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The COVID Tracking Project

Here, have a COVID update

Things are going great.

Texas set yet another record for coronavirus deaths Thursday with 154 — the third day in a row above 100.

The previous record was July 8 when 112 deaths were logged, according to a data analysis by Hearst Newspapers that shows the state reported 105 deaths on Wednesday and 104 on Tuesday.

The streak in deaths comes two weeks after Republican Gov. Greg Abbott ordered most of the state’s 30 million residents to wear masks. Despite pressure from local authorities that he give back their ability to mandate stay-at-home orders, Abbott has insisted increased mask-wearing is the key.

Abbott told Houston’s Fox 26 on Thursday that “the last step that would ever be taken is to lock Texans back down” and said other measures would be taken before resorting to that.

“It seems like I get this question a thousand times a day, and there seem to be rumors out there about a looming shutdown,” Abbott said in the interview. “Let me tell you: There is no shutdown coming.”

It will take about three weeks, Abbott said, to see the effects of his mask mandate and his closure of bars in late June. Abbott claimed cases were flattening out in Harris County, though Hearst Newspapers’ analysis shows the county’s rolling average for new cases is more than three times higher than a month ago.

[…]

A new report from Kinsa, a company that uses internet-connected thermometers to predict the spread of diseases, showed that Texas’ rate of illness is spreading faster than those of other states. The company in the past few years has successfully anticipated outbreaks of the flu weeks ahead of the federal government.

The Kinsa data, which tracks whether an uncontrolled outbreak is likely using fever trends and other information, showed that the state is hitting above the threshold for the entirety of the past 30 days.

“This level of sustained, rampant disease transmission suggests that there is likely a lot more illness in the community than what has been reflected in the case numbers to date,” the company said in a press release Thursday. “In other words, there is no relief in store for Texas over the next few weeks, and we fear that the situation there may get much worse in the near-term.”

No, seriously, it’s just terrific.

A coronavirus patient in Anahuac was flown by helicopter to a hospital in El Campo — 120 miles away — because closer facilities could not take him.

Ambulances are waiting up to 10 hours to deliver patients to packed Hidalgo County emergency rooms.

And short-staffed hospitals in Midland and Odessa have had to turn away ailing COVID-19 patients from rural West Texas facilities that can’t offer the care they need.

As the tally of coronavirus infections climbs higher each day, Texas hospitals are taking extraordinary steps to make space for a surge of patients. Some facilities in South Texas say they are dangerously close to filling up, while hospitals elsewhere are taking precautionary measures to keep their numbers manageable.

Doctors warn of shortages of an antiviral drug that shows promise for treating COVID-19 patients. And epidemiologists say the state’s hospitals may be in for a longer, harder ride than places like New York, where hospitals were stretched to capacity in the spring and some parked refrigerated trailers outside to store bodies of people who died from COVID-19.

“It used to [be that] if one hospital got kind of overwhelmed … you would start transferring out ICU patients to other facilities that had ICU beds available,” said Dr. Robert Hancock, president of the Texas College of Emergency Physicians. “And there really is none of that now, because everybody’s in the same boat and they’re struggling to get their own patients admitted.”

You might say we’re red hot.

A document prepared for the White House Coronavirus Task Force but not publicized suggests more than a dozen states should revert to more stringent protective measures, limiting social gatherings to 10 people or fewer, closing bars and gyms and asking residents to wear masks at all times.

The document, dated July 14 and obtained by the Center for Public Integrity, says 18 states are in the “red zone” for COVID-19 cases, meaning they had more than 100 new cases per 100,000 population last week. Eleven states are in the “red zone” for test positivity, meaning more than 10 percent of diagnostic test results came back positive.

It includes county-level data and reflects the insistence of the Trump administration that states and counties should take the lead in responding to the coronavirus. The document has been shared within the federal government but does not appear to be posted publicly.

Dr. Ashish Jha, director of the Harvard Global Health Institute, said he thought the information and recommendations were mostly good.

“The fact that it’s not public makes no sense to me,” Jha said Thursday. “Why are we hiding this information from the American people? This should be published and updated every day.”

[…]

The 18 states that are included in the red zone for cases in the document are: Alabama, Arkansas, Arizona, California, Florida, Georgia, Idaho, Iowa, Kansas, Louisiana, Mississippi, North Carolina, Nevada, Oklahoma, South Carolina, Tennessee, Texas and Utah.

The 11 states that are in the red zone for test positivity are Alabama, Arizona, Florida, Georgia, Idaho, Louisiana, Mississippi, Nevada, South Carolina, Texas and Washington.

In May, the World Health Organization recommended that governments make sure test positivity rates were at 5 percent or lower for 14 days before reopening. A COVID-19 tracker from Johns Hopkins University shows that 33 states were above that recommended positivity as of July 16.

“If the test positivity rate is above 10 percent, that means we’re not doing a good job mitigating the outbreak,” said Jessica Malaty Rivera, science communication lead at the COVID Tracking Project, a volunteer organization launched by journalists from The Atlantic. “Ideally we want the test positivity rate to be below 3 percent, because that shows that we’re suppressing COVID-19.”

But don’t worry, Greg Abbott is on it.

As the number of new coronavirus cases in Texas continues to rise and hospitals grow more crowded, Gov. Greg Abbott said Thursday there is no statewide shutdown looming.

Abbott said last week that if the spread of the virus didn’t slow, “the next step would have to be a lockdown.” But in a television interview Thursday, he said that there have been rumors of such a move and stressed that they were not true.

“Let me tell you, there is no shutdown coming,” he told KRIV-TV in Houston.

Abbott pointed to measures he’s taken in recent weeks, including a statewide mask mandate and an order shutting down bars, to slow the spread of the virus. It will take a few weeks to see a reversal in coronavirus case surges, he said.

He has repeatedly stressed this week that, if people wear masks, he’ll be able to avoid shutting down the state. On Wednesday, he told KPRC-TV in Houston that it seems like people ask him about a shutdown “like a thousand times a day.”

“People are panicking, thinking I’m about to shut down Texas again,” he said. “The answer is no. That is not the goal. I’ve been abundantly clear.”

To also be abundantly clear, Abbott is correct that it will take a bit of time for the mask order and other interventions to work, just as there was a lag between the increasing case rate and subsequent increases in hospitalizations and deaths (not that we responded in time for them, but never mind that right now). He is also correct that universal face mask wearing would be a big help, though it may not be enough at this point, and he’s fighting headwinds from Donald Trump and his fellow Republicans on that score. And if we really want to be clear, we need to remember that Abbott mostly speaks in riddles these days, so we turn to an expert in the field for true clarity:

Yes, that’s the kind of straight talk you get from Greg Abbott.

Lawmakers quickly discovered something remarkable. It was possible to stare the man in the eyes, to speak with him for a half-hour or more, and walk away with no better idea of where he stood on important legislative matters. He seemed unwilling to speak forthrightly about nearly anything, drawing a veil around his positions, lest he alienate some key legislator or interest group.

When Abbott did make himself clear, it was to issue marching orders to those who had no reason to follow them, or to punish those who had defied him. “There was no comparison to Perry. [Abbott’s] concept of governing is ordering people around,” Republican state representative Sarah Davis told me in 2018. “He came into the regular session and kind of chided us, and then was absent for the rest of the session.”

And his public statements often contradicted his private ones. Publicly, Abbott endorsed the infamous anti-transgender “bathroom bill” in the 2017 session and pretended to advocate for its passage. But in private he reassured business groups—who worried the state would be boycotted by lucrative conventions and sports tournaments—that the bill would never pass. He was publicly accused of that duplicity by Republican state representative Byron Cook in 2018. The governor’s office has never addressed it.

[…]

Fast forward a few years, through 130,000 American deaths from the coronavirus, at least 3,500 of them from Texas so far, and the onset of the worst economic circumstances since the Great Depression. Now Abbott’s governing style is under strain. Arguably, the root cause of the current crisis is his tendency to talk a lot without saying much and his propensity to take the path of least resistance regardless of the circumstances, especially when confronted by the inchoate demands of the Republican party’s right wing. This modus operandi is on display every time Abbott gets in front of a television camera. But as we see more and more of it, the artifice is becoming more clear. Abbott’s disapproval numbers have been rising just a bit, even as other governors have seen a surge of popularity during the crisis.

Here, we could talk about Abbott’s quadruple-backflip on mask mandates; the time he issued a statewide lockdown disguised under a bureaucratic name while insisting it wasn’t one, before clarifying that it was the next day; the Shelley Luther saga, which saw him ordain that violators of his shutdown order should be punished with fines and jail time only to blame local officials for enforcing it, before retroactively nullifying what he had expressly commanded; or the way he opened the state for business before fixing the problems the lockdown was designed to address.

But instead, let’s consider a small but important test Abbott recently faced, one that seems instructive. Abbott’s party had long been planning to hold its state convention in Houston, one of the nation’s biggest coronavirus hot spots, which would have brought some six thousand attendees, many of them older and especially vulnerable to the virus, from all around the state for a crowded three-day fete. An in-person convention was a virtual guarantee that some delegates and service workers would get infected and possibly die, and that Houston’s seemingly potent strain of the virus would be spread around the state.

It was an incredibly bad idea that Abbott’s party nonetheless seemed hell-bent on pursuing. What did the governor have to say about it? Would he speak up, in an attempt to save the lives of his own party’s activists? “You’re the top Republican in the state, governor,” said an anchor for KDFW in Dallas on July 6, after Houston mayor Sylvester Turner begged the party to call off the gathering, then canceled it two days later. “What do you think should happen?”

The governor’s answer: “I know that the executive committee for the Republican Party of Texas have been talking about this. I think they continue to talk about it, and they weigh all of the consequences and the public health and measures … They’ll make a decision.”

The anchor persisted: “You don’t want to weigh in on what you think should happen?”

The governor paused and then gave his answer: “Obviously I think whatever happens—whether it be, listen, this convention or any action that anybody takes—we’re at a time with the outbreak of the coronavirus where public safety needs to be a paramount concern, and make sure that whoever does anything and whatever they do, they need to do to reduce the spread of the coronavirus.”

Huh?

A day later, an anchor for KENS in San Antonio tried a different tack: “Will you be attending in person?” Abbott dissembled, so the anchor tried again. “Yeah, listen, as for myself, as well as for everybody else,” Abbott said, “we will continue to see what the standards are that will be issued by the State Republican Executive Committee, by the state Republican Party to determine what the possibility will be for being able to attend.” To determine what the possibility will be for being able to attend.

Not only could Abbott not say whether he thought the convention was a good idea, he couldn’t even say whether he would be there. The interview went out during the KENS five o’clock broadcast. Not half an hour later, during a meeting of the SREC, the party’s executive director announced that elected officials would be pre-recording messages instead of giving in-person speeches. Abbott surely knew this important fact when he was on the air.

I hope this clears everything up.

That’s not how you test

Oops.

Texas health officials made a key change Thursday to how they report data about the coronavirus, distinguishing antibody tests from standard viral tests and prompting slight increases in the state’s oft-cited daily statistic known as the positivity rate.

The positivity rate is the ratio of the confirmed cases to total tests, presented by the state as a seven-day rolling average. The Texas Department State of Health Services disclosed for the first time Thursday that as of a day earlier, it had counted 49,313 antibody tests as as part of its “total tests” tally. That represents 6.4% of the 770,241 total tests that the state had reported through Wednesday.

Health experts have warned against conflating the tests because they are distinctly different. Antibody tests detect whether someone was previously infected, while standard viral tests determine whether someone currently has the virus.

Now that DSHS is reporting the number of antibody tests, it has recalculated its daily positivity rates starting Tuesday to exclude such tests. That led to a 0.41 percentage-point increase in Tuesday’s rate and a 0.55 point increase in Wednesday’s rate, according to DSHS calculations.

DSHS acknowledged last week that it was reporting an unknown quantity of antibody tests as part of the “total tests” figure. Despite that, Gov. Greg Abbott incorrectly claimed Monday that the state was not “commingling” the numbers while promising the state would soon break out the antibody test count.

[…]

When public health agencies combine antibody testing figures with viral testing figures, “I want to scream,” said Seema Yasmin, an epidemiologist and director of the Stanford Health Communications Initiative.

Viral tests, usually taken from nasal swabs, can detect an active coronavirus infection. If a person’s biological sample is found to have traces of the virus’s genetic material, public health workers can order them to self-isolate and track down any of their contacts who may have been exposed.

Antibody tests “are like looking in the rearview mirror,” Yasmin said, because they may show if a person has recovered from a coronavirus infection. That can be useful for public health surveillance, but it does not offer much insight about where the virus is currently spreading. Another issue is that many antibody tests have been shown to have high rates of inaccuracy, she said.

“As an epidemiologist, this level of messiness in the data makes your job so much more difficult, and it misleads the public about what’s really happening,” Yasmin said. “We’ve been talking about the capacity for testing increasing over the last few weeks, but now we might have to tell the public that might not be true.”

And dumping antibody testing data into the pool of viral testing data brings the overall positivity rate down, reflecting “a deceptive misuse of the data,” analysts for the COVID Tracking Project wrote last week. That’s because the numbers may make it seem like the state has grown its testing capacity even if a state’s viral testing capacity remains flat.

“This is crucial as we need increased capacity for viral testing before reopening to identify active infections even in the pre-symptomatic or asymptomatic stages,” the analysts wrote.

To be fair, Texas is not the only state to have done this. Florida and Georgia have been accused of manipulating their data in other ways as well. The bottom line here is that we’ll never get our arms around this pandemic if we don’t have good data. The data is messy enough as it is, we surely don’t need to be making it worse.

We still have no idea how many people have been infected

There’s just a real lack of testing being done.

Six times in three weeks, Marci Rosenberg and her ailing husband and teenage children tried to get tested for the new coronavirus — only to be turned away each time, either for not meeting narrow testing criteria or because there simply were not enough tests available.

All the while, the Bellaire family of four grew sicker as their fevers spiked and their coughs worsened. They said they fell one by one into an exhaustion unlike any they had felt before.

By March 18, Rosenberg was desperate and pleaded with her doctor for a test. Dr. Lisa Ehrlich, an internal medicine physician, told Rosenberg to pull into her office driveway. But Ehrlich warned Rosenberg, “I can only test one of you.” She swabbed her throat through an open car window. The result came back the next day: positive.

The rest of her family was presumed to be positive but untested – and thus excluded from any official tally of the disease.

As the number of confirmed cases of the potentially deadly virus continues to explode across the Houston region – tripling from 1,000 to more than 3,000 in just the past week – there is mounting evidence that the true scope of the disease here could be far worse than the numbers indicate.

A Houston Chronicle analysis of testing data collected through Wednesday shows that Texas has the second-worst rate of testing per capita in the nation, with only 332 tests conducted for every 100,000 people. Only Kansas ranks lower, at 327 per 100,000 people.

In cities across Texas — from Houston to Dallas, San Antonio to Nacogdoches — testing continues to be fraught with missteps, delays and shortages, resulting in what many predict will ultimately be a significant undercount. Not fully knowing who has or had the disease both skews public health data and also hampers treatment and prevention strategies, potentially leading to a higher death count, health care experts say.

[…]

As the pandemic’s march quickened, Texas was slow to ramp up testing.

The first confirmed case in Texas, outside those under federal quarantine from a cruise ship, was March 4, striking a Houston area man in his 70s who lived in Fort Bend county and had recently traveled abroad. By month’s end, the Houston area had more than 1,000 confirmed cases. A week later, the number had pushed past 3,000.

Yet it was not until March 30 that the rate of testing per 100,000 people in Texas topped 100. As of Wednesday, the state was testing 327 per 100,000, according to a Chronicle analysis of data from The COVID Tracking Project, which collects information nationwide on testing primarily from state health departments, and supplements with reliable news reports and live press conferences.

Twenty-six states in the U.S. are testing at least double the number of patients per capita as Texas, in some cases six times more. New York, for instance, is testing 1,877 per 100,000 people while neighboring Louisiana is testing 1,622 per 100,000. Even smaller states, such as New Mexico, are testing triple the rate of Texas.

Texas officials defended the state’s response.

“We’ve consistently seen about 10 percent of tests coming back positive, which indicates there is enough testing for public health surveillance,” said Chris Van Deusen, a spokesman for the Department of State Health Services, in an email, “If we saw 40 or 50 percent or more of test coming back positive, we’d be concerned that there could be a large number of cases out there going unreported, but that has not been the case.”

It is unclear if that is a reliable measure. Nearly 41 percent of New York tests were positive, the second-highest rate in the country. In Texas, about 9.4 percent of tests were positive — roughly the same as Washington state, where one of the largest outbreaks of coronavirus has occurred.

Not the first time we’ve talked about this, and it won’t be the last. This also means that the official number of deaths attributed to coronavirus is likely too low. This has been the case globally, especially in the hardest-hit places, where the difference between the normal daily mortality rate and the observed mortality rate during the crisis is a lot bigger than the official count of COVID-19 deaths. The good news is that as yet our hospitals have not been overwhelmed, but we can’t say with confidence that that will continue to be the case.

The number of people hospitalized with COVID-19 in the Houston area is continuing a steady climb, not close to crisis levels but unnerving enough that experts still aren’t sure when the area’s grand experiment in social distancing will start showing up in daily counts.

After a week in which COVID-19 hospitalization numbers more than doubled in Harris County, epidemiologists and infectious disease specialists said it likely will be another week to 10 days before they know if the stay-at-home orders and closures are reducing the rate at which the coronavirus is spreading and keeping health care facilities from being overwhelmed.

“Even though we’ve been social distancing for three weeks, it’s too early to know when we’ll be on the downward slope,” said Catherine Troisi, a professor of epidemiology at UTHealth School of Public Health. “The numbers we’re seeing now reflect people who were exposed to the virus up to four weeks ago.”

Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and Texas Children’s Hospital, said the social distancing has paid off in terms of keeping hospital volumes under control so far but added that the pay-off in terms of ending the pandemic is unclear. He said that “we need to continue stay-at-home orders until the end of the month, then reassess whether to extend them longer.”

Hotez and others said that aggressive social distancing is more important now than ever, given modelers are projecting that the number of COVID-19 cases in the Houston area should peak in the next few weeks. They said people venturing out during the peak period will put themselves at high risk of contracting the virus.

[…]

The study, released on March 24, originally said the virus’ spread in the Houston area would peak April 7 and burn out by mid-May if stay-at-home orders are continued until May 12. It was not clear Tuesday when the study projects the virus will burn out now.

Eric Boerwinkle, the lead researcher, could not be reached for comment Tuesday and UTHealth officials had no update on the study. Boerwinkle, who did not make the original modeling publicly available, has briefed top local government officials on the work.

Another modeling study, conducted by the University of Washington’s Institute for Health Metrics and Evaluation, now projects that the Texas peak use of hospital resources for COVID-19 will be April 19, some two weeks earlier than it previously projected. The study, reportedly relied on by the Trump administration, foresees no bed shortage in the state, including in intensive care.

“That’s why you shouldn’t place too much weight on any one model,” said Dr. James McDeavitt, Baylor’s dean of clinical affairs. “They depend on assumptions plugged in and can show everything from Houston being able to handle the surge to a New York City-like situation.”

McDeavitt noted the wild cards that go into modeling — the number of people admitted to a hospital, the percentage that need intensive care, how long it takes to get patients off ventilators, how long they need to recover in a regular bed once they move out of intensive care. Those are the assumptions that drive models, he noted.

McDeavitt said he doesn’t think the number of cases will come down in the Houston area until the end of the month.

That story was from earlier in the week, so all of the numbers are a bit out of date by now. But the bottom line remains that we don’t know where we are on the curve because we don’t really know how many people are or have been sick. Models all rely on data, and we’re also not good with the data.

The information Texans are working with is too damn thin.

Where to start? Not enough tests have been completed, or taken, to really know who has or doesn’t have the disease, where the Texas hotspots are, or whether people who have died of respiratory problems had COVID-19. The relatively small number of test results also means we don’t know which people had the disease and recovered (and how many people have recovered) and whether the projections being made with that skimpy data are accurate enough to guide our public health decisions.

It’s not enough to say that the testing is getting better, that we know more than we knew just a few days ago. What we still don’t know overshadows what we do know.

We’re like pilots flying in clouds without instruments. We know a little bit, but not enough to make really solid decisions or to figure out what’s next. We’re learning as we go. As of Thursday, Texas was reporting 10,230 cases and 199 deaths, 1,439 hospitalized COVID-19 patients and 106,134 tests conducted.

Given the level of testing right now, it’s hard to know how many cases Texas really has. Because the best way to get tested for the new coronavirus is to show symptoms that a medical professional finds troublesome, it’s probably safe to say we’re not testing many people who are carrying the virus but don’t have symptoms.

It’s easier — because it’s more obvious — to map the institutional cases. When someone in a nursing home or a state supported living center or a prison tests positive, testing everyone in that location is simple and smart. It’s simple to figure out that everyone in a given building or campus might have been exposed.

Even that data isn’t always available. The state of Texas initially wasn’t sharing details about the data it has collected from nursing homes where COVID-19 cases have been found. But a few days after The Texas Tribune’s Edgar Walters and Carla Astudillo wrote about it, the state revealed 13% of nursing homes have at least one confirmed case.

We’re doing a lot of flying blind. If we want to make good decisions about things like when and how to restart the economy, we need a much better understanding of where we are, and where that means we’re likely to be going.