July 9, 2020
Dear Members of the Baylor College of Medicine Community,
This has been a difficult stretch in our COVID-19 experience. Texas – and frequently Houston and the Texas Medical Center – became the focus of international media attention as a new epicenter in the pandemic. Our affiliate hospitals are all strained. Intensive care units are full to their normal operating capacity as hospitals bring on “Phase 2” expansion capacity. Our clinical faculty leaders are working hard to ensure we have adequate staff to handle a greater number of patients. Patient demand is surging. As we see spread of the disease in the community, we probably all know someone personally who has had the infection. And, by the way, the new interns, fresh out of an unusual final quarter of medical school, reported for duty on or about July 1.
It has been a difficult week. We will get through this.
I would like to reflect on where we were a couple of weeks ago, where we are today, and where I think we will be in the next couple of weeks. It is always risky to prognosticate, but in this case I think it is important to help us maintain perspective.
Let’s look at where we were on June 23, and compare it to July 7, two weeks later:
- New confirmed community cases in the Houston metropolitan area rose from 1,100 to 1,600 per day. The past few days seem to be leveling off, but it is too early to call it a trend.
- As the incidence of the virus in the community increased, it drove an increase in daily hospitalizations. On June 23, across all TMC facilities, total new COVID-19 admissions were rising at a rate of 7.5% daily. By July 7, the rate of new admission was falling by 2.1% daily.
- Increase in daily admissions has driven an increase in overall hospital COVID-19 census. Across all TMC facilities the census was 1,586 patients on June 23, and climbed to 3,175. There are essentially twice as many confirmed COVID-19 patients in our hospitals now compared to two weeks ago. However, the rate of increase has moderated somewhat: from 5.6% to 3.8%.
- Finally, the all-important “Rt”. Rt is an estimate of the infectivity of the virus in an immunologically naïve population. If Rt = 1, than an infected individual will statistically infect one other person. Any value greater than one will produce community spread. On June 23, Chris Amos’ lab estimated the Rt for COVID-19 in Houston to be close to 2. By July 7, the infectivity seems to have been substantially reduced, to less than 1. Recent public education efforts, heightened media attention and policy decisions are beginning to have an impact, as they did with our earlier “Stay Home, Work Safe” effort.
So what can we expect? First of all, as always, there are major caveats. Projections can change. Trends can be over-interpreted. The public’s compliance with distancing efforts could wane. The July 4 holiday may have caused some issue with data submission. Holiday celebrations may result in more spread. However, based on the information available at this time, I expect:
- Based on the drop in Rt, new cases in the community will continue to mitigate.
- Daily admissions will moderate over the next couple of weeks, and hopefully decrease.
- Hospital COVID-19 census will remain high, as existing patients move towards discharge (or unfortunately, expire). High census will continue through late July, and then begin to moderate.
So there are two broad messages here. First, we cannot back away from beating the social distancing drum. Masking, distancing, symptom monitoring, and avoidance of crowds (especially in confined spaces) remain critical. This is a message we will need to push for months to come. Second, we are still in for a difficult couple of weeks, but there appears to be light at the end of this particular tunnel. I know there are many sacrificing much right now for the benefit of our patients.
Thank you, and stay safe.
James McDeavitt, M.D.
Senior Vice President and Dean of Clinical Affairs