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Texas COVID hospitalizations drop to lowest levels since early July

As hospitalizations increased dramatically in June and July, Abbott issued a statewide mandate requiring most Texans to wear a mask in public spaces.
Credit: Methodist Katy
When Methodist Hospital in Katy set up a new Highly Infectious Disease Unit to treat coronavirus patients, they asked for volunteers to staff it. Doctors, nurses and therapists from all over the hospital answered the call to care for sometimes dying patients.

TEXAS, USA — The Texas Tribune is using data from the Texas Department of State Health Services to track how many people have tested positive for the novel coronavirus in Texas each day. 

The state data comes from 57 city and county health departments, about 600 hospitals and 340 laboratories and the state vital records registration. It may not represent all cases of the disease given limited testing.

In order to publish data quickly, the state has to bypass what is normally a months-long process of reviewing the COVID-19 data and performing quality checks before publishing. That’s why all of these numbers and information are provisional and subject to change.

Under Gov. Greg Abbott’s plan to revive the economy, businesses started reopening in May. But he paused further reopening plans and scaled back others in June, telling one TV station he regretted reopening bars too quickly.

As hospitalizations increased dramatically in June and July, Abbott issued a statewide mandate requiring most Texans to wear a mask in public spaces, which experts say may have led to a plateauing of cases and hospitalization levels. Abbott has said he hopes Texans wearing masks will slow the spread of the virus significantly enough to avoid a state shutdown.

    

What you should know:

  • 7,437 Texans are in the hospital for the coronavirus as of Aug. 91,173 less than a week ago. They occupy 13.7% of hospital beds.
  • 4,879 new cases were reported on Aug. 9. There were 13,786 viral tests reported on Aug. 8. That made the positivity rate — the percentage of positive cases to viral tests conducted over seven days — 20.3%.
  • 8,459 Texans have died as of Aug. 9116 more deaths reported than the day before and 1,480 more than a week ago.
  • From July 23 to July 28, between 9% and 18% of hospitals reported incomplete hospitalization numbers due to changes in reporting to meet federal requirements. As of July 29, 5% of hospitals are reporting incomplete data, which falls within what the state says is the typical range of incomplete data.
  • Abbott said local health authorities can shut down schools if there’s evidence of an outbreak after students have returned to campus — but cannot shut them down before schools open.

Where are most of the cases in Texas?

On March 4, DSHS reported Texas’ first positive case of the coronavirus, in Fort Bend County. The patient had recently traveled abroad. A month later on April 4, there were 6,110 cases in 151 counties. As of Aug. 9, there are 486,362 cases in 250 counties. 

How many people are in the hospital?

On April 6, the state started reporting the number of patients with positive tests who are hospitalized. It was 1,153 that day and 7,437 on Aug. 9. This data does not account for people who are hospitalized but have not gotten a positive test.

From July 23 to July 28, between 9% and 18% of hospitals reported incomplete hospitalization numbers due to changes in reporting to meet federal requirements.

Experts say there’s a lag before changes in people’s behaviors, like more social interaction, are reflected in coronavirus case data. It takes about nine to 16 days to see increased infections and generally another five to seven days to see changes in the numbers of people hospitalized, said Rebecca Fischer, an infectious disease epidemiologist at the Texas A&M University School of Public Health. (Some individuals are only diagnosed once they make it to the hospital.)

On Aug. 9, the state reported 11,749 available staffed hospital beds, including 1,123 available staffed ICU beds statewide. COVID-19 patients currently occupy 13.7% of total hospital beds. In late April, Abbott ordered hospitals to reserve 15% of beds for COVID-19 patients.

According to DSHS, these numbers do not include beds at psychiatric hospitals or other psychiatric facilities. They do include psychiatric and pediatric beds at general hospitals, and pediatric beds at children’s hospitals.

Regional differences exist in the availability of beds — some hospital officials have reported that intensive care units are near or over capacity. In the Rio Grande Valley, the increases have stretched hospital staff, while in Houston some hospitals have had to turn away patients because of overcrowded emergency rooms.

“One of the most critical measures of the ferocity of the COVID virus is the use of intensive care unit beds,” said Britt Berrett, a healthcare management professor at the University of Texas at Dallas. “Healthcare professionals will need to be vigilant in monitoring the time it takes from diagnosis in the emergency room to treatment and admission into the ICU bed.”

How many people have died?

The first death linked to the coronavirus in Texas occurred March 16 in Matagorda County. As of Aug. 9, 8,459 people who tested positive for the virus have died.

The rate of deaths in Texas has been accelerating. It took 53 days to get from the first death to 1,000 deaths and 39 days to get from 1,000 to 2,000 deaths. On July 10, the state surpassed 3,000 deaths — 24 days after 2,000 deaths were reported. It took only 10 more days for Texas to reach 4,000 deaths and only 6 days after that to reach 5,000.

Experts say the official state death toll is likely an undercount.

On July 27, DSHS began reporting deaths based on death certificates that state the cause of death as COVID-19, instead of relying on counts released by local and regional health departments. On that date, the state added more than 400 previously unreported deaths to the cumulative total. This does not include the deaths of people with COVID-19 who died of an unrelated cause. Death certificates are required by law to be filed within 10 days.

How have the number of cases increased each day?

On March 24, the Texas Department of State Health Services changed its reporting system to track case counts directly from counties instead of relying on official case forms, which came in later and caused the state’s official count to lag behind other tallies.

The state only tracks confirmed cases of the coronavirus, not probable cases, based on criteria published by the Centers for Disease Control and Prevention. However, DSHS may still accidentally include probable cases for certain counties.

Because the state does not include probable cases, these numbers don’t include the results from tens of thousands of rapid-result antigen tests, which suggests the state is vastly underreporting the number of Texans who have tested positive for the virus. Antigen tests are taken by nasal or throat swab like other tests, but results are much faster.

Increases in testing have led to more detected cases. In May, a large one-day spike was reported after testing was done at meatpacking plants in the Amarillo region. Delays and backlogs in reporting can also create one-day surges, when cases from multiple days are added on the same day.

In June, the number of new cases each day trended dramatically upwards, before dropping in late July. Abbott issued his mask order on July 2.

How has the positivity rate changed?

Gov. Greg Abbott said he is watching the state's positivity rate — the percentage of positive cases to tests conducted. The average daily positivity rate is calculated by dividing the seven-day average of positive cases by the seven-day average of tests conducted. This shows how the situation has changed over time by de-emphasizing daily swings. Public health experts want the average positivity rate to remain below 6%.

In early May, Abbott said a rate over 10% would be a “warning flag.” The state exceeded that mark in June for the first time since April.

The positivity rate differs from the infection rate. In order to obtain an infection rate, everybody would need to be tested, said Hongwei Zhao, an epidemiology professor at the Texas A&M University School of Public Health.

How many people have been tested?

As of Aug. 9, Texas has administered 4,379,446 tests for the coronavirus since March. Expert opinions differ on how much larger that figure needs to be. We do not know the number of Texans who have gotten a test because some people are tested more than once. Tests from private labs, which make up the majority of reported tests, are not deduplicated. The state’s tally also does not include pending tests.

On August 7, DSHS started breaking viral tests out into molecular and antigen tests on their site. 

The DSHS data also might not include all of the tests that have been run in Texas. The state has said it is not getting test data from every private lab, and as of mid-May only 3% of tests were coming from public labs. The state has since stopped differentiating between tests reported by public and private labs.

Even as demand for testing has increased, both public and private labs continue to prioritize Texans who meet certain criteria, but every private lab sets its own criteria.

On May 21, DSHS disclosed for the first time that as of a day earlier, it had counted 49,313 antibody tests as part of its "Total Tests" tally. That represents 6.4% of the 770,241 total tests that the state had reported on May 20. Health experts have warned against counting antibody and standard viral tests together because they are distinctly different tests. Antibody tests detect whether someone was previously infected, while standard viral tests determine whether someone currently has the virus.

Antibody tests are typically reported a day late.

How is this impacting Texans of color?

The limited data released by state health officials offers a murky glimpse of the virus' impact on Texas communities of color. Race and ethnicity are reported as unknown for a significant portion of the completed case reports. (Agency officials said some people prefer not to provide the information.)

On July 27, the state released complete demographic data, including race and ethnicity, for coronavirus deaths after changing its method for counting deaths to rely on death certificates. The data shows that Hispanic Texans make up roughly 48% of the total deaths, but only 40% of the state’s population.

Case data gathered various parts of the state shows the disproportionate impact of the virus on Black and Hispanic neighborhoods. The areas with the highest positivity rates in Harris County are predominantly Hispanic, according to a UTHealth School of Public Health analysis. In Dallas County, lower-income Black communities have also reported some of the highest positivity rates.

Although state leaders acknowledge the demographic data for cases and tests is lacking, they have indicated the state won't be taking steps to mandate reporting to fill in the gaps. In June, the state announced they are planning on ramping up testing in areas of the state that are predominantly Black and Hispanic, as well as launching a study on the coronavirus’ effect on vulnerable populations.

What else should I know about this data?

These numbers come from the Texas Department of State Health Services, which updates statewide case counts by 4 p.m. each day. The data is from the same morning, and it may lag behind other local news reports.

The state’s data includes cases from federal immigration detention centers, federal prisons and starting in mid-May, some state prisons. It does not include cases reported at military bases.

From March 13 through March 24, the Tribune added cases from Lackland Air Force Base in San Antonio, where hundreds of American evacuees from China and cruise ships were quarantined. Those case counts came from the Centers for Disease Control and Prevention.

Notes about the data:

On March 24, the state changed how it reported numbers resulting in a sharp increase in cases.

Antibody tests were included in the new total tests counts for each day before May 14. Previously, the state had counted about 50,000 total antibody tests as virus tests, artificially deflating the positivity rate.

After a system upgrade on June 7 resulting in incomplete test data, the state revised the test numbers for June 6 to show a decrease in total viral tests. As a result, the daily positivity rate for June 6 was incalculable because there were no new viral tests reported.

On June 16, the state included 1,476 cases previously reported by the Texas Department of Criminal Justice from Anderson and Brazoria County in its cumulative case count. The new cases for June 16 do not include those cases.

On July 17, the state received about 5,268 additional cases from Bexar County. The state only included 608 of those cases as new confirmed cases for that day and added the rest to the cumulative count.

On July 19, the state removed 3,676 duplicate antibody tests from the previous day’s total.

From July 23 to July 28, between 9% and 18% of hospitals reported incomplete hospitalization numbers due to changes in reporting to meet federal requirements.

On July 25, the state removed 2,092 probable cases from the Corpus Christi-Nueces County Public Health District that had been previously included in the cumulative case count.

On July 27, the state began reporting deaths based on death certificates that state COVID-19 as the cause of death. On that day, more than 400 previously unreported deaths were added to the total death toll due to the reporting change.

On July 30, the state said an “automation error” caused approximately 225 deaths to be incorrectly added to the overall death count; a subsequent quality check revealed COVID-19 was not the direct cause of death in these cases. We updated the cumulative numbers for July 27-29 to account for this error. The automation error also caused us to incorrectly state the percentage of Hispanics who have died of COVID-19 and the number of previously unreported deaths on July 27. These have been corrected.

On August 3, the state removed 536 duplicate confirmed cases from the overall cases count for Bexar County. Bexar County reported 471 new confirmed cases on this date.

On August 7, DSHS started breaking viral tests out into molecular and antigen tests on their site. We’ve combined the two to come up with the total number of viral tests.

On August 7, DSHS reported some PCR tests had been miscoded, inflating the number of antibody tests over the previous couple of days. This was corrected, resulting in the number of antibody tests to decline from the 6th to the 7th. Because a breakdown of these tests is not available, the charts are showing the inflated numbers on those days.

Carla Astudillo, Mandi Cai, Darla Cameron, Chris Essig, Anna Novak, Emily Albracht and Alexa Ura contributed to this report.

This story is from our news partners at the Texas Tribune. Read more here.

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