New Year, New Grim Milestones in Austin’s COVID-19 Crisis

Amidst an unprecedented surge, Austin could reach ICU surge capacity within the next week

Health officials said they could soon activate the field hospital at the Convention Center (pictured here in July) if local hospitals exceed capacity (Photo by Jana Birchum)

The start of the new year witnessed several grim milestones in Austin's COVID-19 crisis.

On Tuesday, Jan. 5, the seven-day moving average for COVID-19 hospitalizations reached an all-time high of 83 for Austin and Travis County, marking a 160% rise in new hospitalizations since Dec. 5. For comparison, that metric hit 75 at the peak of Austin's earlier surge in July. Earlier this week Austin Public Health reported 752 new cases, which is the first time daily cases have exceeded 750 since that same mid-summer surge. Occupied ICU beds – 161 – and ventilator use – 99 patients – also recorded alarming highs on Tuesday, representing a 99% and 130% increase, respectively, since early December.

Central Texas' unprecedented surge is following the trajectory already seen elsewhere in the state. As of Tuesday, COVID patients accounted for more than 15% of a region's hospital capacity for at least seven consecutive days in 17 of Texas' 22 Trauma Service Areas. Per Gov. Greg Abbott's GA-32 executive order, that means local officials in those regions now have the authority to mandate most businesses reduce capacity from 75 to 50%. Interim Health Authority Dr. Mark Escott expects Central Texas' 14-county TSA will likely trigger the 15% rule sometime this weekend, which would also entail a rollback on elective medical procedures for the region. As of Jan. 5, there are only 39 ICU beds available in our TSA, according to state data.

"We've really reached the limits of what we can do under state law and under the [state] executive orders," said Escott of what would lie beyond the current Stage 5 of local pandemic risk guidelines. "We would encourage the state to reassess their plan. What we've seen is jurisdiction after jurisdiction transitioning into a surge, and then once they transition to surge, it continues to worsen," said Escott. "I don't think the rollback to 50% occupancy at retail and restaurants is doing the trick."

UT-Austin's COVID-19 Modeling Con­sort­ium predicts that should Austin's disease transmission trends continue as they stand today, Jan. 7, then Austin could reach its ICU surge capacity of 200 beds as early as the end of this week. Escott estimates that APH will soon begin to activate its Alternative Care Site at the Austin Con­vention Center. The Downtown field hospital, prepared over the summer to take in patients should local hospitals become overwhelmed, has never been utilized. Health officials originally planned for only those patients requiring limited care to be transferred to the ACS, while patients needing higher-level or intensive care would still be cared for at hospitals.

“We are getting very close to the stage where our hospitals are going to run out of beds.” – Dr. Mark Escott, Interim Health Authority

"We are getting very close to the stage where our hospitals are going to run out of beds. And if they run out of beds, they not only run out of beds for COVID-19 patients, but they run out of beds for everybody," said Escott. He anticipates that Austin's positivity rate – 17.8% for the week ending on Jan. 2 – will rise above 20% this week, putting us on par with Los Angeles County, where currently one in five people getting tested for COVID-19 are testing positive.

Contact tracing efforts have shown that much of Austin's surge has resulted from holiday gatherings and activities in recent weeks, according to APH Chief Epi­dem­i­ologist Dr. Janet Pichette. APH officials said they expect to see the impact of New Year's celebrations at Austin-area bars – which were allowed to stay open over the weekend after the state's successful legal challenge over local dine-in limitations – in the agency's data within the week.

Meanwhile, the state continues its rollout of COVID-19 vaccines with uneven success. Although Texas officials expanded eligibility to Group 1B of the state's COVID vaccination strategy – include those 65 years old and up and those with certain high-risk medical conditions – many localities, including Travis County, have yet to receive enough vaccine to expand beyond Group 1A, which is primarily front-line health care workers. As of the third weekly allocation from the Texas Department of State Health Services – the agency in charge of distributing vaccines in the state – Travis County has received 42,000 doses, said Cassandra DeLeon, APH's interim assistant director for disease prevention and health promotion. "That does not go very far, and that does not meet even the needs that we have for our direct health care staff."

The state's current vaccine strategy allows for distribution to the 1B group only at pharmacies and grocery store chains like H-E-B – in addition to a federal program to vaccinate patients and staff in long-term care facilities. This is a problem in low-income communities of color that historically have had unequal access to such stores. Earlier this week Austin Council Member Natasha Harper-Madison, joined by state Rep. Sheryl Cole, Travis County Commis­sioner Jeff Travillion, Manor Mayor Dr. Larry Wallace Jr., and Pflugerville City Council Member Rudy Metayer, released a statement calling for local alternative strategies to improve vaccine access to Black and Latinx communities living in the Eastern Crescent.

These could include using facilities such as fire stations and schools for pop-up vaccination clinics, as well as prepping firefighters, paramedics, school nurses, and nursing students to help administer the vaccine as the supply increases. "We will not tolerate a hands-off vaccination strategy that ends the pandemic quickly for the privileged while letting it linger indefinitely among our most marginalized constituents," said the joint statement. "This community can and must do better and we won't rest until it does."

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Stage 5, COVID-19, Austin Public Health, Mark Escott, UT-Austin's COVID-19 Modeling Consortium, Alternative Care Site, Greg Abbott

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