Baylor College of Medicine

Deja Vu All Over Again


Feb. 3, 2021


Dear Members of the Baylor College of Medicine Community,

Welcome back to what is now a familiar place: The backside of a COVID-19 surge. The past several months have been a long slog. Community cases have been climbing since late September and are finally starting to level off (but not fall dramatically). New cases peaked at an average almost twice that of the July surge. Hospitalizations now appear to have peaked about 10 days into January and are clearly declining, although hospitals are still stressed.

Nationally we are vaccinating an average of 1.4 million people per day. As I said last week, I think this needs to reach a rate of at least 2 million people per day, and quickly. There is good news that both Moderna and Pfizer have promised additional vaccine delivery by July (bringing the total to 600 million doses available in the U.S.), and it appears the much-more-stable and easier to administer Johnson & Johnson vaccine is on track for approval in the next few weeks. Texas has vaccinated about 10% of its population, and almost every U.S. state is making progress to solve the “last mile” administration challenge. We are currently the fifth ranked country in the world in terms of per capita vaccine administration.

As we ride the back of the current surge down, I am reminded how we felt at a similar point during first (April) and second (July) Houston surges. Some hopes and fears have been constant – others have changed.

In April we were grateful the surge had passed, and we did not relive the experiences of Lombardy, Italy, or New York City. We hoped the summer weather would prevent a summer surge (it did not). We hoped we could encourage masking, distancing and good viral control practices to drive our new cases below 200 a day, a level we thought we could still do effective contact tracing. We came through the first surge with fewer than 200 deaths in greater Houston from COVID-19.

We feared we would see a second wave.

In July it came, and it would tower over the first. At least three times the rate of new cases. Cumulatively, close to 1,500 Houstonians dead. Our health systems bent but did not break. Up to that point, no region had surged a third time. We hoped maybe we were through the worst of it. Maybe the virus would settle down to a low enough level we could start to resume elements of normal, pre-pandemic life. We hoped we would have a vaccine.

We feared the impact of cooler autumn weather driving people indoors. We feared vaccine would not arrive for a year or more. We feared we were losing our collective resolve to follow safe practices.

We feared we would see a third wave.

Like the strengthening bands of a tropical storm in September it came, more terrible than the last. New cases that eclipsed July levels. Cumulatively almost 4,500 Houstonians dead. More and more disturbing stories of COVID-19 survivors with prolonged respiratory, neurological, and cardiac symptoms. The health system is still bending and is weeks away from some semblance of normal operations. We are grateful we have vaccines and with them a realistic path out of this crisis. Local supply is slowly increasing, but still far inadequate to meet the demand. We are hopeful we will have adequate vaccine supply and the community-by-community logistical wherewithal to reach herd immunity quickly.

We fear we are now in a race against variants. That continually mutating viruses will ultimately produce a SARS-CoV-2 that is more virulent, more infectious and less susceptible to existing vaccines. That we are not bringing this to an end, but transitioning to an endemic state with fourth, fifth, sixth waves.

This fear is not groundless and should strengthen our resolve to maintain effective viral control practices (mask, distance, avoid crowded indoor spaces, do not work if you are sick). It should also drive a real sense of urgency around vaccine administration. Our best defense against emerging variants is to reach herd immunity as rapidly as possible to prevent viral spread. Less spread, less opportunity for mutation.

It is hard to believe, but we are now almost a year into our pandemic experience. It has been a year in which everyone has been impacted by the virus. Health, economic security, mental health, relationships have been affected; for many in profound and lasting ways.

I look to the future with optimism. I picture a time in the fall. A time when in a quiet moment you pause to reflect on your greatest hopes and greatest fears – and none are related to a global pandemic. That is my wish for all of us.

James T. McDeavitt, M.D.
Senior Vice President and Dean of Clinical Affairs

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