TEXAS HOSPITALIZATION CRISIS POINT
Barring swift and resolute action, Texas is facing what amounts to be a mass casualty event unprecedented in its history
"The total number of people hospitalized for COVID-19 in North Texas is expected to substantially increase over the next several weeks. Critically, the current pace of hospitalization growth could put Dallas and Tarrant Counties above January surge levels before September, placing increased stress on the collective capacity of regional health systems. Hospital volumes have risen 99 percent over the past two weeks and 327 percent over the past month. At the current pace of vaccinations, levels of hospitalization will far exceed past records as we enter the fall."
"The predicted increases are due to high levels of transmission as well as climbing hospitalization rates. This is likely attributable to the increasing prevalence of the highly transmissible Delta variant, which now represents over 90 percent of all positive test samples at UT Southwestern and has been linked to more severe disease in some studies. The increasing number of new cases of COVID-19 and subsequent hospitalizations also reflects the large numbers of individuals who are not yet vaccinated and therefore particularly susceptible to infection."
-COVID-19 Current State Analysis and Forecasting for the DFW Region, UT Southwestern Medical Center at Dallas, 04 August 2021
High resolution version of today’s graphic:
https://drive.google.com/file/d/1E4bplFC1g6IPE00Vt4yKYVdfVtDwAGEB/view?usp=sharing
BACKGROUND
All y'all know this story already.
Little to no pandemic mitigation measures. Gubernatorial action banning mask mandates. Highly contagious Delta variant in the community. Test positive rates, community prevalence increasing. Vaccination rates not high enough. School is about to start, some districts have started already.
Hospitals are already filling up across the state with COVID cases.
Let's get on with the data.
DATA SOURCES FOR TODAY
The top half of the graphic comes from the University of Texas COVID-19 Modeling Consortium forecast page. Can see their pandemic forecasts for the whole state of Texas (as I have done here) or by Trauma Service Areas (TSAs) which are based around metropolitan areas of the state. Check it out for yourself here: https://covid-19.tacc.utexas.edu/dashboards/texas/
The lower half of today’s graphic comes from the pandemic dashboard for the University of Texas Houston School of Public Health, www.texaspandemic.org. If you go to the "Hospitalizations" section of their page, at the bottom half of the page it breaks down ICU utilization and hospitalizations by Trauma Service Area (TSAs) again.
This is a map of the Trauma Service Areas and which counties fall in which TSA: https://www.dshs.texas.gov/emstraumasystems/TSA_CountyList2010_RAC.pdf
I cross checked UT Austin's data against UT Southwestern's forecast modeling data and they're in close agreement overall. You can review UT Southwestern's latest forecast data here: https://www.utsouthwestern.edu/covid-19/about-virus-and-testing/forecasting-model.html
HOSPITALIZATION AND ICU FORECASTS FROM THE UT AUSTIN COVID-19 MODELING CONSORTIUM
I've been following UT Austin's Modeling Consortium since the start of the pandemic and have found their work to be solid and of much use in determining the pandemic trajectory. The two plots here are for both daily hospitalizations and daily ICU patients in Texas- green plot is historical data and then it shows several model runs going to Labor Day weekend.
I have listed three forecasts for each plot- the worst case scenario, the best case scenario, and the median case scenario. Think of the best case and worst case as the 95% confidence intervals for the median case. Think of the median case as like the most likely outcome but that can fall anywhere within the 95% confidence interval range.
These outcomes are based on current trends (as in societal behavior) remain as they are- no mask mandates, 100% in-person schooling, lower than desired vaccination rates, and no social distancing or capacity restrictions on public spaces.
I have also included what is currently available and that's from official State of Texas numbers.
DAILY COVID HOSPITALIZATIONS IN TEXAS
We currently have 8,093 available hospital beds across the entire State of Texas. Assuming no changes in what we are doing *now* in terms of pandemic mitigation, the number of hospitalized COVID patients in Texas by Labor Day weekend could range from as low as 23,268 to as high as 48,058 patients.
And that's for 8,093 currently available hospital beds.
Yes, we could probably do surge capacity but where do get more physicians and nurses to staff those beds? Trained personnel is the bottle neck in hospital bed capacity.
DAILY COVID ICU PATIENTS IN TEXAS
We currenlty have 439 ICU beds across the entire State of Texas and by official number, 6,991 ventilators. Assuming no changes in what we are doing *now* in terms of pandemic mitigation, the number of COVID ICU patients in Texas by Labor Day weekend could range from as low as 6,281 to as high as 12,972 patients.
AND THAT IS FOR JUST 439 AVAILABLE ICU BEDS. IN THE WHOLE STATE OF TEXAS.
Not every ICU patient will need a ventilator. Early in the pandemic, about 75% of patients admitted to an ICU for COVID needed a ventilator. Thanks to what we now know about treating serious infection, that percentage is now about 50% of ICU patients will need mechanical ventilation.
CURRENT ICU AND HOSPITAL BED MARGINS IN TEXAS
The lower graph comes from the University of Texas Houston School of Public Health and shows the occupancy in ICUs across Texas by trauma service area (TSA) as well as occupancy in regular hospital beds. The fraction occupied by COVID patients is shown as well.
I have added a redline to show the 10% margin. In watching this data over the course of this pandemic, that's roughly where margin can easily be eaten up inside of 24 hours by a surge in COVID admissions.
In terms of ICU margins, the most critical TSAs are the following:
Laredo 0%
Bryan/College Station 2%
Houston 3%
Galveston 4%
Austin 4%
Dallas/Fort Worth 5%
Abilene 7%
Killeen 7%
Wichita Falls 8%
San Antonio 8%
Lubbock 9%
Amarillo 10%
In terms of general hospital bed margins, the most critical TSAs are the following:
Laredo 2%
Dallas/Fort Worth 9%
Houston 9%
Killeen 9%
San Antonio 10%
TAKE HOME MESSAGES
1/ Hospitalizations are lagging indicator. What hospitalizations look like NOW is a reflection of the pandemic environment 3-4 weeks ago. What we do NOW as a state will influence hospitalizations and ICU admissions in the days around Labor Day weekend.
2/ In the absence of swift, broad ranging intervention, we will face a hospitalization and ICU crunch unprecedented in our state's history. It will be a mass casualty event of the highest order. I have never seen the numbers this bad, even during the holiday surge that stretched from the end of October 2020 well into January of this year.
3/ Keep in mind we need ICU beds for things like car accidents, heart attacks and strokes, diabetic complications, victims of violence and accidental injuries. Where should we send them when the need for ICU beds due to COVID is outstripping what is available SIXTEEN TO THIRTY TIMES OVER?
4/ The medical and scientific community has made repeated warnings about the Delta variant's impact with schools in Texas going 100% in-person with no mask mandates. That would be throwing gasoline on this fire. Pediatric hospitalizations are on the increase to historic levels nationwide. The mutations in the genetic code for the Delta variant make it a clear and present danger to those who choose to not be vaccinated and those who are too young to be vaccinated.
5/ What we learned about schools as transmission vectors for COVID last year DOES NOT APPLY THIS YEAR. The Delta variant has changed that game and our assumptions from last year are going to be overturned in the worst possible way if they are not abandoned by school boards across Texas quickly.
PARTING THOUGHTS
Is there a way out?
Yes.
But do our communities, our school boards, our elected officials possess the moral fortitude to take swift and bold action?
If we continue our current course, this forecast is will be our Labor Day weekend.
If we return to what we did from October 2020 to June 2021 with mask mandates, social distancing and capacity restrictions, virtual learning options in our schools, then this hospitalization crisis coming could potentially be less than we experience during the holiday surge.
Especially if we can get more people vaccinated.
Do we as a state possess such moral courage?
PAST PANDEMIC POSTS
SCHOOLS AND COVID RISK: DFW METROPLEX (06 August 2021):
https://www.facebook.com/jp.j.santiago/posts/10219288099490212
COVID TRENDS: TEXAS (03 August 2021):
https://www.facebook.com/jp.j.santiago/posts/10219275998347691
NEW VARIANT OF CONCERN: AY.3 (DELTA SUBVARIANT) (22 July 2021): https://www.facebook.com/jp.j.santiago/posts/10219219371852064
HE SAID WHAT? A WARNING FOR THE UNITED STATES (12 July 2021): https://www.facebook.com/1141591254/posts/10219175207947994
WHERE IS THE DELTA VARIANT SURGING? (11 July 2021):
https://www.facebook.com/1141591254/posts/10219170740476310
COVID VARIANTS TABLE UPDATE (30 June 2021):
https://www.facebook.com/jp.j.santiago/posts/10219119070944604
MAYO CLINIC GRAND ROUNDS: VACCINES AND VARIANTS (14 June 2021):
https://www.facebook.com/jp.j.santiago/posts/10219031846404045
THE MOLECULAR BIOLOGY OF THE E484K MUTATION (10 May 2021):
https://www.facebook.com/jp.j.santiago/posts/10218832046529173
IMMUNOLOGY 101: THE IMMUNE SYSTEM- REPOST/UPDATE (05 May 2021):
https://www.facebook.com/jp.j.santiago/posts/10218801066954703
COVID VARIANTS OVERVIEW AND UPDATE (22 April 2021):
https://www.facebook.com/jp.j.santiago/posts/10218722676514991
NEW COVID VARIANT OF INTEREST: B.1.617 (18 April 2021):
https://www.facebook.com/jp.j.santiago/posts/10218699298170547
CASE SURGES CAN RESULT IN COVID VARIANTS (12 April 2021):
https://www.facebook.com/jp.j.santiago/posts/10218657527966318
THE OVERVIEW & STATUS OF COVID VARIANTS (9 April 2021):
https://www.facebook.com/jp.j.santiago/posts/10218637120816152
QUICK UPDATE: THE COVID FAMILY TREE (01 February 2021):
https://www.facebook.com/jp.j.santiago/posts/10218211054244754
COVID MUTANTS: VARIANTS OF CONCERN (31 January 2021):
https://www.facebook.com/jp.j.santiago/posts/10218204381877949
COVID MOLECULAR BIOLOGY: THE SPIKE (6 January 2021):
https://www.facebook.com/jp.j.santiago/posts/10218019683340601