As Texas numbers spike, Houston is a bright spot
Cases in region have plateaued compared with Dallas, but officials warn against letting guard down
As Texas confronts a huge spike this month in new coronavirus cases, the best glimmer of hope may be in Houston.
One month after Texas Medical Center leaders proclaimed the area had begun flattening the COVID-19 curve, the rate at which disease spreads through the community, Harris and surrounding counties have firmly settled into a plateau, the number of new cases typically coming in at between 100 and 200 a day. That is a far cry from the 786 new cases the area reported April 9.
The state, meanwhile, has spiked significantly in the last week, marked by six straight days of more than 1,000 cases a day. About 37 percent of reported cases and nearly 40 percent of Texas deaths have occurred in the past two weeks.
“It was fortuitous that our leaders took immediate and decisively strong actions like shutting down the rodeo,” said Darrell Pile, CEO of the Southeast Texas Regional Advisory Council, a state group that coordinates the emergency response to disasters in a 25-county area centered in Houston. “It may be the equivalent of hitting the brakes hard to minimize inju
ry as compared to gradually coming to a stop.”
But medical center leaders, expressing disappointment that the Houston area hasn’t experienced a significant decline, warned against complacency that could lead to new flare-ups as the economy reopens.
“If you’re making a sauce, we’re simmering, not boiling,” said Dr. Paul Klotman, president of Baylor College of Medicine.
That sauce is boiling in Dallas County, epicenter of the recent state increase. It went from an average of 95.6 new cases a day in late April to 245.7 by May 10. No other Texas county saw such a big spike over the same period of time.
Three problem areas
A number of Houston and Texas experts contacted by the Chronicle on Tuesday were at a loss to explain the contrast, given both Harris and Dallas counties issued stay-at-home orders about the same time.
Dallas County officials did not respond to a Chronicle inquiry on Tuesday. But the Dallas Morning News reported last week that County Judge Clay Jenkins said that the recent spike in cases couldn’t be attributed to a significant increase in public testing, a common explanation, but rather a change in who is being tested: Front-line workers at grocery stores and big-box retailers are now able to get tested for COVID-19 without symptoms.
The newspaper also reported that more than a third of Dallas County’s coronavirus deaths have been associated with longterm care facilities, according to health officials.
COVID-19 deaths associated with long-term care facilities is not unique to Dallas. Nursing homes also account for a high percentage of deaths in Houston as well as around the state and nation. Thirty-five percent of the deaths nationally have occurred in long-term care facilities, according to the New York Times.
At his news conference last week, for instance, Gov. Greg Abbott included long-term care facilities in his list of locations responsible for Texas’ high numbers.
“Basically, there are only three categories causing any type of outbreak,” said Abbott. “There are meatpacking plants, there are jails and there are senior centers. If it weren’t for those three categories, the people in Texas testing positive would be very minimal.”
Abbott referred to “surge forces” Texas has created to focus on the three areas, “like putting out a fire” in regions where there are flare ups. He noted one surge force is currently working in the Texas Panhandle, which has become one of the nation’s hot spots for the spread of COVID-19, because of meatpacking plant outbreaks. Just north of Amarillo, in Moore County, at least 240 workers at a JBS beef slaughterhouse have tested positive for the virus; Potter County, where Amarillo is the county seat, has recorded 1,027 cases.
Abbott and others also attributed the spike in cases to increased testing. A spokeswoman for the Texas health department noted the Texas Military Department have been “testing in areas where there was very little testing previously and in areas with known outbreaks.”
Manageable rate
Testing has ramped up in Houston too, and that hasn’t led to a spike in case numbers. Klotman noted that the growth of the spread has steadily dropped from increasing 3.5 times every seven days when the outbreak first started in the area in early March to just 1.1 times every seven days Tuesday.
“People keep getting infected every day, but we’ve effectively come into an equilibrium at a rate we can manage,” said Klotman. “Nobody’s missing a ventilator, no one’s going to get a lack of care because we’re overwhelmed.”
Klotman noted that COVID-19 is bringing 40 to 50 admissions a day to TMC hospital systems, which account for 70 percent of the area’s hospitals across nine counties. Such patients represent only 12 percent of ICU censuses at those hospitals.
One point of comparison between the state’s two biggest metro areas: there are 2.13 COVID-19 cases per 1,000 people in Dallas and 1.6 per 1,000 in Houston.
Gerald Parker, director of the pandemic and biosecurity policy program at Texas A&M’s Bush School of Government Service, says the contrasting numbers in Dallas and Houston aren’t surprising.
“The dynamics of a pandemic is that not every community is hit at the same time,” said Parker.
“They’re hit at different times and with different intensities, a hot spot one moment, no longer another. It’s not so much that Houston is doing something different as it is a factor of time, where the epidemic is spreading.”
Spencer Fox, a research associate with the University of TexasAustin COVID-19 modeling consortium, added that “any of Texas’ metropolitan regions could flare up again and change the dynamics in the state.” He also said pandemics typically emerge and spread first in large metropolitan areas — “exactly what we’ve seen in Texas” — then diffuse into smaller cities and towns and rural areas.
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But the recent increase in new cases statewide is not due to a spike in cases in rural or suburban areas, according to a Houston Chronicle analysis. New cases per day in counties of less than 200,000 people actually declined on average in the last two weeks.
The smaller counties that did see an increase were modest in nature, like Frio County in South Texas. It went from .3 new cases a day on average in late April to 3.7 new cases a day by May 10.
Pile, from the Southeast Texas Regional Advisory Council, said that despite the strong showing in the Houston area — he’d feared devastation like that seen in Italy or New York City — he worries that people will begin lowering their guard now that restrictions are being relaxed. He also worries about “disturbing comments on Twitter and Facebook that the COVID-19 crisis is just a hoax.”
“Remember, when we say the virus has plateaued, we’re not saying it’s gone away,” said Pile. “It’s still here, just as fierce, now having gained a footing. It’s up to us to not relax.”