(Charlie L. Harper III/Austonia)

Austin's three major hospital systems are currently at 70% capacity. One epidemiologist said that at 80% surge plans come into play.

Three months into the pandemic, the long-anticipated COVID-19 surge has arrived.

Key indicators both in Austin and across Texas—a rising daily average of new hospital admissions, rising case numbers and a growing positive rate in COVID-19 test results—have spurred policy changes at both the local and state levels.

Here are some questions we can answer:

    What steps has the government taken to address this surge? 

    Hospitalizations statewide over time.

    (Texas COVID-19 dashboard)

    Statewide hospitalizations have soared. (Texas COVID-19 dashboard)

    A few:

    • Texas Gov. Greg Abbott issued an executive order this morning that re-closes tubing businesses and bars and reduces permitted restaurant capacity from 75% to 50% on Monday in an effort to slow the spread of the coronavirus.
    • Abbott also re-suspended elective surgeries and procedures in Bexar, Dallas, Harris and Travis counties yesterday to ensure hospital beds are available for COVID-19 and emergency patients.
    • Locally, Austin Mayor Steve Adler and Travis County Judge Sam Biscoe issued orders requiring businesses to mandate masks among their employees and customers, after Abbott signaled that such a mandate would be legally permissible under his reopening plan. They took effect on Monday and expire Aug. 15.
    • Biscoe issued a second order yesterday that prohibits outdoor gatherings in excess of 100 people through July 10, after the governor granted local officials the right to do so. Violators may be fined up to $1,000.

    In a poll, nearly 60% of Austonia readers said the city and state should shut down again, given the surge.

    How many beds are available at area hospitals?

    Hospital capacities by region in Texas with the top of the chart, 1, representing full capacity. Each region represents a separate Trauma Service Area, which are used to analyze how different parts of the state are affected by the spread of the coronavirus and other hospitalizations. (UT Health)

    Hospital capacities by region in Texas with the top of the chart, 1, representing full capacity. Each region represents a separate Trauma Service Area, which are used to analyze how different parts of the state are affected by the spread of the coronavirus and other hospitalizations. (UT Health)

    Dr. Mark Escott said he is not worried about available hospital capacity this week or next during a virtual press conference on Wednesday, but he is concerned about what happens after that.

    Projections by the COVID-19 Modeling Consortium at the University of Texas at Austin show that Travis County's caseload could double by mid-July, overwhelming area hospitals.

    Currently, 227 people are hospitalized with COVID-19 in Travis County, of whom 88 are in the ICU and 34 are on ventilators. This is a fraction of the available capacity, but non-COVID patients continue to require care.

    Austin's three major hospital systems—Ascension Seton, Baylor Scott & White Health and St. David's HealthCare—reported that they have 2,470 staffed beds between them, 71% of which were occupied on Wednesday.

    University of Texas Health epidemiologist Katelyn Jetelina told Austonia that when hospital occupancy cracks 70% public health officials begin to worry. When it reaches 80%, surge centers come into play.

    The systems can increase their capacity to 3,250 beds by adding beds to single-occupancy rooms and drawing in nursing staff from other cities, among other interventions.

    What if hospitals fill up? 

    Austin metro seven-day moving average hospitalizations.

    (Key indicators dashboard)

    Austin metro seven-day moving average hospitalizations. (Key indicators dashboard)

    The city released a three-stage surge plan in early April. Once hospitals maximize their available bed space, the second stage is to expand care to "Type 2" facilities, such as outpatient surgical centers and former hospital buildings. The city has identified six such buildings that can serve 50-100 people but has not named them.

    In the last stage, the city will open "Type 1" venues—field hospitals that could serve low-acuity patients, such as those who need an IV or supplemental oxygen. The city has declined to identify these venues, but in the Wednesday press conference, one local physician indicated the Austin Convention Center is being prepared.

    Who is getting COVID and who is dying of it?

    The vast majority—70% of new cases reported June 8-23—were in the 20-39 age group, according to Austin Public Health data.

    This increase in infections among young people may be contributing to a lower mortality rate—for the time being—given their better chances at recovery.

    However, despite improvements in treatment and increased testing, the disease remains deadly for some—especially for older patients and nursing home residents.

    Patients over 60 account for 86% of Travis County's COVID-19 deaths, per APH data.

    What can I do to stay safe?

    masks mask

    (Charlie L. Harper III)

    (Charlie L. Harper III/Austonia)

    Abbott and local officials are united in their advice: stay home, wear a mask when you're out, socially distance and wash your hands.

    "It's crunch time for now, over the next week to 10 days," Adler said during a video update posted to his Facebook page on Thursday evening. "We really need to see what we can do to turn this thing around."

    What is behind this surge?

    (Texas COVID-19 dashboard)

    The state positivity rate has risen above 10%. (Texas COVID-19 dashboard)

    Local health officials attribute the spike to a combination of factors: the state's reopening, which began on May 1 and has scaled up since then; Memorial Day festivities and other mass events; rising case numbers among young people, who may be more likely to socialize; and loosening adherence to masking, social distancing and other precautions.

    Specifically, data shows cases began to rise when the state moved into the second phase of its reopening plan, which allowed restaurants to increase capacity to 50% and bars and salons to open, Jetelina told Austonia.

    During a virtual press conference on Wednesday, Dr. Escott and local physicians implored Austin residents to stay home when possible and to stay vigilant when not.

    "If the situation doesn't improve in the next week to two weeks—I'm going to have to make a recommendation to the mayor and the [county] judge that we shut down," Dr. Escott said. "And I don't want to do that."

    How does this compare to what is happening nationally? 

    This trend is not limited to Austin. Twenty-six states have seen their caseloads increase over the past week, with the most substantial changes in Arizona, Michigan, Texas and Florida.

    New York, New Jersey and Connecticut announced Wednesday that they would require travelers from Texas to quarantine for 14 days—a reversal of roles from earlier in the pandemic.

    Robert Redfield, director of the Centers for Disease Control and Prevention, said Thursday that the number of people who have been infected with COVID-19 in the U.S. is likely 10 times the number of confirmed cases, which is hovering around 2.4 million.

    Are schools still opening in August?

    So far, yes.

    Abbott announced last week that students will return to Texas public schools for the new school year. Austin ISD returns to the classroom on Aug. 18 and is planning on a hybrid model that combines in-person instruction with distance learning for those families who choose it.

    Education Commissioner Mike Morath issued a statement saying it was safe for students to return, that schools would not be required to mandate face masks or screenings and that the TEA would provide more detailed guidance this week, which has yet to arrive.

    What does this mean for area businesses?

    Domain (Karen Brooks Harper/Austonia)

    (Karen Brooks Harper/Austonia)

    Businesses are already struggling to make money while observing capacity limits and dealing with the economic fallout of the first shutdown.

    Last week Adler urged restaurants to reduce their capacity in light of the mounting surge, prior to the governor's mandate that they do so.

    Local attorney Kareem Hajjar, who represents hundreds of restaurants in Austin and across Texas, told Austonia that heeding the mayor's advice would be devastating.

    "At this point, I don't have a single client that is going to close again or lower their capacity," he said. "It would wipe them out."

    (Austonia staff)

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