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Baylor College of Medicine

Winter is Coming

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Nov. 11, 2020

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Dear Members of the Baylor College of Medicine Community,

Do not give up on this message after the first couple of paragraphs. It starts out bleak, but I promise it will lighten up by the end.

There is much to be concerned about this week. Nationwide, the U.S. has reached record highs of new infections. El Paso is experiencing a major surge, airlifting ICU patients to hospitals around the state and providing medical care in a field hospital in its convention center. Our local TMC data continues to show the same pattern it has for the past four weeks – a slow but steady rise in new community cases; a slightly slower, but also steady increase in hospital admissions. Are we headed for another surge, or are we in some tenuous equilibrium? If this were a flood, most of our neighbors’ houses have already flooded. We hope ours will not, but quietly believe it will. The Biden transition team has taken warning of a “very dark winter,” to my ear a depressing mash-up of Mother Teresa’s “dark night of the soul” and Game of Thrones “winter is coming.”

My personal belief is we will surge again – in fact, we already are. I do not believe we will reach our July peak levels. But – and this is an important “but” – no one really knows. We are in uncharted territory, which is the most maddening thing about this crisis. We are never sure if the worst is behind us, or yet to come.

Yet, even if the worst is to come, I remain an optimist, and there is rational cause for optimism. We have been here before. In early June, our numbers were creeping up and the future was murky. It turned out that we had a very difficult late June and July, briefly becoming the world-wide epicenter of the pandemic. As we again live through weeks of uncertainty about what is around the corner, it is useful to reflect on how our community has changed in a short time. Houston is a different place than it was in June. In many ways, we are far better prepared. Here is my list; Baylor College of Medicine has been a major contributor to every item.

  • Hospitals and our health care system are COVID-19 hardened. I will not belabor this point, as this has already been discussed at some length in prior messages. Our physicians have therapeutics that were not available earlier in the year. Personal protective equipment is in good supply. We have learned how to operate a safe clinical environment, minimizing in-hospital or in-office spread to health care providers. Clinical treatment and ventilator protocols are vastly improved. Having surged once, if necessary, hospitals and systems are able to reactivate existing plans rather than developing them from scratch. Our health system – Baylor and its affiliates – has learned a great deal in a short time and is better prepared. 
     
  • Community leaders have pulled together. To a large degree, we used to be a community of silos – health care providers, the business community, colleges and universities, school systems, city and county public health services, communities of faith. In a remarkable manner, community and civic leaders across all silos have formed functional and meaningful collaborations. Leaders in our community, who were at best casually acquainted, are now on a first name basis and have each on speed dial. There are many scheduled opportunities for communication; more importantly, previously isolated community leaders have formed a broad and effective network. As a result, Houston has enhanced its ability to mount a coordinated response to a shared threat. 
     
  • Public health capacity has improved. Although the viral load in our community is still too high to perform effective contact tracing as a containment strategy, both the city and county health departments have made substantial strides in mitigating the disease in Houston. There is a good understanding where the community hot spots are located, down to individual zip codes. Notably, led by Baylor’s TAILOR labs in collaboration with the Houston Health Department and Rice University, analysis of viral remnants in sewage seems to be highly correlated to growth in new cases. In fact, the wastewater analysis seems to provide a week or two of advance warning of developing hot spots. This gives the health department valuable time to deploy a neighborhood specific strike team to provide focused community education and testing. 
     
  • The public is engaged. As noted above, El Paso is surging for the first time in the pandemic, while our numbers are more modest. One of the big differences is our adoption of masking and distancing. I took my granddaughter to the zoo this weekend – with a degree of trepidation – and was gratified that everyone was wearing a mask. Timed entry helped to keep the crowds down, and it was easy to maintain distancing. I believe the severity of our crisis in the summertime won many converts to the importance of masking and distancing. There are clearly exceptions, but individuals, businesses and public institutions that continue to take the threat seriously are helping to protect the entire community. If we avoid a repeat of our mid-summer surge, it will be thanks to the people of Houston. 
     
  • All we had was a switch, now we have dials. When the rodeo closed, the pandemic was its infancy, and our knowledge was severely limited. Many leaders felt the only prudent course of action was a broad and prolonged shut down of most activity – closure of schools, businesses, places of worship, etc. Now we know much more and have a great deal of accumulated experience. If we experience another major surge, it will result in another series of governmental restrictions on activity. I hope this does not occur, but if it does, I expect the restrictions will be far more nuanced, focused and time-limited than earlier in the summer, with less social disruption and less economic impact.
     
  • Vaccines are on the horizon. Based on the preliminary but good news emerging from Phase III clinical trials, it appears the nation will have at least one – and likely more – safe and effective vaccines available by early next year. Many will be disappointed that the introduction of a vaccine will not lead to an immediate declaration of the pandemic’s end. There will be production and distribution challenges. It will still take several months of to achieve herd immunity on a national scale. Masking and distancing will be with us for some time to come. However, earlier in the summer, we were having an “if” vaccine conversation. Now we are discussing “when.” We will have an important new weapon in this battle in the near future.

So, I am hopeful. It is not a hope born of desperation. It is a hope born of the confidence our team has been here before and proven our resilience. It is a hope born of pride that the College always rallies to support the people of Houston. It is a hope born of knowledge that there will be an end to this crisis, and that we will emerge stronger than ever.

Stay well and keep your guard up. We will get through this.

James T McDeavitt, M.D.

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