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Where is the risk?
First things first, it's helpful to know what is driving the current spike in new cases.
Spinner said the risk extends far beyond essential workers and is not necessarily concentrated where one might expect, such as in school classrooms.
"We see this from a lot of casual gatherings," he said. "That's how we're seeing more and more people getting infected.
Local case investigations bear this out.
"In our discussions with our epidemiology team, there are simply dozens and dozens of examples of entire families being infected based on Thanksgiving holidays in our jurisdiction," Austin-Travis County Interim Health Authority Dr. Mark Escott said Tuesday.
What's the most prudent course of action?
Spinner encouraged Austinites to stay within their bubbles this holiday season. He will be spending Christmas with his wife and their son's family, all of whom have avoided grocery stores and restaurants.
"We feel comfortable with that," he said, adding that the best way to minimize risk is to avoid seeing people outside of your household.
What if I get tested before attending a gathering?
Austin Public Health reported a spike in demand for COVID-19 testing the week before Thanksgiving, which officials attributed to people wanting a negative result before attending a holiday gathering.
But this isn't a failsafe method—and may lead to a false sense of security.
"The issue as far as testing … it's a snapshot," Spinner said, adding that a negative result only confirms that a person probably wasn't infected on a certain day.
A more accurate way to rule out COVID would be to get testing every day in the lead up to a gathering, which is prohibitively expensive and time-consuming for most people.
Is there anything I can do to make gathering less risky?
Yes.
"If you're really looking to gather more than your immediate family together on Christmas, one approach is they all quarantine at home for 14 days," Spinner said.
With less than two weeks until Christmas, this method would require groups to have already begun their quarantine period.
The Centers for Disease Control and Prevention recently updated its quarantine guidelines, including a 10-day period as an alternative to their previous recommendation of two weeks.
"Reducing the length of quarantine may make it easier for people to quarantine by reducing the time they cannot work," the federal agency wrote on its website last month.
Although a 10-day quarantine is better than one of a shorter duration, Spinner encouraged Austinites to self isolate for the full two-week period, which he called "the gold standard."
Is it safe to travel?
This depends on how much risk one is willing to take on.
"If you really, really want to be safe, stay home," Spinner said. "That's ultimately the best approach."
For those intent on traveling, he recommended trips that require no more than one day of driving to avoid exposure at hotels or rental properties.
If that isn't an option, he suggested renting an apartment or home to avoid interacting with others. If one is required to stay at a hotel, he urged cleaning the room after checking in as a precaution.
What about flying?
Spinner discouraged air travel but offered some suggestions for how to make it less dangerous.
Most fliers who get COVID while traveling are exposed in their airport, so he encouraged fliers to wear a mask; eye protection, such as a face shield; and gloves.
He also said to avoid any public restrooms, if possible, and wipe down surfaces before using them
Still, he added, "it is a risk."
Who should be most cautious?
"The more people you have (around you) who are higher risk, the closer to the vest you should play it," Spinner said.
High-risk populations include those 65 years of age and older; people with co-morbidities, such as diabetes and suppressed immune systems; and those who are pregnant.
He encouraged everyone to be cautious because of the possibility that they could transmit the disease to others—or get sick themselves with a severe case.
"Who wants to take the chance with themselves or their loved ones?" he said. "Unfortunately, a lot of people do, but they shouldn't."
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Is the local COVID situation improving?
No.
Despite the good news of V-Day, local health officials painted a grim picture of disease spread in Austin, which they attributed to the "Thanksgiving effect"—and warned that Christmas gatherings could cause a surge on par with El Paso.
"Our situation is getting worse in Travis County," Austin-Travis County Interim Health Authority Dr. Mark Escott said Wednesday. "Right now we are at a place where we have more active infections in our community than we've had at any other time in this pandemic."
Since the beginning of December, Travis County has seen a 45% in the average number of COVID-19 cases confirmed each day and a 57% increase in the number of daily COVID-related hospital admissions. The positivity rate has also increased to 9%, up from 7.4% last week, which Austin Public Health Director Stephanie Hayden said was "extremely high" on Wednesday.
Escott attributed these numbers to Thanksgiving gatherings and relaxed adherence to pandemic precautions, such as masking, social distancing and hand washing.
"It's a concern for us because if we see surge happening now because of Thanksgiving and we see a repeat of that activity during Christmas, we really have the risk of an El Paso or Lubbock type of substantial and catastrophic surge," he said Tuesday.
How are hospitals faring?
Hospitals in the five-county Austin metro are faring okay—for now.
The three major hospital systems—Ascension Seton, Baylor Scott & White Health and St. David's Healthcare—reported an overall occupancy rate of 82% and an ICU occupancy rate of 83% on Wednesday.
"We're not at the stage yet of asking our hospitals to scale back on elective procedures, because we do have enough cushion there to absorb a bit more," Escott said Tuesday. "What we're concerned about is two or three weeks from now."
The current surge in cases is due to Thanksgiving gatherings, Austin Public Health officials have stressed. If people continue to gather for Christmas, New Year's and other holidays, the surge could accelerate quickly.
"We're very concerned that the Christmas holiday may transition into that hockey stick, or exponential, phase of active case growth, which would put our hospitals in danger," Escott added.
Does this affect the local risk level?
The Austin-Travis County area is at Stage 4, according to APH's risk-based guidelines. At this stage, local health officials recommend that individuals at high risk or who live in households with people who are high-risk avoid gathering with others as well as non-essential activities, such as dining out and shopping.
Updated projections from the COVID-19 Modeling Consortium at the University of Texas at Austin, which were published on Sunday, suggest the region is on the precipice of reaching the threshold for Stage 5, which is a daily average of 50 or more COVID-related hospital admissions.
Already, local health officials are imploring Austinites to avoid nonessential trips in an effort to flatten the curve.
"Everything you do should be essential trips only," Hayden said. "We really encourage you not to connect with others who do not live in your household."
(COVID-19 Modeling Consortium at the University of Texas at Austin)
How does this compare to the state of Texas?
Compared to other large Texas counties, Travis County has reported the fewest active cases and cumulative deaths per capita over the course of the pandemic.
However, Austin officials said that the area could see a surge approaching the severity of that seen in El Paso and Lubbock prior to Thanksgiving if residents don't work to flatten the curve.
"This is what the beginning of that kind of surge looks like, what we're seeing now," Escott said Wednesday.
What does this mean for schools?
Disease transmission has largely occurred outside of classrooms, with local officials pointing to extracurricular activities and social gatherings as major reasons for cases among students and staff.
"So schools are safe," Escott said Wednesday.
However, increased community spread could affect schools. Escott doesn't anticipate making a blanket recommendation to close schools, he said, but may advise campuses to return to virtual learning for one or two weeks following the winter break, as happened after Thanksgiving.
If the pandemic continues to worsen locally, the next step would be to significantly reduce or halt extracurricular activities, he added.
In the case of school closures, APH officials would recommend closing high schools first and then middle schools in an effort to preserve in-person elementary education, where students are most adversely affected by virtual learning.
Who will get the COVID-19 vaccine first (and second)?
The initial allotment of COVID-19 vaccines were distributed across Texas earlier this week. UT Health Austin, the clinical arm of Dell Medical School, administered its first shots to frontline healthcare workers on Tuesday.
Earliest access to vaccines will go to frontline healthcare workers, EMT first responders and nursing home residents and staff.
As more doses of the vaccine become available, APH will prioritize those at highest risk of hospitalization and death due to COVID-19. They include people 60 years of age and older, those with underlying conditions and communities our color.
"Our decisions will be data-driven," Escott said Wednesday.
APH is working with a local coalition to arrive at a standardized approach for determining who is prioritized for vaccine access across different community providers.
"There simply isn't enough to go around right now, and there won't be for quite some time," he added.
It also appears unlikely that teachers and other school employees will have any particular priority based on their profession.
"A young, healthy 25-year-old teacher has a quite different risk profile than a 45-year-old teacher with diabetes," Escott explained.
I haven't felt so much joy since before the pandemic, watching the frontline receive such an amazingly effective va… https://t.co/T7iQr5eddp— Clay Johnston (@Clay Johnston)1608049298.0
How will I get vaccinated?
APH is one of more than 200 local providers that have registered to distribute the COVID vaccine in Austin and Travis County.
As the vaccine becomes more widely available, the local health department will focus on low-income and uninsured residents.
"Austin Public Health has always been a safety net provider to our community, and we will continue to be in that space," Hayden said.
Austinites with insurance are encouraged to go through their usual vaccine providers—whether that be pharmacies or primary care physicians—when the time comes.
Does the COVID vaccine control spread as well as prevent infection? What are the differences between the vaccines?
Experts are still working to understand the level of protection that COVID vaccines provide in terms of preventing spread.
For this reason, the CDC recommends that people continue to wear masks and social distance even after they have been vaccinated.
Both the Pfizer and Moderna COVID vaccines rely on a spike protein invented by a team of scientists led by Dr. Jason McLellan, an associate professor of molecular biosciences at the University of Texas at Austin.
The spike protein developed by McLellan's team mimics those found on the coronavirus. When injected via a vaccine, it signals the body to start creating antibodies, which then attach to the virus and lock it in place before it rearranges, preventing infection.
The Pfizer vaccine has been distributed in Texas. While the Moderna vaccine is scheduled to be reviewed by the U.S. Food and Drug Administration for an emergency use authorization on Thursday.
Two other vaccine candidates, from Johnson & Johnson and AstraZeneca, use adenoviruses to deliver DNA from the coronavirus to stimulate an immune response in the vaccine recipient, according to the University of Michigan Health Lab.
What does this mean for the upcoming holiday season?
Local health officials continue to advise Austinites to avoid gathering with people outside of their households and to recommit to precautions such as masking and social distancing.
"We have the possibility of having a miserable Christmas and a miserable New Year's if we allow this kind of transmission to continue," Escott said Wednesday.
Like Thanksgiving, officials recommend developing new traditions this holiday season to minimize risk—and ensure loved ones are around to celebrate in person next year.
"We must alter our holiday celebrations or we could face a real disaster here," Escott added.
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"We certainly are seeing an increase," Austin-Travis County Interim Health Authority Dr. Mark Escott said Wednesday.
Case investigations have revealed that many of the newer cases date back to the holiday
"We are hearing story after story after story about families who gathered during Thanksgiving," Austin Public Health Chief Epidemiologist Janet Pichette said.
Over the last week, the number of new COVID-related hospital admissions recorded in the Austin metro has increased steadily, with a more significant jump in the last couple days.
On Wednesday, 47 people were admitted to hospitals in the five-county area with the virus, bringing the seven-day moving average to 37, according to APH data. Last week, that average was 30.
There has also been an increase in the number of patients requiring intensive care while hospitalized.
"We are concerned," Escott said. "This is about the time we expect to see the hospital side of things start to be more significantly impacted."
What's ahead?
The growing number of hospitalizations doesn't bode well for future projections.
Immediately following Thanksgiving, the COVID-19 Modeling Consortium at the University of Texas at Austin projected a declining number of cases in the coming weeks. This may have been because of an increased demand for testing in the week before Thanksgiving, which lowered the positivity rate.
But now the consortium's model projects a worsening pandemic locally.
(COVID-19 Modeling Consortium at the University of Texas at Austin)
So, too, does the model used by the PolicyLab at the Children's Hospital of Philadelphia, which was updated on Wednesday.
"More areas of Texas are also beginning to realize the winter surge, with Houston, San Antonio and Austin leading the way in case incidence growth," PolicyLab researchers wrote in a blog post announcing their findings.
In other news
Despite the increase in cases and hospitalizations, there are reasons for Austinites to feel hopeful.
Travis County is doing better than any other large county in Texas when it comes to mitigating disease spread, which Escott attributed to residents' commitment to protective measures such as masking and social distancing.
Hospitals are also better at caring with COVID patients now than they were during the last surge period, in June and July. Data shows both the case fatality and ICU occupancy rates have improved over the same period thanks to better treatment options and more familiarity with the virus.
"That doesn't mean we shouldn't be careful," Escott said Tuesday. "But our hospitals are in good shape locally."
Additionally, the U.S. Food and Drug Administration is expected to approve an emergency use authorization for Pfizer's COVID vaccine on Thursday.
Local health officials have said Austin's priority populations—including nursing home residents, first responders and front-line healthcare workers—will begin receiving the vaccine as soon as next week.
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