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The new county COVID risk assessment system

We’ll see how it works.

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

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

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

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

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

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

[…]

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

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

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

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

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

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

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

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

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

Ken Paxton keeps trying to kill the SAISD vaccine mandate

On brand, always on brand.

Texas Attorney General Ken Paxton has filed another petition seeking to reverse a Bexar County judge’s decision that rejected the state’s bid for a temporary injunction to block the San Antonio Independent School District’s staff vaccine mandate.

Even though SAISD’S vaccine mandate remains on pause despite the court’s ruling in its favor, Paxton said he will “continue fighting for medical freedom.”

“Nobody should be bullied, coerced, and certainly not fired because of their COVID-19 vaccination status,” said Paxon in his announcement, adding the decision is not only an affront to individual liberty, but “illegal under Texas law.”

“The governor’s executive order specifically protects workers from the type of mass firings that San Antonio ISD is seeking, and I will continue to fight in court to defend GA-39 and Texans’ medical freedom,” he said.

The petition was filed Sept. 7 with the Texas Supreme Court.

An SAISD spokeswoman said in a statement that the vaccine mandate remains suspended and that no employee was ever disciplined for refusing to get the vaccine.

See here and here for the previous updates. There’s a recitation of the long history of this legal saga in the story if you want that. I remind you that this mandate was never enforced and remains on pause, not that these things matter to Ken Paxton. The appellate court ruling that Greg Abbott doesn’t have the power he claimed to have when he forbade these mandates seems pretty clear to me, but you never know what SCOTx will do. Now we wait to see if they’ll take this up.

Monkeypox case rate slows

Some good news.

Monkeypox infection rates are slowing in Houston, data shows, with health officials pointing to changing behavior as the key reason for the decline.

The 14-day average of daily new cases dropped by 43 percent, from .23 cases per 100,000 people, to .13, between Aug. 23 and Sept. 2, the last day for which data is available. As of Wednesday, Houston and Harris County had recorded a combined total of 693 cases.

Dr. David Persse, Houston chief medical officer, said he thinks it’s too early to attribute the drop to vaccinations, which became available in Houston in late July. Most people have yet to receive full protection from their second dose, administered about a month after the first dose.

“I believe the change … is largely because of individuals changing behavior and thinking twice about some of the high-risk behaviors,” Persse said during a Thursday Q&A session with reporters.

[…]

More than 5,200 people have received their first dose of the vaccine from the Houston Health Department. Harris County Public Health has administered the first dose to an additional 3,600 people.

Persse and Dr. Erick Brown, Harris County’s local health authority, said there are “plenty” of doses left and encouraged eligible people to schedule appointments by calling Houston’s hotline at 832-393-4220 or Harris County’s hotline at 832-927-0707.

“I’d like to strongly emphasize we are not out of the woods,” Brown said.

Monkeypox was never the public health crisis that COVID was – it’s a lot less contagious, and a lot less deadly – but we also had a vaccine already in place and needed to get it to a much smaller population in order to get the outbreak under control, and we didn’t do as well as we should have. We’re in better shape now, and I have hope we can continue to drive the numbers down. In the meantime, if you’re eligible for this vaccine, please do get it.

Our overall vax level is down

Not great!

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

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

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

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

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

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

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

[…]

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

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

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

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

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

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

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

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

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

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

Your omicron booster will be ready this week

I’ll be getting mine.

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

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

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

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

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

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

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

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

The latest COVID wave may be peaking in Houston

Hopefully

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

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

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

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

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

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

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

[…]

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

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

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

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

[…]

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

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

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

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

SAISD vaccine mandate upheld again

Also still on hold, but the state loses again at the appellate level.

A state appellate court upheld San Antonio Independent School District’s authority Wednesday to mandate its workers get vaccinated against COVID-19, almost a year after the district instituted the requirement for all staff to help stem the spread of the virus.

The 4th Court of Appeals on Wednesday denied Texas Attorney General Ken Paxton’s request to overturn a Bexar County judge’s decision not to grant the state a temporary injunction to block the staff vaccine mandate. Judge Mary Lou Alvarez of the 45th District Court issued that ruling in October, allowing SAISD to continue enforcing the mandate.

The court also ordered that the costs of the appeal be assessed against the state.

Paxton filed a lawsuit against SAISD in September, after first suing the district over the mandate in August because the vaccine had not been approved by the federal Food and Drug Administration. The August lawsuit was dropped after the FDA approved the Pfizer COVID-19 vaccine.

The lawsuit has wound its way through the state court system over the past year. Paxton’s office appealed Alvarez’s ruling to the 4th Court of Appeals and also requested the appellate court temporarily block the mandate while it considered Paxton’s appeal. The attorney general then requested the state Supreme Court step in and halt the mandate, which it did in mid-October.

The Texas Supreme Court’s ruling forced SAISD to stop enforcing the mandate while the 4th Court of Appeals considered the state’s appeal of the temporary injunction that Alvarez denied.

[…]

Paxton’s lawsuit argued that SAISD’s vaccine mandate violated Gov. Greg Abbott’s executive order prohibiting governmental entities from implementing COVID-19 vaccine mandates, which the governor claimed he had the authority to do under the Texas Disaster Act. Attorneys for SAISD challenged that reasoning, contending the Act does not give the governor the power to suspend all state laws.

Wednesday’s ruling by the 4th Court of Appeals determined that the Texas Disaster Act does not give Abbott the authority to suspend parts of the Education Code that allow school districts to issue vaccine mandates.

“The Texas Disaster Act expressly limits the Governor’s commander-in-chief authority to state agencies, state boards, and state commissions having emergency responsibilities,” the ruling states. “The District is not a state agency, a state board, or a state commission. Rather, the Texas Disaster Act defines the District as a ‘local government entity.’”

See here for the previous update. This sounds like a solid ruling, one that SCOTx ought to uphold, though who knows what they’ll actually do. It would also be written on sand to some extent, in that if the Republicans retain full control of government next year they’ll just amend the Texas Disaster Act to make it cover school districts and/or explicitly exclude anything having to do with vaccinations. In the meantime, even though the policy remains on hold during the litigation, it’s surely the case that the mandate got some holdouts vaccinated during the period while it was in effect. That will always be a win, no matter what happens from here.

We need more monkeypox vaccines

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

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

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

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

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

[…]

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

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

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

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

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

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

The current state of the hospitals

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

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

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

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

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

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

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

[…]

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

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

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

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

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

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

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

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

COVID hospitalizations up in Houston

Welp.

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

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

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

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

[…]

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

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

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

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

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

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

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

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

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

We have a long way to go.

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

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

[…]

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

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

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

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

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

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

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

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

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

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

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

Get your kids vaccinated

A good start, but we can do a lot more.

Texas Children’s Hospital has administered COVID-19 vaccines to nearly 6,000 children ages 6 months through 4 years old since the youngest age group became eligible to receive the shots last week, the hospital said Thursday.

“We’ve been waiting for a long time to be able to protect our youngest children,” said Dr. Stan Spinner, the chief medical officer and vice president of Texas Children’s Pediatrics. “We’ve had families asking for a long time ‘When is this vaccine going to be available for our kids?’ And now it is.”

Still, the overall share of children younger than 5 who have received the shot is incredibly low — hovering around 1 percent statewide.

Another 3,000 children are scheduled for vaccine appointments at Texas Children’s Hospital or more than 60 Texas Children’s Pediatrics locations in the Houston, Austin and College Station areas, hospital spokeswoman Natasha Barrett said during a news conference.

Vaccines are also available to kids under 5 at other hospitals, including Children’s Memorial Hermann, as well as pediatrician’s offices, pharmacies and other locations.

Across Texas,the overall interest in vaccines for children has been lagging. Just 26 percent of Texas residents aged 5 to 11 and 59 percent of residents aged 12 to 17 are fully v accinated, according to data from The New York Times. Just 4 percent of Texas residents under 18 years old have received a booster.

However, Texas Children’s doctors said they have also been encouraged by that fact that families with children 5 to 11 years old have been signing up for booster shots of the Pfizer-BioNTech vaccine. The U.S. Food and Drug Administration approved booster shots for that age group last month.

My kids are older and got vaxxed and boosted at their first opportunities. If there’s an omicron-specific booster this fall, they’ll get that, too. I’ve definitely been disappointed by the low vaccination rate among younger kids, but maybe that will turn around now. Even with the lower hospitalization and mortality rates, so many people have gotten an infection lately that perhaps the ongoing threat of this pandemic is sinking in again. We all still need to do our part to try to keep this under some control.

Bexar County raises its COVID threat level

Hopefully not a sign of things to come.

Local health officials raised San Antonio’s COVID-19 risk level to high this week after warning of a “silent surge” just two weeks ago.

That surge continues, according to data from the city’s Metropolitan Health District, which is documenting an increase in new cases and hospitalizations.

As the July Fourth holiday approaches, San Antonio Metropolitan Health District chief Claude Jacob urged folks who will be getting together with friends and family to follow COVID-19 prevention strategies: “mask up in crowded indoor places, get tested if you have been exposed or have symptoms and stay up to date with COVID-19 vaccine and boosters.”

Dr. Bryan Alsip, chief medical officer at University Health, said the curve is starting to rise again, “but it’s not as steep an increase. It doesn’t look like the previous waves, not yet, so I think we have to wait and see how that turns out.”

The actual number of COVID-19 cases are suspected to be much higher than what is officially reported, as most people aren’t reporting positive home tests to any health authority.

Metro Health does not collect at-home test data, a spokeswoman said. Some rapid test kits include a way to report results through a mobile app, she noted, and urged everyone who uses a self-test to report positive results to their healthcare provider.

Alsip echoed Metro Health’s prevention strategies, noting that most people have stopped wearing masks. “Now that we know that the data support this high level [of transmission], while we’re in that higher risk timeframe, it would be a good additional layer of protection.”

He also warned that COVID-19 can now include a constellation of symptoms beyond the fever, cough and shortness of breath that characterized the disease at the beginning of the pandemic.

For the record, Harris County is still at Moderate threat level. Given the viral load in Houston’s wastewater these days, it’s not hard to imagine it going up. They key metric is hospitalizations, and that at least has remained at a sufficiently moderate level. It’s still the case that everyone needs to be vaxxed and boosted – kids under the age of five can now get vaccinated, and it looks like we’re getting an Omicron-specific booster later this year – and masking in indoor public places as well as anytime you may feel ill are still necessary. City and county governments can’t do much beyond exhort you to do the civic-minded thing, and for that matter the feds are pretty limited thanks to a bunch of sociopathic court rulings, so this is where we are. Do your part, if only for yourself, and we can make this be less bad than it otherwise would be.

COVID vaccines for kids under 5 are now available

It’s been a long wait.

On Saturday, the Centers for Disease Control and Prevention Director Dr. Rochelle Walensky signed off on Covid vaccines for the youngest Americans. Her endorsement means shots can begin immediately, finally ending the two-and-a-half year wait on the part of parents of children under 5.

Walenksy accepted the recommendation within hours after the CDC advisory committee voted unanimously in favor of the Pfizer-BioNTech and Moderna vaccines for children as young as 6 months. A Centers for Disease Control and Prevention advisory committee on Saturday endorsed Pfizer-BioNTech and Moderna’s Covid-19 vaccines for the youngest children, the last step before CDC Director Dr. Rochelle Walensky could issue her final sign-off.

The unanimous recommendations from the CDC’s Advisory Committee on Immunization Practices followed the Food and Drug Administration’s authorization of the shots on Friday.

President Biden responded to the announcement Saturday hailing it as a “monumental step forward.”

“For parents all over the country, this is a day of relief and celebration,” Biden said. “As the first country to protect our youngest children with COVID-19 vaccines, my Administration has been planning and preparing for this moment for months, effectively securing doses and offering safe and highly effective mRNA vaccines for all children as young as six months old.”

Shortly before Saturday’s votes — one for Moderna and a separate one for Pfizer — many panel members celebrated the milestone, noting that parents will soon have two effective tools to protect their youngest children from Covid after more than two years of living with the virus.

“We want to say today that if you’re not going to immunize your children, we think that’s a misplaced concern and that you should immunize your children to save their lives,” said committee member Dr. Sarah Long, a pediatrician at St. Christopher’s Hospital for Children in Philadelphia.

While young children are generally less likely than adults to experience the most serious outcomes of the virus, some do. Among children 6 months old through age 4, there have been more than 2 million confirmed cases of Covid, more than 20,000 hospitalizations and more than 200 deaths, according to CDC data. Covid is the fifth most common cause of death in children younger than 5.

“This is an opportunity, which one doesn’t get very often, to participate in preventing the death of young children,” said committee member Dr. Beth Bell, a clinical professor in the department of global health at the University of Washington. “A death of a young child is an incredible tragedy, and we know that this disease is killing children.”

It’s a function of where we are now in this pandemic that this isn’t bigger and more exciting news than it is. The vaccination rate for kids in the 5 to 11 year old range remains disappointingly low, and the estimates I’ve seen suggest that maybe 20% of the under-five crowd will get their shots. We could of course mandate COVID vaccines for enrollment in schools, but, well, I think you know what would happen then. The best way forward, as even a modest number of kids getting their shots will help save lives, is for those of us who have kids in that age range to get them vaccinated, and for the rest of us to help persuade our family and friends who do to do the same. Your Local Epidemiologist, who has two young kids of her own, has some ideas on that front. COVID is still out there killing people, y’all. We should try to remember that.

Fifth Circuit upholds dismissal of Methodist vaccine mandate lawsuit

Good.

A federal appeals court on Monday upheld the dismissal of a lawsuit challenging Houston Methodist’s COVID-19 vaccine mandate, which last year thrust the hospital into the national spotlight as the first healthcare system in the U.S. to require the shots for its employees.

The lawsuit, filed on behalf of 117 Houston Methodist employees who refused to abide by the policy, was dismissed in June 2021 by U.S. District Judge Lynn Hughes, who at the time decried arguments comparing the requirement to those made under Nazi Germany.

In its opinion, the U.S. Fifth Circuit Court of Appeals said it affirmed the original ruling “because plaintiffs do not demonstrate any error in the district court’s judgment on the arguments made in that court but instead make an entirely new argument on appeal.”

The plaintiffs’ attorney, Jared Woodfill, said “this battle is far from over.”

“We believe employment should not be conditioned on your willingness to take an experimental shot,” he said in an email to the Chronicle. “During oral argument, the court indicated that one way to potentially address this case of first impression is to take it back to state court. We will pursue every legal avenue available to our clients, including taking this case to the United States Supreme Court.”

Woodfill added that a “companion case” has been filed in Harris County, though records of that lawsuit could not be found by press time.

[…]

The lawsuit brought three separate claims of wrongful termination, alleging violations of state and federal law. In their appeal, the plaintiffs “pivoted” from focusing on the federal law violations to state law, the appeals court notes in its opinion.

The plaintiffs “now even equivocate on whether federal law supports their claim,” according to the opinion. “Federal law does not, and the district court did not err in dismissing plaintiffs’ claim.”

See here for the previous update. As noted at the time, Texas state law isn’t exactly employee-friendly, so the odds of a better result for the vaccine refuseniks seems quite low. But hey, they have Jared Woodfill, Super Genius, on their side. What could possibly go wrong?

When we had more deaths than births in Texas

Seems like that would be a bad thing.

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

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

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

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

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

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

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

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

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

You get the picture.

Are we going to raise the COVID threat level again?

Maybe, but not yet.

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

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

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

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

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

[…]

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

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

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

That press release is worth a read:

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

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

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

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

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

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

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

Checking in again on the wastewater

COVID levels keep creeping up.

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

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

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

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

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

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

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

[…]

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

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

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

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

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

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

Are we about to get more COVID in Houston?

We could be.

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

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

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

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

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

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

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

Paxton threatens HISD over its COVID sick leave policy

We live in such stupid times.

Best mugshot ever

Attorney General Ken Paxton and Republicans in the Legislature are taking aim at Houston ISD, arguing that the district’s COVID sick day policy violates state law.

This academic year, Houston ISD is offering 10 additional days of paid sick leave to employees who are vaccinated against the coronavirus but test positive during the school year. Unvaccinated staff, however, must use personal leave time if they are infected.

In a nonbinding opinion last week, Paxton said the policy likely constitutes a “vaccine passport,” the documentation certifying a person’s vaccination status shown in exchange for “entry or services.” The GOP-led Texas Legislature last year outlawed such requirements for both private businesses and public agencies, and Gov. Greg Abbott issued a similar executive order banning the practice last summer.

“A court would likely conclude that, by offering additional paid leave only to those employees showing proof of COVID-19 vaccination or a medical exemption, the Houston Independent School District’s COVID-19 paid leave policy violates” the executive order, Paxton wrote.

Tejal Patel, a spokesperson for Houston ISD, said Paxton’s opinion “does not change the implementation” of the district’s paid leave policy. The last day of classes is just about seven weeks away.

“No court has ruled that the district’s policy of awarding additional leave days to vaccinated employees violates” the executive order, Patel said. “The district continues to evaluate its COVID protocols in our efforts to maintain a safe learning and working environment.”

The point of this was that since HISD couldn’t mandate that employees get vaccinated, they took the approach of incentivizing it by offering a reward to those who did. And it worked pretty well, as the story notes – over 20,000 of the district’s 24,000 employees have been vaccinated. In practice, this is no different than a million corporate wellness programs out there. The one I’m most familiar with offered a discount on your health insurance premium if you jumped through certain hoops, which ranged from things like taking a dumb survey to getting a blood test. If you participated – it was completely voluntary – you got a couple hundred bucks off the cost of your insurance for the year. This made sense for the insurer as well, as it (supposedly, at least) led people towards healthier lifestyles, which meant they’d pay out fewer claims.

So I struggle to see how one differs from the other. Except of course that we’re dealing with the extremely whiny snowflakes who refuse to get a COVID shot and who therefore must be catered to at every turn by politicians like Ken Paxton and Paul Bettencourt, who requested the opinion. God knows, we cannot deprive these special delicate flowers of anything. I approve of HISD’s response. So far, the school districts have done pretty well for themselves ignoring Paxton and Abbott. No guarantees here, and of course the Lege can deal with this next year if the Republicans remain in control, but for now I’d say keep on keeping on and hope for the best.

New variants being detected

Got to keep an eye on that.

Two new omicron subvariants that health officials say are contributing to a COVID uptick in New York State have been identified in Houston, according to researchers at Houston Methodist.

Genome sequencing efforts within the hospital system have detected 83 cases of BA.2.12 and three cases of BA.2.12.1 — two sub-lineages of the dominant variant BA.2 — since the start of the year.

Local case numbers, however, are sitting at their lowest point in nearly a year, according to the Harris County Public Health COVID dashboard, which reports an average of 20 new cases per 100,000 people over the last seven days. That number was as high as 1,256 in mid-January, during the height of the omicron surge.

It’s a different story in New York, which has seen a 70 percent increase in new cases over the two weeks, from a daily average of 3,231 on March 13 to 5,467 on Thursday, according to the New York Times virus tracker.

[…]

Houston wastewater surveillance data show an increasing viral load at a growing number of the city’s treatment plants as of April 4, when samples were last collected.

The city’s wastewater dashboard shows 14 out of 39 total wastewater treatment plants experiencing an increase from the week before, compared to eight on March 28.

The wastewater data is here. As of April 4, the virus level was at 38% of where it was on July 6, 2020, which is the date when this collection project started and is used as the baseline. We’ll have to keep an eye on that of course, but we also have to consider infections versus hospitalizations and deaths. It makes sense to wear a mask in most indoor settings – I do, and plan to continue doing so for the foreseeable future – but it’s not clear yet that we need to do more than that. Other than get vaxxed and boosted, of course, which if you haven’t by now I don’t know what to say to you.

Grand jury indicts three Hidalgo aides

Not great.

Three Harris County staffers at the center of a mounting investigation into a since-canceled vaccine outreach contract have been indicted with misuse of official information and tampering, according to district clerk records.

Aaron Dunn, Wallis Nader and Alex Triantaphyllis face one felony count on each of the charges. Warrants for their arrest have been issued. Documents elaborating on the charges were not yet available on the district clerk’s website.

Lawyers for at least two of the defendants professed their innocence Monday as the charges were made public.

“Aaron Dunn is innocent — he has been an honest public servant,” attorney Dane Ball said.

A lawyer for Triantaphyllis said she believes upcoming court proceedings will “shine a light” on the lack of wrongdoing.

“These charges against my client are unsupported by a full and objective review of the facts and the voluminous evidence in this case,” lawyer Marla Poirot said in a statement. “In his service to Harris County, Alex has made the people the top priority and worked to ensure that taxpayer resources are utilized as effectively and efficiently as possible.”

Nader’s lawyer could not be reached for comment. The three defendants are expected Tuesday in the 351st District Court.

In the months leading up to the indictments — the Texas Rangers, at the request of the Harris County District Attorney’s Office, identified the three staffers in search warrants as having a role in potentially steering a vaccine outreach contract in 2021 to a vendor by giving them early access.

The three worked under County Judge Lina Hidalgo at the time of the $11 million contract, which she canceled in September amid accusations that her office manipulated the procurement process.

Dunn has since left the office, while Triantaphyllis is the judge’s chief of staff and Nader is her policy director. According to lawyers for Hidalgo and the aides, the three did not view Elevate Strategies, owned by Democratic political consultant Felicity Pererya, as a potential vendor while planning the contract, their lawyers have said. Pererya’s company ultimately won the bid.

The lawyers have argued that one of the documents outlining the outreach contract’s scope of work were sent by mistake. Another was sent as part of an unrelated project.

There are reasons to be dubious of the evidence, but once there’s a headline like this, it’s hard to shake no matter what happens next. I certainly have my doubts about these indictments. We’ll know more soon enough. That’s all I’ve got to say at this time.

COVID hospitalizations at a low in the state

Good news (say it with me) for now.

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

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

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

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

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

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

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

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

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

Here comes BA.2 in Houston

But don’t panic, it’s just a change in the virus composition, not an increase in viral load.

Houston is seeing an uptick in the number of BA.2 cases, with genome sequencing and wastewater testing picking up higher levels this week compared to last week.

The more contagious omicron subvariant was identified in 24 percent of patients who were sequenced at Houston Methodist, a jump from the 1 to 3 percent previously reported. BA.2 was also detected at six wastewater treatment plants on March 21 — the most recent day for which data is available — after the Houston Health Department last week said it had not been detected at any plants.

“Previously, we saw some indications of mutations consistent with BA.2 but were not confident in the determination at the time,” health department spokesman Scott Packard said in an email. “Retrospective analysis indicates BA.2 was likely in the wastewater in low levels starting in mid-to-late January.”

The recent data is the first indication of a significant rise in BA.2 in the Houston-area. Eventually, the subvariant is expected to become the dominant strain here, lining up with the nationwide rate, according to the health department.

[…]

In Houston, the average positivity rate over the last two weeks is 1.8 percent, down from the high 30s in the early January. Wastewater testing shows an increasing viral load at nine wastewater plants, while the remaining 30 are plateaued or decreasing.

“Although BA.2 appears to be more contagious than BA.1, the good news is that countries experiencing a spike in cases are not seeing a proportionate spikes in hospitalizations,” Packard said. “That means being up to date on vaccines (initial shots plus boosters) remains highly effective against serious illness, even with BA.2.”

As a reminder, you can see the Houston wastewater dashboard here. I don’t know how long we will be in this trough, but at least in the short term our vax level plus the sheer number of people who contracted the BA.1 version of omicron should help.

In the longer term, as immunity wanes and new variants pop up, it will be time for more shots. A fourth shot has now been authorized by the FDA for us old folks.

A second round of booster shots was greenlighted for everyone over the age of 50 by public health officials on Tuesday, kicking off the regulatory process for shots to likely be available in pharmacies this week.

Everyone 12 and older is already eligible for a booster shot five months after their initial vaccine series if they received an mRNA vaccine like Pfizer or Moderna, or two months after getting the Johnson & Johnson vaccine.

But for those over 50, determined to be a vulnerable age group, officials at the Food and Drug Administration and Centers for Disease Control and Prevention have decided the data on waning immunity justifies making another shot available four months after the first boost. And while anyone who meets that criteria can now get another booster, CDC Director Rochelle Walensky said it was “especially important” for those 65 and older and those 50 and older with underlying medical conditions.

“This is especially important for those 65 and older and those 50 and older with underlying medical conditions that increase their risk for severe disease from COVID-19 as they are the most likely to benefit from receiving an additional booster dose at this time,” Walensky said in a statement on Tuesday.

My niece is getting married in June in Washington state. I expect all of us who will be there for it and who are eligible for that booster will have gotten it by then. I ain’t messing around.

COVID may be down but it’s definitely not out

Just a reminder, this pandemic hasn’t gone away. It’s less of a threat to us here right now, but it’s still very much a threat.

The evolution of the coronavirus is likely to produce dangerous new variants that escape built-up immunity and evade vaccines, according to a new study that may offer clues for the future of the pandemic.

In a searing condemnation of “misconceived and premature theories” about the demise of COVID-19, the authors — microbiologists at the European Commission and the University of Oxford — take aim at what they call the “persistent myth” that the virus will evolve to be benign.

That omicron caused relatively mild disease “has been enthusiastically interpreted to be a sign of the approaching end of the pandemic,” the authors write in the study, which was published Monday. “Yet the lower severity of omicron is nothing but a lucky coincidence.”

Instead, the microbiologists believe more severe strains could be on the way as the virus adapts to dodge natural immunity and vaccines. Analyzing the possibilities for how COVID may evolve in the coming months and years, they attempt to debunk the notion that omicron’s lessened severity represents a step towards normalcy.

“Omicron is not at all a good predictor for the future,” said Dr. Peter Markov, a scientist at the European Commission’s Joint Research Centre and lead author of the study.

Many viruses that plague human populations, including HIV and Hepatitis C, do not evolve to be less severe over time, Markov said.

You can find more details here. You know that BA2 omicron variant that’s already making case counts go up in Europe? We’re starting to see evidence of more infection in the US as well. In the wastewater, of course.

There’s a whole thread to read for that. The good news locally is that our wastewater virus levels are still trending down, as of March 7. That of course can change quickly. You know what the best protection from this is, of course.

That drum has been beaten to death, and yet the US as a whole and Texas and Harris County in particular are not great on getting shots in arms. Too many vaccinated people haven’t gotten boosters. Too many vax-eligible kids haven’t gotten theirs. The anti-vaxx crowd is as loud and obnoxious and dangerous as ever. And yet even with all that, we’re in a better position than some other places.

Another thread to read. An astonishingly small number of people over the age of 80 have been vaccinated in Hong Kong, which is absolutely getting slammed right now, and in China as well. That and a lack of immunity from prior exposures – this is their reward for suppressing the first waves of COVID so well – are the underlying factors. Our vax rate in Texas isn’t great, but so many people have been infected at least once that it helps make up the gap somewhat. But vax + booster is still by far the most effective protection against hospitalization and death. If the next variant is more effective at avoiding existing protections, or is more severe in addition to being more transmissible, we’re going to be in deep trouble. Hope for the best, make sure everyone in your circle is vaxxed and boosted, and stay vigilant. Stace has more.

How low can COVID go?

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

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

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

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

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

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

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

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

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

MLB’s Canadian conundrum

Here’s an interesting wrinkle to the recently-resolved MLB lockout.

With the Major League Baseball season set to start, unvaccinated players will once again need to sit out series against the Toronto Blue Jays at Rogers Centre.

Players who haven’t been fully vaccinated against COVID-19 will not be able to play in Toronto.

In addition, unvaccinated players won’t be paid for games or service time for the entirety of a series played north of the border. Each day spent on a baseball club’s active roster or injured list represents one day of service time.

Current vaccination guidelines still doesn’t allow foreign unvaccinated travellers to cross the Canadian border. Athletes no longer have special status in order to travel without having taken the vaccine after the federal government revoked the exemption on Jan. 15.

Sportsnet’s Shi Davidi reports the subject was “a significant point” in players’ CBA discussions with “a few teams” taking issue before ultimately relenting.

According to the story, about 88% of “tier one individuals” are fully vaccinated, which includes players, coaches, and other staff that travel with the teams, so the extent of the problem should be relatively limited. Still, if we assume that is the value for active players as well, on a 26-man roster, that’s three players per team, and as anyone familiar with the Kyrie Irving situation knows, who the unvaxxed players are matters. It’s one thing to miss a reliever at the back of the bullpen or a starting pitcher whose turn in the rotation wouldn’t have happened anyway. It’s another thing to miss your starting catcher or an All Star outfielder. Some teams will be much more affected than others, and if a team in the same AL East division as the Jays has its own Kyrie on it, that could affect the playoff races.

The collective bargaining agreement that has settled the lockout is still preliminary and subject to some details being worked out, including those relating to this situation. It may be that Canada eventually relaxes this rule, and it may be that some holdout players give in so as not to be the reason why their teams are disadvantaged. Most likely, this will be an ongoing story and another reminder that however done we may be with COVID, COVID is not done with us.

And we’re back to yellow again

Let’s hope it lasts.

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

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

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

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

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

We’ve had a lot of COVID

Wow.

More than half of Texans had been infected by COVID-19 as of late January, according to a nationwide blood sample survey conducted by the Centers for Disease Control and Prevention.

The survey was based on samples from 52 commercial laboratories across the country and included specimens that were collected as part of routine care and sick visits unrelated to the virus. The specimens were tested for a specific type of antibody developed in response to an infection but not vaccination.

The CDC has been regularly gathering the data since August 2020 to track the percentage of people with resolving or past infections, and how that varies across geographic areas and age groups.

The survey estimates that 14.7 million Texans — or 52.8 percent — had been infected. That’s well over the 6.5 million cases that have been publicly reported. That figure is also likely an undercount, reflecting only a portion of the new infections from the record-breaking omicron wave, during which Texas reported more than 50,000 new cases in one day.

The high number of infections underscores new CDC guidance that no longer recommends mask-wearing indoors for most of the country, including Harris County, except during times of high transmission. Addressing the rationale for the change, CDC Director Dr. Rochelle Walensky said that with “widespread population immunity, the overall risk of severe disease is now generally lower.”

About 64 percent of Texans are fully vaccinated, according to the Texas Department of State Health Services. While health experts agree that the omicron surge likely bolstered vaccine-related protection, the degree to which people are immune because of a previous infection remains unclear.

“What we don’t know for sure with COVID is how long that natural immunity lasts,” said Dr. Catherine Troisi, epidemiologist with UTHealth School of Public Health in Houston. “And there is the added question of how protective are the antibodies that you’ve made against the (variant) you’ve been infected with.”

Yeah, that’s pretty much the sum of it. We’re likely as well protected right now as we can be given our unacceptably low vaccination rate, but we’re sitting ducks if and when there’s a nastier version of COVID out there. Get your booster if you haven’t – it really matters. We can certainly act in ways that are better suited to risk level and the given situation, but let’s not forget that there’s still a risk out there, and it can and will change over time.

The Rodeo is back

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

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

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

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

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

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

“We will definitely be masked,” she said.

[…]

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

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

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

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

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

HISD lifts its mask mandate

A bit earlier than expected.

The Houston Independent School District will lift its mask mandate Tuesday, no longer requiring the use of face coverings at all facilities and buildings, district officials said Monday.

The change in policy at Houston ISD arrived three days after the Centers for Disease Control and Prevention changed how it measures community spread to account for hospitalizations in addition to caseloads. Additionally, Harris County Judge Lina Hidalgo last week lowered the county’s COVID-19 threat level to “significant,” the second-highest possible threat level, while Mayor Sylvester Turner lifted a mandate that required city employees and visitors to municipal buildings to wear masks indoors.

“Masks within HISD schools, facilities, and school buses will become optional,” Superintendent Millard House II said in an e-mail to principals Monday morning. “Please encourage students, staff, and any other HISD stakeholders that may need an additional layer of protection or are exhibiting symptoms of a communicable disease to wear a mask regardless of vaccination status.”

See here for the official announcement. I was expecting this to come in a couple of weeks, but here we are. My kids have been pretty dedicated mask wearers, so we’ll see what they and their friends do. I hope that we have done what we can to improve air circulation in the schools, and I hope this spurs some people to get their kids vaccinated. And I really really hope we don’t have to change directions again this semester. The Press has more.

Orange is the new threat level

New again, anyway.

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

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

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

[…]

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

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

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

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

COVID madness

How many ways will unhinged lunatics find to kill us?

A federal appeals court has reversed a ruling, effectively halting United Airlines’ COVID-19 vaccine mandate for employees. The majority on the 5th U.S. Circuit panel ruled in favor of lifting the mandate. The majority explained its ruling was on very narrow ground, but in a seething dissent, one judge said he would rather “hide my head in a bag” than join the unpublished ruling he indicated would not be upheld on the merits.

The case was brought by a group of United employees challenging the airline’s policy that all employees receive the vaccination or remain on unpaid leave. Two workers received religious exemptions from getting the vaccine. The majority on the New Orleans based court held these exempt workers would suffer irreparable harm if the mandate remained in place, because “they are actively being coerced to violate their religious convictions.”

In an unsigned 22-page ruling from U.S. Judges Jennifer Walker Elrod and Andrew S. Oldham, the court reversed the ruling and remanded the case to the trial judge in the Northern District of Texas for re-consideration of the legality of the company’s vaccine mandate. The majority said the trial court must properly analyze the irreparable harm of making an employee choose between “the job or jab.”

The third judge on the panel, Jerry E. Smith, penned a 57-page signed dissent vehemently calling into question the wisdom of his colleagues’ conclusion, however narrow, that the lower court’s reasoning about the mandate was faulty.

Smith said his colleagues’ findings were “head scratching.” And then Smith offered a searing indictment, highlighted in a thread by attorney and prolific appellate law tweeter Raffi Melkonian.

The dissenting judge wrote, “If I ever wrote an opinion authorizing preliminary injunctive relief for plaintiffs without a cause of action, without a likelihood of success on the merits (for two reasons), and devoid of irreparable injury, despite the text, policy, and history of the relevant statute, despite the balance of equities and the public interest, and despite decades of contrary precedent from this circuit and the Supreme Court, all while inventing and distorting facts to suit my incoherent reasoning,” then “I would hide my head in a bag.” He went on to say, “Perhaps the majority agrees. Why else shrink behind an unsigned and unpublished opinion?”

You really should read that Twitter thread, and also Mark Joseph Stern’s analysis. I know some of y’all are tired of me calling the Fitch Circuit a lawless abomination, but here’s one of its senior jurists, and old school Reagan-appointed capital-C conservative calling it the same thing. Do you believe me now?

Of course, these nutballs need fuel for their fire, and there’s no shortage of that.

Texas Attorney General Ken Paxton and U.S. Rep. Beth Van Duyne, R-Irving, are suing the Biden administration to end mask mandates on planes.

The lawsuit, filed Wednesday, argues that the mandate imposes a “restriction on travelers’ liberty interests” and that the Centers for Disease Control and Prevention does not have the authority to introduce such a blanket preventive measure.

First issued in January 2021, the federal mask mandate requires travelers to wear masks while using public transportation services or facilities, including airports and subway stations. Those who violate the mask mandate could be subject to fines.

Travelers younger than 2 years old or with disabilities who cannot wear a mask are exempt from the requirement. The CDC also amended the order in June 2021 and said the mandate would not apply to outdoor settings.

The federal mandate is set to expire on March 18.

Airline companies — including Texas-based American Airlines and Southwest Airlines — have cited federal law as a reason for requiring face coverings and barring violators from travel.

The suit is the latest in a slew of state efforts to challenge COVID-19 safety measures in court. The state is locked in several legal battles with cities, counties and school districts over masks in public schools. Texas also has sued the Biden administration over federal vaccine mandates for health care workers, federal contractors and large businesses.

I’ll tell you what, when airlines impose a vaccination requirement for flying, which frankly the feds should have done months ago, then I’ll agree that the masks can go. Flying on a commercial aircraft is a privilege, not a right. That privilege can and should be revoked for reckless and dangerous behavior, despite what some Republican Senators would have you believe. Do you think Ted Cruz would actually want to be on the same plane as this guy? So-called “conservatives” have been yelling at us for years about the decline in civil society. Well, they were eventually right about the decline, but completely wrong about the cause. I think we all know the real reasons for it.

Omicron on the decline in Houston

Some good news.

Omicron is receding in the Houston area, new data show, even as hospitals continue to feel the strain of January’s post-holiday bump in COVID-19 cases.

The region’s rate of transmission — a key metric used to gauge how likely an infected person is to spread the virus to others — fell for the third week in a row, health officials reported Monday, fueling hopes that omicron may be on its way out.

The COVID transmission rate across the Houston area was 0.74 last week, meaning the average person who had the virus gave it to one person or less, according to the Texas Medical Center. Spread has remained below 1.0 for two weeks, reflecting omicron’s loosening grip.

New hospital admissions also fell, an encouraging sign after an explosive surge that pushed Texas emergency rooms and intensive care units closer to capacity than at any time during the pandemic. About 2,300 people were hospitalized for COVID in the nine-county region around Houston on Sunday, down 20 percent from two weeks ago.

Houston averaged fewer positive COVID tests last week relative to the mid-January peak. Around 5,400 people tested positive for the virus each day in the greater Houston area, 60 percent as many as the previous week, when the region averaged 9,000 new cases daily, according to TMC data.

That’s good, and it’s consistent with other reporting. We could sure use a bit of a breather. That said, and as the story notes, hospital ICUs are near capacity, and there’s no reason to believe this wave will be the last wave. We still need to get a lot more people vaccinated and boosted. At least on that note, there’s a little more good news.

Earlier this month, Ipsos conducted surveys in Italy and France to gauge the support levels among the populations there for the tough new vaccination mandates that were just introduced. The polling firm shared the data exclusively with Fortune, and the findings surprised not only the pollsters, but also Fortune readers.

As a result, Fortune asked Ipsos to expand the survey to include four new countries: the United States, the United Kingdom, Germany, and Australia.

The findings were remarkably similar across all six countries. Among the general population, there’s wide support for compulsory vaccination rules. And even more startling, the ranks of unvaccinated see some merit in selective vaccination mandates. For example, there is overwhelming support for requiring teachers and health care workers to get vaccinated across all those polled. Requiring that private sector workers be vaccinated draws less support, but there’s still a majority in all but the U.K.

Even in the United States, where mandate battles have raged from state to state since the early days of the vaccination campaign, a majority of poll respondents are seemingly okay with rules requiring vaccination to enter workplaces, shops, and attend public events. This finding comes as courts across the country, and even the U.S. Supreme Court, strike down a variety of enforcement orders that would have required employees at large businesses get vaccinated, undergo weekly testing, or simply wear a mask.

But what continues to surprise pollsters the most is that the most strident blocs in each country—the unvaccinated—are showing signs that they, too, will go along with tougher measures in certain circumstances.

Call it a case of Omicron fatigue: This highly infectious variant is testing the resolve of even the most dogged anti-vaxxers, the pollsters find.

“They are definitely not a group of people that are hard-core sure they are right,” says Andrei Postoaca, CEO of Ipsos Digital. The data from these surveys tell him that there is probably one-quarter of the remaining unvaccinated who don’t fall into the strident “true believer” category. “More and more are willing to take a jab, are willing to accept a mandatory vaccination. So the question is: Step by step, will you get people to cross the line” and drop their opposition to vaccines and vaccine mandates?

“What I would say is clearly the vaccinated support a decision of mandatory vaccination. And a decent chunk of the unvaccinated in most countries also support it,” Postoaca adds.

The poll suggests that about 13% of unvaccinated Americans are planning to get their first COVID shot. That’s not a lot, but if it’s accurate it would raise the overall vaccination rate in the US by about four points, and that’s not nothing. Here’s hoping.