I don't want my concern to be misinterpreted as 'Oh my god, we are all going to die'. I recognize that DFW and Houston aren't yet at the Italy or New York levels. But We are trending in the wrong directions, and the rate of change seems to be accelerating (if you look at the graph on worldometer for texas, on the Total caes chart, using logarithmic scale, you can see that the slope of the curve increased slightly around June 15. This is concerning, as it means that the growth rate is increasing)

I measure my concern based on 1) the likelihood that medical rationing will occur, and that patients will suffer avoidable negative outcomes due to a shortage of resources, 2) the increased likelihood that, even with social distancing, people will be exposed eved performing minimal, essential tasks, and 3) the likelihood that public efforts to slow the spread are seen as fruitless and are abondoned. I see all three of these things increasing in Dallas and Harris county. And people like the blogger that Nozsr referenced, with their 'It's all fine, this is just the media' narrative make a meaningful and effective response much more difficult.

CNN video on the situation in San Antonio

Harris, Dallas, and Bexar county (and I think Tarrant and Tracis as well) are all at the same stage. "We have enough medical resources to deal with critical patients, but are terrified looking at the curve, as new cases are being diagnosed at record levels."

Just to bring it back to poker, a lot of rooms are in, or are fed by, states that are facing difficulties. California, Texas, Arizona, Florida to name a few are all looking at (or have already done) pauses or reversals of reopening plans. I find it questionable that more rooms are coming online while the pandemic seems to be mounting a major offensive.

perfect... two months before the predicted second wave.
titanically mishandled
thanks leaders

Just for what its worth to SOME (since far too many only want to focus on case tallies), the fatality rate in Texas has dropped by more than half since mid-May. With the update yesterday, we are down to 1.28%.

By comparison, on May 19th, when our total of deaths was 1369 (roughly half of yesterday's 2715 report), the rate was 2.74%. That was with 49,912 reported positive/presumptive positives.

It appears that we may have a more contagious yet less lethal variant floating around the State. I have not looked at official numbers from other States to see if the trend holds in the other media-labeled 'hot spots.'

There are a couple of theories on that. Some say that our actual number of cases has only gone up slightly, and that more testing is revealing more cases (and that, of course, critical cases and deaths would be evident regardless of the testing capacity). Of course, the positive rate for tests has also gone up.

I have read some researchers are postulating that we are dealing with a more contagious, less lethal mutation.

There is also some that theorize that better, more nuanced supportive care coupled with treatments like remdesivir, convalascent plasma, and dexamethasone have helped reduce the CFR.

Others are saying that the CFR is not actually going down, that we are just looking at a lag between the leading edge of a surge, and when that surge results in fatalities.

The real answer is likely 'Yes, all of these'

It's not like people that will die after testing positive are dying the day they test positive. I'm not sure it's fair to say that the uptick in cases hasn't resulted in an uptick of deaths quite yet...? Not saying it will happen. I just think it's not fair to say that the fatality rate is going down when this recent surge hasn't had time to take people down yet. We'll see. I'd love for everyone to live

Very unlikely.

The average age of people getting Covid is now much lower than it was 3 months ago. In Texas the median age is now 44. It was likely around 65 in March and early April.

There are now treatments that will save lives as noted above. But that would account for 25% to 33% reduction in death rates overall.

When you look at death rates as a % of known cases you are allowing for the total number of known cases to become a significant statistic. Which as you point out in your post it isn't. There is no way right now to know the total number of cases in Texas.

The # of deaths/day in Texas is now at all time highs for 7 day and 14 day rolling averages. It is closing quickly on 21 day avgs as well.

The good news for Texas is that the number of deaths per capita is low (for the US) at less than 100/million. And their Governor is now abandoning the pretense that everything is under control and is actively seeking to reduce the spread of transmission.

The bad news for Texas is that the positive test rate 7 day avg is over 14% and has been for 6 days of the last 10. Which means that the number of known cases in Texas is nowhere near what the official count is. The silver lining may be that the positive test rate hasn't been going up lately.

Texas people should have more than one source for "news".

And a reliable source for "facts".

Actually, recovered people and people who have antibodies to any flu, cold, or other corona virus test positive... and some contaminated tests test positive...

... and untested people - and up to 15 people they know - are considered "infected", see below.

You are quite welcome.

***

Ron Paul: Is the Texas Covid ‘Spike’ Fake News?

As Judge Hill said at that May 18th meeting, “If you have a subjective fever and you have a headache and you live in Collin County, you now meet the qualifications to be a probable COVID patient. It is remarkable how low the standard is now.”

Even worse, once a “probable” case was determined based on possibly unrelated subjective criteria, up to 15 people in possible contact with that “probable” case were also listed as “probable cases.” And “probable cases” were considered cases.

http://www.ronpaulinstitute.org/arch...ike-fake-news/

Excerpts from a longer article about Texas, published 07-01-20... I have tried to edit out the smaller points and the politarding...

...
As of June 25, Texas had 54,700 staffed acute care hospital beds, but only 41,950 were being used, implying a occupancy rate of just 76.7% and 12,750 empty beds still available. Moreover, only about 5,000 beds representing 12% of the current census were occupied by confirmed or suspected Covid patients. So as of June 25 the state had nearly 2.5X more empty hospital beds than it had Covid patients, notwithstanding the surge of new cases and hospitalizations during the month of June.
...
On March 18, Texas had 46,550 occupied hospital beds, reflecting an occupancy rate of 85% or well above the 76.7% level as of June 25. But back in March virtually none of these occupied beds were attributable to Covid patients. That’s because at that point there had been only be 83 confirmed Covid cases and 2 deaths reported for the entire state! By then what happened over the next three months, as the Covid caseload built up from zero to the present 5,000, is that even more beds emptied out due to:

state orders prohibiting elective surgeries and other treatments;
normal seasonal declines in occupancy; and
aggressive reclassification of patients admitted for other reasons as Covid patients.

... Texas health officials started logging every single COVID-19-positive patient in the state as a COVID-19 hospitalization, even if the patients themselves were admitted seeking treatment for something other than the coronavirus. As Lindsey Rosales, a spokesman for the Texas Department of Public Health Services, confirmed recently to an independent investigator: “The number of hospitalized patients includes patients with a lab-confirmed case of COVID-19 even if the person is admitted to the hospital for a different reason,” Rosales said.

...

In other words, the first wave of Lockdowns created a huge backlog of demand for elective surgeries and other discretionary treatments, which were banned by state authorities. But once those bans were lifted and people got in the hospital for deferred treatments, they were tested for Covid and became the statistical gruel for the so-called second wave.

... Texas hospital statistics over the last three months [do not indicate] that Texas hospitals will soon be overflowing into the hallways. To wit, here is the trend of unused acute care beds in the Texas hospital system:

3/18: 8,155;
4/1: 18,411;
4/15: 21,489;
4/29: 19,432;
5/20: 16,035;
5/27: 15,315;
6/3: 15,219;
6/10: 13,271;
6/17: 14,993;
6/25: 12,571

In short, Texas had gone from virtually no Covid cases or deaths on March 18 to 131,917 cases and 2,296 deaths by June 25, but it actually had 56% more empty hospital beds on the latter date!
...

As of last week, the Houston area alone had 12,458 staffed acute care beds (23% of the statewide total), but 2,675 or 21% of these were empty; and on top of that they had an additional surge capacity of another 925 beds. That’s especially salient because the rise in cases in Texas and Houston has generally been among a much younger population than earlier in the pandemic, and the need has been for exactly these kinds of general beds, not ICU beds. So the fact is, as of last week the Houston area hospitals had just 795 lab confirmed Covid patients, representing just 8% of their 9,785 daily census. That also means that given Houston’s 3,600 beds of remaining surge capacity, they could actually accommodate a 4X increase in their current Covid caseload.
...
For instance, the CEO of one Houston’s leading hospitals, Memorial Hermann, pulled no punches: "We actually still think we have plenty of capacity to meet the demand for Covid, as well as non-Covid patients. We’re always busy in the summertime, and what we’re seeing now is a typical summer for us. Callender, whose not-for-profit health system has 17 hospitals in the Houston area, stressed that the medical network’s capacity is “constantly in flux” and needing to be managed. “But right now, we’re able to do that very well,” he said. “Across our system, we have about 4,000 beds that we can bring into play” for intensive care, he said. “Right now, only about 30% are being utilized for Covid care, so we still have plenty of capacity for Covid patients as well as patients who need hospitalization for other illnesses.”
...
“We’re seeing a slightly lower rate in terms of the number of typical hospital bed patients who convert to a need for ICU hospitalization. We’re also using ventilators less frequently,” he said. “We have more drugs at our disposable that we know help limit the severity and duration of the illness. So overall we’re faring better than we did just a couple months ago.” Likewise, chimed in Dr. Marc Boom, President and CEO of another leading institution, Houston Methodist:
The number of hospitalizations are “being misinterpreted,” said Houston Methodist CEO Marc Boom, “and, quite frankly, we’re concerned that there is a level of alarm in the community that is unwarranted right now.” “We do have the capacity to care for many more patients, and have lots of fluidity and ability to manage,” Boom said.

...

Boom pointed out that his hospital one year ago was also at 95% ICU capacity – long before Covid was a thing! That’s right. Apparently, 95% utilization of the ICU is a typical June condition, not the sign of the Covid Apocalypse. And contrary to the heated headlines on the MSM, only about 25% of Houston’s fully occupied ICU’s are accounted for by Covid patients. Again from Boom: "It is completely normal for us to have ICU capacities that run in the 80s and 90s,” he said. “That’s how all hospitals operate.”

…..the hospital “[has] many levers in our ability to adjust our ICU,” he said, claiming that the hospital capacity regularly reported by the media is “base” capacity rather than surge capacity. Boom also alluded to hospitals’ ability to turn regular beds into ICU beds as well as to turn recovery, and pre- and post surgical areas into ICU areas if needed as a kind of coronavirus “flex area.”
...
Boom said overall, hospitals are seeing younger COVID-19 patients, who stay for a shorter period of time, and fewer deaths. Houston Methodist CEO Dr. Marc Boom told CNBC on Monday that the demographics of the outbreak have “flipped” and that the mostly-younger people arriving in the state’s hospitals often don’t require ICU beds, even though many do get very sick.

... [a] CNN anchor, ... on Saturday had been bemoaning that the situation was allegedly so desperate that a Houston children’s hospital had been drafted into Covid service at great risk to the children. Not at all, according to Mark Wallace, Texas Children’s Hospital president and CEO. Actually, this was just part of the systems’ surge plan: Texas Children’s started accepting adult COVID-19 positive patients this week and is currently operating at a 74 percent ICU occupancy, Wallace said. “We have the ability to take care of all of the Houstonians that need a critical care environment, that need to be operated on, or acute care,” Wallace said.
...

Your information is not accurate. Below are the criteria needed to classify a patient as a probable case

"Clinical criteria needed to meet the definition of a probable COVID-19 includes:


at least two of the following symptoms: fever that is measured or subjective, chills, rigors, myalgia, headache, sore throat, or new smell and taste disorders;

at least one of the following symptoms: cough, shortness of breath or difficulty breathing; or

severe respiratory illness with at least one of the following: clinical or radiographic evidence of pneumonia, or acute respiratory distress syndrome and no alternative more likely diagnosis.


Epidemiological links needed to meet the definition of a probable case includes:


close contact with a confirmed or probable case of COVID-19;

close contact with a person with clinically compatible illness and linkage to a confirmed case of COVID-19; or

travel to or residence in an area with sustained, ongoing community transmission of SARS-CoV-2."

This is quite a bit more definitive than the blurb you referenced.

https://communityimpact.com/dallas-f...collin-county/


By the way, Collin County, which has done a piss poor job of maintaining preventative measures, currently accounts for only 1.5% of Texas cases. If I were t hazard a guess (based on conversations I had with a pulmonologists based in Collin county), the comments Hill is making are a deflection against an expected surge in cases that they should be seeing in the upcoming weeks.

Things are getting bad in Dallas, Houston, and San Antonio (with Fort Worth and Austin not looking great). There really isn't that many different ways you can spin. The issue is real. The strain on the healthcare system is real (I have a few ICU nurses in my network who work in Presby Dallas, and they are burning out). No amount of Ron Paul investigative journalism is going to change that.

I will defer to your local knowledge.

But thank you for confirming my main point, the "or" between points 2 and 3 make it quite clear:

"close contact with a confirmed or probable case of COVID-19" constitutes adequate criteria.

Specifically, close contact with a probable case makes you a probable case, and probable cases are counted one by one and the count is merged into the total of "real" cases as if probable cases are "real" cases, and that merged total is the total statistic reported.

That's not epidemiology. I won't be a name-caller but anyone who understands that key point can come to their own conclusions.

The last point is interesting and new to some of us readers, a point that has not been previously or widely mentioned.

"travel to or residence in an area with sustained, ongoing community transmission of SARS-CoV-2."

If you live where there are more and more probable cases, you too are a probable case.

With such a circular definition, any or all residents of any given community (where probable cases are identified) can also be considered probable cases.

Taken literally, that makes 100% of all people in any sized neighborhood of an epidemiologists choosing, a probable case.

Fascinating.

Not particularly useful from a medical standpoint, but perhaps it might be from some other standpoint.

I can't quite tell if I am misunderstanding you, or you are misunderstanding the article. In order to be a probable case, you would need both symptoms and exposure. "close contact with a confirmed or probable case of COVID-19" independent of symptoms would not be adequate to constitute a probable case.

OK, I saw what Hill is talking about now. Texas is being considered endemic, so that the epidemiological criteria is automatically met.

Of course, this flows both ways. Yes, someone with symptoms (fever and headache) would be counted as a probable case, but they would also qualify more easily to be tested, which would either confirm their position as a COVID patient, or remove them from the count.

You might find this update from TMC (the very large campus of hospitals servicing Houston)

https://www.tmc.edu/coronavirus-updates/

They are 100% utilized with regards to ICU beds, and 8% into phase 2 (which is using additional beds and staffing to increase their ICU capacity). I don't think they are looking at emergency surge capacity yet. But the biggest concern here is that the hospitlization numbers, and more specifically the critical care numbers, are trailing indicators. The new case curve in Harris county is still accelerating. As these cases continue to accumulate, I am not sure how sustainable it is to be operating consistently at over 100% of normal planned load.

I actually wish you were right and that the issues in Texas were just fear mongering and number cooking, but it really does not look like that is the case.

https://www.indiegogo.com/projects/b...ken=e3d5e3fe#/

this can save poker

Don't hang out there then. I played in 3 poker rooms the day before they closed, and been playing in rooms every day for weeks and I'm still breathing, as far as I can tell.

/

And here is what I still don't understand about WHY poker rooms are open in some parts of the country and not others ...

NO ONE IS FORCING ANYONE TO PLAY!!! If you don't feel safe playing, then just stay home and don't play, but for those who do want to play, why do our options have to be so limited?

If you live anywhere in the Northeast part of the US you are limited to just 2 places to play right now, Maryland Live and MGM.

All the poker rooms in NJ (Atlantic City), all of PA and DE are still closed down, yet those 2 in Maryland seems to operating just fine.

Why can't the choice be left up to the players if they want to play or not?

But nooooooo, instead they wanna keep all the poker rooms shut down in those states.

These tyrannical governors in those states have really used governmental overreach to keep so many businesses closed (especially restaurants) and have put many others out of business for good as well as ruined people's livelihoods!

Let the people decide!!! If you can go to Walmart and supermarkets and other so many other crowded places, why can't you have a choice to play poker too???

If you're worried about becoming infected, it's very simple, STAY HOME!!!

New Hampshire poker rooms are open.

Some parts of the country are more heavily infected than others.

Leaving the decision to players is irresponsible because some players will play thinking that this virus is a hoax, and those who are infected will infect other people. But it is real, and it is dangerous. More than 150,000 people in the United States have died from this virus in the last several months.

You just don't get it, do you? Or you don't want to get it. Or you love your twisted notion of FREEDOM. If you're sick and don't care you could easily transmit Covid to someone who does care. And you're argument about going to the grocery story being the same is bogus. If I'm in a grocery story, mask or not, I'm moving around and out fairly quickly. At a poker table I'm sitting in the same spot for hours. It's basic math, which I assume as a poker player you understand.

Lastly, as I've said before: I have the right in my house to get stinking drunk every night and fall asleep in my urine. I DO NOT have the right to get stinking drunk and drive down the expressway.

It seems to me that poker and too many poker players seem hellbent on committing suicide.

fyp

You are right to question this number. The actual number is probably higher.

By the way, good call on Texas not really being heavily hit. Now, if only we can get all these crisis actors to leave the ICU's......

Can you provide your citations showing hospitalizations and deaths tailing off in Texas and Florida. Last time I checked, which was today, we were setting all time highs in Texas.

And this sentence seems to be particularly lacking in awareness:

"So tell me then, why can't places in the tri-state area (PA, NJ, DE) which are doing quite well with respect to cases, open their poker rooms??? There's no reports of hospitals being overwhelmed there."

It seems like you are saying 'States that have had aggressive policies towards closing businesses are doing better with regards to handling the virus, so why are they not reversing those policies?'