Baylor College of Medicine

Long, Dark Winter


Jan. 6, 2021


Dear Members of the Baylor College of Medicine Community,

I wish there was better news to report. If you spend just a few minutes reviewing the data, the trends are clear and do not require an advance degree to interpret.

SARS-CoV-2's hold on our community is as bad as it ever was and will likely get worse before it gets better. Nationally, new daily cases continue to rise and daily death rates are at disturbingly high levels. On Jan. 5 alone, the U.S. experienced 3,478 deaths, close to twice the daily deaths attributed to heart disease or about the same number as nine downed 747 jets.

Across Texas, a couple of weeks ago I used the analogy of a severe weather front sweeping from the northwest to the southeast. El Paso was buried in COVID-19, and Houston was relatively spared. Unfortunately, the analogy proved apt. When you look at test positivity rates and new cases per 100,000 population, many counties to the north and west are improving while the trend lines for Harris and surrounding counties are generally all headed in the wrong direction. The front has arrived.

In Harris and surrounding counties, the new daily case rate now exceeds our July peak. Daily hospitalization rates are very close to July levels and hospital COVID-19 census is about 80% of the July peak. On a small positive note, demand for ICU beds is somewhat less than it was in July, but is still solidly in major surge territory.

There is no way to sugarcoat the situation – we are likely entering the worst period of our pandemic. This is no doubt discouraging to many, disheartening and frightening to a few. We will get through this. We have been here before. Our hospitals and providers have learned to operate effectively in a challenging environment. We are experts in treating this disease, and have treatment options that were not available to us earlier in the year. Many of our physicians and health care workers have been vaccinated, reducing the fear they will be exposed at work.

Importantly, this is likely the last major surge we will experience. January and February will be challenging, but this surge will end. Like a late-May blizzard, or November hurricane, we can take some solace in the knowledge this is the last one.

There is one important note that is probably obvious to all. We are in an environment with a higher prevalence of active disease than we have ever experienced. Those of us who have grown a little sloppy in our viral control practices may have gotten away with it in September. The risks are much greater now. Recommit. Mask and distance. Avoid aggregating in indoor spaces. Do not show up to work or school if you are experiencing any symptoms, however mild. Assume everyone you meet is infected with the virus.

I receive many questions around how to get vaccinated, so I want to finish with some general comments around vaccinations. This is still a rapidly evolving situation, so please refer to prior and ongoing Baylor-specific vaccine messages for more details.

The development, testing, and rapid distribution of vaccine to states has been a triumph of science and public-private partnership. However, there has been much confusion and dissatisfaction around the final stages of the national roll out – the actual vaccine administration.

Part of the challenge has been a "last mile" problem. By way of analogy, we built a fabulous collection of modern power plants, and an electrical grid to distribute power efficiently around the country. However, we neglected to hook up electrical lines to people's homes. States were allocated available vaccine based on population, and each came up with a methodology to distribute doses. Texas, like most states, took a decentralized approach to vaccine distribution, shipping to health systems, pharmacies, local health departments and others. The expectation was (and remains) that these hundreds of organizations would figure out how to efficiently administer doses.

There is some strength to a decentralized approach, but it also led to variability in practice between providers. This variability has led to inconsistency in who has received vaccine resulting in confusion and dissatisfaction. Baylor's approach has been to follow the Texas DSHS instruction to focus on Phase 1A (faculty, staff and learners in clinical settings) and 1B individuals (qualified employees and Baylor Medicine patients).

Much of the problem is supply and demand. There is far, far more demand for vaccine than current supply. As a small example, we estimate of all the established active patients in the Baylor Medicine managed practices, roughly 63,000 fall into the 1B category, and should be eligible for vaccine. To date, we have been allocated a total of 4,000 doses. Much of that has gone to vaccinate our 1A providers, employees and students.

It is disappointing the nation did not get 20 million people vaccinated by the end of 2020, the expectation that was set. However, keep in mind we have been at this for a little more than three weeks. The supply will increase. Providers will become more facile with managing our two vaccines, which are complex to manage and administer. Additional vaccines will be approved. "We" will solve the last mile problem. "We" will figure out how to balance the speed of administration with getting vaccine to the highest risk population. "We" is in quotes because it is a broad group – state and local governments, civic leaders, health departments, health care systems, pharmacies.

In the next couple of months, there will be a great deal more clarity. Until then, here is my best advice – based on what is known today – for family and friends seeking vaccine:

  • If you do not qualify as 1A (health care workers in clinical environments) or 1B (65 and above or people with high-risk conditions) do not try to find a path to vaccination at this time. If you are not eligible, calling sites to attempt to get scheduled ties up already overburdened phone lines and limits the ability of vaccine-eligible people to get through. Keep monitoring reliable media sources and communications from Baylor. Over the coming weeks, Texas DSHS will expand vaccination eligibility criteria, administration site options will expand (e.g. commercial pharmacies) and supply will increase.
  • If you are 1B eligible, and you have an established primary care physician (PCP), reach out to your doctor's office for information. I would suggest you check their website or try to send a message through your electronic medical record before calling. Baylor Medicine established patients are encouraged to use MyChart. The vaccine scheduling number for Baylor Medicine patients only is 713.798.8600 (please do not call this number if you are not an established patient of Baylor Medicine).
  • If you do not have a PCP, Texas DSHS posts the location of all vaccine providers, and you can drill down on your neighborhood. I would also check the website for the health department in the county where you live. Most provide some information about vaccine administration. At this time, all the health departments seem to have limited supply.

Wherever you are trying to get vaccinated, please be kind to the staff working to get you scheduled. They are at the very last step of an extraordinarily complex process. If things are not going well, it is almost certainly out of their control.

We are in for a rough few weeks. Keep the faith -- the backside of this surge is coming. Double down on your viral control practices. Encourage others to be patient as we wait for vaccine supplies to catch up with demand.

Better days are coming.

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

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