Six months ago this week, when the World Health Organization declared COVID-19 a public health emergency of international concern, Texas had zero cases—and few reasons to expect it would become one of the hardest-hit areas in the world.
But as hospitalizations and deaths have surged in recent weeks, its departure from successful public health responses in the rest of the country—and the world at large—has only grown more stark.
“In the past six weeks, the total number of cases [globally] has roughly doubled,” the U.N. health agency’s director-general, Tedros Adhanom Ghebreyesus, said on Monday, repeating the public health mantra to maintain distance from others, wash your hands, avoid crowds, and wear a mask.
“Where these measures are followed, cases go down,” said Tedros. “Where they’re not, cases go up.”
Though the pandemic was slower to ravage Texas the way it first hit states like New York, there are few parts of the world where these ironclad, century-old health principles were more difficult or contentious to implement than the Lone Star State.
After a brief lockdown, Texas was one of the first states in the U.S. to reopen, at lightning speed. And after weeks of skyrocketing case totals—with local officials clashing with state leaders on everything from the reopening of bars to mask mandates—the inevitable surge in fatalities has arrived.
As of Monday, according to state health data, Texas had 385,924 total cumulative cases and 5,713 deaths. Just a week earlier, on July 20, Texas passed 4,000 deaths from the disease. To be clear, that means 20 percent of all deaths in the state happened in just six days. Meanwhile, public health experts have repeatedly said that official totals are likely to be an undercount, since not all people who die with coronavirus symptoms ever get tested.
Of the state’s 254 counties, 242 have active cases. Hospitalizations and deaths are surging, a trend that was expected, considering those factors are lagging indicators behind infection counts. The state peaked at 10,791 cases on July 15, and while daily infection totals have leveled off, they have done so at record highs, according to the Texas Tribune.
White House officials touted local mask ordinances as helping turn the tide on Arizona’s infections last week, and public health authorities have said they are cautiously optimistic that Texas Gov. Greg Abbott’s mask mandate—ordered three weeks ago—could be helping curb the Texas case surge. Still, many have asked the governor to consider a second shutdown if things don’t improve, and fast.
Diana Fite, president of the Texas Medical Association and an emergency physician based in Houston, said the entire state has a need for all experimental forms of COVID-19 treatment. That includes convalescent plasma—transfusions from patients who’ve successfully recovered from the virus—and Remdesivir—a broad-spectrum antiviral drug that has in early trials improved severe cases.
“There is not enough to give to all the people who are sick. Everybody is trying to use these transfusions,” Fite told The Daily Beast, cautioning that it’s not a cure and that experts are still not “100 percent sure that it’s working,” even if some preliminary studies have been promising.
“There’s nothing that’s in abundant supply,” Fite told The Daily Beast, noting that all experimental therapies are divided amongst states based on hospital data, which she compared to “a lottery system.”
“We’re crowded with a lot of patients that need to be in the hospital,” said Fite, calling the day-to-day marathon “hectic and very stressful.”
“When you have such an increased volume of patients, and still a small percentage of those are very very ill, you’ve still got a large number,” said Fite.
It may have taken local ordinances, a statewide mask mandate, and skyrocketing cases, but now, according to Fite, “Texas citizens are once again understanding that this is a serious issue, and that they need to socially distance, wear masks, and stay away from large gatherings.”
Even if Fite is right that Texans have begun to take the virus more seriously, more deaths are coming. Hidalgo County was reportedly the first in the state to begin storing—not just transporting—bodies in refrigerated trucks earlier this month. Crematoriums in the area are said to have a two-week wait list. That delay was worse in one town, where a crematorium’s ovens “overheated” from the extreme use and broke down.
Meanwhile, about 300 miles north, residents in Houston—where Fite is based—have begged for the city to lock back down as hospitals are deluged with patients. “We’re completely out of our depth here,” one Houston ER nurse told The Daily Beast last week.
Another 250 miles north, 14 members of the same family in the Dallas area got sick following a backyard barbecue—after the state’s restrictions had been lifted—leaving one of them dead after an extended stay in the hospital.
“Somebody is going to have to make a decision about this,” said Irwin Redlener, founding director of the National Center for Disaster Preparedness at Columbia University and an expert on U.S. readiness for pandemics. “We may have to go back to sheltering and staying in place.”
But Abbott has repeatedly said that “closing down Texas again will always be the last option.” And last week, he tweeted, “a community lock down is not needed as long as masks & other distancing strategies are used.”
A day later, he met with community leaders in the hard-hit Rio Grande Valley and announced that the state was providing “substantial resources” to the area, including five U.S. Navy teams from the U.S. Department of Defense and a U.S. Army Urban Augmentation Medical Task Force to help combat the spread of the virus and supplement overrun medical workers at hospitals in the area. The state has sent additional ventilators, lab staff, test kits, ambulance strike teams, oxygen concentrators, morgue trailers, personal protective equipment, and Remdesivir to the area.
The problem is that there’s little reason to think even this momentary plateau in cases—and the belated surge in fatalities—is the end of the state’s COVID-19 woes. As Redlener said, the reopening of schools “is going to become a major challenge from one end of the country to another.” But especially in hot zones like Texas where doctors are begging for plasma donations, bodies are being stored in refrigerated trucks, and crematoriums can’t keep pace with demand.
“We don’t do enough testing to begin with, and we certainly don’t do enough testing of school children,” said Redlener. “We just don’t have enough information to make completely evidence-based decisions here, and this tsunami is coming.”