A UTSW nurse inside a COVID-19 patient's room in July. Elizabeth Lavin

Coronavirus

Dallas County’s COVID-19 Numbers Point to Trouble Leading Into Thanksgiving

New infections are up, hospitalizations are up, and health officials are pleading with the public to heed their advice ahead of Thanksgiving.

In the past 19 days, the provisional seven-day average of new coronavirus infections in Dallas County has jumped from 588 to 958, an increase of 63 percent. When we recorded 588, on October 28, that was the most new cases since July. Fast forward three weeks, and we’re pushing into entirely new territory. On Monday, Dallas County recorded 1,831 new infections, the most ever in a day.

Last Thursday, UT Southwestern Medical Center updated its forecasting. Hospitalizations across the 19 county Dallas-Fort Worth region are up 151 percent since their pandemic low, in September. There are now just over 600 people hospitalized with COVID-19 in Dallas County alone, a 163 percent increase over that same time period. The health system believes Dallas and Tarrant counties “are expected to exceed previous highwater marks in the next week or so.”

As it stands, we’re on pace to record 2,500 new daily COVID-19 infections by November 24. Tarrant County can expect 2,900 per day by November 27.

This is all part of the drumbeat for Thanksgiving, a holiday that seems uniquely positioned to spread the virus through families by all the time spent indoors around the table. Let’s hope the weather stays mild enough that folks can sit in their backyards. In the past week, 10 K-12th grade schools in Dallas County have canceled in-person schooling because of coronavirus infections. In that time, 843 children between the ages of 5 to 17 have been diagnosed with the virus.

Meanwhile, 90.3 percent of available hospital beds are now occupied in Dallas County, the most since the pandemic started. Of those, about 12 percent are COVID patients. Health officials say this is exactly what they’re worried about; the patient census at hospitals always increases during the winter months.

“That’s one of the reasons we’ve all expressed so much fear about the fall and winter; we know those are baseline busier times for hospitals,” says Dr. Mark Casanova, the president of the Dallas County Medical Society and a palliative care physician at Baylor Scott & White Health. “To have COVID on top of that will make things that much worse.”

Dr. Philip Huang, the head of Dallas County Health and Human Services is urging workplaces to telecommute and telling residents to stop congregating inside other people’s homes. He says this is a “time of extreme spread.”

“With Dallas County, for example, having the highest number of COVID-19 cases reported today, there is a lag time before some of these people will be hospitalized,” says Steve Love, the president of the Dallas-Fort Worth Hospital Council. “We ask everyone to please wear a mask, physical distance and ensure they even wear masks at home if visitors or extended family members visit for the holiday. The is a very serious public health threat to North Texas.”

I encourage you to keep your eye on this tool, a COVID-19 risk assessor from researchers at the Georgia Institute of Technology and Stanford University. Right now, in Dallas County, there is a one-in-five chance that a COVID-19 positive individual will be among a gathering of 10 people. It is 65 percent likely if that gathering goes up to 50 people. If the room includes 100 people, the likelihood jumps to 88 percent.

Think about that for restaurants. Gov. Greg Abbott is allowing them to operate at 75 percent. If you’re going out to eat and sitting inside, the risk is high that you’ll come into contact with a sick person.

Gilley’s in the Cedars apparently hosted the rapper Larry June on Friday, which filled the larger ballroom with people that were packed in shoulder to shoulder. There were at least 500 people inside, judging from the video linked above; according to the risk assessment tool, that room was certain to include at least one COVID-19 positive person. Meanwhile, keep in mind larger rooms are able to scale their attendance. This Dallas Morning News story found that Deep Ellum’s Bottled Blonde is legally allowed to let in 992 people because of its capacity limits.

Casanova and Huang are concerned that those very people dining out and spending time in bars are also bringing it home. Among a small, indoor gathering, the risk of transmission is high considering aerosolized coronavirus can hang in the air for up to three hours.

“Stop going into restaurants and certainly stop going to any bar,” Casanova says. “And sure as heck stop those family gatherings. I think that’s where we’ve had our knees taken out from under us, those family and friend gatherings. Enough of those people do that on enough of a scale and you see exactly what we’re seeing in viral transmission.”

He is not, however, calling for a shutdown. Takeout and delivery remain safer options, and it’s clear that distancing and mask wearing have stunted the growth of transmission in the past months. There will come a time when it’s appropriate to dine in, but it’s not when the spread of the virus is at its current levels, Casanova says.

“These congregate settings, we need to tap the brakes on. We’re not saying shut down, we’re certainly not saying shut down—as a matter of fact, that’s why we’re saying this,” he says. “Let’s get strong again. We’ve done it before. Let’s get through the other side of this to the spring and the summer.”

A study this week in the journal Nature by researchers at Stanford and Northwestern highlighted the impact that occupancy limitations have on the spread of the virus. The research used anonymized cell phone data to make its conclusions, rather than contact tracing samples. But it basically found what other studies have: this virus is spread indoors, largely by a concentration of social butterflies who are picking it up and putting others at risk, often in their own families and social circles. There is good news in that study: “One can achieve a disproportionately large reduction in infections with a small reduction in visits,” it reads.

Reducing maximum occupancy is more effective than broader, less targeted measures and is also better for the economy, the study found. But the governor’s executive order basically strips the ability of local authorities to enact measures in the interest of public health. Which means that call would have to come from Abbott. The federal government hasn’t been eager to pay people to stay home, which puts businesses—including restaurants—in the remarkably difficult position of operating during a pandemic to keep the business afloat. And right now, they’re legally allowed to welcome 75 percent of their capacity, despite objections from local health officials.

Providers at hospitals have become better equipped to manage the disease, Casanova says. But he made himself clear—it’s not treatment. The only treatment for COVID-19, the antiviral drug Veklury, was approved by the FDA just three weeks ago, about seven months into the pandemic. Patients can be flipped onto their stomachs to enhance oxygenation of their blood. Providers know to watch for blood clots and use steroids to try and prevent the need of an ICU trip.  It remains a deadly disease and can leave survivors straddled with lingering side effects for months.

There is concern that the reproduction rate will cause further strain on the region’s hospitals, necessitating surge plans that free up beds.

Meanwhile, our behavior is what will save us. And right now, things are looking precarious.

“You look at the models and you look at what’s being predicted a month ago and you see it unfolding and there’s almost this helplessness,” Casanova said, referring to the region’s caregivers. “I think there is almost a plea, a crying out from the depths of our souls to say, ‘listen, we can do this, we can take care of you on the back end once you’re sick enough.’

“But there’s a much more effective way to not get to me, or not get to my ICU colleagues. And that’s by doing the things we know work.”

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