Texas lags in sharing health data
TRANSPARENCY: Advocates call for updates on hospitalization figures
Texas is bracing for a pandemic that is projected to kill tens of thousands of people across the U.S., but health officials and state leaders are struggling to provide the public with timely updates on how many people are infected and how many hospital beds and ventilators are available for the critically ill.
Other states across the country have been providing coronavirus hospitalization figures for weeks. On Friday, Gov. Greg Abbott announced that 827 people have been hospitalized in Texas. But the true number of cases is likely far higher than the official tally due to a short
age of reliable tests and delays in delivering results, which can take up to 10 days.
Even with the limited number of confirmed positives, Harris County’s top epidemiologist says it feels like her team is constantly behind.
“It’s become overwhelming,” said Dr. Dana Beckham, director of the county’s Office of Science, Surveillance and Technology, which traces the steps of people who test positive for COVID-19 to determine how they got the disease and who they may have infected. “We’re always behind the eight ball.”
The county’s epidemiologists were pulling 12-to-16-hour days, seven days a week and they still couldn’t keep up, Beckham said. They brought in more workers — roping in other county government employees and hiring outside contractors — to prevent burnout and alleviate stress, tripling the number of people working in the unit to about 65. It’s still not enough, she said. As health officials scramble to mitigate the worst pandemic in generations, the level of detail released by Texas lags behind that of some counties and cities.
The Texas Department of State Health Services publishes a daily update of the official number of confirmed coronavirus cases — there were 5,330 statewide as of Saturday and 90 deaths. But the agency doesn’t routinely publish other key measurements that could show the potential for strain on Texas’ health care system in the coming weeks.
On March 24, Abbott ordered hospitals across Texas to report their bed capacity to DSHS to help prepare for a surge of new coronavirus patients. The agency also is receiving reports showing how many ventilators are available at each hospital. The mechanical breathing devices help the critically ill survive the respiratory disease.
The reports from hospitals have been flowing to DSHS on a daily basis — but until recently, most of the information wasn’t released to the public, and there was initially confusion about the state’s reporting requirements.
“There’s an issue that a lot of people in Texas have had upon their mind as we work our way through responding to the coronavirus,” Abbott said at a news conference Friday. “And that is, what is the capability for hospitals across the entire state to be able to meet the needs of people — in whatever region they may live in — to access the health care they might need in the event they need to visit a hospital?”
For the public to properly hold their leaders accountable, people need the most up-to-date and accurate information as possible, community leaders said. They need to know the extent of the problem in order to asses if their leaders are dealing with the problem effectively.
“I don’t understand it,” said Houston activist Erin Toberman, who founded a nonprofit to help Galveston residents recover from Hurricane Ike.
“In a disaster, the very best thing you can give to people is good, timely, accurate information.”
Abbott announced how many coronavirus patients have been hospitalized in Texas — 827 people. The governor promised Texas, with a population of about 29 million, can handle more. Abbott said Texas has 19,695 available hospital beds and 8,741 ventilators, and the state can add even more beds if necessary.
New York state, which has more than 100,000 confirmed cases, says it needs 30,000 ventilators and could need 140,000 hospital beds.
State officials haven’t released their estimates on how many resources they’ll need when the pandemic peaks. But Abbott cited a study by the University of Washington showing that more than 17,000 coronavirus patients will have to be hospitalized — and there will be beds for them.
The model, which assumes full social distancing through May, projected a shortfall of about 300 ICU beds in Texas. But both state and local officials have been making plans to help free up ICU bed space, including using NRG Park as an emergency hospital if needed.
“Our capacity should prevent us from facing the type of situation that New York is having to deal with today,” Abbott said, referring to a surge of cases that has killed nearly 3,000 people in that state and led to a dire shortage of ventilators and protective equipment.
A confusing process
The 827 hospitalized coronavirus patients in Texas are confirmed COVID-19 cases — not suspected cases in which patients are exhibiting symptoms but have no test results, said Chris Van Deusen, a spokesman for DSHS.
Frontline health care workers in the Houston area have told the Houston Chronicle that many patients who should be tested and hospitalized are slipping through the cracks. They also worry that patients admitted with other conditions, such as a heart attack, who also are showing symptoms of the virus may not show up in overall counts.
Unconfirmed COVID-19 cases are likely taking up a significant number of hospital beds. According to the Southeast Texas Regional Advisory Committee, an organization tasked with tracking medical resources in Houston and the surrounding area, as of Thursday more than 700 patients with COVID-19 symptoms — which includes confirmed and suspected cases — had been hospitalized in Harris County alone.
More than 240 were being treated in intensive care units in the county, which has about 4.7 million residents. There were 480 patients on ventilators as of Thursday and 684 additional ventilators were available.
“Currently, we do not have any hospitals reporting that they are nearing capacity,” Darrell Pile, SETRAC’s chief executive officer, told the Chronicle in an email. “Available beds can actually rise if a hospital opens a closed wing, or opts to use beds in the recovery room or other specialty areas to care for inpatients.”
Van Deusen said the state health department had initially collected statistics on suspected cases from hospitals, but by Tuesday had only received reports on 629 patients statewide, raising questions about the accuracy of the state’s figures.
“Hospitalization reporting is a work in progress, and we’re definitely still refining the process,” Van Deusen said.
Van Deusen blamed the confusion on the questionnaire that hospitals fill out. Some hospitals reported the total number of COVID-19 patients who were hospitalized in the past 24 hours; others reported the number of new COVID-19 patients during that time frame, not the grand total. Van Deusen said DSHS clarified its reporting requirements and the confirmed cases cited by Abbott on Friday are accurate.
Lagging behind
While hospital and ventilator statistics haven’t routinely been made available to worried Texans, residents in most other states are able to receive daily updates on coronavirus hospitalizations, according to the COVID Tracking Project, a website that compiles coronavirus data from all 50 states and Washington, D.C.
Every state reports positive and negative test results for COVID-19, but Texas is one of 15 states that hasn’t shared timely statistics on hospital-bed usage. Five states report the number of patients in intensive care units, and only two states — Oregon and Louisiana — report how many patients are on ventilators.
Joseph Larsen, an open-government advocate in Houston and lawyer with the Freedom of Information Foundation of Texas, said state law allows public health officials to withhold a wide array of information pertaining to contagious diseases, ostensibly to prevent panic.
But the magnitude of the coronavirus pandemic shows the limitations of the law, Larsen said.
“In the situation that we’re in, I tell you what’s going to cause a panic: It’s not knowing what’s going on,” Larsen said. “And you know what’s going on with the coronavirus? We don’t have a clue.”
Health officials are playing a difficult balancing act in deciding what information to release while avoiding the very real risk of stoking panic, said Summer McGee, dean of Health Sciences at the University of New Haven in Connecticut.
“Information transparency in a pandemic is a moral gray area,” McGree told the Chronicle in an email.
“In normal times, we would always want to be as transparent as possible with the public,” McGee said. “But in times of crisis we have to be sure that the information shared will help people and not harm them. Anxieties about running out of medical equipment and ventilators are already at an all-time high.”
Dwindling supplies
Until Abbott’s news conference on Friday, it was unclear how many ventilators were available in Texas. State officials didn’t release that information, and Van Deusen declined to say how many ventilators Texas has requested from the Strategic National Stockpile, a federal resource for medical supplies that’s been stretched thin during the outbreak.
“That’s not information we’re sharing yet,” Van Deusen said. “But we’re determining the best way to share that.”
While Van Deusen declined to comment on Texas’ supply of ventilators, he said the national stockpile provided other medical resources to Texas. Among them: Texas received more than 484,000 N95 respirators, which block air particles and are in high demand by health care providers.
Texas has also received 1.15 million surgical masks, 219,000 face shields, 179,000 medical gowns and 637,000 gloves, Van Deusen said.
“We got a whole lot of people all out beating the bushes looking for other sources,” Van Deusen said. “So we’re not just relying on the (Strategic National Stockpile) for these kinds of things.”
Differences in disclosure
While hospitalization data can offer a glimpse into the scope of the outbreak, many Texas counties do not report it.
Out of 23 Texas counties with more than 40 reported cases, about half publish hospitalization figures; 13 percent report the numbers of intensive care patients; and 13 percent report ventilator usage.
Neither Harris County nor the city of Houston publish updates on hospital-bed usage. Mayor Sylvester Turner said the city plans to begin releasing figures on hospital bed capacity on Monday.
In San Antonio, city officials said they didn’t know how many patients were on ventilators and, until recently, didn’t know how many had been hospitalized.
San Antonio officials also initially declined to release the age and gender of victims, citing federal and state privacy laws. Larsen criticized the move, saying the laws apply to health departments, not city leaders.
COVID-19’s unprecedented impact on society shows how important government transparency can be in a time of crisis, Larsen said.
“What the people need is the real data,” Larsen said.