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It's about to be a year since the first reported COVID death in the Austin-Travis County area, and despite improvements in treatment for the virus over a course of a year, the case-fatality rate—defined as the number of reported deaths per confirmed cases—has increased slightly in the last few months.
But local health experts say that outcomes are improving even if they are not yet reflected in the data, and will continue to do so as more of the population is vaccinated.
"The severe or ultimately fatal cases do seem, at least anecdotally speaking, to be less frequent," said Dr. Matthew Robinson, medical director of infectious diseases at St. David's South Austin Medical Center. "But it's hard to divorce that from (the fact that) we're just seeing less overall cases."
What the data shows
The Austin-Travis County case-fatality rate has generally declined since its peak of more than 3% last April, during the early weeks of the pandemic. After dropping to less than 0.5% in June, it rose slightly as the first summer surge emerged and faded. Since September, it has generally been on the decline, rising slightly to 1.6% last month.
Overall, the local case-fatality rate is better than the national average. With 802 deaths reported and 78,193 confirmed cases as of Sunday, it is 1.03%—significantly lower than both the statewide rate of 1.95% and the national rate of 1.82%, according to data from the Texas Department of State Health Services and the Coronavirus Resource Center at the Johns Hopkins University of Medicine.
The slight increase in the local case-fatality rate comes at a time when confirmed cases and reported deaths are dropping sharply in the wake of the last surge, which was exacerbated by holiday gatherings and travel. The average number of new confirmed cases reported daily has fallen more than 85% since a peak of 701.7 on Jan. 17, according to Austin Public Health data. Just over 100 new cases are reported each day, as of Sunday. COVID hospital admissions have also dropped precipitously: since hitting a peak of 93.7 on Jan. 9, the average number has dropped nearly 77%, to 21.6 on Sunday.
The rate is also an imperfect metric given that the number of confirmed cases is almost certainly lower than the number of actual cases in the community. "The denominator of total cases is somewhat of a hard number to be accurate with," Robinson said.
What the doctors say
Since the early months of the pandemic, doctors have grown more familiar with COVID—and gained greater access to treatment options. In addition to hospital-based treatments, such as steroids and the antiviral drug remdesivir, other interventions have emerged that are intended for patients in the early stages of the disease to prevent them from requiring hospitalization. These include convalescent plasma, which is sourced from recovered COVID patients, and monoclonal antibodies, a lab-made protein that acts as a substitute antibody.
These treatment options, combined with more experienced doctors, fewer hospitalized patients and wider availability, have improved case outcomes. "We've refined our knowledge of who benefits from which therapeutic interventions at which time, so we try to tailor that therapeutic response to the patient, and generally we have access to what we need at this point," Robinson said.
But there are still limitations. Remdesivir remains the only antiviral available for treating COVID patients, and it is not a cure-all in the way that antibiotics can be for bacterial infections. Like other treatments, such as convalescent plasma and monoclonal antibodies, its efficacy depends on the patient's comorbidities, viral load and the strength of his or her immune response. "There's not really a panacea for this process, and I don't think there will be," Robinson said.
This is why the increasing vaccination rate is so promising. Although it's too early to know definitively, Robinson has noticed fewer patients requiring hospitalization in certain high-risk populations, such as nursing home residents and people 65 and older, at St. David's South Austin Medical Center. "I suspect we are beginning to see some impact of vaccination penetration in the community in concert with reducing cases, but it's hard to know for sure how much to attribute to that," he said.
As of Sunday, 27% of the Travis County population ages 16 and older have received at least one dose of the COVID vaccine and around 11% are fully vaccinated, according to DSHS data. But some high-risk groups have much higher vaccination rates.
Austin-Travis County Interim Health Authority Dr. Mark Escott told Austonia earlier this month that increasing vaccine access among nursing home residents has translated into a sharp drop in new cases at long-term care facilities. In the last two weeks, six new COVID cases have been reported at Travis County facilities, compared to around 350 during the two-week period from late January to early February. "It's been a remarkable and rapid decline of cases as a testament to the efficacy of the vaccine," he said.
At this stage in the pandemic, higher rates of natural immunity—among people who have contracted COVID and recovered from it—may also be contributing to case outcome improvements. Combined with growing vaccine access, Robinson is optimistic about the case-fatality rate decrease moving forward. "I think we're beginning to reach numbers where we should be able to see some impact," he said.
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After Austin voters passed Proposition B, reinstating a ban on public camping, City Council directed staff to look into possible sanctioned campsites where homeless residents could live legally. Now two members are asking to shelve discussion on the controversial topic.
Staff presented dozens of possible sanctioned campsites across each fo the 10 council districts in late May, following the election. But members mostly pushed back on the proposed locations, citing cost, wildfire risk and lack of transparency as concerns.
With updated criteria, staff recommended two sites—one in District 1 and the other in District 8—for further review last week. After being briefed on the options during Tuesday's work session, Mayor Pro Tem Natasha Harper-Madison, who represents District 1, and Council Member Paige Ellis, who represents District 8, issued a joint statement proposing "a pause" on further discussion of temporary sanctioned encampments.
"We are not convinced that these sites would be a cost-effective solution, but rather a band-aid tactic when we need to be supporting the long-term strategy to get folks off the street permanent," they said. "It is our responsibility to look at the situation holistically and objectively, and to spend out city's limited resources on solutions we know can work."
Homeless Strategy Officer Dianna Grey noted that the two locations were imperfect and would require a lot of time and money to outfit as sanctioned campsites during the briefing.
City staff and homeless experts have previously raised concerns about sanctioned encampments, saying they are expensive to maintain, challenging to manage and hard to close, even when intended to to be temporary.
In 2019, staff declined to make recommendations for such sites despite being directed by council to do so, citing 2018 guidance from the U.S. Interagency Council on Homelessness. "Neither authorized encampments nor parking areas provide housing for people experiencing homelessness," staff wrote in a memo. "Rather, each option detracts from the staff resources assigned to addressing this moral imperative."
But with Prop B being enforced and too few shelter beds and affordable units for the estimate unsheltered homeless population in Austin, the city is facing the same predicament that prompted District 9 Council Member Kathie Tovo to pursue possible sanctioned campsites in the first place: "When individuals in encampments ask where they should go, we need to have places to suggest," she said at a May 6 council meeting.
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Don't lose your mask just yet—the Centers for Disease Control and Prevention announced it is now recommending masks in areas that are surging as cases rise nationwide and the Delta variant looms.
The CDC announced Tuesday that even fully vaccinated individuals should mask up indoors if their community is experiencing substantial transmission—defined as areas with more than 50 cases per 100,000 people. Travis County is sitting at an average of 94.59 cases per 100,000 over the past seven days, falling into the highest risk category, according to the CDC.
#DeltaVariant surging in U.S. New data show Delta much more contagious than previous versions of #COVID19. Unvaccinated people: get vaccinated & mask until you do. Everyone in areas of substantial/high transmission should wear a mask, even if vaccinated. https://t.co/tt49zOEC8N
— CDC (@CDCgov) July 27, 2021
After two COVID-19 recommendation stage jumps in the last two weeks, from Stage 2 to Stage 4, Austin-area cases are the highest they have been since February. The seven-day average for cases is on an upward trend, reaching 226 on Tuesday.
The CDC is also recommending that all students K-12 wear masks indoors, regardless of vaccination status. A May executive order by Gov. Greg Abbott prohibits schools from requiring masks, regardless of vaccination status. Austin ISD is "strongly" encouraging students to wear masks.
Although vaccinated individuals are still protected against the most severe symptoms of the variant, infections are spreading rapidly and now make up 83% of confirmed cases in the U.S. At least a dozen cases of the delta variant have been confirmed in the Austin area, though there are likely more since testing for it is limited.
CDC Director Dr. Rochelle Walensky said that hospital admissions are "almost exclusively" coming from people who are unvaccinated but those who are vaccinated can still catch and spread the virus.
"Unlike the alpha variant that we had back in May, where we didn't believe that if you were vaccinated you could transmit further, this is different now with the Delta variant," Walensky said. "That leads us to believe that the breakthrough infections, rare that they are, have the potential to pool and transmit at the same with the same capacity as an unvaccinated person."
Research suggests those who become infected carry 1,000 times more of the virus than other variants and could stay contagious for longer.The announcement comes on the heels of the Biden administration ramping up cautionary measures in the face of the Delta variant. Just last week, the CDC said it had no plans to change its May guidance of vaccinated not having to wear masks unless there was a significant change in the data. Officials met on Sunday night to review new evidence, according to reports.
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The Moody Center, a $338 million, 530,000-square-foot multipurpose arena at the University of Texas at Austin, celebrated its topping out on Tuesday.
With the final beam placed, the arena's steel-frame structural phase—which involved more than 5.3 million pounds of steel—is complete.
"This past year has been full of unprecedented events, not to mention weather challenges, and yet the women and men working on this project continue to deliver," Moody Center General Manager and Senior Vice President Jeff Nickler said in a press release.
To celebrate the topping out Oak View Group, the development and investment firm behind the Moody Center will affix a tree to the final beam in keeping with the time-honored tradition.
The practice dates back to ancient Scandinavian religious rites, which involved placing a tree atop new buildings to appease tree-dwelling spirits displaced during the construction process, according to the International Association of Bridge, Structural and Ornamental Ironworkers in Washington D.C.
After the steel-frame structure phase, the development will move on to enclosing and finishing the interior of the Moody Center.
The arena is set to open next April and already has some major acts scheduled for its inaugural year, including The Weeknd, Justin Bieber, John Mayer and The Killers. It will replace the 43-year-old Frank C. Erwin Jr. Center and serve as the home of UT's men's and women's basketball games, among other sports and community events.
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