Thanksgiving Cases and Unchecked COVID Numbers in Rural Counties Are Worrying

The ever-narrowing collision course of the COVID-19 pandemic and a vaccine can’t get here quick enough. This week  Texas Gov. Greg Abbott Tweeted that distribution of the Pfizer vaccine should begin as early as Dec. 14 and 7,200 providers, including major retail pharmacies, have already been selected.

Climbing hospitalization rates continue to stress the medical system. As of Dec. 9, there are active outbreaks at 101 long-term care facilities in Dallas County alone, making next week feel a painful distance away.

UT Southwestern recently updated its COVID-19 modeling for Dallas and Tarrant counties, and the average volume for hospitalizations is 65% higher than a month ago. In just the past two weeks (through Dec. 4), COVID-19 hospitalizations had increased 14% from the previous two weeks.

Unfortunately, UT Southwestern’s projections for the next few weeks are a bit blurred. While hospitalizations were relatively flat the week after Thanksgiving, the impact of the holiday has yet to be seen, “as any newly infected patients requiring hospitalization may not start arriving at the hospital for another week or so.” Adding to that, hospitalizations typically occur two weeks after a person is infected, which would be Dec. 10. It’s also unknown if the recently reduced occupancy rates for businesses will help tamper the spread.

In one encouraging note, except for retailers, UT Southwestern’s Google Community Mobility Analysis showed “no notable increase in visits to retail locations on Black Friday.”

Double the Hospitalization Rate
This week, for the first time, the U.S. Department of Health and Human Services in coordination with the University of Minnesota released data that shows the stress of COVID-19 hospitalizations at county levels. This data is in stark contrast to Texas’ reporting.

NPR used the information to create a tool that shows hospital capacity by county. Until this was released, the percent of COVID-19 hospitalizations was solely based on large regions called Trauma Service Areas (TSA). For Dallas and Tarrant counties (TSA E) this region extends north to the Red River and includes many surrounding rural counties, making it hard to decipher occupancy rates in dense suburban areas versus outlying counties with fewer resources.

The percentage of COVID hospitalizations is significant, in part, because when it hits 15% it triggers rollback of business reopenings, which went into effect last week. Also, it’s a better way to measure the pandemic; while test results might be muddled, people in hospitals are indisputable. In all its charts, graphs and numbers, the word “capacity” is literally never used in Dallas County’s daily or more in-depth biweekly reports on COVID-19. True hospital capacity rates have been elusive.

According to the NPR tool, though, in Dallas County an average of 26% of hospital beds are occupied by COVID-19 patients. Tarrant County is at 27%. For all of TSA E, the average is 33%. Whereas the state’s dashboard reported just over 16% on Wednesday, the same day this report was released.

NPR uses only adult in-patient beds at hospitals for its numbers. The Texas Department of Health and Human Service data also includes pediatrics, outpatient beds, emergency department beds, telemetry and psychiatric beds.

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Ring of Fire
The NPR model also shows that the counties surrounding Dallas and Tarrant County are battling much higher COVID-19 hospitalization rates. For example, 50% of adult inpatient beds at Baylor Scott & White Medical Center in Waxahachie are COVID-19 patients; and the hospital is at 97% capacity.

We reached out to Chris Wilson of the Dallas-Fort Worth Hospital Council and asked what is driving the higher hospitalization rates in rural areas; is it lower compliance or fewer beds? Further, what impact will those surrounding spiking hospitalization rates have on our local hospitals, if any? He had this to say:

“The spread of the virus has exhibited clear trends, erupting in populated urban centers and then spreading to rural areas. Reasons are everything you have mentioned [lower compliance, fewer local beds]. Impact will be severe to hospitals in Dallas and Fort Worth as this will create patient migration which overloads our metro hospitals.”

Dallas County reported the second-highest number of COVID-19 deaths on Dec. 9 and County Judge Clay Jenkins implored people to plan for the holidays in advance, use curbside pickup or online shopping as much as possible, noting that modest changes can help limit our number of contacts. Maybe his sense of urgency is based on this new tool that shows the Parkland Hospital System at 95% capacity.

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