No letup of virus yet for Texas

COVID cases ease, but deaths still high

After a brutal coronavirus summer, the delta wave is finally subsiding in Texas, though the state still has nearly 12,000 hospitalized coronavirus patients and one of the highest mortality rates in the nation.

Health experts warn that Texans cannot let their guard down just yet — even if that’s not the message they are receiving from the state’s Republican leaders.

While Gov. Greg Abbott has highlighted the state’s declining case counts and hospitalization rates in recent weeks, public health experts say infections may rise again this winter as the contagious delta variant continues to spread and the efficacy of immunizations declines over time. They’re offering the same advice now that they have been for more than a year: Mask up, social distance and get vaccinated.

It’s advice that has worked recently in other big states, such as Democrat-led New York and California, while Abbott has instead used his emergency power to prohibit masking and vaccine mandates.

“This will not go down anytime soon,” said Juan Gutiérrez, a mathematics professor at the University of Texas at San Antonio who has modeled COVID-19 trajectories in Texas. “We might have an increase in the number of cases later in the year. And this is the result of lack of guidance for our communities regarding sensible public health guidelines.”

In the past month alone, more than 5,000 Texans have died of the virus. Hospitalizations — now on a steady two-week decline — peaked at nearly 14,000 earlier this month, roughly the same number as during the winter surge in late 2020 and early 2021.

As of Wednesday, 250 children were hospitalized with the virus — down from a record of 345 earlier in the month but still far higher

than the state had seen before. Unlike previous waves, the delta surge has hit schools particularly hard, causing some to close down just as the academic year started last month.

Abbott has also banned mask requirements in schools, where many students are not immunized. Children under 12 are not yet eligible for the vaccine.

The severity of the state’s outbreak is a constant in the national and statewide conversations on government-issued public health orders, including mask and vaccine mandates.

Daily death rates

While states that have embraced those directives have seen lower hospitalizations and deaths during this wave, others that have banned or undermined such requirements — including Texas — have borne the brunt of the crisis this summer, experts say.

Florida, for example, is currently seeing an average of 377 COVID deaths a day — about 1.75 people for every 100,000. Texas stands at 284 daily fatalities for a per capita rate of 0.98, according to the New York Times’ coronavirus tracker.

In New York and California, the average daily deaths are 35 and 117, respectively, for per capita rates of 0.18 and 0.3.

In Texas, the seven-day average for deaths peaked in January at 341, according to data from the Johns Hopkins University’s coronavirus resource center.

In part, the lower death rates in New York and California reflect the dramatic surges they faced when COVID first began spreading in the U.S. in early 2020. The scare quickly forced residents to embrace public health measures, and they have maintained that attitude, said Michael Li, a Ph.D. student at the MIT Operations Research Center who has helped project the severity of COVID outbreaks across the nation.

But the current gaps are also attributable to those states’ higher vaccination rates and hospitals that are better equipped to treat the virus, Li said. The governors of both states have embraced masking and vaccines, issuing directives promoting their use or requiring them in certain sectors. They have also allowed local officials to implement their own public health orders as deemed necessary.

Mask use is particularly key, especially for the unvaccinated, as face coverings prevent the spread of respiratory droplets, which carry the virus, experts say.

Abbott lifted the state’s mask mandate in March, when the COVID vaccine first became available to most of the population. He has since banned masking orders outright, and Attorney General Ken Paxton has taken school districts and local governments to court for requiring face coverings.

At the onset of the delta wave, Texas didn’t see a surge in COVID cases, and those who wanted to get the shot rushed to their local pharmacies.

But infections began to creep up again this summer — and then they skyrocketed. Abbott doubled down on the need for personal responsibility and prohibited public entities from requiring that their employees get immunized. Even as the surge began picking up in late July, he canceled an executive order he issued earlier in the pandemic that allowed localities to restrict capacity for businesses in areas where COVID hospitalizations were peaking.

Abbott’s COVID shift

The governor had handled previous outbreaks differently.

When hospitalizations and deaths spiked last winter, Abbott formed surge teams to tamp them down in places including Laredo and Lubbock, was aggressive in touting vaccines on social media, halted nonemergency surgeries in high-hospitalization regions and allowed counties and cities to reduce capacity of stores and restaurants in hard-hit regions.

Through it all, Abbott consistently called on Texans to mask up.

“While vaccines are an important step in the long-term fight against the virus, I encourage Texans to continue to follow the best practices to keep yourself and loved ones safe like wearing a mask and practicing social distancing,” Abbott said Jan. 11.

This time, the governor has shied away from such public statements. He hasn’t held a COVID-related news conference since March, and the majority of his recent news releases on the virus have touted the opening of nearly two dozen antibody infusion centers to treat high-risk COVID patients.

And since Abbott announced that Texas would not issue any more coronavirus mandates, the state has navigated its way through the delta wave with no restrictions for businesses, no mask requirements and no mandates for regions to reduce nonemergency surgeries — though Abbott has requested that hospitals postpone those.

If Texas embraced those precautions on a statewide level, “the number of hospitalizations, cases, the number of deaths would be substantially lower than what it is today,” said Gutiérrez, the UTSA professor.

Like other Republican governors around the nation, Abbott now rarely wears masks in public. Last month, at a political event in Collin County, he was maskless as he interacted with crowds with little social distancing.

Days later, he tested positive for the virus. He credited his vaccination status for his mild case, and in a video statement he encouraged Texans to get the shot.

Asked about his decision to scale back personal mask use, Abbott’s press secretary, Renae Eze, reiterated that Abbott is focused on vaccinations, which are “the best defense against getting COVID or becoming seriously ill.”

“Right now, at the peak of this, when the hospital systems are stressed, we need to be doing all we can to prevent the spread, because every case counts,” said Dr. David Lakey, the vice chancellor for health affairs and chief medical officer at the University of Texas System, who advised Abbott earlier in the pandemic. “You continue to encourage individuals to wear masks in those types of situations.

“Whether the state comes in — I think the argument from the state about not doing that is that everyone knows this information by now, and you have the strong arm of the state doing that versus education. I think people of goodwill are debating that.”

‘A big dose of humility’

So far, about 9,000 people have died of the virus during the state’s delta wave, compared with more than 28,000 in the wave last winter and 14,000 in the first wave that began in summer 2020. While fatalities are still expected to rise in the coming days and weeks, the relatively low number of deaths is the most promising statistic to come out of the delta wave because hospitalizations and case numbers have so closely matched the previous surges.

In his social media posts and public messaging, Abbott has largely emphasized Texas’ progress in combating COVID — noting repeatedly that the positive test rate and hospitalization numbers have dipped in recent weeks.

“People are tired, and people are, at the same time, suffering loss,” Lakey said. “I think all of that has to be understood as we think about how the leader of the state talks about what’s going on in Texas, and wanting to strike that balance of risk communication — so people do the right things to take care of themselves — but also at the same time convey that this is going to end and we are going to go forth as a state.”

But given the novelty of the coronavirus and the multitude of factors contributing to Texas’ COVID statistics, it’s not clear that there’s an easy or simple solution for the pandemic’s continued impact on the Lone Star State. While Texas had a respite from the virus in the spring, the arrival of the highly contagious delta variant offered everyone a “big dose of humility,” Lakey said.

Even with the state’s positive COVID trends, hospital systems are still overwhelmed and will continue to be slammed heading into flu season, Lakey said. Cold weather and the declining effectiveness of the COVID vaccine for those who have already received it may also complicate matters this winter, experts say.

“Come December, January, February — that might be a double crunch in terms of wintertime and vaccine efficacy waning,” said Li, the Ph.D. student at MIT. “I mean, I hope that doesn’t happen. But we have to consider the scenario even if we don’t like it.”