Like many states across the country grappling with the onset of the omicron variant, Texas’s fight against Covid-19 took a turn for the worse in December. And due to the state’s relatively low vaccination rates, and a Republican state government that has fought public health officials’ recommendations on masking, vaccine mandates, and business restrictions, matters may not improve soon.
Although the symptoms of Covid-19 are typically milder for the vaccinated, omicron is more transmissible than previous variants, even among people who have had two shots. Together, the infectiousness of omicron and Texans’ resistance to getting the vaccine have created a crisis for hospitals and medical workers, one that disproportionately puts unvaccinated people in danger.
The numbers aren’t encouraging: On Wednesday, more than 61,000 Texans were confirmed to have tested positive for the virus, but given the prevalence of home testing and that people might be sick but not testing at all, the numbers are likely much higher.
Hospitalizations have more than doubled since last month to over 11,500, including over 2,200 patients in the ICU. It’s the first time Texas has had more than 10,000 Covid-19 hospitalizations since September 2021. Pediatric hospitalizations, which are on the rise nationally, increased by 200 percent in the state between Christmas and January 3.
That has put hospital capacity under strain yet again. As of January 12, 87 percent of available ICU beds across more than 500 Texas hospitals are in use, and about a third of those beds are filled with Covid-19 patients. That leaves only 315 available adult ICU beds across the entire state. Those numbers are concerning, especially if hospitalizations have yet to peak during the latest wave.
“Ideally, everybody would take this thing seriously and follow the steps that we know work, which is primarily get vaccinated and boosted, but also be smart about gatherings and wear a mask,” said John Henderson, the president and CEO of the Texas Organization of Rural and Community Hospitals. “But in Texas, especially rural Texas, people have prioritized getting back to normal. On some level, I understand that. But the virus is in charge and until we get control of the virus, we can’t get back to normal.”
As is the case nationally, unvaccinated people account for the vast majority of the hospitalizations in Texas — Dallas County’s health director, Philip Huang, told me that they make up roughly 80 percent at the hospitals he oversees. About 58 percent of the state’s population is fully vaccinated, slightly below the national rate of about 63 percent. Fewer than a third of fully vaccinated people have received booster shots, which have proven to be the best defense against omicron.
What happens next depends on whether more people get vaccinated and boosted, and whether they take the necessary preventative measures. Projections for north Texas from the University of Texas Southwestern Medical Center indicate that if the public returns to their patterns of behavior in the early summer of 2020 — limited masking, social distancing, and business restrictions — hospitalizations could peak at less than half what they would under the status quo.
But given that the same study found willingness to get vaccinated has remained flat and mask usage has steeply declined, that’s an unlikely scenario, particularly since Republican state leaders like Gov. Greg Abbott are opposed to vaccination and mask mandates. Instead, Texas could see a repeat of September 2021, when hospitals were so full that they erected overflow tents outside, patients were being treated in waiting rooms, and Abbott was forced to ask out-of-state medical staff for help.
Hospital capacity and staffing are the major challenges
Rural hospitals in the state’s northern panhandle, like Hereford Regional Medical Center, have been overwhelmed with Covid-19 patients. Just before Christmas, the hospital reported “unprecedented need for emergency medical care and hospitalization.” All those requiring hospitalization were unvaccinated. Five were in critical condition, including two who were on a ventilator.
The hospital had stopped accepting patient transfers from other hospitals due to a lack of beds and staffing shortages, and wasn’t able to transfer its patients to larger urban hospitals because those facilities were also overwhelmed. At the same time, hospital officials worked with the state to secure supplemental staffing and replenish supplies of critical medications that had been caught up in global supply chain backlogs.
The state has since helped with staffing and medical supplies. But Hereford Regional is still in crisis mode, with many more very ill patients than its two ICU beds and no end in sight.
“I don’t think that we’ve hit the peak with the surge yet,” said Jeff Barnhart, the CEO of the Deaf Smith County Hospital District, which oversees Hereford.
The shortage of beds is driven as much by the delta variant as it is the new omicron variant, Henderson said.
Under normal circumstances, Hereford’s two ICU beds would be more than enough to serve the local community, and patients requiring complex care could easily be transferred to larger urban hospitals in Amarillo or Lubbock, according to Barnhart.
But over the last few weeks, the ICU has been full and Covid-19 patients are being treated on the medical surgical floor, which is typically reserved for patients preparing for or recovering from surgery. All the nearby hospitals have been too full to accept transfers: The Amarillo Public Health Department has reported that 73 percent of ICU beds and 81 percent of total hospital beds in the surrounding Potter and Randall counties are currently in use.
Hospitals that do have space don’t always have the resources to airlift patients. That means Hereford has had to transport Covid-19 patients by ambulance with a constant oxygen supply, sometimes as far as Albuquerque, Oklahoma City, or Dallas.
Staffing shortages are also a near-universal problem across Texas hospitals. That’s in part because many medical staff have tested positive for Covid-19 and are in home quarantine.
“If you don’t have the staff, you can’t take care of patients, even if you have beds,” Henderson said.
The Centers for Disease Control and Prevention recently changed its recommendation for people to quarantine for five days instead of 10, if they are fever-free for 24 hours without the use of fever-reducing medication and if other symptoms have improved. That guidance could allow asymptomatic health care workers to return to work much sooner, helping alleviate staffing shortages and the availability and quality of medical care for all. There is a risk, however, that health care workers who return to work too soon after testing positive could spread the virus to their colleagues and patients.
Retaining medical staff is also proving a challenge. They’re burnt out after two years on the frontlines of the pandemic and working extra shifts at the pleading of their supervisors. With nationwide demand high, and supply dwindling, Barnhart said he’s been losing nurses to traveling positions that pay $125 to $200 per hour — much more than his small rural hospital ever could.
All of this has hurt quality of care not only for Covid-19 patients, but also for others with critical medical needs.
“It’s not just Covid patients who come to the hospital,” Huang said. “The ability of the health care workforce to provide needed care to people who are coming in for other serious conditions, like car accidents, is compromised.”
Despite omicron, it’s business as usual in Texas
Despite the pressure on Texas hospitals, omicron hasn’t shifted state Republican leadership’s pandemic strategy. Since March 2021, Gov. Abbott has been primarily focused on rolling back public health measures that had been used to curb the pandemic and keeping Texas open for business, no matter the risk.
He ended the state’s mask mandate and business capacity limits. He banned local officials from implementing their own mask and vaccine mandates and has taken those who defy him to court.
Texas Attorney General Ken Paxton signed on to a lawsuit challenging the Biden administration’s vaccine-or-test mandates for large businesses and health care workers, which is now before the US Supreme Court. Paxton also successfully fought another federal mandate that requires federal contractors to be vaccinated, which has been blocked in court.
That’s despite the fact that most Texas voters support mask mandates and allowing private businesses to require that their workers be vaccinated. There is, however, a large partisan divide on the topic and significant opposition to such mandates among Abbott’s Republican base. For example, a October University of Texas/Texas Tribune poll found that while 89 percent of Texas Democrats believe employers should require their employees to be vaccinated or to be able to show a recent negative test, 72 percent of Republicans believe employers shouldn’t have those requirements.
Though Abbott says he is pro-vaccine, his public remarks on the topic of vaccination have largely focused on protecting the right to be unvaccinated. He told the Dallas Morning News in July, for instance, that people have “the individual right and responsibility to decide for themselves and their children.” He hasn’t held a press conference on Covid-19 in months. He has never tweeted about booster shots, and it’s not clear whether he has received one himself.
His supporters seem to be taking cues from him, and that’s proving to be dangerous amid the omicron wave. It also means hospitals are unlikely to see any relief until omicron begins to decline naturally. In the near term, in part due to personal choices and in part due to policy choices, health care workers in Texas will continue to face an overwhelming number of Covid-19 patients. And all of their patients will continue to suffer for it.
“The lesson that we learned is that we can’t be complacent,” Huang said. “We can’t just go back to the way things were. We need to still keep our guard up.”