of doing pandemic things, but 1) if said person is not vaccinated then they can just STFU right now, as this is all their fault, and 2) as the kids say, we may be done with the pandemic but it’s not done with us.

Thankfully, HISD is doing it right.

While outbreaks have forced some districts to close schools already, Houston ISD has fared comparatively well two weeks into its school year.

By midday Friday, the state’s largest district of nearly 200,000 students had confirmed 1,085 active cases among students and staffers, according to its dashboard.

The most important mitigation strategy the district could implement is one it already has in place — ensuring people wear masks, Superintendent Millard House II said Thursday.

“As we look at the data in our schools, yes we have COVID cases,” House said during an agenda review meeting. “But if we look at the percentage of spread in our schools in comparison to the number of kids that we have, it looks — it does not look bad in comparison to some of the other schools that don’t have mandates in place.”

Health professionals agree the mask mandate may be helping HISD reduce the risk transmission inside its classrooms, even as kids younger than 12 remain ineligible to be inoculated and the delta variant continues to spread mostly unchecked in the Houston area.

“I attribute it to that,” said Dr. Quianta Moore, Huffington Fellow in child health policy at Rice University’s Baker Institute for Public Policy. “There are some schools that the parents and the community are wearing masks and they are also having low transmission.”

As I said before, I don’t want to get overconfident, but again, we know that masking helps. Given the risks, the current legal status, and the complete lack of consequences for defiance, I can’t think of any good reason for a school district to not have a mask mandate in place. We’re either trying or we’ve given up.

The contract health worker surge

Sep 6th, 2021
by Charles Kuffner.
4 comments

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

Aug 30th, 2021
by Charles Kuffner.
4 comments

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

Aug 29th, 2021
by Charles Kuffner.
2 comments

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.

Abbott flails about on the COVID surge

Aug 12th, 2021
by Charles Kuffner.
5 comments

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.

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