Welcome to the weekly COVID-19 outbreak update for Texas. If you’ve been following along you know I’ve predicted, based on the trends, that things were going to get very ugly starting in July. I didn’t need a crystal ball for that, just hard data, and it’s nothing epidemiologists haven’t been shouting about for weeks now. Well, the first week of July is officially in the bag, and we’re off to the terrible start I feared.
To his credit, Governor Abbott issued a mandatory mask order across the state, taking effect July 3rd, along with tighter restrictions on public gatherings, closing bars, and has discussed the possibility of re-opening schools needing to be re-examined. To his negative credit, this is weeks too late to stop the crisis barreling down on us, and was probably not nearly strict enough coming before another major holiday weekend. Memorial Day’s aftermath has proved that backyard cookouts and family gatherings were a terrific vector for the disease to spread, and by not returning to shelter in place and permitting people to gather without masks in private it is very possible that July 4th will be a similar time bomb. In about 2-3 weeks we’ll see the impact of both events on new cases, and it will be very interesting to see the data at that point.
Despite my criticism of the governor, the mask order IS a good thing. I’m just concerned it’s coming far too late for many Texans who may well die this month, and I’m concerned that July 4th will end up undercutting it by providing the pandemic a massive boost.
A closer look at the data is below the jump; as always, the 7-day moving average will be used to provide a clearer picture of trends as compared to the daily fluctuations.
As usual, I’ve marked where shelter-in-place equivalent restrictions were lifted on May 1st, Memorial Day weekend (which started the current upward trend), and going forward I’ll be making one mark for the July 3rd statewide mandatory mask order and 4th of July weekend (since these two events took place within 24 hours of each other). I’ll also be taking a closer look at the regional hospital data starting this week, since we’re getting closer and closer to a crisis point in capacity.
The good news about new cases, such as it is, is that we’re not seeing exponential growth in new cases yet. The slight dip can likely be attributed to reduced testing over the holiday weekend; we’ve seen over 9,000 cases on Monday and Tuesday, both times were record one-day highs. This has given Texas a solid lock on 3rd most cases in the country, right behind California and New York and staying ahead of Florida despite their equally impressive efforts to mismanage the pandemic.
Active cases are not slowing down at all. It’s hard to tell if the reason the rate isn’t steeper is due to limits on number of daily tests or not. Daily tests are at about 50,000 per day with a positivity rate of 13.51%, much higher than had been discussed as acceptable for keeping the state open.
Daily deaths are on the rise, and we hit 47 per day on average at the end of the day Tuesday. Tuesday also saw a new record for deaths in a single day, right after Monday matched the previous record. For reference, at this rate Texas alone will have had more COVID-19 deaths than died in 9/11 before next week. Hospitals still aren’t at maximum capacity, so as troubling as these increases in deaths are they probably represent a floor rather than a ceiling as we go into July.
The hospital situation is getting progressively worse. If hospitalizations continue to follow the past month’s trends in terms of total patient growth and proportion of patients in urban hospitals, we’re about 2 weeks or less from being completely out of available beds. At that point we’ll be in NYC/Northern Italy crisis territory. Right on schedule, unfortunately.
Total hospitalizations are continuing to grow; we’ve added over 2,700 in just a week, an increase of 34%. The statewide capacity numbers are not looking good: there are almost 800 fewer available beds. That’s a bigger weekly decrease than last week, so beds are filling up faster despite Governor Abbott resuming the ban on elective surgeries at the end of June. There are 250 fewer ICU beds open and almost 300 fewer ventilators. As the pandemic intensifies, it’s worth taking a look at how serious things are in the major urban areas; since the outbreak is concentrated in urban areas, the strain will be greatest there and the statewide numbers may not paint an accurate picture of their situations.
Texas Urban Hospital Information (Courtesy Texas HHS)
urban region
|
available
beds
|
available
icu beds
|
available
ventilators
|
current
patients
|
Dallas/Ft. Worth |
2,715 |
320
|
1,213 |
1,704 |
Houston |
2,121 |
118 |
1,194 |
2,699 |
Austin |
769 |
85 |
347 |
550 |
San Antonio |
867 |
101 |
481 |
1,350 |
El Paso |
386 |
47 |
248 |
246 |
A little over half the open regular and ICU beds in the state are in the major urban areas, along with 2/3 of the available ventilators. However, 70% of the state’s patients are in these five regions; this isn’t surprising, as these five regions also contain an estimated 70% of the state’s total population. This means that urban hospitals are already running out of equipment and space faster than their rural counterparts.
We’re getting closer and closer to the anticipated July crisis. It’ll be at least two to three weeks before the new case curve begins to flatten, assuming the mask order has a much greater impact than the 4th of July weekend. If the 4th of July weekend causes another spike in cases, the subsequent rise in hospitalizations should begin in the first or second week of August. If hospitals are at or near capacity before then (as they are on track to be), it’ll greatly exacerbate an already major crisis. Due to the delay between actions taken and impact on cases, hospitalizations, and deaths, it’s already too late to do anything but wait and see how things unfold. We’re watching a train wreck in slow motion here, the only question is how bad a wreck it turns out to be.
Please spread the word to everyone you care about: wear a mask whenever you leave the house, wash your hands frequently and always before touching your face, and for the love of God try not to go out more than you have to and practice social distancing when you do. This is going to get worse before it gets better, but if you haven’t been infected yet you can greatly reduce the risk you will be, even now. If you have been infected, you can help protect those around you.
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