Health professionals race ‘the curve’



New terms such as social distancing, community spread, and the curve are cited at every turn as healthcare officials try and explain how mitigation can be a critical factor in coping with the COVID-19 virus, but the data that illustrates the importance of these concepts isn’t always so easy to understand.

A number of tests conducted, with the number of confirmed cases thrown in next to the correlating death toll is important data, but it only tells the story to date based on the aggressiveness of testing efforts.

Projections are what become most important in mitigation efforts and that is a much more sticky proposition.

“There are different models that take different projections and there’s not one we have said is the Texas state model or that we are going by,” said Chris Van Deusen with the Texas Department of State Health Services. “We’re looking at all of those things as we’re doing our planning. We know we have some time left to continue to flatten this curve and to continue to increase healthcare capacity as much as we can.”

In the end, making sure the need for hospital beds, ventilators and healthcare workers doesn’t outpace those resources available today – or those that can be mobilized – is the goal.

“We’re looking at those numbers and what those projections look like and we’re continuing to make those preparations. I can’t give you a date where we think it’s going to play out because there’s no perfect information,” he said. “All of the models make assumptions and have inputs and as we move along I think we’ll be able to see if one of those models seems to be mirroring the situation more closely than others then maybe that will give us an indication, but we’re not at that point yet.”

No one can predict the peak of the COVID-19 outbreak in Texas, but Williamson County Judge Bill Gravell said what he is being told by his healthcare sources is that late April is the most current projection, but he hedged, saying that projection was just the “best guess of really educated people.”

“I’m seeing the peak is somewhere between April 26 and May 15,” he said. “But we do not know what we have because we have no testing.”

What’s at stake in Williamson County is knowing how far its current resources can extend.

Access to ventilators is something being monitored closely, both in hospitals as well as for first responders.

“Recently I issued an authorization to purchase six ventilators for ambulances in Williamson County and we are stepping up as we need to with that to help,” Gravell said.

Currently in Williamson County there are 315 hospital beds available, 90 intensive care unit beds, 65 ventilators for children, and 221 adult ventilators across seven hospitals.

Plans are being made for a filed-type hospital if needed, but Gravell was not ready to share details on where or how large it might be.

“We’re working on a temporary hospital location, but we’re not disclosing the location at this time,” he said. “Our team has been working on the temporary hospital for at least seven days and now we’re working with state emergency management. When the State of Texas deems that it is necessary for us to have that alternative hospital locally, then they will provide the doctors, nurses and all that is necessary.”

Rather than needing mobile hospitals, health officials continue to cite the curve, and the ability to flatten it or lessen the number of cases to avoid overwhelming the healthcare system. Texas and the United States continue to be on the upward trajectory of the curve today.

“We’re certainly on the upswing,” Van Deusen said. “We’re on the increasing part of that curve now and that’s where we need everybody’s help. That’s the most important thing people can do is try to help flatten that curve and make it go up less quickly, and maybe make it not go up as high, so we won’t exceed the ability of the healthcare system to care for people that need it.”

Flattening the curve means fewer cases of the virus at a slower rate of infection, and healthcare professionals and public officials say that’s where all the new orders are coming from.

“That’s where the social distancing comes in and where the advice to stay home comes from,” Van Deusen said. “There are various different models that have had different projections, but what they consistently show is the more you do that social distancing the fewer cases you’re going to have all at once, and hopefully, by all working together, we can avert the issue of the healthcare system running out of room or the ability to care for people.”

As residents essentially self-quarantine, they filter through daily reports of testing, cases and deaths from the virus, but without the mountains of data being digested by researchers it can be difficult to know what to make of the numbers.

“One of the key things is to look at where it’s present in Texas and the change over time,” Van Deusen said. “If we continue to see things accelerate, particularly in someone’s local area, I think it’s something that people should pay attention to. It shows this virus is present in the community and it should instruct everyone to take steps to try and limit their exposure and limit the exposure to anyone else.”

Beyond their local numbers, it is important to see how the virus has spread from some of the original locations with confirmed cases.

“It is a whole array of statistics and numbers coming at people, but people should also look at what’s going on elsewhere in the state because we’re seeing that most of the cases were first in the large metropolitan areas then we have seen it filtering out from there,” Van Deusen said. “I think we continue to see new counties added to the list every day and we continue to see the number of cases rise, and so I think it is something people need to be paying attention to.”

The virus has been confirmed, as of Tuesday, in 122 of 254 counties, with Harris (563) – the Houston area – Dallas (549), and Travis (206) counties reporting the most cases.

The lack of test kits throughout the state has made gathering reliable and up to date data even more difficult, but Van Deusen said that situation is improving.

“We continue to see testing ramping up,” he said. “In Texas, we started seeing cases a little bit later than other parts of the country, certainly the west coast and New York area, so a lot of the private labs really focused their attention on those areas first. But over the last few weeks, we have certainly seen the number of tests in Texas continue to ramp up as the big national providers and private labs that do business in Texas get more and more of their testing capacity online.”

Testing roadblocks can be as simple as a lack of swabs for gathering samples.

“We know some providers have had difficulty getting the swabs used to take the nasal swab to run the test,” Van Deusen said. “I think there are certainly still challenges with that. We’re continuing to work with our federal partners on getting those supplies out into the community.”

The correlation between testing and total confirmed cases is unmistakable, though.

“We certainly expect as testing continues to ramp up that we will find more cases,” Van Deusen said. “We know that no matter what the illness, you name it, we’re not going to identify every single case. You can assume there is more of it going around than has been identified by a laboratory test. We want to test as many people as possible, we want to identify as many cases as we possibly can, but we always know there is likely more illness out there than we’ve identified.”

Once the test kits are more readily available, Van Deusen said the lag time in getting results remains.

“If it is done through the public health system at one of our labs here in Texas, like our state lab here in Austin, that turnaround is usually two or three days, it could be a little longer or a little shorter,” he said. “The same issue is on the private side, it depends on the lab. Some are doing testing here in Texas, some are sending it to locations in other states and that obviously builds in a little extra time to get those tests to a lab if it is somewhere else.”

Work to control the spread in Williamson County – beyond stay at home orders and social distancing – boil down to thorough tracing and investigation when a case is confirmed. The County has put teams of three on each case, focused on tracking the locations visited and people the patients with the virus have been around.

“Generally on a team is a statistician, someone keeping a written record, generally a seasoned or retired detective and a nurse,” Gravell said. “Those three make a team, and for example, every new case we have, that team of three does an investigation into that person.

“Those three communicate with (those who test positive) virtually and they look at every place they have been, every person they’ve been in contact with within a certain time frame, then that team comes back and they start communicating with those other folks that would be within that possible infected range and ask them to self-quarantine. That group goes on another master list (the team is) daily checking up on.”

Officials say that most who contract the virus will be able to recover at home, and so far, there is no specific treatment for COVID-19.

“We know that folks are working on getting some kind of antiviral drug that could treat infections, hopefully shorten the infection and alleviate the symptoms,” Van Deusen said. “But we don’t have that yet. It will likely come before a vaccine.”

The goal for patients is to manage their symptoms, said Van Deusen.

“You want to make sure people stay hydrated, making sure you treat their symptoms, and most people will be able to manage that at home, especially those who are otherwise healthy,” he said. “If people can manage symptoms at home we encourage them to do that so that the healthcare system can serve people who aren’t able to do that. For the vast majority of people they will recover just fine without the need for hospitalization.”