Health officials say they’re seeing alarming upticks in some COVID-19 numbers, though they’re not sure yet whether North Texas is on its way to a surge in cases.
A COVID-19 forecast from UT Southwestern Medical Center predicts continued increases in hospitalizations in Dallas and Tarrant counties, which have already risen in recent weeks, and also projects 1,000 new infections a day in Dallas County by later this month.
Those numbers show the situation is fragile, so experts urged North Texans not to ease up on coronavirus precautions as society pushes for a return to normal.
The upward trend comes as Texas’ governor allowed counties to reopen bars at half capacity — though some counties, including Dallas, won’t reopen theirs — and as cases are surging elsewhere in the U.S.
Researchers with the University of Washington’s Institute for Health Metrics and Evaluation predict the nation could see nearly 2,200 COVID-19 deaths a day by the end of December, roughly matching the peak of daily deaths in April.
Dr. Ali Mokdad, professor of health metrics sciences at the institute, said the projections take into account the “seasonality” of COVID-19. By studying countries in the southern hemisphere, researchers saw the effects of the virus worsen in the fall and winter.
The expected surge in deaths also accounts for national data that show a decrease in mask wearing, but “nothing is written in stone,” Mokdad said.
“We can change that,” he said. “We can control this virus.”
But to do so, people can’t go back to pre-COVID behavior, he said.
“We have to adapt our life and adopt the new reality that we have,” he said. “You and I cannot go back to our normal way of life until we have an effective drug or an effective, safe vaccine.”
Dallas, Tarrant, Collin and Denton counties are showing upticks in emergency room visits because of COVID-19 and new COVID-19 hospital admissions, said Dr. Rajesh Nandy, associate professor of biostatistics and epidemiology at the University of North Texas Health Science Center’s School of Public Health.
Those increases are more pronounced in Dallas and Tarrant counties, he said.
If the hospitalization trends continue for another week, “it’s likely that it’s a sign of another surge,” Nandy said.
Experts also track the contagiousness of the virus, using a measure called the Rt number.
When the number is 1, that means on average, each newly infected person with the virus would infect one other person. Even an Rt number that might not look too much larger than 1, like 1.1 or 1.2, can make a big difference in how fast the virus spreads, experts say.
The number has been above 1 in Dallas and Tarrant counties since mid-September, according to UT Southwestern, which calculates the Rt value as 1.14 for Dallas County.
It’s concerning that the number is above 1, Nandy said, but if it stays there for another week, he would be alarmed.
“This growth is not additive — it’s multiplicative,” he said. “That’s why it can grow big very quickly. That’s the risk: that it starts small, but it can get big very quickly.”
Health experts say it’s important to consider the number of infections in a given area, along with the rate of growth, to see how quickly the disease could multiply, said Dr. Mujeeb Basit, assistant professor of internal medicine and cardiology at UT Southwestern.
“If you’re doubling every five days, it’s a complete difference if you have 10 cases or if you have 1,000 cases,” he said. “So the Rt numbers in isolation is only one factor. The other one that we look at is how many patients that we have that are currently hospitalized, and how much then can we extrapolate to how many patients that we have in the community.”
Trajectory for Dallas and Tarrant counties
In Dallas County, the head of the county health department told commissioners last week that rising hospitalization numbers are disturbing.
County Judge Clay Jenkins said Thursday that the county’s numbers were “going in the wrong direction.” Since Sept. 27, hospitalizations have increased by 43% and new daily cases have risen by 20%, Jenkins said.
“Remember that the people going to the hospital today, they got sick a couple of weeks ago,” he said. “The decisions that you make now … will have a big impact on what happens next week and the week after.”
Dr. Philip Huang, the director of the county’s health department, said officials are particularly concerned about the number of emergency room visits for COVID-19 symptoms, which has risen in recent weeks after declining steadily since July.
“We know that when it takes off and when it starts to go up, it can go up really quickly, and then it takes a long time to come back down,” he said.
Confirmed hospital admissions are also following a similar trend, he said.
Dr. Miguel Benet, chief medical officer of Medical City Healthcare, said over the last two weeks, active cases in the Dallas-Fort Worth region have risen by 38%, while admissions at his hospitals have risen by 18%.
He said the increases can be attributed to changes across the region, including the reopening of schools and businesses, and probably will continue over the next two weeks. But he said they’re still not indicative of a surge.
“We’re seeing a steady increase for sure, and over time it will get us to similar numbers to what we’ve seen in the Dallas-Fort Worth area before,” Benet said. “But that slope, that increase, isn’t steep enough yet to call it a surge.”
He said that small, steady increases aren’t as concerning as rapid spikes, similar to what North Texas experienced in July. But it’s still important to remain vigilant about public safety protocols, as well as hold off on further reopenings, to ensure the situation stays under control, he said.
“The big difference between now and before is that we’re starting from a higher base,” Benet said. “You’re starting from a place where the chance of getting a quick increase is greater than it was before.”
A new COVID-19 forecast Thursday from UT Southwestern predicted similar rises in Dallas County hospitalizations — and 1,000 new coronavirus cases a day by Oct. 20.
It’s difficult to say what is driving that trend, said Basit, of UT Southwestern.
“The people who know this the best are the contact tracers because they actually get to see that this person became positive, what was the source?” he said. “There are so many factors, and to really try to tease out exactly what it is — we just can’t do causality with the information that we have, unfortunately.”
Huang said the UTSW model reinforces the need to stay vigilant about social distancing and mask wearing.
“We’ve seen certainly before, if we relax as a community … you can get a lot of people infected at once, and then they get other people infected,” he said. “It just grows exponentially.”
Both Dallas and Tarrant counties are expected to return to mid-August hospitalization levels over the next two weeks, according to the latest UTSW COVID-19 forecast for the region.
Researchers there project that Tarrant County will see more COVID-19 hospitalizations and higher numbers of COVID-19 patients in intensive care, along with about 700 new infections per day by Oct. 20.
That’s a lower figure than was previously forecast. Recently, Tarrant County has seen a slight reduction in its Rt number, Basit said.
“It’s still a little bit early to completely hang your hat on the fact that Tarrant County’s dropping — we like to see at least two three weeks of consistent data — but at least the data is looking a little bit better,” he said.
Outlook in Collin and Denton counties
UT Southwestern’s forecasts don’t include Collin or Denton counties, where the data researchers have for those counties are less timely, Basit said. More detailed data from the other counties allow for better forecasting, he said.
In Denton County, there aren’t many “hard and fast lines” for what metrics would be considered concerning or would indicate the beginning of a surge, said Dr. Matt Richardson, the county’s public health director.
He said county health officials mainly want to ensure that COVID-19 patients make up less than 15% of hospitalized patients, the threshold that Gov. Greg Abbott has said would indicate an area is faring well.
The seven-day moving average of the percentage of hospitalized patients with the coronavirus was relatively flat through most of September, fluctuating between 6% and a little more than 7%. It decreased to below 6% at the end of the month but began increasing again recently.
Richardson said Denton County is also monitoring the number of children who test positive for the virus.
The number of school-aged kids with the virus rose during September, which health officials expected. That trend has been seen in other North Texas counties as students returned to classrooms.
But the share of children with the virus is especially important to watch as the region gets further into the flu season, he said.
“We’re very concerned about the nexus of flu season and COVID-19,” he said. “We don’t know what that’s going to mean, but we are watching kids because we know that they can be efficient spreaders of disease. … If we have several weeks of additional pediatric cases, that’s going to be a harbinger of things to come.”
Benet noted that one factor to be optimistic about is that the flu season in the southern hemisphere, which health experts monitor to predict what the flu season here will look like, was lower than it has been in many years.
Darrell Willis, a spokesman for Collin County’s health department, said the main indicator the county watches is hospitalization rates.
He said the county monitors the COVID-19 hospitalization rate daily, watching to make sure it stays under 15%. Collin County was well below that benchmark in September — the percentage of the county’s total hospital beds occupied by COVID-19 patients hovered between 2.4% and 4%.
When Collin County had its highest number of hospitalized COVID-19 patients, in July, they occupied about 8.5% of the county’s total hospital beds.
“As long as that stays below 15%, we’re going to be operating as normal,” Willis said.
‘A picture of concern’
Health experts say that if a surge in cases comes this fall, it’ll be hard to pinpoint any one reason for it.
The combination of increased restaurant capacity, which the governor announced last month, the reopening of bars, flu season, the start of school, cooler weather and the holiday season all “paint a picture of concern,” said Dr. John Carlo, former Dallas County medical director and CEO of Prism Health North Texas.
Huang said that some of the current numbers may look concerning, past data show that public health intervention can work.
“We determine where this goes,” he said. “We need to be vigilant. This has to be the new normal, but if we do these things, then we can safely open up things. We just have to do it in a different manner, in a safe manner.”