The Texas Medical Center in Houston is the largest health care complex in the world, so vast it describes itself, accurately, as a “medical city.” About 106,000 people work there, traversing 50 million square feet of property. If TMC were a stand-alone business district, it would be the eighth largest in the U.S.
TMC isn’t a mere business district, however. It’s a conglomeration of more than 50 medical institutions, all nonprofits, including 21 hospitals, eight academic and research centers, four medical schools, seven nursing schools, three public health organizations, two pharmacy schools and a dental school. It is home to the world’s largest children’s hospital and the world’s largest cancer hospital. It treats eight million patients annually.
Covid-19 may soon overwhelm TMC.
So many Houston residents have been infected, and the case rate is growing so rapidly, all hospitals in the greater metropolitan area may run out of intensive-care unit beds as soon as today. If forced to tap what the industry calls “surge capacity,” the city’s hospitals estimate they’ll be filled to the brim in 10 days.
TMC, the goliath of this group, said that as of Tuesday, 97% of its 1,330 ICU beds were occupied (only 27% are currently filled by patients with Covid-19; 70% are non-Covid patients). TMC estimates it can handle a surge of about 373 more patients and, in extreme circumstances, another 504. If all those additional 877 patients are admitted, TMC’s maximum capacity of 2,207 ICU beds will be reached.
That might not take long. As of Tuesday, the Houston metropolitan area, home to about seven million people, had 32,154 confirmed Covid-19 cases, according to TMC, up from 24,885 one week ago, 14,846 a month ago, and 7,506 two months ago. Exponential growth is one of Covid-19’s calling cards.
Apart from the danger and uncertainty that clothe the coronavirus wherever it travels, two other realities are at work in these numbers.
First: Sprawling and impressive as it is, TMC has only 9,200 total hospital beds — 9,200, even though it treats eight million people a year. That reflects a broader problem with patient capacity in all U.S. hospitals. A combination of public policy, merger-happy industry dynamics that have brought about an unhealthy concentration of hospital networks, and decades of movement away from inpatient treatment has led to a nationwide shortage of hospital beds. Covid-19 has laid bare the vulnerabilities that are created when hospitals are run like assembly lines.
Second: TMC is populated by talented and brave professionals contending with what may become health care’s version of a massive tsunami — but one that might have been avoided, or at least mitigated once it swept in.
After all, New York and New Jersey, epic Covid-19 hotspots, have already demonstrated both the perils of responding too slowly and how to act properly and admirably once the threat is recognized. Yet Texas appears to have embraced magical thinking rather than practical combat tactics, leaving its 29 million residents, its economy and its health care networks exposed.
The proper response isn’t complicated. As TMC’s experts noted this week, social distancing, wearing a mask in public, washing hands regularly, and testing followed by isolation if needed all help slow the spread of Covid-19. Adopting such a regimen requires belief in science and medical expertise, however.
Enter Texas Governor Greg Abbott.
On March 19, when the state had 306 cases, Abbott issued a handful of relatively gentle executive orders to close schools and prohibit visits to nursing and retirement homes. Public gatherings of 10 or more people were also banned. Visits to bars, restaurants, gyms and the like were discouraged, but not forbidden. On March 26, Abbott ordered visitors to Texas from hot-spot states to be quarantined for two weeks. On April 17, with new Covid-19 cases in Texas plateauing at several hundred to a thousand a day — a rate that would hold until the end of May — Abbott created the Task Force to Open Texas to advise him on on how to “safely and strategically” reopen the state.
Businesses were gradually reopened through early May. On May 18, Abbott announced “Phase 2” of his plan, allowing more people to patronize restaurants, bars and other public venues. Meanwhile, total coronavirus cases in Texas had grown to 49,177 — from 2,792 on March 29.
On May 22, Abbott issued a “Be A Good Neighbor. Be a Good Texan” statement that encouraged — but didn’t require — residents to keep their distance, wear face masks and regularly wash their hands. On June 3, with daily Covid-19 cases spiking, a trend that has yet to abate, Abbott unveiled yet another aggressive reopening push, Phase III, which allowed all businesses to operate at 50% capacity.
“The people of Texas continue to prove that we can safely and responsibly open our state for business while containing Covid-19 and keeping our state safe,” Abbott said, even though the virus had not been contained. “As anticipated, the new positive cases that we are seeing are largely the result of isolated hot spots in nursing homes, jails and meat packing plants. Thanks to the effectiveness of our Surge Response Teams, we have the ability to contain those hot spots while opening up Texas for business.”
Abbott, a Republican, plowed ahead despite criticisms from Democrats and senior state officials that he was moving too fast and possibly jeopardizing public health.
On June 11, joined by baseball legend Nolan Ryan, Abbott rolled out another public service announcement. Titled “Don’t Be a Knucklehead,” it again encouraged, but didn’t mandate, social distancing and mask wearing. Four days later, with daily infections soaring, Abbott, along with Jaylon Smith of the Dallas Cowboys, encouraged Texans to “Wear a Mask On and Off the Field.” But Abbott told local authorities they couldn’t fine people for going maskless. He also resisted pleas from a large group of Texas mayors who wanted to make masks mandatory because they “could prove to be the most effective way to prevent the transmission of this disease.”
On June 16, with Texas reporting 93,569 cases of Covid-19, Abbott assured his constituents that “despite an uptick in positive cases, there continues to be abundant hospital capacity.” In a TV interview around the same time, he said there was “no real need to ratchet back the opening of businesses in the state” because “we have so many hospital beds available to anybody who gets ill.”
Reality has finally intervened. As of Wednesday, Texas had 125,921 reported cases of Covid-19. About 4,000 coronavirus patients are hospitalized, up from 3,000 several days ago. TMC and other hospitals are sagging beneath the weight of Covid-19.
And, suddenly, Abbott is speaking more plainly about the peril his state faces. “There is a massive outbreak of Covid-19 across the state of Texas,” he said in a local TV interview on Wednesday. “There are some regions in the state of Texas that are running tight on hospital capacity that may necessitate a localized strategy to make sure that hospital beds will be available.”
Abbott has company across the Sun Belt, with Florida, Arizona and California also experiencing surges of Covid-19. These aren’t explained by more ubiquitous testing, as some have suggested. Abbott recently tried to blame his state’s case rate on Texans in their 20s who aren’t “following these appropriate best health and safety practices.” But no data indicate that young Texans are behind the surge, and Abbott offered no evidence to substantiate his claim.
“Oh look — the guy who opened the state against all scientific and expert recommendation is now blaming us for his failures,” tweeted Kendall Scudder, a young Texan who is the host of a political podcast, Pod Bless Texas, after he heard Abbott’s remarks.
Abbott may soon run out of explanations for Texas’s corona-surge and the strains on institutions such as TMC. But it’s as obvious as the mask on my face that any accounting for how Texas arrived here during a pandemic already months in the making will have to include Abbott’s failure to lead.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
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