Last week, an exhausted Dr. Joel Hendryx, chief medical officer of University Medical Center of El Paso, was overseeing the conversion of the hospital’s fourth floor into a COVID-19 ward. With the city’s recent deadly spike in coronavirus infections, the number of COVID patients at the hospital had grown from 30 at the end of September to 230. Every available bed was full, and the hospital was setting up tents on its campus to house some patients, as well as transferring others to a makeshift fifty-bed unit at the city’s convention center. Asked how his team of doctors and nurses was handling the strain, Hendryx took a long pause.
“You know, people are quiet,” he said. “People have their own systems of how they deal with the stress. They’re professional, they work through it, but it is trying, knowing that it’s day after day. They see the numbers keep going up and wonder why people aren’t taking a little better care so they don’t transmit the virus.”
Over the last two weeks, the number of active COVID-19 cases in El Paso County has grown exponentially, from 7,000 to nearly 28,000. El Paso is a hot spot, but cases and hospitalizations are rising across Texas. This renewed surge has pushed the state’s coronavirus statistics past an unfortunate milestone. Texas has seen more than one million confirmed cases of the disease. As of Wednesday morning, Johns Hopkins University data placed confirmed cases at 1,010,364, though the state health department count remains a little lower. That’s the most of any state and more than all but only nine nations in the world.
Texas reached this unfortunate distinction, several experts told me, through a combination of policy and personal decision-making. The future course of the pandemic in the state is likewise up to Texans to determine through their collective actions during the critical months to come. Texas has done enough to put itself in the middle of the pack in terms of cases per capita—twenty-first among the fifty states. Yet Texas’s response also has clearly been lacking compared with the likes of California, which has seen fewer COVID-19 cases despite being home to more than 10 million more people.
Texas waited until July 3 to issue a statewide mask order, two weeks later than California. In one June survey, 64 percent of Texans said they always or often wore a mask in public, compared with 84 percent of Californians. But more recent, albeit regional, numbers suggest the gap is closing. A Pew Research Center survey from early August showed 85 percent of people in the West South Central region (Texas, Oklahoma, Arkansas, and Louisiana) wore masks all or most of the time while inside stores or other businesses, up 27 percentage points from early June. The Pacific region (California, Oregon, Washington, Alaska, and Hawaii) was already at 75 percent mask compliance in June, and by August had increased to 92 percent. Texas also pushed more aggressively than California to reopen businesses following the temporary shutdowns of the spring. California, for instance, didn’t allow any indoor dining until late August (compared with May 1 in Texas), and even then it was restricted to counties where infections had slowed.
“We don’t spend, at the health department, a lot of time looking at those state-to-state comparisons,” says Chris Van Deusen, a spokesperson for the Texas Department of State Health Services. “What’s most instructive to us is comparing where we are now to where we’ve been, where we think we may be going as we look at the trends over time.”
After summer brought a surge of cases, each of Texas’s most populous counties managed to regain some measure of control over the pandemic and saw confirmed infection levels decline. Dr. David Callender, president and CEO of Memorial Hermann Health System in Houston, attributes that leveling off to people “feeling the presence of the virus and taking precautions when they feel they might be at a higher level of risk.”
Travis, Harris, and Bexar counties currently have rates below 14 cases per 100,000 people, although Dallas County has ticked back up to 38 per 100,000. (For now, at least with respect to hospital capacity, North Texas is still a “slow burn,” says Steve Love, CEO of the DFW Hospital Council.) El Paso sits at a worrying 222 cases per 100,000 people. (There’s no single, satisfying reason for El Paso’s greater spike compared with the rest of Texas. A number of factors likely are involved.) With the seven-day average reaching 8,662 cases Monday, the statewide totals are almost double what they were a month ago.
Lauren Ancel Meyers, a mathematical epidemiologist at the University of Texas at Austin who leads a team that models the potential spread of the disease and advises policy makers, says that Amarillo, Abilene, El Paso, and Bryan–College Station have reached, or almost reached, their estimated ICU capacities. Yet there are a few encouraging data points in Meyers’s tracking of the spread in those communities. The average number of people in El Paso to catch the virus from each infected person—the so-called reproduction rate—seems to have peaked at 1.75 in the first half of October but has now fallen below 1. If that rate were sustained, the number of infected El Pasoans would steadily fall. Meyers sees signs of slowing but cautions that considerable uncertainty remains.
“How this virus spreads, or how quickly it spreads, and whether we end up in these very precarious situations, really is under our control as policy makers and as individuals in a community,” Meyers says. She emphasizes low-cost measures like wearing a mask and physical distancing, and cautions that getting together indoors for food and drink remains risky.
Monday brought good vaccine news, as pharmaceutical company Pfizer announced that its coronavirus trial vaccine was more than 90 percent effective in preventing COVID-19. Though it could be available to some frontline workers and vulnerable patients by the end of the year, significant logistical hurdles remain in producing and distributing enough of the vaccine (and others similarly on track for FDA approval) for all Americans.
It’s worth noting that, though still deadly, COVID-19 does not pose the same measure of threat today that it did back in early April, when it killed almost a thousand patients a day in New York City. Memorial Hermann’s Callender says that improvements in treatments have had significant effects. “If you look at our length of stay associated with coming into the hospital with moderate or even a severe case, those have been cut dramatically,” he says. Mortality rates, too, are down, Callender says. One study of patient mortality in New York found patients were 18 percent less likely to die in August compared with March.
But all of that likely brings little solace to El Paso, which just yesterday called for an additional four mobile morgues. The county is seeing about nine COVID-19 deaths a day, and County Judge Ricardo Samaniego fears that number could increase to as many as twenty.
The long-term forecast is tough to predict. Factor in the upcoming winter—and with it, the flu season, holiday get-togethers, and cold weather pushing us indoors—and these next few months could spell danger for Texas (as with all of the United States). Experts hope enough of us will observe social distancing and wear masks long enough for a vaccine to establish herd immunity in the general population. Of course, there’s no guarantee that a vaccine will provide permanent protection. It could, however, still play an important role in further reducing the severity of symptoms even among the most vulnerable.
This story was updated to reflect Texas surpassing the one-million case mark as of November 11, 2020.