When David Persse, Houston’s chief public health doctor, looks at the increasingly steep curves of Covid-19 cases in the Texas metropolis, he sees devilish decisions ahead.
“How do we manage the ambulance traffic when we’ve got all or nearly all hospitals saying they can’t take another ambulance? What are we going to do?” he has been asking, as local hospitals fill up. “Nobody has a good answer.”
The emergency room physician-turned-health department official is just one of many public health leaders in Houston raising the alarm as the city becomes one of America’s new Covid hotspots. Their warnings — of dwindling spare capacity at hospitals, difficulty obtaining protective equipment and an inability to contain the spread of the virus — echo those of places such as New York City in the early stages of their outbreaks.
The difference is that Texas has been easing, rather than imposing, lockdown measures, and Texans appear to have been throwing off their caution about the disease.
The curve graphing US Covid cases is sloping upward again. The national daily tally of new cases hit 32,984 on Monday, the biggest one-day increase since May 1, according to the Covid Tracking Project. The surge was led by Texas and California, which both reported record high daily totals with more than 5,000 new cases. Arizona also posted its largest one-day increase on the same day.
In the greater Houston area, the cumulative number of Covid cases identified since the pandemic began has increased by almost a third over the last week — and this has not just been a consequence of more testing.
At Texas Medical Center — a campus of dozens of hospitals and medical facilities that describes itself as “the largest medical city in the world” — the number of Covid patients in hospital is 47 per cent higher than a week ago.
Inside the two fullest public hospitals in Houston, Dr Persse described patients on stretchers in emergency department corridors, some forced to double up in rooms meant for one, and stressed nurses rushing everywhere.
Harris county, which includes Houston, could run out of existing intensive care beds in 11 days, on current trends, although surge capacity would be enough to manage for a further 27 days after that.
Houston hospitals have elaborate plans to put patients into operating rooms and doctor’s offices, Dr Persse said, but that leaves open the question of how to expand the staff that takes care of them.
“You don’t have more nurses, more doctors, more housekeeping staff, more food preparation people,” he said. “It takes a lot to run a hospital.”
Houston Methodist, a large hospital network that stretches over 40 miles across the sprawling city, is treating three times as many Covid-19 patients as it was on the Memorial Day holiday at the end of May.
Marc Boom, its chief executive, said it was coping so far — but he is worried about what happens in two or three weeks, if the numbers double again.
“There was this psychological change that happened with Memorial Day. Everybody let their guard down and said, ‘Summer is here. Let’s just act like it never happened’,” he said. “I think we’re starting to really pay the price for that now.”
Graduation celebrations and pool parties have tempted younger people to get too close for comfort, with Texans under 30 testing positive at the highest rate since the pandemic began. They are less likely to be admitted to hospital — but can spread Covid-19 to older relatives.
Georges Benjamin, executive director of the American Public Health Association, says the problem is clear. “Frankly, we’ve opened up places too fast,” he said.
The situation in Houston is repeated in new hotspots that were not hit hard in Covid’s first wave. Anthony Fauci, a top adviser on the White House coronavirus task force, told the Financial Times last week that he was concerned about securing enough hospital beds in the sunbelt states seeing spikes.
Case numbers are soaring before many states have finished building their contact-tracing teams to contain the virus. With 800 new cases a day in Houston, the 200 contact tracers cannot keep up, since it takes days to follow up the contacts for each case.
Doctors have new tools for fighting the disease, including the Gilead drug remdesivir, which received an emergency use authorisation in the US after a trial showed it cut recovery time. But while the company is scaling up manufacturing, there is not yet enough to go around.
Houston Methodist participated in the trial and then received some of the initial supply that the company distributed for free. “The challenge everybody has now is, it’s running out,” Dr Boom said.
Meanwhile, there are still shortages of almost 9,600 hospital products, including personal protective equipment for staff, according to Premier, a group that represents thousands of US hospitals. The majority of suppliers are rationing based on pre-pandemic ordering levels, not which hospitals have the most Covid-19 cases, Premier said.
Add to that many southern states have smaller and poorer public health departments than the north-eastern states such as New York that were hit earlier.
“As we reopen, we are beginning to have a competition within the nation and ultimately globally for masks and gloves and testing equipment,” said Dr Benjamin of the APHA.
Texas governor Greg Abbott said on Tuesday that coronavirus in his state was “rampant”. In an interview with KBTX television, he said people should stay home where possible. “There’s never a reason for you to have to leave your home,” he said. “Unless you do need to go out, the safest place for you is at your home.”
Peter Hotez, a professor of virology at the Baylor School of Medicine in Houston, warned that without a big shift in behaviour, his city could be on track to be the worst hit in the US.
“I’m worried that if we keep on this trajectory, things are going to look very dire for our city,” he said.