As COVID-19 Cases Increase, Texas May Be Heading for Trouble

Texas set new daily records for COVID-19 hospitalizations and new positive cases this week. Could that be a trend? What can we expect in the coming weeks and months?

Here we ask three questions to three medical professionals in Texas.

Dr. Faisal Masud is the medical director of critical care at Houston Methodist Hospital.

As numbers of cases of COVID-19 rise in Texas and hospitalizations increase, what does this mean for Texas?

Masud: “This means that we are really going back to square one. During March and April, hospitals were getting flooded. What is different now compared to March is that we have had a lot of patients who have been holding off coming to the hospital. Now they’re showing up in droves. Our hospitals are full – not from COVID, but from a lot of untreated patients and COVID combined. Now it’s a double whammy. To me, a patient is a patient, whether they have COVID-19 or cancer. My team’s obligation is taking care of patients regardless of the disease they have. We don’t pick and choose. We take care of everybody.”

If numbers keep rising, are we headed for a NYC-type situation in our major metropolitan areas?

“The answer is no. The reason is – New York City was not prepared for what hit them. Clearly we, especially in the Texas Medical Center, are way better prepared. We learned a lot of lessons from New York City. And we have been tested. In March and April, we had unbelievable challenges. If you look at the TMC website, admissions are high, but we are managing our patients better now. Plus, we have new therapies to help, so the ICUs don’t get overrun. We will fill them, but I think we are better prepared.”

If people aren’t doing what they need to do to be safe now that Texas is reopening, what can we expect down the road? During the next weeks, months and this fall?

“The challenge we face in health care is the mixed messaging — people hear different things from the city, state, the Centers for Disease Control and Prevention and the World Health Organization. That mixed messaging has impacted people’s decision-making. There’s an element of complacency. COVID-19 is here to stay, and I do anticipate there will be another peak in the fall, because we will also be dealing with the regular flu. This is going to be very challenging for the rest of the year. We have to think not only about ourselves but about our communities. Don’t think about yourself only — think about people around you.”

Dr. Robert Atmar, an infectious disease specialist at Baylor College of Medicine, has a longstanding interest in the study of respiratory viral pathogens, including their epidemiology, pathogenesis, diagnosis, treatment, and prevention.

As cases rise, when will Texas be in trouble? Is it based on positive diagnoses, number of hospitalizations, deaths, etc.?

Atmar: “I think Texas is already in trouble – this is based upon the number of hospitalizations and new diagnoses. These data indicate that the virus is surging in the state.  We have certainly seen that in Houston.”

Are we headed to a NYC-type situation?

“I hope that we are not headed to where NYC was, but that is still a potential concern.  If the public does not practice good social distancing practices, there is a real danger that the pandemic will place increasing burdens on our health care system and affect a larger part of the population.”

If people are not following social distancing and wearing masks, what can we expect down the road?

“If people do not follow appropriate social distancing and other preventive measures (such as wearing a mask in public places), then we can expect the number of cases to continue to rise, and we will face the risk that our health care system will be overwhelmed. The success in flattening the curve in April-May shows that these practices can be successful in slowing transmission, but we need the public to follow these practices in order to blunt the impact of the virus in Texas.”

Dr. Charles Lerner is a San Antonio Infectious Disease Specialist and member of the Texas Medical Association COVID-19 Task Force.

As numbers of cases of COVID-19 rise in Texas and hospitalizations increase, what does this mean for Texas?

Lerner: “The number of hospitalizations is the best measure we have for the incidence of COVID-19 because the percentage of severe infections remains constant. The number of positive tests is a function of how many tests are done and may not reflect changes in the frequency of infection. The increase in the number of hospitalizations reflects an increase in the number of infections. The lack of social distancing that was seen in pictures of Memorial Day activities and the lack of wearing a mask, which was also common, is responsible for the increase in the number of infections. Hospitalization generally occurs in the second week of illness and will peak 3-4 weeks after the infection episode.”

“I anticipate another spike following the protests not only because of the lack of social distancing and the lack of wearing masks but also because of the shouting which increases the spread of respiratory droplets which are responsible for passing the infection.”

If numbers keep rising, are we headed for a NYC-type situation in our major metropolitan areas?

“Yes. Even though we have ample numbers of ICU beds and ventilators available now, a dramatic rise in the number of cases could overwhelm the system.”

What can we expect during the next weeks, months and this fall?

“With increasing contact among people, we can expect a steady rise in the infection rate. This could be kept to a minimum and possibly even prevented if everyone wore a mask, kept their distance from other people as much as possible and washed their hands frequently or used hand sanitizer. The main benefit of wearing a mask is that it prevents the wearer from spreading their infection to others. It is not a statement of fear and has nothing to do with liberty. It is a statement that ‘I care about you.’”