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Texas Department of State Health Services

The fourth wave

We’re not ready.

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

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

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

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

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

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

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

[…]

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

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

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

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

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

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

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

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

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

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

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

Are any state leaders going to talk about the rising COVID rate?

Just curious.

With less than half of Texans vaccinated and the highly contagious delta variant of the coronavirus spreading, the percentage of COVID-19 tests coming back positive in the state has climbed to a rate unseen since winter.

As of this weekend, Texas’ positivity rate is over 10% — a level that Gov. Greg Abbott and the Trump administration had identified as a red flag earlier in the pandemic. Meanwhile, daily confirmed new case totals and hospitalizations are climbing fast, but are far below their winter peaks.

On Saturday, the seven-day average for new confirmed cases in the state was 2,119. That’s nearly triple the average on the first day of the month, when it was 757. Meanwhile, the number of people hospitalized for the coronavirus in the state climbed from 1,591 on July 1 to 2,834 on Friday.

More than 14,200 people with COVID-19 were hospitalized on Jan. 11 — the highest number of pandemic hospitalizations in Texas so far.

But the positivity rate stands out among the rising numbers because experts view it as a leading indicator.

“The early signs are similar. They are all right there,” said Benjamin Neuman, a virologist and professor at Texas A&M University. “Epidemiologists read test positivity stats like the low tide, and it looks as though we are in for a big wave.”

In the last seven days, about 144,000 molecular tests, such as nasal or throat swab tests, were administered in Texas, and 10.2% of those came back positive, according to the Texas Department of State Health Services. The last time the state’s positivity rate was above 10% was in February, and the rate hit an all-time low of 2.8% in mid-June.

The positivity rate does not clearly measure how prevalent the virus is spreading across the state since it depends on the number of administered tests, Neuman said, but “what it indicates is that we are missing a lot of cases.”

“Ten percent of the state is not infected right now,” he continued. “But 10% of the people with the sniffles have COVID, which means we are at the start of something like another wave. We have seen the numbers in the rest of the U.S. go up and Texas has been a little bit behind, but it looks as though we may be catching up fast.”

[…]

Public health experts have been raising alarm about the delta variant in recent weeks, especially in places like Texas where the vaccination rate is low. Around 43% of Texans are currently fully vaccinated.

The vaccines have been shown to be highly effective at preventing new coronavirus cases, though there have been some rare occurrences of breakthrough infections — which Dr. John Carlo, the CEO of Prism Health North Texas and president of AIDS Arms Physicians, explained is when someone who is completely vaccinated contracts the virus anyways.

“The reason that is happening more and more is because if we still have people that are unvaccinated circulating with those who are vaccinated, it still presents a risk for breakthrough infections, even though the risk is minimized,” Carlo said.

Evidence also suggests that the small numbers of people who are vaccinated but do get infected tend to face less severe versions of the illness.

“The good news is that though we are seeing breakthrough infections, these are only mild cases,” Carlo said. “The vaccines show great protections but we knew it was never going to be perfect, it’s not 100%. And the big thing to know is that the vaccine removes the high chance of severe symptoms if you do get the virus.”

In a statement, DSHS said the delta variant is “having a significant effect on unvaccinated people leading to increases in new cases and hospitalizations.” Texas officials have not said how many of the new cases are among vaccinated and unvaccinated people, but national and local health leaders say the most severe impacts appear to be happening overwhelmingly among the unvaccinated.

I mean, I know there are walls to be built, and voters to suppress, and trans kids to kick around. Greg Abbott has a busy schedule, you know? I’m sure he’ll get around to talking about the rising COVID rate and the need to get vaccinated and maybe the return to mask wearing any day now.

Our Delta future

Don’t expect anything to change, except for the number of people getting sick and dying.

The new and highly contagious Delta variant of the coronavirus may have sparked the recent outbreak of 125-plus cases of COVID-19 linked to a Houston-area youth church camp, and a Texas virologist says the breakout should be a wake-up call for communities.

“Clearly, COVID is not over,” said Dr. Benjamin Neuman, a virologist and professor at Texas A&M University.

“COVID isn’t ever gone until it’s completely gone,” Neuman said. “And I think we’ve made the mistake of assuming that the virus would go away or assuming that the virus wouldn’t affect children … We keep stumbling into the same mistakes over and over, and that is not a way out of COVID-19.”

The Galveston County church camp took place in June with more than 450 adults and youth in attendance, according to the Houston Chronicle. More than 125 COVID-19 cases have been reported, of which three thus far have been confirmed to be the Delta variant.

The Delta variant is poised to become the leading strain in the United States in coming months according to Texas health experts, whose top concern is the risk it represents for those who are unvaccinated.

That strain, known by scientists as B.1.617.2, now accounts for about a quarter of virus infections in the nation, according to the Centers for Disease Control and Prevention. First discovered in India, it triggered a devastating outbreak there in April and May and has since spread to 85 other countries, attacking areas where vaccination rates are the lowest.

While dozens of strains have spawned from the original COVID-19 virus, the Delta variant is the most transmissible so far, said Dr. Rebecca Fischer, an infectious disease epidemiologist and assistant professor at Texas A&M University’s School of Public Health. It is also leading to higher rates of hospitalization for those infected, according to research.

[…]

DSHS said it recommends people protect themselves from the variant the same way they do for other strains of the virus.

“The best protection from all strains of COVID is getting fully vaccinated,” the statement said. “People who are not vaccinated should continue to follow COVID precautions, like wearing a mask and social distancing.”

Though the CDC says people who are fully vaccinated do not have to wear masks in public spaces, Neuman is pleading for everyone to continue wearing them, especially with the Delta variant spreading in Texas.

“The only confirmed cases that we know are cases that spread through the air,” he said, and those are “from somebody’s mouth to somebody else’s mouth.” Because of that, “blocking one or both of those mouths is really the ultimate way to stop the virus from spreading.”

Some more data, if you need it.

More than 40 percent of new COVID-19 hospitalizations at Houston Methodist are the Delta variant, researchers said Wednesday, a number expected to rise as travel returns but vaccination rates stagnate nationwide.

“The number of Delta variant COVID-19 cases at Houston Methodist has nearly doubled over the last week and is sixfold higher than in May,” said Houston Methodist spokesperson Lisa Merkl. Delta variant cases made up just 20 percent of hospitalizations at the hospital system the week prior.

COVID-19 vaccinations are critical to reducing infection rates, epidemiologists said, especially as the more contagious strain of the virus spreads worldwide. Positive case and hospitalization rates are also trending upward at Houston Methodist.

Experts expect that Delta, which is thought to be 60 percent more transmissible than the original SARS-CoV-2 strain, will soon become the dominant coronavirus variant in the U.S. Houston Methodist’s models estimate the Delta variant will make up 92 percent of all new infections within the coming weeks.

Not sure what more you need to know. The people who are vaccine hesitant, or who have obstacles in their way for getting vaccinated, will for the most part eventually get vaccinated. It will take too much time and I doubt there’s anything we can do now that we haven’t already tried to speed it up, but this group will steadily shrink. The anti-vaxxers are not going to get vaccinated, and there’s not a damn thing we can do about it. They’re also not going to wear face masks – they were the most whiny and resistant about it when that was the only mitigation available for when you had to be among other people. There’s also basically no chance Texas will impose any face mask requirements again, and local governments are prohibited from doing so. I wouldn’t even expect Greg Abbott to make a timid suggestion that maybe some people should think about wearing masks again.

If the Delta variant really takes off in Texas and we start looking like Missouri, I have no idea what happens. I have a hard time imagining Abbott even asking for federal help, though maybe the locals can do that. In many ways, we are where we were before, which is to say we’re on our own as far as Texas government is concerned. At least this time, some of us have more protection than others.

The COVID death spike

Another way to visualize the data. It’s bad no matter how you look at it.

More than 51,000 Texans have died of COVID-19, according to the state’s latest tally.

That is larger than the capacity of Minute Maid Park, though it represents less than two-thousandths of Texas’ 29 million residents.

So, was the virus, which killed less than 2 percent of the Texans with documented cases, responsible for anything more than a blip in historical death trends?

An examination of Texas the past 50 years reveals the answer: Unequivocally yes.

Deaths in Texas historically are cyclical, explained Mark Hayward, a sociology professor at the University of Texas at Austin who studies mortality trends. They peak in winter with the annual flu season and ebb in summer, and steadily increase overall as the state’s population grows.

During the pandemic, however, that pattern was disrupted by a surge in mortality with no precedent in modern history. Hayward said that will lead to a decreased life expectancy for Texans; a British study published this week found the average lifetime of Americans decreased by almost two years in 2020.

“You don’t lose two or three years of life expectancy without actual catastrophe happening,” Hayward said. “Modern populations don’t go through that. In any kind of normal year, there’s never that kind of impact on a population’s mortality such as we’ve seen from COVID.”

Instead of falling in the summer, Texas deaths surged beginning in June 2020. They peaked in the third week of July at 6,211, up 71 percent over the same week the previous year. A second wave of the virus during the holiday season peaked the third week in January at 7,154, a 69 percent year-over-year jump.

The Chronicle examined weekly deaths in Texas back to 1964, the earliest year the state health department has reliable data. From that year through 2019, deaths in Texas increased an average of 2 percent annually. Deaths jumped 23 percent in 2020.

Considering that the pandemic reached Texas in March, deaths over the next 12 months jumped 32 percent over the previous year. Of the 285,108 Texas deaths between March 2020 and March 2021, 17 percent were from COVID-19, according to state health records.

You’ll need to click over to see the chart. It’s not just the number of deaths that increased – you would expect that based on overall population trends – but the rate as well. As the story notes, this is further evidence that the “official” COVID death count is well below the true number, with many factors contributing to the undercount. There’s nothing to be done about what has happened, but we might want to give some thought to why it happened this way and what we might do differently (and hopefully better) next time.

Another upward revision of the freeze death count

Buzzfeed News takes a deep dive.

The true number of people killed by the disastrous winter storm and power outages that devastated Texas in February is likely four or five times what the state has acknowledged so far. A BuzzFeed News data analysis reveals the hidden scale of a catastrophe that trapped millions of people in freezing darkness, cut off access to running water, and overwhelmed emergency services for days.

The state’s tally currently stands at 151 deaths. But by looking at how many more people died during and immediately after the storm than would have been expected — an established method that has been used to count the full toll of other disasters — we estimate that 700 people were killed by the storm during the week with the worst power outages. This astonishing toll exposes the full consequence of officials’ neglect in preventing the power grid’s collapse despite repeated warnings of its vulnerability to cold weather, as well as the state’s failure to reckon with the magnitude of the crisis that followed.

Many of the uncounted victims of the storm and power outages were already medically vulnerable — with chronic conditions including cardiovascular disease, diabetes, and kidney problems. But without the intense cold and stress they experienced during the crisis, many of these people could still be alive today.

[…]

The BuzzFeed News analysis of deaths during the storm is based on mortality data from the CDC. It relies on a method called “excess deaths” analysis, recently used to estimate the full toll of the COVID-19 pandemic.

Our analysis, reviewed by three independent experts, suggests that between 426 and 978 more people than expected died in Texas in the week ending February 20 alone. Our best estimate is that 702 people were killed by the storm that week. Even the lowest end of the range is almost three times the number officials have acknowledged. Neighboring states that were hit hard by the winter storm but did not experience the widespread power outages seen in Texas did not show a spike in deaths.

BuzzFeed News reached out to relatives of people who died during the power outages, identified from dozens of wrongful death lawsuits as well as death reports obtained from public records requests to medical examiners in eight of the biggest counties in Texas. Interviews revealed stories of anguish and confusion, as families struggled to find out exactly how their relatives died.

This confusion also poses real economic challenges for survivors. For Mary Gonzales, the delay in obtaining a cause of death for her husband meant she was unable to claim an income from his pension for almost three months. And without an official acknowledgment tying their loved ones’ deaths to the storm, families will be unable to claim federal assistance for funeral costs.

The high death toll adds pressure on state legislators, energy regulators, and Texas Gov. Greg Abbott to harden the state’s infrastructure to avert another deadly disaster.

Abbott’s press secretary, Renae Eze, did not respond to questions about the significantly higher death toll or whether the state would investigate further, but said Abbott was “working collaboratively with the House and Senate to find meaningful and lasting solutions to ensure these tragic events are never repeated.”

“The Governor joins all Texans in mourning every single life lost during the winter storm, and we pray for the families who are suffering from the loss of a loved one,” she said.

But with the state’s legislative session ending on May 31, lawmakers only have a week left to finalize a proposal to address some of the vulnerabilities that made the February storm so horrific.

“As it stands, nothing has happened,” said Michael Webber, a professor of mechanical engineering focused on energy infrastructure at the University of Texas at Austin.

As of the end of March, the official death count was at 111, and a Houston Chronicle analysis in early April estimated it at 194. As this story among others notes, there are only so many medical examiners in the state, and only so many deaths result in an autopsy. As was the case with COVID, some deaths are attributed to chronic conditions like heart disease despite the obvious external cause. Similar statistical methods that estimate “excess deaths” have been used for COVID as well, and you can read how they arrived at these figures in the story. We’ll never know an exact number, but we do know that the official number will always be too low. Daily Kos has more.

Hospitalizations are down

Very good news.

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

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

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

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

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

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

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

“There’s still a risk,” he said.

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

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

The kids are getting vaxxed

Good news.

In the first week that Texas adolescents were eligible to be vaccinated for COVID-19, after a year of pandemic-induced isolation from their families, peers and classrooms, more than 100,000 kids ages 12-15 poured into pediatricians’ offices, vaccine hubs and school gyms across Texas to get their shots.

One of them was Austin Ford, a 14-year-old in Houston whose mother is a pediatric nurse, whose father has a disability that makes him vulnerable to COVID, and who lost a family member to the virus last month.

“It was a no-brainer for us,” said his mother, Sherryl Ford, 46, who took Austin to Texas Children’s Hospital for his shot last Friday, less than 24 hours after the Pfizer vaccine was approved for emergency use for his age group. “I have friends who took their kids the night before. In the days since the federal approval on May 13, about 6% of Texas children ages 12-15 have gotten a dose of the Pfizer vaccine. It took more than a month to reach that percentage for eligible adults last winter when the vaccination effort began.

It marks a promising start, health officials and others say, to the state’s first attempt to inoculate Texas’ estimated 1.7 million adolescents, who have endured isolation and virtual-learning challenges for more than a year.

“It’s amazing,” said Dr. Seth Kaplan, a Frisco pediatrician and president of the Texas Pediatric Society, which represents about 4,600 pediatricians and other child medicine professionals.”

[…]

In Texas, where the issue of vaccinating children for any kind of illness has sparked intense political debate, parents are permitted to opt out of vaccines required to attend public schools, as well as opt in to a statewide immunization registry that tracks childhood vaccinations.

But while Texas health officials have expressed concern about what they describe as a growing anti-vaccine movement, between 97% and 99% of Texas schoolchildren are fully vaccinated, according to the Texas Department of State Health Services.

State health officials don’t expect that high of a number with the COVID vaccine, at least not right away, but say that number signals a high rate of general vaccine acceptance among Texas parents, said Chris Van Deusen, spokesperson for DSHS.

The state is doing research to determine the best messages and outreach for parents, who will be targeted in a public awareness campaign over the summer, Van Deusen said.

Texas pediatricians have also been talking with parents for months about vaccinating their kids, in preparation for its availability to that age group, Kaplan said.

See here for the background. My younger daughter is in that six percent, and in less than two weeks we’ll be a fully vaccinated family. That’s not only good for the kids, it’s good for our overall vaccination numbers, which can use all the help they can get. Given the universal return of in-person school and the removal of mask mandates, this makes a lot of sense. The schools themselves will be used to help get kids vaccinated, which is a big deal considering how many obstacles some folks face in getting the shots.

Statewide, more than three dozen school districts from Laredo to McKinney and from East Texas to El Paso have become official providers and have received vaccines, either for students or staff or, in McKinney’s case, for both.

“We want to be part of the solution for our staff and our students, and we want education and our school experience to get back to what it was pre-pandemic,” Pratt said.

Although the vaccines require parental consent, a key part of the enthusiasm appears to be coming from teenagers themselves.

“Most of the kids that I’ve spoken to are really ready to get it because they understand that even though we kind of opened everything up and they are getting back to normal, there’s still a risk for them,” Kaplan said. “If they can get vaccinated, then their participation in activities that they want to be participating in is that much safer for them.”

I don’t know what we need to do to get HISD involved as well, but we should do that. The Dallas Observer has more.

Please get your second shot

I hope this is mostly a function of incomplete data.

Millions of Americans — including tens of thousands of Houstonians — either have delayed or are forgoing their second dose of a COVID-19 vaccination.

As of late last month, roughly 51,000 people who received their first inoculation through the Houston Health Department were “overdue” for their second dose. The department’s number is preliminary but includes any person who has gone at least 42 days since their first round without returning for a second shot.

Statewide, more than 630,000 of the roughly 11 million people who’ve received one dose are more than six weeks overdue, the Texas Department of State Health Services told the Houston Chronicle.

“We need a lot of those folks from February to come back in and get their second dose now,” Dr. David Lakey, a DSHS commissioner who sits on Texas’ COVID-19 Expert Vaccine Allocation Panel, said last week.

Part of the gap, however, is likely due to people who opted to receive their second dose through other health care providers as vaccine availability expanded.

It’s not cause for alarm just yet, said Rice University health economist Vivian Ho, though she said the trend does not bode well for the overall goal of herd immunity.

[…]

Ho said people shouldn’t be dissuaded from rescheduling appointments that they missed, as they’ve been shown to give additional antibodies even if they come late.

“The first dose really does boost your antibodies, but it’s the second that really gives you the second umph,” she said.

Houston Methodist radiologist Dirk Stotsman worried that some people are forgoing their second round of inoculations because the first doses of Moderna and Pfizer have been proven highly efficacious against the virus.

While the first dose offers a good level of protection, he said, the extra antibodies provided by the second dose will be integral to prevent the spread of more infectious and dangerous strains of the virus.

Getting just the one Pfizer or Moderna shot is better than nothing, but it’s not as good as it should be. If you’ve gotten one shot and for whatever the reason not gotten the second one, it’s not too late. Go ahead and make an appointment or do a walk-in where available.

In related news:

With the rescission of the mask mandate and full reopening of businesses, medical experts worried spring would bring a debilitating fourth wave of COVID-19 infections to Texas.

But as vaccination rates slowly leveled off in recent weeks, the rate of infections and hospitalizations did as well. More than a year after businesses closed, offices sent workers home and traffic vanished from Houston’s concrete jungle of freeways, public health officials are cautiously optimistic efforts to quell the spread of the virus and vaccinate as many people as possible are working.

Yet despite claims from officials like Gov. Greg Abbott that this downturn is linked to “herd immunity” — the mysterious target ranging between 60 and 80 percent fully vaccinated against COVID-19 — experts say Texas cannot rely on vaccinations alone to achieve what some think may mean the end of the pandemic.

“Nobody knows for sure what’s going to happen,” said Catherine Troisi, an infectious disease epidemiologist with UTHealth School of Public Health in Houston. “But my educated guess would be as more of the population becomes either vaccinated or immune through natural infection, we won’t see as many cases.”

Fewer than 3,000 patients have been hospitalized across the state for the past five weeks, according to a Chronicle data analysis. It’s the longest streak with that few patients since June 2020.

Dr. Carl Vartian, chief medical officer at HCA Houston Healthcare’s Clear Lake and Mainland hospitals, worries the public conflates “herd immunity” with “ending COVID-19.” But COVID-19 may not truly end. Rather, experts suspect it will become “endemic,” never fully leaving the population — like influenza, which still infects hundreds of thousands of people a year in the U.S.

Again, what we have now is better than what we had before, but not as good as it could be. Even at “herd immunity levels”, there’s still a lot of unvaxxed people. The difference is that it becomes harder for the virus to really take off as it has done before. But people can and will still get sick and die if they’re not vaccinated. It’s up to us what the level of those illnesses and deaths are.

Now it gets harder to vaccinate people

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

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

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

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

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

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

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

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

[…]

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

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

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

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

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

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

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

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

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

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

Our COVID numbers are staying down

Let’s keep this going.

While the East Coast struggles with a fourth wave of rising COVID-19 infections, Texas experts say the state is doing “reasonably well” as case rates stabilize across the state.

Case rates and hospitalizations have plateaued in the region in recent weeks, averaging roughly 3,500 new daily reported cases, the lowest it’s been since early-to-mid September. The decline in hospitalizations has been an even more welcome trend, with fewer than 3,000 patients hospitalized for COVID, the lowest it’s been since June.

Medical experts such as Dr. Carl Vartian, an infectious disease specialist and chief medical officer at HCA Houston Healthcare Clear Lake and Mainland hospitals, suspect the winter freeze, increasing vaccination rates and the prevalence of antibodies in Texas’ population have kept case rates low over the last month.

[…]

“Texas is doing better than most states, which are seeing a pretty sharp rise in the number of daily new cases,” said Ben Neuman, a virologist at Texas A&M University.

The lower rate of infections doesn’t mean that Texans can let their guard down, though. Fewer than 37 percent of state residents have received at least one dose of the COVID-19 vaccine, and just over 20 percent have been fully vaccinated.

“You have to plateau before you rise, and I think that’s where we’re headed,” Neuman said.

The flat line of case rates starts with a sharp drop-off in testing. According to data from the Department of State Health Services, results from PCR testing dropped sharply during the winter freeze in February, and have not rebounded. As of April, Texas is testing at just half the rate it was before the state iced over.

While the number of daily tests has declined heavily, so too has the positive test rate. It’s now under 5 percent, and the second-lowest it’s been since the start of the pandemic, according to state data. Even with the reduced number of tests being conducted, fewer people are testing positive for COVID.

The low number of tests mean there could be a lag before a potential surge, Neuman said.

In Houston, medical experts are cautiously optimistic there won’t be a rise.

Usually, case rates spike first, followed by hospitalizations the week after and ventilator demand and deaths after that. So far, all three have stayed low in Houston, Vartian said.

The freeze was basically a one-week lockdown in the middle of February, and that no doubt helped keep infections down. I don’t know what it’s like anywhere else, but at least in my little part of the world people are still masking up, despite the Governor’s order. I won’t extrapolate from such a limited data point, but I feel hopeful that at least in the big cities people are still inclined to be cautious.

And I take heart at the progress in getting shots into arms. The Astros are getting their shots. The Rockets are getting their shots. Judge Hidalgo has gotten her first shot. People are celebrating the ways that their lives have been improved by getting vaccinated. (Can confirm, by the way.) I’m hopeful. We still have to be careful, but I can see the road ahead, and it’s going someplace good.

Chron analysis puts freeze death total at 194

Sobering, to say the least.

The deaths of nearly 200 people are linked to February’s cold snap and blackouts, a Houston Chronicle analysis reveals, making the natural disaster one of the worst in Texas this past century.

The tally, which is nearly double the state’s official count, comes from an investigation of reports from medical examiners, justices of the peace and Department of State Health Services, as well as lawsuits and news stories.

The state count, which is preliminary, has yet to incorporate some deaths already flagged by medical examiners as storm-related.

The 194 deaths identified by the Chronicle so far include at least 100 cases of hypothermia that killed people in their homes or while exposed to the elements, at least 16 carbon monoxide poisonings of residents who used dangerous methods for heat and at least 22 Texans who died when medical devices failed without power or who were unable to seek live-saving care because of the weather.

Sixteen deaths were from other causes, such as fires or vehicle wrecks, while the remaining 40 were attributed by authorities to the storm without listing a specific cause.

“This is almost double the death toll from Hurricane Harvey,” said State Rep. Rafael Anchia, D-Dallas. “There was no live footage of flooded homes, or roofs being blown off, or tidal surges, but this was more deadly and devastating than anything we’ve experienced in modern state history.”

The toll is almost certain to grow in coming weeks as death investigators in the state’s most populous counties clear a backlog in cases from the cold snap. The Travis County medical examiner alone is investigating more than 80 deaths between Feb. 13 and Feb. 20.

The deaths come from 57 counties in all regions of the state but are disproportionately centered on the Houston area, which at times during the crisis accounted for nearly half of all power outages. Of the known ages, races and ethnicities of the victims, 74 percent were people of color. Half were at least 65. Six were children.

The previous count released by the state was 111, but as noted then and in this story that is sure to go up. There’s no central database for this kind of thing, only 14 counties have a medical examiner’s office, and not all county data is currently available. As with COVID deaths, there are likely some cases where one could argue whether the freeze was the actual cause of death or whether it was just proximate. The main point here is that the freeze was responsible for a lot of misery around the state and by any count more deaths than there were from Hurricane Harvey. It remains to be seen if the Legislature and the Public Utility Commission (which currently has no members) are taking adequate action to prevent this from ever happening again.

Winter storm death count now at 111

A revision of the numbers. Expect this to happen at least once more.

At least 111 Texans died as a result of last month’s winter storm, according to updated numbers released Thursday by the state Department of State Health Services.

The newly revised number is nearly twice what the department had estimated last week, and will likely continue to grow. Some of Texas’ larger counties, such as Tarrant County, have yet to report any storm-related deaths.

The majority of people died from hypothermia, but health officials also attributed deaths to “motor vehicle accidents, carbon monoxide poisoning, medical equipment failure, exacerbation of chronic illness, lack of home oxygen, falls and fire.”

[…]

Harris County reported 31 storm-related deaths, the largest share in the state. Travis County followed with nine deaths.

Health officials will continue to update their preliminary findings weekly.

According to DSHS, the data is compiled from forms that certify deaths are related to a disaster, notification from death certifiers and analyses of death certificates from state epidemiologists.

See here for the background. As a reminder, there were 103 deaths attributed to Hurricane Harvey, so the February freeze event (I’m sorry, I’ve not adopted the new paradigm of naming winter storms, so I have not and probably will not again refer to this as “Winter Storm Uri”) has now surpassed that total. And will likely put some more distance between them when the next month’s data is available.

There has been a bit of legislative action on this front.

A bill that would overhaul Texas’ energy industry — including mandating weatherization for natural gas and power generators — was approved by a Texas Senate committee on Thursday.

The sweeping Senate Bill 3, sponsored by Republican state Sen. Charles Schwertner of Georgetown, includes a number of reforms that have been floating around the state Capitol since last month’s deadly winter storm left millions without electricity during freezing temperatures. While the Texas House earlier this month approved a package of similar, standalone bills, Thursday’s vote represents the first substantive action on the issue by the upper chamber.

“This is an important issue to get right for the people of Texas, for the future of Texas, for the economy of Texas,” Schwertner said.

Chief among the bill’s provisions is a requirement that all power generators, transmission lines, natural gas facilities and pipelines make upgrades for extreme weather conditions — a process known as weatherization. Many power generators and gas companies were ill-suited for the freezing temperatures in February, which led gas pipelines to freeze and power transmission to falter.

The measure would delegate rulemaking authority to the Texas Railroad Commission, which regulates the oil and gas industries, and the Texas Public Utility Commission, which regulates the electric and telecommunication industries. If a gas or energy company fails to comply with the weatherization rules, it would face a fine up to $1 million for each offense. The bill does not address funding to pay for the required upgrades.

A Texas House committee earlier this month passed a similar weatherization bill. But the requirements only apply to electric companies, not natural gas companies. In public testimony before the Legislature, Railroad Commission Chair Christi Craddick largely dodged talks of winterizing the natural gas supply chain.

There’s more, so read the rest. I don’t know enough to offer a general critique of these bills, but I would certainly argue that natural gas companies should have the same weatherization requirements. All of these bills are sure to change as they move from one chamber to the other, so we’ll need to see where they wind up.

The vaccination eligibility list is about to be wide open

Go ahead and get on it, though be prepared to wait as the supply issues work themselves out.

Everyone age 16 and older, regardless of occupation or health status, will be eligible for the COVID-19 vaccine in Texas starting March 29, state health officials said Tuesday.

The Texas Department of State Health Services is still asking providers to prioritize appointments for people who are 80 and older, and to prioritize walk-ins from anyone in that age group who shows up without an appointment. The vaccines are not limited to Texas residents, and citizenship is not a requirement for the vaccine.

“We are closing in on 10 million doses administered in Texas, and we want to keep up the momentum as the vaccine supply increases,” said Imelda Garcia, DSHS associate commissioner for laboratory and infectious disease services and the chair of the state’s Expert Vaccine Allocation Panel.

Until now, eligibility for the vaccine was mainly restricted to a few groups: health care workers, people ages 50 and older, those with certain underlying health conditions who are 16 or older, and employees of schools and day care centers. Texas began receiving vaccines in mid-December.

The vaccine is still in short supply as the announcement makes about 22 million people eligible on Monday. The state has been allocated more than 14 million doses since distribution began in December — far short of the supply needed to fully vaccinate everyone right away.

[…]

The state is also launching a website next week for people to sign up for vaccines at public health centers and state-run clinics. The Texas Public Health Vaccine Scheduler will alert participants to upcoming events and available appointments. For those who do not have access to the internet, the state will also be creating a hotline for appointments by phone, officials said.

The DSHS has more on Twitter. Great news for those who have not yet been eligible, though as we have previously discussed it’s not necessarily great for the distribution effort or for vaccine equity. All states were mandated by President Biden to make the vaccine generally available by May 1, so this is just getting a one-month head start on that.

County Judge Lina Hidalgo calls this a milestone moment.

“Opening vaccine eligibility vaccines to every adult is a key milestone in our fight against COVID-19,” Hidalgo said. “The onus is now on each adult to do their part. This vaccine is safe and effective, and the faster we all get a vaccine the sooner we’ll be able to pull through this crisis, get our economy running at full speed, and get life back to normal.”

Many experts have continued to raise concerns about unequal access to vaccines, particularly among low-income communities.

Rice University health economist Vivian Ho said the opened eligibility could help on that front because public health agencies will be able to, for example, vaccinate all workers at a grocery store.

“Now you can say we are going to go to workplaces, because there’s no age limit,” she said.

Conversely, Ho said, the announcement will do little to convince people who have already decided not to get vaccines, namely in communities outside of major cities.

Opening eligibility criteria will clear confusion for many communities who have hesitated to get a COVID-19 vaccine because of constantly changing age and medical condition restrictions, said Luis Torres-Hostos, dean of the University of Texas – Rio Grande Valley School of Social Work.

Torres-Hostos, who has worked with his university to get the message out to Latino communities, is hopeful public health officials will have more luck with immunization with these changes.

“Where are the vaccine deserts? Where are the places where it’s really hard for members of the community to get their vaccine?” he said. “We’ve got to do something to make sure that the vaccine is being given there.”

However, even his optimism comes with a caveat. Expanded criteria will only fix inequities if it comes with increased vaccine supply.

Communities of color and low-income communities are not hesitant to get the vaccine; a recent poll by the Kaiser Family Foundation finds 7 in 10 Hispanic people surveyed have received or want to book an appointment for a COVID-19 vaccine.

“If we build it, they will come,” Torres-Hostos said.

I sure hope this will help with the inequity issue, and I agree it will clear up any lingering confusion. We’ll look for that DSHS website when it’s up (and hopefully doesn’t crash). Y’all get yourself – and anyone you know who might need some assistance – in line for the vaccine.

Winter storm death count at 57

This is likely to rise as we get better data.

At least 57 people died in Texas as a result of last month’s winter storm, according to preliminary data the state health department released Monday.

The largest number of deaths — at least 25 — occured in Harris County, the Texas Department of State Health Services reported.

The deaths occurred in at least 25 counties between Feb. 11 and March 5, the state agency said. The majority of verified deaths were associated with hypothermia, but health officials said some were also caused by motor vehicle wrecks, “carbon monoxide poisoning, medical equipment failure, falls, and fire.”

The preliminary data is “subject to change” as state disaster epidemiologists gather additional information and additional deaths are verified, the agency said. The information will be updated weekly, it said.

For purposes of comparison, there were 103 deaths in Texas attributed to Hurricane Harvey, 68 to direct effects of the storm and 35 more in the aftereffects. The financial costs of the freeze were higher. Just keep all that in mind when you see Greg Abbott and Dan Patrick and others play the blame game.

Vaccine progress

Good news.

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

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

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

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

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

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

Harris County alone topped 1 million doses on Tuesday.

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

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

Not so good news.

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

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

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

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

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

Good news for some, just news for others.

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

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

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

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

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

Teachers can get the COVID vaccine now

About time.

Texas teachers are now eligible for COVID-19 vaccines, health officials announced Wednesday.

Effective immediately, all Texas vaccine providers should include all school staff, Head Start program staff, and child care staff in their vaccine administration programs, according to a notice the Texas Department of State Health services sent to providers.

The notice comes after the Biden administration Tuesday urged all states to prioritize vaccinating teachers and school staff. Texas had not previously prioritized teachers. Texas received a letter from the U.S. Department of Health and Human Services Tuesday night directing it to expand eligibility, according to a DSHS news release.

Those eligible are “those who work in pre-primary, primary, and secondary schools, as well as Head Start and Early Head Start programs (including teachers, staff, and bus drivers) and those who work as or for licensed child care providers, including center-based and family care providers,” according to the federal directive.

State health officials said earlier this week that they expected to finish vaccinating older and most vulnerable Texans in the next few weeks and broaden eligibility to include more Texans by the end of the month.

That new group was expected to include teachers before Wednesday’s announcement, but officials have not said who else would be in that new “1C” group.

[…]

Educators and advocates have been begging the state to include teachers as it rolled out its vaccination program this winter and spring. After Abbott’s announcement Tuesday, several educator groups chastised him for removing the mask requirement without prioritizing teachers for vaccines.

“Abbott has shirked his responsibility to stick with medical advice and clarify what needs to happen to keep our schools safe. Every top health official has stressed that even with vaccinations we need to keep using the most simple tools to stop the spread,” said Zeph Capo, president of the Texas American Federation of Teachers, in a statement Tuesday.

If you want schools to be open – and you should want schools to be open, if they can open safely – then you need to make sure that everyone who works at those schools can get vaccinated. It’s pretty simple. Naturally, this took a nudge from the federal government for it to happen.

Dr. John Hellerstedt, who serves as commissioner for the Department of State Health Services, told the the Texas House of Representatives’ Committee on Public Health moments before the release was published that the change came after President Joe Biden announced Tuesday that he will direct states to prioritize teachers and school-based staff for vaccines.

“Right now we’re planning in Texas to see how we will bring that to functioning operation,” he said. “We are actively engaged in that as a priority item.”

About 30 states currently allow teachers to get earlier access to vaccines than the general public, Biden said Tuesday. Biden added that he was “directing” the remaining states to follow suit — though he did not specify what power he planned to employ to force the change — and announced he would use a federal pharmacy program to deliver vaccines to school employees and childcare workers.

“Not every educator will be able to get their appointment in the first week, but our goal is to do everything we can to help every educator receive a shot this month, the month of March,” Biden said.

The federal directive defined the people now eligible as “those who work in pre-primary, primary, and secondary schools, as well as Head Start and Early Head Start programs (including teachers, staff, and bus drivers) and those who work as or for licensed child care providers, including center-based and family care providers.”

Good thing the vaccine supply is increasing. It would be nice if most school districts continued to require masks for everyone, so that the teachers who can’t get a vaccine in the next week or so still have some protection. The Press has more.

Abbott lifts statewide mask mandate

Unbelievable.

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

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

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

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

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

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

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

[…]

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

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

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

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

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

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

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

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

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

[…]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

One more thing:

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

More vaccines coming

Bring ’em.

The Food and Drug Administration approved Johnson & Johnson’s COVID-19 vaccine on Saturday for use in the U.S., the third vaccine to be approved since the pandemic began.

Texas could initially receive more than 200,000 doses, according to the Texas Department of State Health Services, but the agency hasn’t received a timeline for when they would arrive. The company has said it plans to ship 20 million shots in the U.S. by the end of March and an additional 80 million doses before the end of June.

Texas received about 1.5 million vaccine doses by Pfizer and Moderna this week, including doses that had been undelivered earlier in the month because of the winter storm.

Unlike those vaccines, Johnson & Johnson’s formulation is the first to only require one dose, and it can be stored at regular refrigeration temperatures. The others require two doses, and Pfizer doses must be stored at below-freezing temperatures.

[…]

Five million vaccine doses have been administered overall in Texas as of Feb. 25. That equals about 5.8% of the state’s population — a long way from the 70% to 80% that experts estimate is necessary to achieve herd immunity. It would require nearly 100% of adults to be vaccinated to reach those figures, according to census numbers.

Scientists are still monitoring how well vaccines prevent the spread of the coronavirus, and health officials advise those who are vaccinated to continue wearing masks, social distance and follow other COVID-19 safety guidelines.

Hopefully, the J&J vaccine will really kick this up a notch, since it only requires the one shot. But as always, it’s first a matter of supply, and just having another supplier should help. If J&J is delivering 80 million doses nationally by the end of June, that should be six or seven million for Texas. It’s all about the numbers.

We can get back to vaccinations

Federal vaccination super site opening this week.

COVID-19 vaccination efforts are about to significantly ramp up next week in Houston.

The region’s first vaccination “super site” will open on Tuesday at NRG Stadium, Harris County Judge Lina Hidalgo announced on Twitter Friday afternoon.

The site will vaccinate 42,000 people per week for three weeks, Hidalgo said.

The site is one of three in Texas backed by the Federal Emergency Management Agency. The two other Texas super sites are located in Dallas-Fort Worth at AT&T Stadium and Fair Park, the Houston Chronicle reported.

The opening of the super site means Houstonians who signed up via the city or county’s vaccine waitlist should keep an eye out for updates on when they may be able to schedule an appointment. Residents who have yet to sign up for either waitlist are encouraged to do so.

See here for the background. COVID vaccinations pretty much came to a halt last week, which puts a bit of a crimp in the pace to get 100 million vaccinations administered in the first 100 days of the Biden administration, but they had been running ahead of pace and should be able to get back on track. Sure is nice to be able to type and read those words and nod along instead of scoffing, isn’t it?

We should be vaccinating grocery workers

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

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

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

[…]

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

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

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

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

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

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

Here come the super-sites

Cool.

Texas is working with the federal government to open vaccination “super sites” that could administer upward of 5,000 COVID-19 vaccines per day, Gov. Greg Abbott said Monday.

Houston and Dallas will likely host the initial two sites, Abbott said, with “possible expansion to other locations.” They would be open every day for eight weeks, offering as many as 672,000 shots between them.

The sites would be the largest to administer COVID-19 vaccines in Texas, which has lost more than 35,000 residents to the coronavirus. They come at the beginning of an increased federal presence in the state’s vaccine rollout, as President Joe Biden has promised to scale up vaccine distribution as quickly as possible.

In recent weeks, Texas officials have employed a similar strategy at the state level, designating about 80 vaccination “hubs” statewide that receive most of the weekly vaccine allotment. The largest hubs clock in just above 10,000 doses a week, though allocations vary by site.

Lauren Lefebvre, a spokeswoman for the Federal Emergency Management Agency, said officials are working with Texas on the specifics for the super sites, which weren’t solidified yet Monday. The agency is partnering with state governments across the nation to pilot up to 100 community vaccination centers primarily staffed by federal employees.

[…]

Harris County Judge Lina Hidalgo said the “super site” announcement was “good news” that would allow county officials to begin chipping away at a vaccination waitlist including roughly 300,000 residents — far exceeding available doses.

“The sooner we increase vaccine supply, the faster we can reach herd immunity,” she tweeted. “We’re ready to support state and Biden administration efforts to distribute more vaccines.”

See here for some background. According to the Trib, FEMA brings its own supply of the vaccine, which is separate from the weekly allotment the state gets from the CDC. That ought to help ease the supply burden a bit. Good news all around.

“Nobody is getting enough”

Pretty much says it all.

As Texans scramble for appointments for the COVID-19 vaccine, federal data helps explain why: Relative to its population, the Lone Star State ranks near the bottom in the country in number of doses received.

Texas has received the second-highest number of doses in the country. Per capita, however, Texas comes in closer to the bottom at 49th out of all 50 states, Washington, D.C., and Puerto Rico, according to an analysis of Centers for Disease Control and Prevention data. Federal officials say there is a good reason for that: Vaccine distribution is based on the adult population of each state. And roughly a quarter of Texans are under the age of 18. Still, even when adjusted for adults only, Texas ranks 48th.

As Texas politicians from Congress down to local county judges push for more doses, the supply remains scarce, even for people older than age 65 and those with serious medical conditions.

“Nobody is getting enough. That is plain and simple,” said Brazoria County Judge Matt Sebesta, estimating that more than half of the roughly 130 providers that signed up to distribute vaccines in the county have yet to receive any doses. “We are kind of where we were last April with personal protective equipment and testing equipment: not enough to go around.”

State health officials insisted they are ordering as many doses as they can from the federal government and distributing them as quickly as they can.

“The supply of vaccines is limited by both the manufacturers’ ability to produce it and the amount allotted to Texas by the federal government,” said Lara Anton, a spokeswoman for the Texas Department of State Health Services. “The federal government determines how much vaccine will be sent to providers in the state on a weekly basis.”

U.S. Department of Health and Human Services spokesman Bill Hall said the vaccines are distributed based on an algorithm that takes into account the adult population in each state and U.S. territory. “We are committed to fair and equitable allocation of vaccines and therapeutics,” Hall said.

Texas has received more than 3.5 million doses of the vaccine, though the rollout so far has been anything but smooth. County registration lines have crashed under demand.

We know the story by now. There’s more vaccine coming, and that supply will increase further over time, but the administration of those doses has been chaotic. Greg Abbott has done the hard work of taking credit for everyone else’s hard work, but he never did anything to push the Trump administration to have a plan – let alone make sure the state of Texas had one, given Trump’s plan was to make the states do it – and it’s hard to imagine him making a diplomatic call to the Biden administration to ask for more help. He has reassured us that everything is going great, though, so at least we have that.

More vaccines coming

Still not enough, but getting better.

Texas this week expects to receive more than half a million first doses of the COVID-19 vaccine from the federal government, state health officials announced Friday.

The 520,425 doses will be shipped to 344 providers, including 82 hubs, in 166 counties across the state, according to the Department of State Health Services.

Officials attributed the boost in available vaccine to a 30 percent increase in Moderna doses being sent to the state and a “one-time return” of 126,750 doses of the Pfizer vaccine that the state had been required set aside for a program that overestimated the number of needed doses.

Doses that had been set aside, for a long-term care facilities program, will specifically go to providers located in counties that have been allocated “significantly” fewer vaccines than their share of the population, including in the suburban Houston area, health officials said.

[…]

As of Friday, providers across the state had administered about 2.2 million doses, according to DSHS. More than 1.75 million people had received at least one dose while more than 410,000 people were considered fully vaccinated.

Reread that last paragraph, please. When you see “the state had administered about 2.2 million doses” of the COVID vaccine, do you think “2.2 million people have been vaccinated for COVID”? Because if you do, and I wouldn’t blame you if you do, what do you then think when you read “1.75 million people had received at least one dose while more than 410,000 people were considered fully vaccinated”? It’s a very different reality, isn’t it? That’s the magnitude of the problem here.

For what it’s worth, the 520K doses is almost exactly what would be needed to meet the 75K per day goal that Greg Abbott has set. (We’ll put aside the second-shot question for the moment.) Again, though, this puts us in range of getting everyone vaccinated in a little more than a year. We don’t have that kind of time. We need to be aiming for something like one million vaccinations per week, or close to 150K per day, to get this done in a timely fashion, and that’s still a duration of more than six months. Federal help is coming – in fact, it’s already here – and I expect to see our daily and weekly totals rise soon, but we really need to appreciate how massive the scope of this project is, and how far behind we already are thanks to the criminal incompetence and negligence of the previous administration and its enablers. Be very, very upset about this.

More vaccination hubs

Keep ’em coming.

State health officials Saturday announced 79 hub providers that are expected to receive allotments of COVID-19 vaccines this week, including newly designated hubs in some suburbs of Houston.

The hub providers include two in Galveston County, one each in Fort Bend County, Montgomery County and Liberty County and six in Harris County, according to a list of the hubs that are intended to focus on mass vaccination efforts. Officials plan to distribute 333,650 first doses of COVID-19 vaccines to 260 providers across the state. Additionally, the state will order about 500,000 doses expected to be the second ones for people who received their first shot a few weeks ago.

Earlier this month, the Houston region’s three hubs were all in Harris County, making officials in some surrounding counties fear they’d been forgotten. The Texas Department of State Health Services previously said more hubs were likely to be added but that the main obstacle was a short supply of vaccines.

“In the past week, Texas became the first state to administer 1 million doses of vaccine, and vaccine has been administered to residents of all 254 counties,” state health officials said in announcing the allocation breakdown of the week’s doses. “Vaccine remains limited based on the capacity of the manufacturers to produce it, so it will take time for Texas to receive enough vaccine for all the people in the priority populations who want to be vaccinated.”

The vaccine first arrived in Texas on December 14, so that million doses was administered over about five weeks, or less than 30K per day. Things have surely picked up since the first few days, with the emergence of hubs. We’re still working to get to that 50K per day minimum target, which as we have discussed is still a 20-month time frame. Getting the rate higher than that is going to depend on the federal supply, which was very much over-promised and under-delivered by the Trump administration. But today is a new day, and now we have a new President, and things should be looking up soon. Let’s all hope so.

Vaccine roundup

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Greg Abbott’s Politics Create a Vaccine Stampede

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

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

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

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

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

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

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

And, just as a reminder:

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

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

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

Abbott speaks about the vaccination effort

It’s going great! We swear!

More than 877,000 Texans have received a COVID-19 vaccine since they first began arriving in Texas nearly four weeks ago, and that number is expected to increase by at least 50,000 more per day, Gov. Greg Abbott said Monday.

“Never before in the history of this state has Texas vaccinated so many people so quickly, “ Abbott said during remarks at the Esports Stadium Arlington & Expo Center, a newly-designated “vaccination hub” that local health officials said can vaccinate thousands per day. “It’s stunning to see what we’ve accomplished.”

The Arlington center, home to the city’s mass vaccination effort since December, is among 28 sites designed by the state as hubs.

“Our goal is, by the end of the week, we have no vaccines left,” said Tarrant County Judge B. Glen Whitley. The county’s health district was allotted 9,000 doses in the most recent shipment this week.

The hubs are meant to streamline vaccinations at a time when the state is seeing an unprecedented surge in COVID-19 cases, deaths, and hospitalizations. Texas continues to prioritize vaccinating health care workers, people who are 65 and older, and those with medical conditions that increase their risk of hospitalization or death if they contract the virus.

The large sites will receive most of the state’s next shipment of 158,825 COVID-19 vaccine doses this week. Just over 38,000 doses will go to 206 additional providers across the state, including several in rural counties that until recently had not received an allotment.

Officials promise bigger allotments in the weeks and months to come, but a patchwork local system of vaccine distribution, among other issues, has created a tumultuous rollout to the long-awaited vaccine.

On Monday, Abbott said Texas expects to see an additional 310,000 first doses per week for the rest of January and up to 500,000 second doses earmarked for those who have already received the injection in Texas. Continued increases are expected, Abbott said, depending on the federal government allotments.

[…]

The data on the number of doses administered has a reporting lag of at least two days, Abbott said, but added that Texans will start to see a significant uptick in those numbers as this week’s vaccinations are reported.

“You are going to see those numbers increase, as it turns out, somewhere between 50,000 and 75,000 per day,” Abbott said.

Texas Health Commissioner John Hellerstedt said the rate and scale of the state’s rollout has been “a really amazing operation” and said the creation of the hubs would ratchet up the rate of administration.

“Through the kind of vaccination operation we see here, we’re very confident it’s going to accelerate here even more,” Hellerstedt said. “It is really the way forward.”

That’s a lot of number being thrown at us. For sure, 50K per day is a big improvement over the “100K per week” we were at earlier in the year. That was a six-years-to-full-vaccinations pace, whereas 50K per day will get everyone vaccinated in 20 months. At the promised high end of 75K per day, we’re at about 13 months. Still not great – we sure would like to finish this task before 2022, wouldn’t we? – but at least in a timeframe we can envision. Note though that we are not at that pace yet – the 310K first doses per week rate is less than 50K per day, and puts us back at an almost-two-years duration. Again, I do expect things will get better, assuming of course that Abbott and the rest of our state leaders don’t reject federal assistance in the name of stupid partisan politics, but every week it takes us to get up to speed is that much longer to get to where we want to be. The hub approach is a sensible model, but it’s going to take a lot of effort and resources to make it work.

Coronavirus 2.0

Happy New Year.

The first known case of a new and possibly more contagious coronavirus strain has been reported in Texas, in an adult male resident of Harris County who had no history of travel, according to the state health services department and County Judge Lina Hidalgo.

The variant known as B.1.1.7 was first identified in the United Kingdom, where it has spread quickly, and cases have been found in several U.S. states, including California and Colorado. It does not cause a more severe disease, and vaccines “are expected to be effective against it,” the health services department said, citing the existing scientific evidence.

“The fact that this person had no travel history suggests this variant is already circulating in Texas,” said Dr. John Hellerstedt, commissioner of the state’s health services department. “Genetic variations are the norm among viruses, and it’s not surprising that it arrived here given how rapidly it spreads.”

While this variant doesn’t appear to be any nastier, as far as we know, and should still be covered by the vaccines, it is apparently capable of spreading faster. Really makes you want to stay away from people, doesn’t it?

On the plus side, maybe.

State officials will start distributing most of Texas’ vaccine doses next week to a handful of large pharmacies and hospitals, creating “vaccination hubs” where more people can get a shot quickly, the Department of State Health Services announced Thursday.

“As the vaccination effort continues to expand to people who are at a greater risk of hospitalization and death, in addition to frontline health care workers, these vaccination hubs will provide people in those priority populations with identifiable sites where vaccination is occurring and a simpler way to sign up for an appointment with each provider,” the department said.

Those hubs could vaccinate more than 100,000 people next week, officials said.

DSHS issued a survey earlier this month to vaccine providers gauging their ability to operate community vaccination sites. The state will release the final list of large-scale providers later this week, after the federal government decides how many doses Texas will receive next week.

We expect another 200K total doses next week as part of this preparation. That’s good, but as we’ve discussed before, the numbers remain daunting. Texas has almost 30 million people in it. At 100K shots a week, you’re looking at six years to get everyone vaccinated. The optimistic interpretation of this story is that 100K per week is a starting point, and we’ll accelerate from there. Great, I sure hope so, but if we want to get enough of the state done to get close to herd immunity this year, we need to get to 500K per week, and every week we operate at less than that makes the target number have to be a little higher. (A better and more organized federal response will surely help.) I know, it’s a hard problem, everyone’s doing the best they can (well, not really, but let’s be generous for these purposes), and so on, but this is the math. As someone once said, the stars may lie but the numbers never do.

There is a website for COVID vaccine signups in Houston

You can’t use it right now, but it’s there.

Houston’s Health Department launched an online portal for residents to apply for an appointment at its COVID-19 vaccine clinic Monday but quickly ran out of available slots for the remainder of the month.

“The response to Houston’s first COVID-19 vaccine clinic was massive, quickly filling the appointment slots for the department’s current vaccine allocation,” Mayor Sylvester Turner said at a City Hall news conference where he was about to get his own shot in the arm.

“The vaccine clinic appointments are booked for the rest of this month, and the department is not taking additional appointments at this time.”

Turner said the city is working to set up additional sites and create additional capacity, although it is unclear when new appointments will be available. Turner said the city hopes to open a “mega site” on Saturday.

The portal, available at houstonemergency.org/covid-19-vaccines, added another way for qualifying residents to book for an appointment. A hotline also is available at 832-393-4220.

The city clinic vaccinated nearly 2,000 residents with the Moderna vaccine in two days. It is accepting residents from the first two phases of the state’s distribution plan, which include front-line emergency workers, people 65 and older, and those over 16 with certain high-risk health conditions.

It’s a good start, but at 2K shots a day, we’re talking two years to get to 75% distribution in the city. We’d like to go a little faster than that. Obviously, the city is limited by how much vaccine it can get, as well as the state regulations. Harris County had its own rough rollout thanks to confusion over who was allowed to sign up. On that first front at least, help is on the way, so maybe in another month or two we’ll see much higher numbers. And at least there is now a central location for this for Houston residents, something that had been sorely lacking before.

There’s some more vaccine coming to Texas, but it’s still not a lot.

On Monday, state health officials announced that 325,000 additional vaccine doses would be getting into the hands of 949 providers in 158 Texas counties over the next week, part of the first round of vaccinations for front-line health workers as well as nursing home residents, Texans over 65 and those with certain medical conditions, among others. Some 121,875 doses are earmarked for long-term care facilities such as nursing homes and assisted-living centers.

But with the number of vaccine doses available still falling far short of what’s needed to cover those who are eligible — and with state officials pushing hospitals and other providers to administer vaccine doses that the providers say they don’t have, aren’t sure are coming or have already administered — confusion and frustration have surrounded the initial few weeks of the vaccination rollout.

Providers have 24 hours to report their vaccination statistics to the Department of State Health Services, and the agency updates its numbers each afternoon with data reported by midnight the day before, so the state’s numbers could lag up to two days behind the reality on the ground.

Officials from the White House down to local doctors have warned that it would take months to have vaccine doses available to everyone who wants one.

“The problem is unrealistic expectations based on the reality on the ground,” said Marshall Cothran, CEO of the Travis County Medical Society, which received 700 doses through a local partnership and had them all scheduled within 48 hours for physicians and staff who are not affiliated with hospitals or other care organizations.

With the new shipments this week, the state has been allotted a total of 1.5 million doses through the first four weeks of distribution, officials said Monday. Providers in 214 of the state’s 254 counties will have received shipments by the end of the week, health officials said.

Some 793,625 doses had been received by providers by midnight Sunday, according to the Texas Department of Health Services.

Of those, 414,211 — just over half of those delivered — had been administered, according to the agency’s dashboard.

Hardesty said the nearly 16,000 doses his facility received are being administered “fast and furiously,” and about 10,000 people have gotten their first dose, with second doses to start in the next week.

“We’re giving them as quickly as we can,” he said.

I don’t doubt that, but let’s be clear that 1.5 million doses is five percent of the state’s population, and that 414K is just a bit more than one percent. Seven hundred doses for Travis County, with 1.3 million people, is a drop in the bucket. If you vaccinated 700 people a day in Travis County, it would take you six years to get everyone. In the end, this won’t take anywhere near that long, but we are talking months, and in the meantime the hospitals are also dealing with an insane surge in new cases. I can’t emphasize enough how much we needed to keep a lid on this, and how badly we failed at that.

Anyway. Here was the Harris County website for vaccine registration, which is still up but doesn’t have any method for signing up for a COVID shot at this time. Dallas County has its own website, while Bexar County had a similar experience as Houston did. It will get better, I’m sure, but the early days are going to be chaotic.

How’s the vaccine rollout going?

Not very quickly.

Top Texas officials again urged health care providers to administer more coronavirus vaccines Tuesday, the same day the state reported that the proportion of Texans whose coronavirus tests come back positive has hit levels not seen since a summer wave of cases that overwhelmed some hospitals.

The state reported Tuesday that 163,700 Texans had been vaccinated with at least one dose of the vaccine. About 1.2 million doses have been allocated to providers across the state through the first three weeks since their arrival, according to the Department of State Health Services.

“A significant portion of vaccines distributed across Texas might be sitting on hospital shelves as opposed to being given to vulnerable Texans,” Gov. Greg Abbott said in a tweet Tuesday evening.

That tweet came after health officials asked providers that received doses of the COVID-19 vaccine to “immediately vaccinate” all eligible Texans, including people 65 and older and those who are at least 16 with a qualifying medical condition. That renewed push echoed a statement Dr. John Hellerstedt, commissioner of the Texas DSHS, sent to providers last week directing them to “administer their entire allotment with all deliberate speed.”

“Dr. Hellerstedt put out that statement today to make it clear to all providers that people over the age of 65 and people with medical conditions that put them at greater risk of severe disease of death from COVID-19 are eligible to receive vaccine now,” said spokesperson Douglas Loveday. “Vaccine supply remains limited but more vaccine will be delivered to providers each week. It will take time to vaccinate everyone in those priority groups.”

To be fair, lots of states are stuck in low gear right now, but even accounting for that, Texas is in the back of the pack. There are distribution problems, and there is confusion over who can get a vaccine and where and how they can get it.

A single state website and hotline, with accurate and updated information about vaccine locations and supplies sure would be nice. What we have here evokes the old proverb that a person with one watch knows what time it is, and a person with two watches is never sure. Maybe when Greg Abbott and Ken Paxton are finished harassing the city of Austin, they can spend a few minutes thinking about that. In the meantime, hospitals are pushing back against the claim that they are the bottleneck.

The state’s largest hospital association is pushing back against a suggestion from Gov. Greg Abbott and the state’s top health official that a large number of coronavirus vaccines could be going unused in Texas hospitals.

The back and forth comes as the state vaccine dashboard shows that just 205,463 Texans had received the first dose of the coronavirus vaccine as of midweek, although 678,925 doses have been shipped around the state.

Abbott and Dr. John Hellerstedt, the commissioner of the Texas Department of State Health Services, sounded the alarm Tuesday, urging health care providers to begin vaccinating people 65 and over and those with underlying health conditions, including pregnant women, if they have concluded the first phase of vaccinations.

But most hospitals in the state are still vaccinating the first group of eligible Texans — hospital staffers working directly with coronavirus patients; long-term care residents and staff; emergency workers; and home health care workers — or have not yet received any shipments of the vaccine, according to Carrie Williams, spokeswoman for the Texas Hospital Association, which represents more than 85% of the state’s acute-care hospitals and health care systems.

“Vaccine is not sitting on hospital shelves,” Williams said, suggesting the state’s immunization reporting system has caused delays in reporting data. “With regard to data, we have no certainty it is accurate at this point in time. The number of doses administered is higher than what’s indicated.”

While the number of vaccines shipped across Texas is accurate, there have been “varying reports of the actual number of vaccines administered,” a spokesman for the Texas Division of Emergency Management said Wednesday.

The agency launched a website Wednesday showing up-to-date numbers of vaccine doses and therapeutics available at health care providers.

Abbott spokeswoman Renae Eze touted the website as a source of “real-time reporting system to show vaccine usage data from health care providers across Texas.”

The site, however, does not show how many COVID-19 vaccine doses have been administered.

[…]

For their part, hospital directors say the call from state leaders to move onto the next tier of vaccinations has caused chaos across the state as hospitals try to manage a vaccine rollout and a growing number of COVID-19 patients, Williams said.

“Hospitals are being flooded with calls from the general public seeking vaccine, which creates further operational challenges,” she said. “And, there are still hospitals that have not received any vaccine for their frontlines.”

The story doesn’t indicate what the URL of this new website is. The TDEM website is here, but all I found on a cursory search was information about testing, not about vaccines. This WFAA story about the bumpy vaccine rollout says that this DSHS page is the state’s main vaccine information center, but it’s mostly about eligibility. The story also reports, as Miya Shay did in her tweet, that DSHS and TDEM have two different maps showing providers who have received vaccine doses, and advise people to reach out to providers with their questions. That is not going to help with the flood of questions hospitals are already getting. Meanwhile, State Rep. Donna Howard tried to answer some questions on Twitter:

You can read the thread, but it largely comes down to lags in reporting, the timing of distribution, and confusion over who is eligible. For a guy who’s emphatically rejected calls for further COVID restrictions because the vaccines will save us all, you’d think Greg Abbott would want to put more effort into getting the vaccine distribution part of it right. Just a thought, but maybe this should be a campaign issue next year. What has been your experience trying to chase down a vaccine, for yourself or for a family member?

UPDATE: Later last night, the Trib published this longer story that covers all of the topics I’ve touched on here and more. At some point, Greg Abbott really needs to feel some heat for this.

A new high in hospitalizations

This is fine.

The Texas Department of State Health Services reported Monday a pandemic high 11,351 hospitalizations from COVID-19.

This surpasses the previous all-time high of 10,893, which occurred on July 22.

The record comes in the midst of a holiday season public health experts worry could exacerbate the already rapidly spreading virus and following an increase in cases weeks after Thanksgiving.

This hospital data does not account for people who are hospitalized but have not gotten a positive test, and DSHS says some hospitals may be missing from the daily counts. As of Monday, the state is also reporting 49 deaths from COVID-19, a lagging indicator of the extent of transmission rates, and more than 12,800 new confirmed COVID-19 cases. Reported cases may have appeared lower the last few days because some local health departments did not report data to the state over the holiday week.

Earlier this month, Texas’ ICU capacity was already the lowest since the start of the pandemic, leaving health care experts worried hospitals could be pushed to the brink as coronavirus cases continue to climb. Across the state, COVID-19 patients occupy 17.8% of the state’s hospital beds, and only 745 staffed ICU beds are still available.

At a press conference Monday, Mark Escott, Austin’s interim medical director and health authority, said that this week alone, “ICU utilization” is up 62% in Travis County and that hospital beds could become scarce in a matter of weeks.

“Our projections forward into the new year continue to look worse and worse day after day,” Escott said. “I think right now it appears we’re going to enter 2021 in a state of emergency.”

This is fine:

This is fine:

Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine, said he anticipated a major fall surge amid a wave of new infections in West Texas and the Panhandle.

Those areas are among the hardest hit in the country, he said.

“Up in Midland and places like that, it’s still a really tough area,” he said, adding, “In terms of surges, I’m maybe a little less worried about the Texas Medical Center. But in other parts of the state, it’s going to be a real concern.”

There are 745 ICU beds available across the state, according to data from the Department of State Health Services, the lowest number available since the pandemic’s surge during the summer. Among 63,679 staffed hospital beds, 13,416 are available statewide.

Further, 15 of the state’s Trauma Service Areas are reporting that more than 15 percent of their total hospital capacity is taken up by COVID-19 patients, crossing the threshold for what the state considers “high hospitalizations.”

At the Texas Medical Center, the weekly average of new COVID patients has more than doubled since early November, from 104 to 248. Medical center data from Sunday shows 1,594 total COVID patients and another 404 in the ICU. There are 1,298 total occupied ICU beds with hundreds more available, the data shows.

“The medical center has gotten a lot of heft, in terms of being able to accommodate COVID patients,” Hotez said.

[…]

The sporadic use of masks has contributed to the surge, said Hotez, adding that he doesn’t anticipate the number of statewide hospitalizations decreasing anytime soon. He noted that the number of beds is less of a concern than the number of trained staff available.

Hotez said he did not know how much Christmas gatherings would impact the number of infections. But he warned people that New Year’s celebrations would be the “best party the COVID virus can hope to have.”

“I would just say any kind of New Year’s celebration is fraught with risk ,” he said. “Because when you have this high level of transmission going on in the state, anytime you bring four or five people together, there’s a good likelihood they’re going to have COVID.”

I’m really scared for what the next few weeks may bring. Wear your mask, practice social distancing, avoid indoor gatherings, and try to survive until you can get vaccinated.

Next in line for the vaccine

Attention will shift to more vulnerable populations.

Texans who are 65 years old and older, and those who are at least 16 with certain chronic medical conditions will be next in line for the COVID-19 vaccine, the Texas Department of State Health Services announced Monday.

“The focus on people who are age 65 and older or who have comorbidities will protect the most vulnerable populations,” said Imelda Garcia, chair of the state Expert Vaccine Allocation Panel and DSHS associate commissioner for laboratory and infectious diseases. “This approach ensures that Texans at the most severe risk from COVID-19 can be protected across races and ethnicities and regardless of where they work.”

The vaccine, which arrived in Texas on Dec. 14, has been available so far only to front-line health care workers and residents of long-term care facilities. There are nearly 1.9 million Texans in that group, so it will likely take a few weeks before the state transitions to the next phase, state health officials said.

The state expects to receive 1.4 million vaccine doses by the end of the month. Eligible facilities under the current phase include hospitals, pharmacies, nursing homes and Texas Department of Criminal Justices facilities.

The city of Houston will also receive 6,000 doses that are ticketed for firefighters and health care workers, so that’s good. A list of comorbidities that would get you onto the eligible list for the vaccine is in the article, so click over and check it out if you think this may apply to you or someone you know. But do keep in mind that bit about it taking a few weeks to transition into that next phase, because it will take awhile to get through the first phase. We need to continue to practice prevention so as not to sicken and kill many more people needlessly.

Indeed, for those of us in Houston, the next few weeks are looking rough.

The spread of COVID-19, steadily increasing in Houston and Texas since the beginning of November, is expected to accelerate in coming weeks, according to the latest modeling, a trajectory that could make the city and state one of the nation’s next hot spots.

The models project COVID-19 numbers — cases, hospitalizations, deaths — to continue rising in Houston and many other parts of Texas before likely peaking sometime in January. Parts of the state at crisis levels the past month have peaked.

“There’s a lot of concern about the Houston area as we enter the Christmas season,” said David Rubin, a pediatrician and director of The Children’s Hospital of Philadelphia’s PolicyLab, which produces one of the models. “If I were to say what areas in the country still have the potential to surge, the Houston area definitely would be one of them.”

Rubin and others urged everyone to hunker down over the coming holiday period in an attempt to limit the damage from the coronavirus’ seeming last onslought before gradually deployed vaccines can begin to shut down the pandemic. He noted widespread deployment won’t be in time to affect Houston’s winter peak.

[…]

“What’s concerning is that so many regions of Texas look to be hit about the same time,” said Spencer Fox, associate director of the UT COVID-19 Modeling Consortium. “It’s a sad trend at a time when the vaccines are almost within reach.”

The Houston-area trends are worrisome in two of the models. Fox’s group projects 2,121 COVID-19 hospitalizations in the area on Jan. 15, for instance, an increase of 36 percent over the 1,561 such admissions for Dec. 17.

In addition, the CHOP PolicyLab modeling shows the number of Harris County COVID-19 cases should nearly double by the end of the first week of January. The model projects 2,919 cases on Jan. 7, up from 1,478 on Dec. 14.

A third forecast, by the University of Washington’s Institute for Health Metrics and Evaluation (IHME), projects the number of deaths in Texas will peak Jan. 5 at 292. The model, the only one of the three that projects more than a few weeks out, says daily deaths would total 280 on that date assuming universal mask wearing but reach 345 by late January if mandates are eased.

Thanks partly to the vaccines, the IHME model projects the number of daily Texas deaths will decrease dramatically after the Jan. 5 peak — 138 on Feb. 1, 55 on March 1 and 17 on April 1. The vaccine’s most immediate effect is expected to be more of reducing severe illness and deaths than cases.

The IHME model does not project past April.

In all, 28,134 COVID-19 Texas deaths are expected as of Dec. 31, according to the IHME model. All but 2,700 of those came after June 30.

“That’s a devastating loss of lives in just a six-month period,” said Dr. Peter Hotez, a Baylor College of Medicine infectious disease specialist and vaccine scientist. “Has Texas ever lost so many lives in such a short time?”

The CHOP PolicyLab foresaw the June/July spike, though they were more alarmist than the situation turned out to be. But between the holidays and the colder weather that makes outdoor dining less feasible, the conditions are certainly there for an uptick. We all know what to do about this, it’s just on us to actually do it.

We still need more than the vaccines

The vaccines are great, don’t get me wrong, and they couldn’t have come at a better time, but they’re going to take awhile to be administered, and in the meantime a whole lot of people are still getting sick and dying.

Gov. Greg Abbott on Thursday applauded the arrival of the new coronavirus vaccine, calling it a “monumental medical miracle” as he sought to boost morale amid some of the pandemic’s toughest days.

Speaking outside a UPS distribution center in Austin, the governor painted an especially rosy picture of the weeks ahead, promising a swift vaccine rollout even as national supplies are limited and the state is reporting high numbers of new daily infections. Hospitals in some cities across Texas have been overrun with COVID-19 patients.

The vaccine, which began rolling out on Monday, “is on a daily basis saving lives and beginning to restore normalcy in our community,” Abbott said.

About 90,000 doses have been distributed in Texas already, and another 150,000 were being shipped out on Thursday. The first batch is intended for health care workers treating COVID-19 patients.

State health officials are still determining whom to prioritize from there, including teachers, public safety employees and prisoners. The governor himself has yet to be inoculated but said he plans to at “the appropriate time.”

Texas expects to receive 1.4 million doses by the end of the year, not quite enough to treat all of the 1.6 million health care workers who would be eligible.

[…]

State and national health experts have cautioned that it will be well into 2021 before vaccines become widely available and that infections will continue to spread as long as some resist safety measures such as physically distancing and masking in public.

“It’ll still be weeks, perhaps months, before it is absolutely available to anyone who chooses to have it,” said John Hellerstedt, commissioner of the Texas Department of State Health Services. “In the meantime we need to continue the kinds of things that have gotten us this successful so far.”

Abbott has so far refused to tighten the state’s mask mandate or impose other new restrictions, even as county officials have asked for them as they battle new waves of infections. On Monday the state reported nearly 18,000 new confirmed and probable cases, as well as 252 deaths. More than 24,000 Texans have died from COVID since March.

For a very sobering look at where we’re headed, read this:

What is the one thing that could mitigate this? Another lockdown, with a mask mandate alongside it. What is the one thing that could mitigate the devastating economic effect of another lockdown? A truly adequate COVID stimulus package from Congress. What are the two things Greg Abbott is never going to do? You get the picture.

There’s also this.

The start of COVID-19 vaccinations for health care workers has sparked hope that the end of the pandemic crisis is within sight, but when it comes to vaccine distribution, this is still the easy part. Local and state health agencies say they will struggle to get hundreds of millions of doses of the vaccines to the general public without a huge amount of additional funding. Even if Congress does manage to pass a compromise relief bill, the amount it provides may not be enough.

The fates of the vaccine and the relief bill, both months in the making, are linked. The $900 billion proposal that Democrats and Republicans on Capitol Hill continue to debate has a number of provisions to mitigate the COVID economic crisis, including additional unemployment benefits and small business support. The latest available version also contains $6 billion in vaccine distribution funding for state and local health departments. But groups that represent state and local health departments say that this funding, while crucial, won’t be sufficient to distribute the vaccine on a massive scale as efficiently and widely as possible.

“We see the $6 billion that’s on the table as an important down payment to scale up staffing, develop and enact communications plans to address vaccine hesitant populations, and enroll more vaccinators,” Jasmine Berry, the communications director at the Association for Immunization Managers, says in an email. “There’s still going to be a need for additional funding for state and local health agencies.”

What’s more, the already months-long delay in getting this funding to state and local health departments may create problems down the line, as the country’s vaccination campaigns expand beyond health care workers and nursing homes.

“Where we’ll really start to see potential delays, or where we are not as successful as we could have been, may be as we move through the phases to the next group, where there’s a much larger population that would need to be served,” says Adriane Casalotti, the chief of government and public affairs at the National Association of County and City Health Officials, which represents local health departments.

How much of the vaccination tab are Greg Abbott and the Legislature willing to pick up if Mitch McConnell continues to block any COVID relief bills from passing? A miracle’s no good if you can’t access it.

Abbott is right that the vaccines will save lives and restore normality to our lives. But only if we live long enough to get vaccinated, and only if the funding is there to make sure everyone can get vaccinated. These things aren’t going to happen by themselves.

The regional COVID situation

Not great, Bob.

COVID-19 is surging across southeast Texas, especially in the suburban counties outside of Houston, which have seen a steady increase in the number of new cases, data show. Galveston, Chambers, Brazoria, Liberty, and Montgomery counties have all had higher COVID-19 cases per capita than at any point during the pandemic. Chambers County leads the region with 463 virus cases per 10,000 residents, followed by Galveston County with 433 cases per capita, according to data compiled by the Houston Chronicle.

Experts say the latest spike is driven by a combination of factors — public fatigue from basic COVID-19 restrictions such as mask wearing and social distancing, but also more family gatherings in households and larger groups in bars and restaurants. While case counts are consistently much higher than they were in previous weeks and months, they have yet to equal the peak seen during the summer.

Yet the virus’s resurgence in places like Galveston County has put business owners like Railean on edge, owing to an executive order from Gov. Greg Abbott that could trigger new restrictions — including the complete closure of some bars — if regional virus hospitalizations exceed 15 percent of hospitals’ total bed capacity for seven consecutive days. At a time when thousands of restaurants — as many as 10,000 across the state, per the Texas Restaurant Association — have closed due to the COVID-19 pandemic, further closures could be catastrophic for the industry.

“It would be absolutely devastating to lose this holiday season, devastating to our businesses,” said Gina Spagnola, president of the Galveston Chamber of Commerce.

The Texas Department of State Health Services divides each of the state’s 254 counties into 22 “trauma service areas” which coordinate systems of emergency healthcare and preparedness for their respective regions. Galveston, Chambers, Brazoria, and Liberty Counties are part of a nine-county region trauma service area where COVID-19 hospitalizations have spiked significantly since early November. On Saturday, the region’s rate of hospital beds in use by covid-infected patients eclipsed the 15 percent mark for the first time before dipping back down to 13 percent by Tuesday.

After seven consecutive days above that 15 percent mark, per Abbott’s executive order, the state health agency would notify county judges in all nine counties of the following restrictions: hospitals must suspend elective surgeries; businesses including restaurants, retail stores, offices gyms, and museums would be limited to 50 percent capacity; and bars and other establishments with more than 51 percent alcohol sales must close.

I wish the Chron had included the comparable number for Harris County. I tried computing it myself based on the Chron’s coronavirus page and 2019 Census numbers I found on Wikipedia, but I got higher totals for Chambers and Galveston than what the story gives. The Harris County number I calculate by the same method was lower than those two, but I don’t know how to adjust them, so we’ll leave it at that. I could still probably make a moral comparison between Harris’s more strenuous effort to combat the virus and the more lax attitude of some neighbors, but I don’t know what that would accomplish at this point. The bulk of the blame for all this remains with Donald Trump, Greg Abbott, and the Senate for not passing further COVID relief, which among other things might have helped all these businesses to survive without being open. We can’t wind the clock back and make Trump take COVID seriously, but we could still do the stimulus. Greg Abbott could still tell our Senators to demand that the Senate pass something that would help our state and our businesses. I’m going to keep saying that, every time. On so many levels, it didn’t have to be like this.

The vaccine distribution challenge

Having a vaccine for COVID-19 is wonderful. Being able to make it available to everyone who needs it is a big challenge.

With cases spiking to over 10 million, the virus is everywhere, and spreading deeply into every corner of the country. This is where the Biden administration will face its biggest challenge, especially as it pertains to rolling out a potential vaccine.

My home state of Texas is a great example. A 2016 report from the Texas Department of State Health Services illustrates the terrible state of rural health care. According to DSHS, 235 of Texas’ 254 counties were medically underserved. There were many isolated counties with little to no access to health care. Some even lacked a single doctor.

This has been a crisis a long time in the making. As the Texas Observer recently noted, in 2019, Texas budgeted $17.7 million for infectious disease surveillance, prevention, and epidemiology—and over $400 million for border security. So even when a vaccine is delivered, it will be going to a state that is understaffed and underfunded.

Lipscomb County, population 3,302 as of 2010, in the northeast corner of the Texas panhandle, doesn’t have a doctor. It is worth noting that Lipscomb County is a 550-mile drive from Austin. Portland, Maine, is a closer drive to Washington, D.C., than those 3,302 isolated souls.

Given this isolation and lack of resources, the vaccines themselves present a logistical challenge alone that borders on the impossible for rural America. The Pfizer vaccine, now the leading contender, will require ultra-cold storage of at least -94 degrees Fahrenheit and two rounds of shots. Another leading vaccine candidate from Moderna also requires cold storage, albeit not to the same extent, according to the company. Typically, hospitals and large clinics have this capability. Small towns lacking even the most basic health clinics do not.

To deploy the Pfizer vaccine or any other one, health planners will have to figure out a way to deliver it to rural areas while maintaining its required temperature long enough to ensure that the population receives both doses. This scene will be repeated all across small-town America. This presents a big risk: An uncoordinated federal roll out of vaccines requiring ultra-cold storage could leave state and local governments competing for resources much like they were competing for PPE earlier in the pandemic.

The Trib expands on this.

How effectively public health officials can prioritize and distribute millions of doses of the new vaccines across a state that covers 270,000 square miles and more than 170 rural counties will determine how quickly Texas turns a corner in a pandemic that is again surging across the state and pushing hospitals to the brink in West Texas and the Panhandle.

The task is made more difficult because the Texas Department of State Health Services, which is largely responsible for the distribution effort, won’t know which vaccines it’s receiving, and how many doses, until one or more is approved by the U.S. Food and Drug Administration.

They will also have to combat misinformation and persuade vaccine skeptics — and those unnerved by the coronavirus vaccines’ historically swift development — of the benefits of being inoculated. World Health Organization experts have said that up to a 70% vaccine coverage rate for COVID-19 may be needed to reach population immunity through vaccination. In the 2019-20 flu season, only about 37% of adults younger than 65 received a flu vaccine. The rate was about 65% for seniors.

“We haven’t seen any efforts that are this broad since probably a polio vaccination in the 1950s,” said Dr. Mark McClellan, a former head of the FDA who has advised Abbott about the pandemic.

“The people who are most likely to benefit from vaccination are people who may have difficulty connecting to health care,” such as elderly people and residents of low-income communities who often lack health insurance, he added — compounding the logistical challenges.

The vaccine is expected to initially be in short supply, and will be first distributed to a state-selected group of people considered to be essential workers or most vulnerable to being severely sickened.

[…]

It’s still unclear, beyond a list of murky priority groups such as health care workers, who will get the vaccine during the initial months when supplies are scarce. In the coming weeks, a state panel of experts is expected to publish more specific recommendations about who will be eligible for a vaccine and when.

Early estimates from the Texas Department of State Health Services found there are more than 5 million people who are vulnerable or work in front-line jobs that increase their exposure risk. That includes more than 3.9 million people who are 65 or older, more than 638,000 health care personnel, more than 327,000 acute care hospital employees, more than 137,000 nursing home residents and more than 66,000 emergency medical workers.

The state’s adult population also includes more than 9.4 million Texans with underlying medical conditions that could increase their risk for severe illness associated with COVID-19.

So yeah, it’s a big problem, and there are many questions that need to be answered, some of which will spark heated debate. In the meantime, as both stories noted, the pandemic rages on, meaning we could be trying to vaccinate people while we’re still in conditions that still demand social distancing and will put everyone involved in the process at risk. So you know, maybe we should try a little harder to contain the spread right now. Just a thought.

UPDATE: From the Trib:

Health care workers will be the first people in Texas to receive a COVID-19 vaccine once one receives emergency approval from the U.S. government, and on Monday a state panel of vaccine experts and politicians revealed which workers in the health field will receive top priority.

The “first tier” recipients, according to the panel’s new guidelines, include:

  • Hospital-based nurses, doctors, custodians and other workers who have direct contact with patients
  • Staff of nursing homes or other long-term care facilities who work directly with residents
  • Emergency medical services providers such as paramedics and ambulance drivers
  • Home health aides who manage “vulnerable and high-risk” patients

Certainly reasonable. We’ll see how it goes after that.