Sept. 2, 2020
Dear Members of the Baylor College of Medicine Community,
I have a very specific favor to ask of you today. Here is the link to today’s message: https://bit.ly/3jEv5q7. Copy the link, and share it widely with your friends and family. Post to your social media accounts. This is a request I do not often make, but after reading today’s message I hope you will agree it is important to spread the message.
I have a major theme today, and a rerun from a prior post. The main theme: There is something going on with COVID-19 numbers in Houston we do not fully understand. Given our lack of clarity – and events on the horizon that may promote resurgence – it is precisely the wrong time to relax our vigilance around virus control in our community.
The numbers this week are a bit of a mixed bag. The new daily case rate for Houston and surrounding counties has clearly decreased, but not as quickly as Texas in aggregate, nor as quickly as new hospital admissions. New cases in Houston peaked around July 17 at 2,450 diagnoses per day (a number that probably is about 1/10th of the total cases, if you allow for positive individuals who are not tested). We are now down to about 1,500 new diagnoses per day, a 39 percent reduction. Hospitalizations are down even more sharply, close to 80%. This is good news, which we should celebrate. We need good news. However, to keep this in perspective, during the same time period, new cases in Texas dropped by more than 60 percent. Houston seems to be not doing quite as well as the rest of the state. To add an additional sobering thought, our improved level of new cases is roughly 10 times what it was during late May (250-300 per day), which we now know was the beginning of our July surge. In summary, we are doing better, but not as well as the rest of the state, not nearly as well as we were in June, and nowhere close to our goal of 200 cases per day, where community contact tracing becomes feasible.
Another warning bell is our R(t). Recall, if this measure of infectivity is less than one, the viral presence in the community is shrinking. Greater than one, it is growing. We had a stretch of more than two weeks of R<1, which was a very encouraging sign that masking and distancing were working. Unfortunately, our R-value increased over the past week to about 1.26, but has since declined to 1.15 (so it is still spreading). Returning to the observation that there is something going on with the Houston metrics we do not fully understand, when you look at the R(t)s for all the major metropolitan areas in Texas, they have all remained persistently below one. In fact, the only two counties with R(t)s higher than Houston are Duval and Dickens (populations 11,157 and 2,444, respectively).
I point this out not to be alarmist, but to highlight the danger of letting down our guard in the face of data we cannot fully explain. Our numbers are clearly improving overall. The Houston differences could be due to a number of factors (for example, differences in population demographics, integrity of data reporting). However, we have no evidence that anything has fundamentally changed regarding viral infectivity in our community. Has it mutated to a less severe form? No. Have we achieved herd immunity? Not even close. We need to keep our eye on the ball as we approach additional events that will stress our ability to maintain control. Opening of face-to-face public schools. Cooler weather. Flu-season. Masking and distancing fatigue.
Which brings me our most imminent stressor: Labor Day. We celebrated the Memorial Day holiday – and we saw an uptick in community cases. We celebrated July 4th – and another uptick. I am sure you share in my desire that this particular bit of our history does not repeat itself. The following is a true story – a “rerun” from just prior to July 4th – which makes the point better than I can:
Note: I changed the name of the main person in this story to Frank Wilson and left out some details, not at his request, but to allow this story to be told without intruding on the privacy of anyone involved in this story. The story is real, the people are real, the impact on their lives is real.
Frank Wilson and his extended family have lived in the same town for more than 40 years – three generations. They are a close-knit family in a close-knit community. They enjoy a pace of life that is at least a half step slower than a city like Houston. This is the story of SARS-CoV-2 in a place far removed from the intensity and complexity of the Texas Medical Center. It is a story of good people in a safe place.
The Wilsons planned to spend their Memorial Day the way they spend most holidays and many weekends – enjoying a family gathering at their favorite picnic spot. This celebration took on a little more significance, as they were coming out of the coronavirus induced lock-down. As regional leaders mandated a partial shutdown of the economy, they suffered along with the rest of the state and the country – lost shifts at work, cancelled family events. Now public officials were reopening the economy, and life was trying to regain its normal rhythm. There was nothing more normal for Frank than a family picnic.
What did he think of all the coronavirus warnings? “I thought it was all a big hoax – the government trying to take control of things”. He knew people in other parts of the country had the virus, but he did not personally know anyone who had it. He didn’t even know anyone who knew anyone who had it. The response of media and civic leaders seemed overblown. “It was a big nothing.” Thankfully, it seemed now it was behind us. We were opening back up. We had beaten the virus.
This Memorial Day was like countless other similar holidays – an opportunity to unwind and relax with family. It would become a day – that would lead to a week – that would change their lives forever.
The first warning sign. Frank’s mother became short of breath. Her symptoms were severe enough they felt compelled to get her checked at a local emergency room. She was evaluated and told that she was suffering from a “broken heart.” She was still mourning the recent death of her husband – Frank’s father – and it seemed reasonable that her symptoms were anxiety related. All were relieved it was not the virus.
Memorial Day was Monday, May 25. Tuesday passed and was uneventful.
Wednesday, Frank went to help a friend tune up the engine of his car. Towards the end of the day he didn’t feel well. That night his temperature went up and he called his boss to say he would not be at work. He went to the hospital and got the COVID-19 test. Results the next day – positive. He had the virus.
Thursday, Frank’s wife developed similar symptoms. She went to the hospital, and was sick enough to be admitted.
Also on Thursday, Frank’s mother-in-law became ill. In retrospect, she had not felt right since mid-May, but had already had a negative test for COVID-19. She went to the hospital, and was admitted.
Friday, Frank’s sister became ill. Like his wife, she went to the hospital and was admitted.
By Friday evening, his mother’s condition had worsened to the point he sat at her bedside all night. He did not realize it at the time, but this would prove to be the last night she would spend in her home. On Saturday, he took her to the hospital, and she was admitted.
Thus ended a week from which the family is still struggling to recover.
Frank was lucky. He did not need to spend time in the hospital. However, he tells me it was the worst thing he has ever had. “It was ten times worse than the worst flu. I had terrible stomach pain, and couldn’t get my breath. It felt like a bomb was going off in my chest.”
His wife’s condition was severe enough that it looked like she would need to go on a ventilator. Fortunately, with a combination of regular proning (face-down positioning that improves air exchange in COVID-19 patients) and high levels of supplemental oxygen, she avoided the ventilator and was discharged after about a week.
His mother-in-law’s condition deteriorated, resulting in a prolonged ICU stay. She is profoundly weak and continues to undergo intensive rehabilitation.
Frank’s sister also wound up in the ICU, and required extracorporeal membrane oxygenation (ECMO). This is used in patients whose lungs are so badly involved that they cannot effectively exchange oxygen between the airways of the lungs and blood, which is much like slowly drowning. The patient’s blood is drained out of the body, infused with oxygen and replaced. Thankfully, she recently improved to the point that she is off ECMO, although she remains hospitalized.
Frank’s mother was the most critical of all. She was admitted to the ICU and received the best and most aggressive treatment possible, at the finest medical center in the world. She participated in the convalescent serum trial, receiving antibodies from another patient who had recovered from COVID-19. Despite heroic efforts, she passed away.
This is a true story, as told to me by Frank – real people, real events. After seeing the devastation, the virus brought to people he loves, his instinct is to do all he can to help others. He wants to donate his plasma so someone might benefit from his antibodies. Most importantly, he wants people to know the threat is real, and that everyone must act responsibly to protect each other – to protect people like his wife and sister and mother.
Let us all stay safe this Labor Day weekend. Mask when in public places and when exposed to others. Practice physical distancing all of the time. Celebrate with your immediate household – not with your extended family, and certainly not as part of a public crowd. Celebrate at home if at all possible. It is important that we relax, unwind and connect with others, but let us be smart about it.
If you are Twitter savvy, share a brief description of how you will enjoy your holiday weekend while remaining safe, and include the hashtag #MySafeLaborDayBCM (or email me at firstname.lastname@example.org). And please share today’s message: https://bit.ly/3jEv5q7.
Have a great holiday.
James McDeavitt, M.D.
Senior Vice President and Dean of Clinical Affairs