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Texas update

Texas Update 2/4/21

Last night I reported that Texas cases are increasing. We are the only state with an increasing trend right now. I was incredibly curious about this, so I looked into it further…

Cases…are plateauing which is probably explaining the mixed results the past few days. This is NOT the same trend as the rest of the country. We have a state R(T)=0.97. We are decreasing transmission, but barely. And, it looks like we are on the brink of exponentially increasing if we don’t do something about it. Case increases look like they are mainly driven by Trauma Service Area (TSA) H (Lufkin R=1.41); TSA L (Belton/Killeen R=1.39); TSA M (Waco; R=1.48); TSA N (College Station/Bryan R=1.87); TSA O (Austin R= 1.23). TSA J (Midland) is doing the best so far with a R=0.52. Go Midland!

Testing…We define hotspots as a Test Positivity Rate >10% AND more than 100 daily cases per 100,000. 232 counties in Texas (out of 254 counties) are considered hot spots today.

Hospitalizations…are decreasing as a state as a whole. However, there are some areas still doing very poorly. TSA E (DFW), TSA I (El Paso), TSA S (Victoria), and TSA T (Laredo) still have more than 20% of hospitalizations due to COVID19. Laredo has more than 47%!!. The Governor loosens restrictions for areas when this reaches 15% or less. And that’s for overall hospitalizations. ICU rates still look very scary. There isn’t one area in Texas that has below 20% COVID19 cases. The highest is in TSA H (Lufkin) and TSA S (Victoria) with more than 60% of their ICU’s taken up by COVID19.

Stay vigilant, Texas. We do not want this increasing, even more so before the new variants become dominant.

Love, YLE

Data Source: from our dashboard www.texaspandemic.org

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Behaviors National changes Texas update

National (U.S.) Update

Your national (U.S.) update as of Feb 3 at 8:00PM CST


Cases… continue to plummet. There’s no doubt that the 2020 holiday season caused a surge in cases. Which is consistent with what we saw on Memorial Day and July 4. The impact that human behavior, like the 2020 holiday season, has on human life is really quite fascinating. Anyways, our 7-day average is now the same as it was on November 12. Today, 42 states have a decreasing 7-day average of cases and 8 states are plateauing. Only Texas has an increasing 7-day case rate (11%).


Testing…is continuing to plateau, which isn’t necessarily bad. Especially if cases continue to decrease. Because this means that test positivity rate will be decreasing. Which is fantastic. We want TPR<10% (<5% is ideal) to get a handle on transmission.


Hospitalizations….are tanking too. Hospitalization trends follow case trends, so this makes sense. Hospitalizations in 41 states are decreasing, 9 states are plateauing, and 1 states is increasing (Vermont=15%). This is also fantastic news. But, remember, decreasing is relative. They are decreasing from the highest peak we’ve every experienced. Today, 91,440 people were on hospital beds for COVID19. This is still higher than the peak in April (59,779 hospitalizations) and July (59,718 hospitalizations).


Deaths…are increasing but significantly losing momentum. In other words, we should see our peak here soon (if it wasn’t today or yesterday). 27 states have decreasing deaths, 15 states are plateauing, and 9 states are increasing. The highest increase in deaths is Iowa, closely followed by South Carolina. Today 3,685 souls succumbed to COVID19. In one day. We were predicting 500,000 deaths by mid-February. This may be end of February now. TBD.


Vaccinations…are slowly (but surely) starting to gain speed and exponentially increase. Which is huge. We (the U.S.) are administering 9.71 doses per 100 people. In the last week, an average of 1.34 million doses per day were administered. Alaska leads with 13.4 doses administered per 100 people. This is followed by West Virginia (11 per 100) and New Mexico (10.5 per 100). Idaho, you’re last, with administering 6.0 doses per 100 people. (Texas you’re close to the bottom too, at 7.2 per 100 people).

Variants...are gaining speed.-B.1.1.7 variant: Has popped up in 541 Americans across 33 states (Florida has, by far, the most people followed by CA). -B.1.351 variant: Detected in 3 Americans in 2 states-P.1: Detected in 2 Americans in 1 state


We are, quite literally, in a race: vaccination rate vs. variant transmission rate. Hopefully we win before mid-March hits.

Love, YLE


Case data: COVID tracking project

Vaccination data: https://ourworldindata.org/covid-vaccinations

More vaccination data: https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/

Variant data: https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant-cases.html

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National changes Testing Texas update

National Update

Looks like we’ve hit our peak in the U.S.? Unfortunately not yet. We won’t start seeing the “true” holiday impact until mid- January. 

You may remember my post (back in April, I think) showing that test and case numbers are dependent on human behavior. In Texas, for example, daily case counts are much lower on days with a thunderstorm or tornado warning because testing sites close due to inclement weather. Case counts are highest on Tuesdays and lowest on Saturday/Sunday/Mondays. Reporting 7- or 14-day averages takes care of these day-to-day fluctuations. 

The same is true for the holiday season; it’s basically a really long weekend in terms of case and testing numbers. Facilities and labs have been inconsistently open, reporting is delayed, places are catching up, etc. You can see a dip in the graphs, but this is due to human behavior (rather than true reduced transmission). We won’t see the holiday impact until reporting has stabilized. It’s irresponsible to make conclusions from case, test, and death data right now. 

Right now, a much more reliable metric is hospitalizations. Hospitals are open 24/7 and, by now, have rigorous, systematic, and completely separate reporting systems than testing/case data. Because hospitalizations lag cases, we have a pretty good idea of whats been happening with cases behind closed doors. 

Unfortunately, hospitalizations are not looking good. Across the U.S., there are 123,614 COVID19 patients hospitalized right now. This is the highest it’s ever been. 

Not all places are equal though.

The Midwest continues their downward trend. Not one Midwest state reported an increase in hospitalizations since Christmas. 

The South, on the other hand, is responsible for 50% of the country’s hospitalizations. This is mainly driven by the high Texas hospitalizations. Also, the South just has more people than the Midwest or Northeast. 

Texas Hospitalizations by Trauma Service Area (TSA)

After we adjust for population, though, the West and Northeast is in worse shape than the South (but not by much) and closing in on Midwest’s peak. The West’s numbers are mainly due to Southern CA where some hospitals literally (not figuratively) have no more ICU beds.

The way we “define” hospitalizations is also changing compared to the beginning of the pandemic. The threshold for sending someone home is much lower than in the past. For example, some hospitals will send someone home with a 90% O2 level, which wouldn’t have happened prior to the pandemic or in the past few months when hospitals had beds. So, in reality, the hospitalization numbers are underestimated compared to hospitalization rates in the past. 

Nonetheless, hospitalization is the best metric we have right now. Continue to keep an eye on this number until other metrics stabilize.

Love, YLE

Data Source: Covid Tracking Project, which never ceases to amaze me with their clean, state-level data. And our dashboard at www.texaspandemic.com

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Texas update Vaccine

Phase 1B opened in Texas

Texans….Phase 1B has opened.

So, if you’re in this category, you can now get the COVID-19 vaccine (depending on local availability):

• People 65 years of age and older

• People 16 years of age and older with at least one chronic medical condition, such as but not limited to:

• Cancer• Chronic kidney disease• COPD (chronic obstructive pulmonary disease)• Heart conditions, such as heart failure, coronary artery disease or cardiomyopathies• Solid organ transplantation• Obesity and severe obesity (body mass index of 30 kg/m2 or higher)• Pregnancy• Sickle cell disease• Type 2 diabetes mellitus

Here is the map of vaccine providers: https://txdshs.maps.arcgis.com/…/webappvi…/index.html…

This week 380,000 doses (175,100 Moderna and 81,900 Pfizer) were sent to Texas providers in 199 counties. This obviously doesn’t cover every Texan in Phase 1B. Be patient. Some providers may not have vaccines available yet. Vaccine supply is limited but providers receive more vaccines each week.

Update: As of 4pm today, 204,463 Texans have gotten their first dose!

Love, YLE

For more, check out the DSHS website here: https://www.dshs.texas.gov/coron…/immunize/vaccine.aspx…

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Deaths FL Hospitalizations National changes Social Distancing Testing Texas update

Thanksgiving Surge?

It’s been 2 weeks since Thanksgiving and I was curious if we had a “surge upon a surge”.

In other words, did our acceleration (the rate of cases) change after Thanksgiving? Unfortunately, it’s a very simple question with a very complicated answer. If this blog were my day job, I could statistically figure this out. But it’s not, so I triangulated a few other data sources instead. This is what I found…

TEST POSITIVE RATE (TPR)

TPR is now 20.3% in the United States. It increased 15% since Thanksgiving. TPR is particularly concerning in the Southeast, where it’s increasing at higher rates since Thanksgiving than the rest of the country. While the Midwest finally seems to be moving past their peaks, their TPR’s are increasing again (likely related to Thanksgiving), which will slow their decline. The WHO has stated that countries need a TPR below 5%. While testing does not have a direct benefit because there is no cure, there are a number of indirect benefits: 1) public health officials know the “true” rate of infection and can deploy resources to the right areas to stop spread; 2) psychologically if someone tests positive then they are more likely to quarantine (hopefully).

CASES

Cases have increased 21% since Thanksgiving. Cases increased 22% two weeks before Thanksgiving. New hot spots have popped up since Thanksgiving, particularly along the Sun Belt (southern CA, AZ, TX) and the Northeast. Boston, in particular, has surpassed 100 daily cases per 100,000. And while Vermont and Maine have been more than impressive this entire pandemic, they too are seeing doubling rates.

HOSPITALIZATIONS/DEATHS

Not enough time has passed since Thanksgiving to see the impact on hospitalizations/deaths. But there is no reason to believe they will not continue to mirror case trends. Fatality rate (number dead out of the number with positive COVID19 tests) continues to remain steady in the United States at ~1.9%. We should continue to see this, unless out health systems are strained too much. Then hospitals will have to start making hard decisions on who to save and who not to save. In April, Italy had to make these decisions (they decided not to treat those 80+ years) and fatality rate increased.

MOBILITY

  1. Airports. The CHOP Policy Lab found circumstantial evidence that the most concerning areas of the country post-Thanksgiving are adjacent to our busiest airports: Los Angeles, Boston, DC, Atlanta, and Dallas. In other words, Thanksgiving air travel led to increased local transmission. For example, in Clayton County, Georgia (home to the Delta Hub and Atlanta airport), cases are doubling compared to surrounding counties.
  2. Distance Traveled. Interestingly, distance traveled did not change, on average, by much. We see an increase right before Thanksgiving, but honestly not as high as I would have expected. This only means people, on average, didn’t travel far. This doesn’t mean that family wasn’t close by and people didn’t get together. It was also very obvious that distance traveled varied by states too (see Figures). Wish I had more time to look into this. But still adds a little piece to the puzzle.

Conclusion: Right before Thanksgiving we were starting to see a plateau in cases. Then, after data reporting caught up, our cases continued exponentially increasing after Thanksgiving. So, I don’t think we saw a surge upon a surge. But we definitely didn’t stop our original surge. The pandemic continues to ravage our communities across the United States.

Love, YLE

Data Sources: I triangulated many sources of data for this report. I couldn’t have done it without the beautifully clean and workable data and graphs from the following sites:

COVID19 Tracking Project: https://covidtracking.com/data

CHOP Policy Lab: https://policylab.chop.edu/covid-lab-mapping-covid-19-your-community

UnaCast: https://www.unacast.com/covid19/social-distancing-scoreboard

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Texas update Vaccine

TX vaccine update

Texas! 1.4 million doses of vaccines will be here on Dec 14. Let’s goooo!!

Phase 1, tier A

1. Hospital staff working directly with covid19 patients

2. Long-term care staff working directly with vulnerable residents.

3. EMS providers who engage in 9-1-1 emergency services

4. Home health care workers

Phase 1, Tier B will be:

1. Staff in outpatient care offices who interact with symptomatic patients.

2. Direct care staff in freestanding emergency medical care facilities and urgent care clinics

3. Community pharmacy staff

4. Public health and emergency response staff directly involved in administration of COVID testing and vaccinations

5. Last responders who provide mortuary or death services to decedents with COVID-19.

6. School nurses

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Texas update

Texas status report…

…and our “baseline” before the holidays.

Texas has a rate of 37 daily new cases per 100,000. This is considered “uncontrollable spread” and ranks us 37th in the country.

Our case count is now higher than cases back in July. Our R(t)= 1.12, so cases will continue to increase at an exponential rate. R(t) has remained fairly steady for the past month (we want this to decrease). Houston cases have increased by 510% in the past week. But this isn’t close to the highest…Crockett cases have increased 1200%, Trinity 900% & Jeff Davis 800%.

Hospitalizations continue to exponentially increase. ICU’s are at 100% capacity in Abilene and Laredo. We are close to ICU capacity (5% beds left) in Amarillo, Waco, and College Station. General hospitalizations are high in Dallas/Fort Worth, with only 10% of overall capacity available. This means DFW hospitals have started opening surge units.

Testing is unacceptable (>40% test positivity rate) in 13 counties: Armstrong, Bailey, Briscoe, Collingsworth, Deaf Smith, Hall, Hockley, Hutchinson, Motley, Parmer, Reagan, Swisher, and Wheeler.

Interestingly mobility has not changed in the past month, despite the spike in cases. People are continuing to travel to non-essential businesses.

El Paso is continuing to do a great job bringing down their curve. With an R(t)=0.75, this will continue to decrease (as long as people keep behaviors up). We hopefully saw their peak.

When the first wave of vaccines are sent to Texas (maybe December?), DSHS has decided to give the following people first dibs (considered phase 1, tier A):

1. Hospital staff working directly with covid19 patients

2. Long-term care staff working directly with vulnerable residents.

3. EMS providers who engage in 9-1-1 emergency services

4. Home health care workers

Phase 1, Tier B will be:

1. Staff in outpatient care offices who interact with symptomatic patients.

2. Direct care staff in freestanding emergency medical care facilities and urgent care clinics

3. Community pharmacy staff

4. Public health and emergency response staff directly involved in administration of COVID testing and vaccinations

5. Last responders who provide mortuary or death services to decedents with COVID-19.

6. School nurses

Love, YLE

Data Source: Our dashboard at www.texaspandemic.orgMore on Texas vaccine allocation plans: https://www.dshs.texas.gov/…/COVID_Vaccine_Principles…

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Texas update

Congratulations Texas

We are the first state to reach 1,000,000 COVID19 cases. Here is a quick report of the current status of our state…

We just moved into the “red” tipping point zone with 25.7 daily cases per 100,000. Transmission is accelerating (state R(t)=1.13) and hospitals are strained.

As of this morning, there are particularly worrisome areas (for their own reasons, see below)…

El Paso (TSA [Trauma Service Area] I)

  • One of the worst hotspots in the nation
  • 123.1 daily new cases per 100,000
  • Test Positivity Rate: 24%
  • Hospitalization: 45% COVID19 patients
  • ICU: 63% COVID19 patients
  • R(t)=1.16

Amarillo (TSA A)

  • Cases are increasing the fastest in the state (increase 162% in one week)
  • 77 daily new cases per 100,000
  • Test Positivity Rate: 16%
  • Hospitalization: 35% COVID19 patients
  • ICU: 70% COVID19 patients
  • R(t)=1.79

Lubbock (TSA B)

  • 85 daily new cases per 100,000
  • Test Positivity Rate: 16%
  • Hospitalization: 23% COVID19 patients
  • ICU: 22% COVID19 patients
  • R(t)=1.12

Others areas to look out for:

  • Waco (TSA M) increasing at alarming rates (60% increase in past week)
  • Victoria (TSA S) increasing at alarming rates (44% increase in past week)
  • Wichita Falls (TSA C) ICU is 53% COVID19 patients
  • There are 13 counties with a TPR > 30%: Andrews, Bailey, Childress, Coke, Cottle, Fisher, Hall, Hansford, Haskel, Hutchinson, Parmer, Sutton and Terry

Love, YLE

Data Sources: www.texaspandemic.org and Harvard COVID19 suppression

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Dashboard Texas update

Dashboard Update 3.0

Texans…

For those of you that haven’t noticed, we updated the www.texaspandemic.org dashboard!

On top of hotspots, trends, hospitalization rates, testing rates, fatalities, and case demographics, we now have added….

Hot spots based on test positive rate (TPR) AND new cases per day. The combination of these two metrics are being used to drive school-, county-, and state- level policy (we hope). Essentially, you want a county to be in the green for BOTH. If a county is in the red for either, we are in trouble in regards to COVID19 spread.

We also included mobility data per county. Using mobile phone data, we can see how movement to work, parks, grocery stores, and to non-essential stores have changed over time. And, as always, we include interpretations in there for you too.

Enjoy!

Love, YLE

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Texas update

Texas Update

Here is an update for my Texans. Haven’t done one in the while.

How’s it looking? Well……..not good. In fact, four out of the five NATIONAL hot spots are located within the great state of Texas.

Here are the overall state numbers (see Figures for regions):
New daily case rate (we need this below 9 to control spread): 23 daily cases per 100,000
Test Positive Rate (we want this well below 10%): Over 15%
Deaths: 32 cumulative deaths per 100,000
Case Fatality Rate (CFR): 3.17%
R(t) (we want below 1.0): 0.90, which means new cases should start decreasing at a faster rate. But in order for this to happen, we need to be testing much, much more too. We will see where this takes us.

I don’t even know what to say other than… It’s really exhausting to be an epidemiologist in Texas.

We need to get it together faster. We know what to do.

For more numbers and data, go to our dashboard at: www.texaspandemic.org

Love, your local epidemiologist

Data Source: DSHS, analysis and tables by me.
CFR=22-day lag; New daily cases= 7-day moving average; TPR= 7 day lag (if you know you know)