Nurses, family and one furry therapy dog named Dexter comfort Miranda Morales, 10, as she receives her first dose of the Pfizer pediatric COVID-19 vaccine at Memorial Hermann-Texas Medical Center in Houston on Nov. 3, 2021. Credit: Annie Mulligan for The Texas Tribune

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As Texans head into the holiday season, there is much to celebrate when it comes to addressing the pandemic. But health experts say the state is not out of the woods just yet.

First, the good news. The number of residents here hospitalized with COVID-19 is at one of its lowest points since the beginning of the pandemic, while average daily deaths from the virus are also dropping and vaccines are finally — after a year of parents anxiously waiting for approval — flowing into the arms of the state’s elementary age children.

The number of residents here hospitalized with COVID-19 is at one of its lowest points since the beginning of the pandemic, while average daily deaths from the virus are also dropping and vaccines are finally — after a year of parents anxiously waiting for approval — flowing into the arms of the state’s elementary age children.

After a miserable summer when the delta variant caused a surge that rivaled the worst moments of the coronavirus pandemic, state health officials and experts say they are grateful for signs of relief. But they’re wary of being too optimistic about a pandemic that has, more than once, had this state in a stranglehold.

“People are just kind of happy or relieved that the most recent surge is done with, but I don’t think anybody’s celebrating anything yet,” said Dr. James Castillo, public health authority in Cameron County. In that county, the share of hospital beds occupied by COVID-19 patients has dropped to 3% percent, down from over 25% during the summer surge.

Still, health officials are now watching a recent increase in the number of new confirmed COVID-19 cases and a small uptick in the rate of COVID-19 tests coming back positive as potential warning signs.

They’re also keeping an eye on a troubling new surge in the nation’s Western states that has hit El Paso, a region that was spared the deadly delta surge that rocked the rest of the state in August and September.

“We’re certainly in a better place right now than we have been in quite a while,” said Chris Van Deusen, spokesperson for the Texas Department of State Health Services. “But we are sort of starting to see things change again. And you know, if there’s one thing we know about this pandemic, it’s that it’s going to keep changing.”

The holiday season brings fresh opportunities for COVID-19 to spread, as families gather — many of them for their first Thanksgiving together in two years, Van Deusen said.

“We aren’t expecting to see another peak as high as we saw it in late summer, but I think it’s just that we’re kind of watchful and concerned,” Van Deusen said. “ As people mix more, it’s an inevitable thing.”

Meanwhile, a continuing shortage of vaccines in the rest of the world means that a virus variant could still emerge and contribute to another surge here.

And while hospital intensive care units have more available beds than they’ve reported in several months, the return of flu season and a rash of respiratory outbreaks could put new pressure on hospitals that are already decimated by staffing shortages and three coronavirus surges — leaving precious few beds, potentially, available should another COVID-19 surge hit.

Every day of good news, it seems, carries with it a note of caution.

At highest risk, officials say, are the millions of Texans who have not been vaccinated. During the month of September, at the height of the surge when about half of Texans had been fully vaccinated, unvaccinated people were 20 times more likely to die from the virus than those who had been vaccinated.

What that means, scientists say, is that a surge among the unvaccinated could still happen.

“Overall, our projections right now are fairly optimistic for the state of Texas,” said Spencer Fox, associate director of the University of Texas COVID-19 Modeling Consortium. “But when we look at the winter, we’re still fairly concerned about what might happen in the future. … Our models suggest that there’s still enough susceptibility in our population to see another pandemic surge if we remove all precautions. I think Thanksgiving will be a lead indicator of what’s to come.”

Surge in the West

As Texas and states to the north and east see similar signs of slowdowns after the summer surge, hospitals in Western states like New Mexico and Colorado and north to Michigan are filling up with COVID-19 patients as the region experiences the surge it largely missed in late summer.

This is the prevailing theory behind rising new cases, hospitalizations and deaths in El Paso, which officials say is more susceptible to community spread in Western states than it is to trends in the rest of Texas.

“Geographically, they’re much closer to Santa Fe and the cities that are just below the border in Mexico, and in areas of New Mexico, than to other areas of the state of Texas,” said Dr. David Lakey, the state’s former health commissioner and now chief medical officer of the University of Texas System. “And so they seem to be tracking more like those areas.”

State health data shows that the El Paso region has seen a 76% increase in the number of daily new confirmed cases in the last two weeks, compared with decreases in most other large counties in the state.

Drops in new cases are being seen in Harris, Dallas, Tarrant, Denton and Collin counties. Cameron County has seen a 21% decrease in cases.

Hospitals in El Paso and surrounding areas are reporting that about 13% of their beds are being used by COVID-19 patients. Statewide, that number is 4%.

On Saturday, Nov. 13, El Paso County reported 627 new confirmed cases, the highest one-day number since early February.

At least some of that is likely due to overconfidence by El Pasoans who believed that they were out of the woods after avoiding the summer’s surge in the rest of the state and recording high vaccination numbers, said El Paso County Judge Ricardo Samaniego.

But locals have high rates of diabetes and cancer that make them more likely to get sick when they do catch the virus, so a surge among those who haven’t been vaccinated is likely to end in worse illness and more hospitalizations than in a more typical population, Samaniego said.

“I think what happened is we got pretty cocky,” he said. “We said, ‘We’re vaccinated, we’re number one, we don’t have to worry.’ … It’s human nature. You’re about two feet from the goal line, and you just relax. We’re so much in a rush to leave it behind us, that’s going to be our downfall.”

The Panhandle is also seeing an upswing in hospitalizations, with 10% of area hospital beds being occupied by COVID-19 patients. New cases are up in that area as well, particularly around Amarillo, which is just over 100 miles from the state’s border with New Mexico.

Lakey said that other areas susceptible to another surge are the ones with the lowest vaccination rates, which include a lot of rural counties.

“I think things are much better now than they were in September,” Lakey said. “But it depends on where in the state you are. … I wouldn’t be surprised if out in East Texas, an area that has some of the lowest vaccination rates in the nation, they get hit hard again.”

Reason for optimism 

But while health experts caution that the pandemic is still far from over, they also point to some reasons for optimism.

Two new medicines are about to hit the market that Lakey said could mute the impact of the virus. Antiviral pills from Pfizer and Merck are on the verge of being approved by the U.S. Food and Drug Administration, having been shown to drastically reduce hospitalization and death from the virus.

More than 72,000 Texans have died from COVID-19, but the seven-day average of daily deaths is down drastically in comparison with earlier this summer. In late September, the state was averaging about 300 deaths a day. Now, that number is around 80 a day.

More than 90% of the state’s older residents, who are most vulnerable to hospitalization and death from the vaccine, have gotten at least one shot, Lakey said. Some 2.5 million Texans have gotten their booster, according to state health numbers.

Another encouraging sign is that while the vaccination rate of children ages 5-11 is still below national figures, more than a quarter-million Texas children in that age group have gotten at least one dose of the Pfizer vaccine, Van Deusen said.

“I think we always want to see that higher than it is, but that is progress,” he said. “And of course, the concern over health effects is less for that population, but there is still a concern about kids being able to get the virus and transmit it to others, particularly if they’re gathering with grandparents and older relatives over the holidays.”

Van Deusen and others said that taking precautions such as masking around particularly vulnerable people and limiting, when possible, extended close contact with them — along with getting vaccinations and booster shots — can help avoid another winter surge.

“I think those kinds of basic precautions still have a place, even as more and more people are getting vaccinated, until we can really get a better lid on this thing,” he said.

Samaniego said Texas is at a critical juncture now, on the edge of the holiday season, and he challenged residents to stay vigilant rather than ignore the warning signs.

“We’re at that point, and which way do we go?” Samaniego said. “If you kill the dragons while they’re babies, it’s a lot easier than when they’re so big they’re spewing fire.”

Chris Essig contributed to this report.

Disclosure: University of Texas System has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.

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