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Why Texas Was the First State to Surpass 1M COVID-19 Cases

Texas this week reached 1 million cases since the start of the pandemic, recording more infections than any other state. For reference, more people have been infected in the Lone Star State than live in Austin.

Closeup of Texas Governor Greg Abbott.
Texas Gov. Greg Abbott on Monday, June 22, 2020. (Ricardo B. Brazziell/Austin American-Statesman/TNS)
Nov. 12—Texas' grim distinction as the national leader in COVID-19 infections came as little surprise to some medical experts, who blamed politicians for conflicting messages about the virus and warned the worst is yet to come.
Texas this week breached a milestone of 1 million cumulative cases since the start of the pandemic, recording more infections than any other state. For reference, more people have been infected in the Lone Star State than live in Austin.
If Texas were its own country, it would rank 10th in terms of total cases, according to data from Johns Hopkins University, placing it higher than European hot spots such as Italy.
The big numbers are not a shock in a state that's home to roughly 29 million people. The rate of 3,508 cases per 100,000 Texans is still lower than in about half of the states in the country. But Texas had more newly reported cases in the last week — an average of about 8,520 daily — than other large, hard-hit states, such as New York, California and Florida. Only Illinois has a higher seven-day average.
On Tuesday, Texas reported more than 11,500 new cases, the highest number since its summer peak in July.
Resurgence of the virus has been slower in San Antonio, but coronavirus cases, COVID hospitalizations and the share of people testing positive for the virus all have gradually increased over the past month.
With cases climbing elsewhere in the state and the U.S., it's only a matter of time before they spike again in San Antonio too, said Dr. Junda Woo, medical director of the San Antonio Metropolitan Health District.
"Eventually it's going to seep back over to San Antonio," she said.
While much of the national attention has focused on the Midwest and upper Midwest, where caseloads and hospitalizations are threatening to overwhelm health systems, Texas is now firmly in its third wave.
Dr. Peter Hotez, dean of Baylor College of Medicine's National School of Tropical Medicine and co-director of Texas Children's Hospital Center for Vaccine Development, saw troubling trends in the state's data.
"The worst is maybe yet to come," Hotez said.
Hotez, a leading expert on the coronavirus, placed the blame for the rising number of coronavirus cases in Texas squarely on the Trump administration for downplaying the severity of the pandemic and attempting to discredit scientists who urged the public to wear masks and practice social distancing.
"Had we had a national plan, a national road map, most of those cases could have been avoided," Hotez said.
A clash over shutdowns
Other experts said Gov. Greg Abbott's clashes with mayors and county judges over their authority to shutdown businesses and enforce face mask orders contributed to the record numbers in Texas. A Hearst Newspapers investigation found that the state was unprepared for COVID-19 and lacked critical testing infrastructure and sufficient epidemiologists, despite years of warnings by experts about the dangers of a pandemic.
Renae Eze, spokeswoman for the governor's office, said in a statement that state leaders are working closely with local officials to deal with spikes in hospitalizations and that Texas is preparing to distribute upcoming treatments for COVID-19 when they become available.
Eze said the state's efforts will only work if Texans do their part.
"The reality is, COVID-19 still exists in Texas and across the globe, and Texans should continue to take this virus seriously and do their part by social distancing, washing their hands and wearing a mask," Eze said.
The spread of the coronavirus is being driven in part by partisanship and disinformation about the pandemic, said Juan Gutiérrez, chair of mathematics at the University of Texas at San Antonio, who has been leading an effort to model the trajectory of coronavirus transmission in the U.S. Cases have risen in smaller counties that voted for President Trump in 2016, he said.
However, Gutiérrez noted that a number of other developments — reopening of businesses, cooler weather and fatigue from prolonged social isolation — are contributing to higher levels of transmission. Those factors have been paired with unique features of the virus, including a high level of contagiousness, significant asymptomatic transmission and an ability to spread over the summer months, that have made containment difficult.
"It is very different, and therefore, it has behaved in ways that we haven't seen truly before," Gutiérrez said.
The state's positive test rate is now 11.63 percent, compared to 7.35 percent a month ago.
El Paso County has become the center of a new wave of COVID-19 cases, with an average of 1,800 newly reported cases daily last week. Hospitalizations of COVID-19 patients reached more than 41 percent of capacity in the El Paso region, according to state data. Several dozen patients have been transported to San Antonio for treatment.
Lubbock and Randall counties, both in the Panhandle, also have been hit hard recently.
Some of the state's largest cities also have become hot spots, with Dallas and Tarrant counties seeing the second and third most cases cases daily during the past week.
Harris County reported an average of about 738 cases daily during the past week, according to Chronicle data. The county's positive test rate is steadily increasing, reaching 8.3 percent.
Hospitals see increase
In Bexar County, the seven-day average for new cases has steadily increased and is now at 239, up from 136 at the beginning of October. The positivity rate has climbed to 8.4 percent, up 3.5 percentage points over the past month.
Hospitals in the county are treating more than 300 coronavirus patients for the first time since early September, up from 189 on Oct. 20. As of Tuesday, 10 percent of staffed hospital beds in the area were available, according to the Southwest Texas Regional Advisory Council, which manages emergency services for Bexar and surrounding counties.
Texas already has the second-highest death toll in the country with 19,248 deaths, trailing only New York.
And the death toll is growing, with Texas reporting 98 deaths daily during the past week, according to Hearst Newspapers' data, well above second-place Illinois. The daily average was about 81 deaths a week ago.
Dr. Paul Klotman, president of Baylor College of Medicine, dismissed the 1 million milestone as "inevitable."
"It shows that for whatever reason we haven't controlled the infection," Klotman said. "And given the size of the state, it shows we're still nowhere near herd immunity."
Klotman said the 1 million mark doesn't alarm him as much as the 100,000 new cases a day nationally.
Masks and social distancing remain the best hope to stop the virus from spreading, he added, noting that the 1918 Spanish flu went away without a vaccine because people adopted such practices.
Catherine Troisi, an infectious disease epidemiologist at UTHealth, said the sheer number of infections is due in part to population, but also the state's large number of Latinos, who make up a larger percentage of essential workers. COVID-19 also has reached rural areas where, previously, "people thought they didn't have to worry about it," she said.
Troisi also cited the state's early reopening this spring, its delayed mask mandate and its lack of adherence to federal health guidelines. Abbott assembled a task force that created guidelines for safely reopening the state's economy based on criteria, including testing capacity, the positive test rate and hospitalizations. But not all of them were met before businesses were allowed to reopen.
Predictably, Troisi said, the number of cases grew rapidly and then schools and colleges began reopening.
Add into that pandemic fatigue, she said, and more bad news is coming.
"People are tired of it. And there is a lot of concern about the holidays coming up and what that will mean," Troisi said. "Almost everybody in public health is predicting we're going to see a surge in cases."
Hotez, despite seeing trouble in the near future, was optimistic about the promise of a vaccine and an eventual respite from the record-breaking numbers.
"By this time next year, we'll be in a much better position than we are now," Hotez said.
Jeremy Blackman contributed to this report. —
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