The Senate Committee on Health & Human Services met on December 7 to hear invited testimony relating to the COVID-19 pandemic, including data needs and response. The committee heard from several witnesses involved with the Department of State Health Services and health care stakeholders concerning the initial and future rollout of COVID-19 vaccines across the state.

The HillCo report below is a summary of remarks intended to give you an overview and highlight of the discussions on the various topics discussed. This report is not a verbatim transcript; it is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

 

Opening Comments

  • Chair Lois Kolkhorst – Discussing the most significant public health event in our lifetimes; has affected Capitol operations, all testimony will be videoconference
  •  Will be examining what happened with the coronavirus event as well as the state response; as if we are holding a hearing about a hurricane with the winds still blowing at maximum velocity
  • Should thank Gov. Abbott and his strike force for leadership and resolve in responding to COVID-19, praise must also be given to essential and frontline workers at all levels
  • COVID-19 will loom over every decision made, every district and community has been hurt
  • Will keep an open mind, cannot be afraid of the virus or competing ideas about the virus
  • Working through an ambitious schedule over the next two days, invites those not invited to submit written testimony that will be distributed to the committee members

 

Invited Testimony

Dr. John Hellerstedt, Department of State Health Services

  • Link to DSHS presentation
  • Providing an overview of COVID-19 and the course of the pandemic
    • Clinical course of COVID varies wildly, significant number have no symptoms, many mild, and some have very severe symptoms and need hospitalizations
    • Timeline Overview – DSHS was aware of the novel coronavirus in 2019 and began preparing, world had an idea of the danger of the virus in late 2019, Chinese authorities identified the virus on January 7, the CDC identified the first US case on Jan. 21, State medical Ops Center (SMOC) was activated in late January & began coordinating Texas response activities, March 4 first positive COVID test in Texas, March 19 Texas public health disaster
    • Data on spread varies over the course of the week, but over time shows a very distinct pattern; see peaks in areas followed shortly by increased hospitalizations
    • Numbers of cases is now higher than peak in the Summer, but hospitalizations have declined
  • Heaviest lift at the start was creating the data needed to track COVID, had to develop negative and positive test reporting infrastructure
  • Important to look at the data as pointing in a direction rather than providing exact numbers
  • Want to preserve hospital capacity as much as possible, critical to have beds for people that need them, number of patients needing inte3nsive care is high and ICU capacity is taken up very quickly
  • Also have secondary impact on other patients needing the ICU, demand for ICU beds for trauma, etc. still exists
  • Strategy has been to expand bed capacity within the four walls of the hospital, have learned what is most needed in alternative care settings as well
  • Still an incredible amount of strain on the hospital system and demand for COVID beds
  • Expenses of COVID is in multiple billions of dollars and we can expect to need to continue to expend resources to respond to COVID to provide therapy and vaccines and lessen strain on hospitals
  • Expenses are largely related to hospital staff, have 10k+ staff assigned to field response
  • Have discovered that patients need very high-flow oxygen and avoid ventilators for as long as possible
  • Texas has been allotted 1.4 million doses of Pfizer initial vaccines allotment, but until distribution is increased we will need to take measures to keep Texans safe; need to continue to maintain distancing, masks, handwashing, etc.; masks protect yourself and others, Summer peak was drastically reduced due to increased usage of masks
  • Chair Kolkhorst – Thanks Dr. Hellerstedt for his and DSHS’ effort, will have more questions later
  • Sen. Charles Perry – Could you give us insight into your daily routine over the course of the pandemic? Public is split over if more or less should be done in response, would help to understand
    • Hellerstedt – Important to remember that science can advise, but it cannot decide; in the response to COVID had to balance decreasing COVID impact in the community and also allow people to go to work, support their family, etc.
    • Issue is that this social closeness, but the most effective solution is distancing and masks
    • Early on it wasn’t clearly understand how asymptomatic people spread COVID, which was very significant; did not understand benefit of wearing masks early on
    • Understanding of virus and its behavior has changed over time, very in-depth and robust dialogue between ourselves, partners at the federal level, and the Governor’s office
    • CDC is a great adviser and subject matter expert, but states decide how to respond to a public health crisis
    • Has seen a response focused on dialogue and information sharing while allowing decisions to be made as close to the locally affected populations as possible
  • Sen. Perry – Who would have been the primary decider on what is an elective or nonelective surgery, there was a lot of uncertainty; did TMB make this decision? Did you?
  • Sen. Perry – Initially we were told we wanted to preserve PPE, is that true or was this more about preventing hospitalizations? Had effects on people who needed “elective” surgeries and did not make it
    • Hellerstedt – Would agree that “elective” is not a very well-defined term, would prefer it was not used
    • Were asking physicians to have discussions with their patients about which procedures could be safely postponed without causing unnecessary levels of risk to the patient; patient access decisions were largely made at this level
    • Early on the big concern was for PPE, need professional grade, up-to-date PPE in hospital settings; supply was close to zero in the early days of the pandemic and did not have large stockpiles
    • PPE was essential as health care workers operate in an environment with known COVID patients
  • Sen. Nathan Johnson – Important for the public to understand the decision-making process for the vaccine, who is involved in this process?
    • Hellerstedt – We know have a 17-member Expert Vaccine Allocation Panel (EVAP) panel for vaccine distribution, Chair Kolkhorst is a member
    • Also have to deal with technical issues like need to freeze vaccine before use, need to resolve supply chain with adequate freezers or dry ice, etc.
    • Frontline workers are the priority for distribution, anything that can help them deal with COVID patients and medical facilities is beneficial
    • EVAP members and others have spent a significant amount of time on this and are united in how they should approach this
  • Sen. Beverly Powell – How great is our capacity to continue to fill the need for medical supply and personnel across Texas?
    • Hellerstedt – Staff and supplies are key, if we stay where we are now we can likely sustain response for a period of time until we have vaccine and population immunity to affect need for hospitals
    • This is still many weeks away, but this is contingent on staying where we are now in terms of case numbers, etc.; need to maintain safe practices
  • Sen. Powell – Concerned about movement of people bringing COVID into areas of the state, i.e. Marfa has asked people to stop coming into the city as it is leading to outbreaks; still a large number of people who don’t believe the truth of the pandemic, need a larger presence in the media where the state is offering a message of how critical safe habits are
    • Hellerstedt – I think you’re absolutely right, we have very sophisticated communications tools
    • Have seen many cases where infections have spread through a chain of people and important to provide info for these people
    • Also dealing with skeptics, one of the best things to do is simple declarative statements, the pandemic is real, no one is making numbers up, disinformation is harming ability to get back to normal quickly, personal liberty should be moderated if it impacts other negatively, etc.
  • Sen. Borris Miles – Does DSHS have a plan on how we’re going to reach the population who lack internet services and do not have regular doctors?
    • Hellerstedt – Yes, as we get more and more quantities of vaccine and types, e.g. Pfizer requires deep freezing and Moderna only requires regular freezing, meaning many more can handle that version
    • Have a web portal were differing entities can register to be a vaccine administrator
    • Getting vaccine out to the most vulnerable, including communities of color who do not have the luxury of working away from the public
    • The vaccine is most needed where people are exposed to it when they can’t take steps to mitigate risk
  • Sen. Miles – If I’m hearing you correctly, we’re going to have a strong grass roots collection, asks for clarification on communities being charged for the vaccine
    • Hellerstedt – They should not be charged
  • Sen. Miles – Also concerned about frequency of vaccine outreach, if organizations will come through once and not again, are we tracking if individuals come back for the second dose? Outreach is important for my area
    • Hellerstedt – State law requires doses to be registered in the system, administrator should make appropriate arrangements to recall people for the second dose
    • Second dose is ideal, but one dose is far better than none at all
  • Sen. Kel Seliger – How many cities and counties in the state have taken affirmative action such as mask requirement or gathering ban, etc.
    • Hellerstedt – Can’t answer this off the cuff, statewide orders mention group sizes; would need to research the specifics
    • Important to note that control of COVID depends on prevention, hopefully enough people are convinced to continue to engage in safe behavior
  • Sen. Seliger – Prevention is key, had more people die in one day than on 9/11
  • Sen. Seliger – Cannot force people to take vaccines, but need to inform the public of their importance
  • Sen. Seliger – For the second dose, we may be able to get name, address, and get HHS people out to those people in order to let them know they can get it
  • Sen. Seliger – Contrary to rumors, public officials will not be the first to get the vaccine
  • Sen. Miles – Echoes Selinger’s sentiments; We all know what it is going to take to respond in our communities and distribute vaccines, our duty to assist with this
  • Sen. Kolkhorst – I am a member of EVAP, none of the conference calls are less than 2 hours, focusing on frontline workers
  • Sen. Kolkhorst – What percentage of fatalities are 65 and older?
    • Hellerstedt – about 70% are 65 and older
  • Sen. Kolkhorst – Roughly 16k of deaths are 65 and older, greatly affects those who are older and with comorbidities; seemingly doing something better were mortality rate is lower now than during the previous peaks, can you speak to this? Are we doing better with therapeutics?
    • Hellerstedt – A lot of the increase in lab-proven tests is due to the increased ability to test; hospitalizations are one of the few metrics where the entire population in question is the state population, testing and thus case positives are not the entire population
    • CDC has said there has probably been as many as 8 times more people with COVID than lab-confirmed tests
    • Still not enough for herd immunity and still means we are at risk
    • Overall hospitalization numbers may reflect better understanding of how to care for COVID patients, e.g. home health, but ICU trending is not different from trends we saw in the past
  • Sen. Kolkhorst – Are you familiar with cycle thresholds on the PCR test?
    • Hellerstedt – Somewhat
  • Sen. Kolkhorst – Cycle thresholds could be very important in determining COVID test results, are we looking at these in Texas? Could be important in understanding the pandemic; some are departing from PCR tests due to lack of trust
  • Sen. Kolkhorst – Looking forward to coordinating with DSHS on data and response

 

Dr. Larry Schlesinger, Texas Healthcare & Bioscience Institute

  • Must be collaborative, education must change from reactive to proactive to tackle infectious disease
  • New diseases occur annually, will have severe economic ramifications by 2050
  • Increased collaboration across the COVID response has allowed for incredibly rapid development of therapies and vaccines
  • Fully confident in the process, FDA is investigating all aspects of interventions developed
  • Research needs to continue and we must be prepared for interruptions with vaccine manufacturing and distribution
  • Have not learned enough from past infectious diseases, must be more proactive, answer the remaining questions from this pandemic and start preparing for the next one
  • Must continue to practice safe measures like distancing, masks, and sanitizing hands, etc.
  • Proactive infectious disease R&D will get us ahead of the curve, increased education will lessen needs for extreme measures in future pandemics
  • Sen. Kolkhorst – You spoke previously about how SARS and MERS were so lethal that they burned out quickly, COVID is not as lethal and this allows it to keep spreading; were not able to complete work on SARS and MERS due to quick burn out
  • Sen. Kolkhorst – For the rest of our lives do wear masks and distance, or do we operate in a free society?
    • Schlesinger – I think ultimately with COVID we will get back to not needing masks, one of the ways this works is with effective vaccine; current COVID vaccines are much more effective than the influenza vaccine, will break chain of transmission
    • COVID is very infectious, will not burn out like SARS or MERS; hopeful that as people acknowledge how impactful infectious disease can be, we will have a better response moving forward
  • Sen. Miles – Do you have any details about vaccine side effects?
    • Schlesinger – Side effects we’re familiar with are largely local, about 10-15% have swelling or pain in the arm; need to educate the community about this
    • Unknowns include how durable the response is and how widespread it will be; we know some will not have a response that protects them against COVID
  • Sen. Perry – There was politicization of this issue, does your institute consider discussions over certain therapeutics that were controversial early on in the pandemic
    • Schlesinger – What clearly distinguishes this pandemic from prior threats is the speed over information and misinformation
    • Bedrock of my institute is rigorous science that tries to objectively determine efficacy, unfortunately this often takes much longer
    • We were not involved in HCQ studies, we are participating in remdesivir studies
  • Sen. Perry – Do you have a responsibility to engage in possible therapeutics or not?
    • Schlesinger – Absolutely, have rigorous practices in place to evaluate efficacy
  • Sen. Perry – Operation Warp Speed moved these vaccines to the frontline quickly, were the studies adequate?
    • Schlesinger – Scientific process has historically been sequential, not parallel which is what’s new here
    • Phase 1, 2, and 3 trials scale up in terms of population, numbers for Phase 3 are perfectly in line with rigorous Phase 3 trials, no corners have been cut
    • Response in the animal model with the Pfizer vaccine has been incredible,
  • Sen. Perry – What is herd immunity?
    • Schlesinger – it depends on the rate of transmission, for COVID it depends on at least 70% of the population
    • If vaccine efficacy is in the 90-95% level, it is anticipated that we will break transmission
  • Sen. Perry – How do you exist, are you private, federal funding, etc.?
    • Schlesinger – Majority of our funding is from various contracts, mostly governmental
  • Sen. Kolkhorst – Have heard of various therapeutics that are effective; frustrated with the lack of information sharing and lack of encouragement for effective therapeutics, what do you say to this?
    • Schlesinger – I’m sympathetic, therapeutics that can tone down the immune response could be helpful in certain cases
    • Biggest challenge currently is we are rolling out vaccines, but we’re still trying to figure out the virus
  • Sen. Kolkhorst – What is the #1 infectious disease that kills the most people around the world?
    • Schlesinger – #1 is tuberculosis, no vaccine and kills over 1 million annually; malaria kills around 500k/year, others like HIV, hepatitis, dengue, etc.

 

Dr. Matthew Leveno, UT Southwestern, Parkland Medical ICU

  • Provides overview of specific COVID treatment protocols for patients, those that require hospital admission, and common associated conditions like pneumonia
  • For patients with minor symptoms, remdesivir and steroids are used as therapeutics; have used remdesivir since May and steroids since June & can help prevent patients from needing more intrusive treatments
  • Most severe patients require oxygen and mechanical ventilation
  • Early in the pandemic there was general guidance to use mechanical ventilation and intubation early, has become clear that supplemental oxygen can avoid this
  • Even with therapeutics, there continues to be a significant subset of patients that deteriorate and need mechanical ventilation; difficult to identify the subset of patients that will need intensive treatments
  • Sen. Perry – We keep hearing about data, is there something that gets reported that helps identify comorbidities, can you speak to this?
    • Leveno – Median BMI is 31, 50% high blood pressure/diabetes, median age is 58 for those requiring mechanical ventilation in the ICU
  • Sen. Perry – Obesity, diabetes are related often, is that a fair statement?
    • Leveno – Yes
  • Chair Kolkhorst – Can you speak to what can help keep patients from advancing to more critical care?
    • Leveno – Unfamiliar with data on outpatient strategies
  • Chair Kolkhorst – What steroids are you administering?
    • Leveno – Decadron
  • Chair Kolkhorst – How is the supply for remdesivir?
    • Leveno – Not an issue currently, but supply chain issues can become a problem suddenly
  • Chair Kolkhorst – What about convalescent plasma?
    • Leveno – By the time I see these patients, convalescent plasma is not recommended
  • Sen. Perry – Did use of HCQ or other therapeutics prohibit use of treatments in your department?
    • Leveno – No, antibiotics use prior to arrival might influence decision making
  • Sen. Perry – are you aware of people who were on HCQ that are in your ICU?
    • Leveno – Anecdotally yes, can’t give you specifics, but have had patients come in after taking therapeutic treatments
  • Chair Kolkhorst – Asks after influenza admissions?
    • Leveno – Don’t have the most recent numbers, but not seeing significant hospitalizations
  • Sen. Perry – Are you confident of the diagnoses between COVID and influenza
    • Leveno – Flu and COVID testing is very reliable in terms of distinguishing one from the other
    • Steps taken to prevent spread of COVID would also be effective for flu, but flu is more apparent and doesn’t have asymptomatic transmission
  • Chair Kolkhorst – Not having influenza admissions in December is remarkable, would love to get averages from previous years
    • Leveno – Can get you this data

 

Dr. James McCarthy, Memorial Hermann

  • Early treatment patterns were informed by experiences from Italy, required universal masking early on; highlights processes used to ensure supply of PPE early in the pandemic
  • Have treated roughly 1,800 people with convalescent plasma, conversion of testing to usable plasma is about 20 to 1 people
  • Saw trends that Hispanic and African American communities were being disproportionately affected, started targeted outreach
  • Have adequate remdesivir now, no supply chain issues in months; have adjusted remdesivir use as it is most effective early on
  • Chair Kolkhorst – Do you use this in combo with a steroid?
    • McCarthy – depends on the case, steroids are usually used when patients require oxygen, but most patients presenting require oxygen
  • Chair Kolkhorst – What pulse ox level do you start using oxygen?
    • McCarthy – Start getting nervous at 90
  • Memorial Hermann is also tracking coagulation and using anti-coagulation agents when appropriate
  • Have seen some data that indicates steroid use can increase time needed to clear a virus, concerned about this
  • While Memorial Hermann has seen significant adverse effect, mortality has decreased across vulnerable groups, likely due to increased experience and new treatments
  • Concerned about provider fatigue, workforce has been stressed in ways never experienced before; added strain on ICU nurses in needing to be the sole contact with patients has put an incredible burden on them
  • Have proven that we can keep our staff safe, very few COVID incidents among staff with very high volume of COVID patients
  • Chair Kolkhorst – 400 COVID patients system wide at Memorial Hermann, what is the current ICU census?
    • McCarthy – Can get this to you
  • Chair Kolkhorst – Have you curtailed elective surgeries?
    • McCarthy – Have not at this point, monitoring this and doing everything we can to maintain adequate capacity
    • Because PPE is so stable, very little reason to disrupt outpatient procedures
  • Chair Kolkhorst – What are you seeing in influenza admission?
    • McCarthy – Exceptionally little
  • Sen. Perry – Do you have any info on the portion of patients with intestinal issues
    • McCarthy – We do see GI complaints, test when patients present with this symptom; most of these patients do present with other symptoms
  • Sen. Perry – Do you see anything with pregnancies, some caregivers are seeing young women with clotting issues
    • McCarthy – No statistic for you, see a significant incidence of COVID in pregnant patients, 100% of pregnant patients are tested for COVID on admission
  • Sen. Perry – Any infants test positive at birth?
    • McCarthy – Have had infants test positive, can’t say if this is prenatal or neonatal
  • Sen. Perry – are heart ablative surgeries elective at Memorial Hermann?
    • McCarthy – Without the chart, difficult to say
  • Sen. Perry – If you delay, is it fair to say arrythmia or other issues would not get better?
    • McCarthy – Yes
  • Sen. Miles – As hospitals working with others to ensure vaccines are delivered to vulnerable communities
    • McCarthy – Thanks Sen. Miles for his work on the Harris LPPF
    • Have had leadership calls with other institutions to plan regionally for vaccine distribution and access, working with clinics and community outreach orgs
  • Chair Kolkhorst – Do you use prophylactic medicines for COVID exposure
    • McCarthy – Not enough science behind these ideas for us to endorse right now
  • Chair Kolkhorst – Do you see any kind of therapeutic that has prevented people coming to your hospital?
    • McCarthy – Ones most commonly talked about are zinc, steroids, etc.; steroids seem most appropriate for those starting to develop pulmonary issues
    • Monoclonal antibody infusion could also ultimately prevent hospitalizations
  • Chair Kolkhorst – Also asks for Primary Care Physicians to submit written testimony on efficacy of drug regiments and therapeutics
    • McCarthy – Responds to previous question, have had 6 influenza patient admissions since October
  • Chair Kolkhorst – Comments that Texas seems to have done better than other states; asks after proning
    • McCarthy – Proning helps to take weight off of the lungs and helps them take in oxygen, can help keep patients off ventilators

 

Imelda Garcia, Department of State Health Services, Laboratory and Infectious Disease

  • Link to DSHS presentation
  • Speaking on vaccine distribution, vaccine distribution plans continue to evolve very quickly and continue to get new info from federal partners that can change plans
  • Expecting very limited doses to be available later this month, but expecting supply chain to increase in 2021
  • Initial supply could be approved one of two ways, could be fully licensed as a vaccine or under an Emergency Use Authorization from the FDA
  • EUA vaccines cannot be mandated, COVID vaccination would be completely voluntary
  • 2 doses from the same manufacturer separated by ~20 days will be required for COVID vaccination
  • While Operation Warp Speed has tried to accelerate the process of vaccine development, each approval FDA step must be completed, CDC will then give specific recommendations for target populations for vaccines
  • DSHS will continue to monitor for safety concerns after the vaccine is distributed
  • 5 of the 6 Operation Warp Speed candidates are two dose vaccines, other is still determining
  • Timing of both doses depends on which brand of vaccine, storage and handling changes as well; this contributes to complexity in distributing the vaccine
  • Moderna and Pfizer are set to receive FDA approval, others are further behind
  • Initially, we are expecting a very limited amount of vaccine available, CDC priority phases guide the state for vaccine distribution
  • CDC priority populations – 1) frontline workers, 2) increased risk of severe COVID illness, 3) individuals at increased risk of acquiring or spreading COVID, and 4) people with limited access to vaccine services
  • States decide how vaccines with be allocated to priority populations, individuals can fit into multiple categories, e.g. frontline working with comorbidities
  • Chair Kolkhorst – If you have tested positive for COVID, do you receive the vaccine or not?
    • Garcia – CDC will make recommendations, but not planning to screen people out at this point
  • Garcia provides a highlight of DSHS vaccine distribution, Phase 1 has a very limited supply is expected at the end of December, most of the vaccinations will occur in occupational settings
  • Expecting pharmacies to begin vaccinations in certain circumstances, e.g. long-term care residents have recently been moved to top priority
  • Phase 2 will come with more vaccine supply, anticipating using specialized vaccine teams to address care gaps
  • Phase 3 would be mid-Summer to October of 2021, would be looking at areas with lower vaccine uptake and targeted outreach
  • Phase 4 would be a return to normal vaccine distribution, no sign on whether annual dose or boosters will be recommended
  • EVAP is charged with establishing vaccination priority for Phase 1 and 2, DSHS will be meeting weekly with providers, DSHS’ Infectious Disease Task Force will also be soliciting feedback
  • Present the Immunization Provider Registration Portal, website for those wishing to provide vaccines to the public, can only get vaccine from the state if you register with this portal
  • Texas has over 7,000 sites currently across the state signed up to administer the vaccine, including those through the federal programs and large pharmacies
  • DSHS will be tracking vaccine utilization data to assist building knowledge on how the vaccine moves through populations; will work into weekly allocations
  • DSHS is planning to add a vaccine component to the COVID dashboard
  • DSHS will be collecting data to create options for the EVAP to decide upon, EVAP will then make allocation recommendations to Dr. Hellerstedt
  • Pfizer will need support for the ultracold freezing so is handling distribution
  • McKesson will be distributing Moderna vaccine supplies along with the vaccine; this includes shot record cards to help track second doses
  • Chair Kolkhorst – Asks for clarification, McKesson will be distributing the Moderna vaccine, but not Pfizer?
    • Garcia – Yes, Pfizer’s vaccine requires ultracold freezing and Pfizer is handling distribution
  • Reviews DSHS’ vaccine allocation guiding principles; EVAP has 17 experts to help DSHS make these decisions, communicating with multiple stakeholders to help make decisions
  • DSHS/EVAP priority distribution –
    • Hospital staff in direct contact with COVID patients, clinical support, long-term care staff, long-term care residents
    • Outpatient staff, non-911 transport
    • Direct care staff at emergency/urgent facilities, pharmacy staff, public health staff
    • Mortuary staff, school nurses
  • Developing a statewide media campaign, planning to provide information on the vaccine and availability; distribution information will be added to the dashboard
  • Chair Kolkhorst – Regarding the allocation tiers, in theory we should have roughly 1.5 million doses by Jan. 1, by week 3 of distribution we could be done with health care workers in Tier 1 and be moving to long-term care residents; looks like we ramp up with Moderna and Pfizer at roughly 300k/week
    • Garcia – Yes
    • Chair Kolkhorst – This is just to give everyone a sense that we won’t be through all these categories immediately
  • DSHS communication and outreach needs to align with vaccine distribution, DSHS will continue to adjust
  • Sen. Perry – Does DSHS have an inventory of locations that can store the Pfizer vaccine that needs ultracold storage? Are allocations made based upon ability to store?
    • Garcia – 170 locations singed up across the state have these freezers, potentially more that have not yet signed up and looking to partner with more
    • Other limitation with the Pfizer product is that it comes in a very large shipment, comes in order blocks of 975 which requires a lot of storage space
    • Pfizer will be available week 1, but Moderna will be available as soon as week 2
    • For week 1, there are distributors without cold storage and DSHS is assessing if dry ice is a viable alternative
    • EVAP will ultimately decide how we allocate for week 2
    • Moderna needs to be frozen long-term, but can stay stable with refrigeration for 30 days; smallest order batch is 100 doses
    • Week 2 allocation options will be brought to EVAP later this week
  • Sen. Perry – Would be helpful to know which portion of those 170 facilities with ultracold storage are rural and how providers access these doses if they are centrally stored
  • Chair Kolkhorst – Previously discussed shipping vaccines only to ultracold storage facilities or if we could ship with dry ice, looked closely at geographic distribution options
  • Chair Kolkhorst – Will not be easy, cannot waste doses, education on procedure to administer the vaccine is needed
  • Sen. Perry – Notes that there are very rural populations outside of the city centers; city centers provide health care services to these rural populations
  • Sen. Seliger – Some communities cannot handle the size of the Pfizer shipments, some can only handle Moderna, hope people keep this in mind
  • Sen. Miles – Need to work together to ensure all communities have access
  • Chair Kolkhorst – Have received questions on where teachers fit into the allocation plan

 

Faith Walters, Pfizer

  • Pfizer has worked together with BioNTech to develop vaccine, moved efficiently through the Phase 1, 2, and 3 trials
  • Recruited diverse group for trials, Phase 3 showed efficacy across age, gender, and ethnicity
  • Main concerns with distribution planning were ensuring all needed materials were distributed alongside and that the vaccine remained cold along the distribution chain; worked with 3rd party suppliers of diluent, assessed the landscape for dry ice availability, sites can use the thermal shipper for up to 30 days
  • Chair Kolkhorst – Pfizer is handling shipping/distribution?
    • Walters – Yes, we get the orders from the CDC and direct ship directly to the site
  • Chair Kolkhorst – On the ability to ramp up, you also ship the matching second dose?
    • Walters – Yes, no doses in the first shipment are held back
  • Sen. Perry – Do you have estimates on how long the vaccines will last?
    • Walters – We are assessing long-term immunity in the vaccinated trial population
  • Sen. Perry – Is this vaccine specific to COVID today, will it cover future mutations?
    • Walters – It is specific to this type of COVID, but our technology allows us to change should the virus evolve
  • Sen. Perry – Some may choose not to get the second round, do you have data on efficacy of first dose?
    • Walters – Will be presenting this data alongside Phase 3 results
  • Sen. Perry – Asks after money set aside for distribution
  • Chair Kolkhorst – My understanding is the money set aside is inadequate to cover distribution entirely, there is some discussion on whether CARES Act funding is usable beyond December 30; there are some holes, we have some money set aside but we will need more
  • Sen. Kolkhorst – Your vaccine does not use any cell material from fetuses, correct?
    • Walters – Correct
  • Chair Kolkhorst – This is true of the Moderna vaccine as well
  • Chair Kolkhorst – There have been concerns about long-term side effects of vaccine, do you have any data?
    • Walters – Safety is important to us, RNA vaccines have been studied for a very long time, will continue to look at safety and immunogenicity over the long-term
  • Chair Kolkhorst – Clarifies that developing immunity is about a monthlong process after starting
  • Miles – Asks after the chain of distribution and how many will interact with the vaccine before a Texan receives it
    • Walters – Refers this to the next speaker from DSHS

 

Imelda Garcia, Department of State Health Services, Laboratory and Infectious Disease

  • Link to DSHS presentation
  • Chair Kolkhorst – Before you begin, can you speak to Sen. Miles’ question over chain of distribution
    • Garcia – Only a handful of people should be pulling it out of the freezing and reconstituting, trying to make it as few people in between as feasible
  • COVID has generated a significant amount of data, important to collect and organize to get an accurate view of what is happening in Texas
  • DSHS was given a Grade A from the COVID tracking project for data transparency, have tried to present accurate and complete data for the public; still areas that need to be bolstered
  • Big takeaways from COVID data are that trends over time provide most guidance for the state, importance of standardizing data, ability to move quickly, and necessity of using data to drive decisions
  • Provides an overview of flow of data between types, systems, and recipients or submitters of data; complicated system that needs to work in concert to provide data for stakeholders, many new systems needed to be developed to meet demands
  • Highlights how collection of testing data has changed since the pandemic; moved from collecting only positive cases to positive, negative, and indeterminate cases, capacity reporting and number of labs reporting data increased significantly
  • National Electronic Disease Surveillance System (NEDSS) was updated, moved some paper reporters to electronic lab reporting, created and improved processes for public health follow up activities
  • In progress improvements include increasing electronic reporting and retaining epidemiologists to support analysis
  • NEDSS upgrades were already in progress when COVID hit, leveraged federal dollars to implement upgrades needed; lab reports processed increased dramatically in August after NEDSS upgrades were implemented
  • Technical data on NEDSS upgrades provided on pg. 46-47 of DSHS presentation
  • Chair Kolkhorst and Garcia discuss difference in local health data versus DSHS data, local numbers can differ due to differences in lab report material submitted
  • New labs being onboarded may not have IT support, Texas rules could differ
  • DSHS is working to proactively work to let local jurisdictions know when large labs are onboarded that contain older data, emphasizing that reporting needs to indicate which labs are older; don’t want old labs to artificially inflate numbers today
  • Sen. Perry – Still uncertain who drives the numbers being reported by county breakdown, need to understand that real-time reporting in this type of situation is unrealistic
  • Sen. Perry – Is a 7-day term relevant enough for local governments to make decisions? Making decisions based on data that could include very old numbers is not good public policy
  • Sen. Perry – Where does personal data come in?
    • Garcia – First level comes in with Globalscape, NEDSS is where this data would be stored
  • Sen. Perry – Does NEDSS control all this data?
    • Garcia – NEDSS is the infectious disease components
    • Hospital data does not have personal information, depending on which source you’re talking about it may or may not personal information
  • Sen. Perry – There’s a database that could identify if I got a test or not?
    • Garcia – Yes, though it would likely lag a couple days
  • Sen. Perry – What’s the retention period?
    • Garcia – Follows the standard retention period, for ImmTrac this is 5 years, not sure on NEDSS
  • Sen. Perry – Would like data on how long this data is held and if there is any need for it beyond the vaccine
    • Garcia – Can get this to you
  • Sen. Perry – Regarding comorbidities, is there a data system in this mix that could identify which comorbidities are the most concerning?
    • Garcia – NEDSS has the capability for case reporting, pursuing this right now, need to onboard this for hospitals and hoping to get there quickly
  • Sen. Perry – Asks after reinfection
    • Garcia – Reinfection requires 3 months of testing negative in between positives, this period gives us the data to make reinfection determinations
  • Sen. Perry – Asks for clarification on probable cases
    • Garcia – Recently adopted CDC guidance on probable cases that say only antigen test positives are probable cases
  • Sen. Perry – Concerned about the possibility of maintaining a narrative with probable cases rather than confirmed cases, concerned that we can’t take assurance in positivity or negativity rate we can take assurance in
  • Sen. Kolkhorst – So the CDC definition for probable includes people being in households with positive cases
    • Garcia – If you have an epi link and symptoms, you could be a probable case if the epi investigation determines it
  • Sen. Kolkhorst – Concerned not only about this, but also about how long we keep negative test data, have long history of issues where private medical data has been sold
  • Garcia highlights Public Health Follow-Up (PHFU), created to break the chain of infectious disease; sometimes called contact tracing
  • Texas Health Trace was developed over the course of the pandemic, now integrated with LHAs, use of THT varies across the state with many counties using local tracing systems as well
  • THT has helped with case investigations, but hasn’t kept up with all local needs
  • Chair Kolkhorst – Should emphasis still be on positive tests or should it be on hospitalization and mortality
    • Garcia – Hospitalizations represent costs to regions, positivity rate can help tell you if COVID is circulating in a community and trends
    • Ultimate point is can the infrastructure survive as the situation stands, all stats are important
  • Chair Kolkhorst – Do we have the ability to know the comorbidity and the other factors
    • Garcia – Have a much better idea of cause of death involved in COVID; someone who dies of unrelated causes is not included in the data currently
    • Can provide these statistics

 

David Gruber, Department of State Health Services, Regional and Local Operations

  • Key to data and reporting is to protect the overall health care system and ability to care for patients
  • Provides overview of state division into Trauma Service Areas
  • Many of the statistics important to COVID were not tracked before the pandemic, e.g. overall state bed status, SMOC began reporting this at the TSA level in March
  • Amount of data collected has skyrocketed over the course of 2020, hospitals now have this massive data reporting burden on top of regular operations and care for COVID patients
  • Sen. Seliger – Nots that state staff have work tirelessly since the pandemic began, has been key to responding in an emergency
  • Chair Kolkhorst – Do we have a good feel for hospital capacity
    • Gruber – Yes, sometimes local entity reporting does not match state reporting, can differ based on timing of data sent and received, can differ based on how bed availability is calculated, some local entities may collect more data
    • Working through issues with partners currently

 

Imelda Garcia, Department of State Health Services, Laboratory and Infectious Disease

  • Available for questions on the morality data
  • Chair Kolkhorst – Do you feel like death certificate data is the most reliable?
    • Garcia – I feel like this is the best information we can have in a timely manner, clears up many of the questions we had early in the pandemic
  • Chair Kolkhorst – Regarding future of state data, includes adding possible cases, positivity rate streamlining, and COVID vaccination dashboard updates?
    • Garcia – Yes
  • Sen. Perry – Can you give me an idea of what is allowed on a death certificate?
    • Garcia – Majority of deaths in Texas are recorded by a physician, physician’s judgment over what may be a cause of death
    • For COVID, we only look at what is listed in the primary cause of death, DSHS makes an effort to educate JPs and others on what should be categorized as COVID deaths

 

Umair Shah, Harris County Public Health

  • COVID has put public health in the spotlight at all levels of government, Harris County staff have been responding 24/7 in numerous ways
  • Pandemic strains an already underfunded public health system that is always asked to overperform
  • One of the biggest challenges for Harris County was receiving timely and complete data, have also faced challenges sharing this data in ways we’ve never been asked to before; mismatch between data systems, types, and jurisdictions has led to large issues
  • Need a larger financial investment into public health and public health informatics, need to make investments in the workforce, federal funding needs to be fairly allocated to local health departments
  • Chair Kolkhorst – Regarding improving state and local data reporting, does this continue to be decentralized or does it need more coordination at a state level
    • Shah – I don’t know if the issue is centralization as much as investing in coordination
    • DSHS should be given a central role in public health, local authorities look to DSHS
  • Chair Kolkhorst – Asks after presumptive cases and reporting
    • Shah – Differs by region, Harris County does not count antibody tests in the same way as PCR testing
    • Local authorities don’t need to report the same set of data, but we do need to be consistent in how we are reporting
  • Chair Kolkhorst – Inconsistencies in data make the results unreliable and this is when the public become mistrustful; would you suggest code provisions on how infectious disease data should be reported?
    • Shah – I would
    • Not as much about putting requirements in code, but more about how we enforce requirements
    • Public health system needs assistance, but lab and provider need to be required to report and have enforcement if they don’t do it correctly
  • Chair Kolkhorst – This is the first time we’ve used private labs to this extent, likely will not go back to what it was
  • Chair Kolkhorst – What do you think about hospitalizations as a more accurate metric?
    • Shah – Unfortunate reality is you need to do both, we need to know positivity rate in the community
    • Positivity rate can give you a breadth of knowledge for the community, hospitalizations and other metrics give us a view into the health system itself
    • Data points give you different kinds of info, e.g. death rates are a lagging indicator, hospitalizations give you an early indicator, but doesn’t give you what is happening in the community and is blind to those who don’t enter the hospital
  • Chair Kolkhorst – We’ve made decisions that will have a long-term effect on people with issues like domestic violence, secondary impacts on health outcomes, etc.
  • Sen. Miles – When we have a digital gap between cities and counties, this costs human lives, correct?
    • Shah – I would agree with that
    • Unfortunately the pandemic has become a political football, but the key piece here is that every decision has consequences
    • Harris County has been trying to let science and evidence drive decisions, but with a pandemic that is unique, we have to do everything we can to respond intelligently
    • Gap between certain communities has been challenging, but if we do not work together then we do not win

 

Dr. David Persse, Houston Health Department

  • Regional and state coordination has been vital to our success, hasn’t always been good
  • Goal has been to test as many as possible, have tried to target vulnerable communities
  • Have more testing capacity now than people seeking tests, part of the goal now is to educate the public on testing resources
  • Trying to highlight to individuals that if they test positive, this knowledge can help protect family members, friends, etc.
  • Testing data is best when it comes in digitally, much more efficient; Houston receives a large number of tests and more automation can lead to better results reporting
  • Highlights the ability of sewage water to predict positivity rates; Houston has seen that viral activity in wastewater predicts positivity rate over the next two weeks
  • Chair Kolkhorst and Persse discuss how many individuals used to call 911 to get COVID tested, set up a system by which these individuals could get transport to a testing site without needing to involve EMS personnel
  • Chair Kolkhorst – How long do you keep personal information?
    • Persse – This is all digital and sent to the state in a short amount of time, it is identified
    • We keep this data for roughly 7 years, we’re required to keep minor data until they are 21
  • Sen. Miles – Looking forward to working with you on vaccine distribution

 

Eric Epley, STRAC

  • RACs are critical to data collection and sharing between stakeholders
  • There is a lack of understanding of methods and need for data collection, lack of reporting of feedback, changing systems requires thousands of man-hours of extra work
  • Data collection systems/IT need sustained funding to remain reliable
  • Reporting requirements have changed quickly and often over the course of the pandemic
  • Chair Kolkhorst – Hoping we can have some more consistency and sustainability to data collected, do you have anything to add?
    • Epley – No, highlights Texas Rapid Test app as something that could be scalable

 

George Roberts, Northeast Texas Public Health District

  • Volume of reports has increased dramatically due to COVID, Smith County counted over 10k positive cases
  • Provides an overview of sources of data, includes clinics, schools, etc. as well as NEDSS; also provides an overview on details on how the district collects data, goes through several review steps
  • Public health funding is inadequate

 

Christine Sable, Quest Diagnostics

  • Earlier this year, Quest entered into a partnership with Memorial Hermann to bolster data collection and reporting
  • Quest supports DSHS reporting all lab results through the APHL AIMS platform, currently limited to Dallas and Houston laboratories, other Quest locations report via fax or other methods
  • Sen. Perry – Have heard concerns about platforms for data collection, but difficult to update platforms for many of the rural areas of the state
  • Sen. Perry – Do you store any data?
    • Sable – Quest is required to store medical records depending on the state, can get this timeline to you
  • Sen. Perry – Does this data contain personal info?
    • Sable – Yes
  • Sen. Perry – Continually learn about data silos in many different places
  • Chair Kolkhorst – Yes, very revealing how many different entities keep the data given to them
  • Chair Kolkhorst – In Texas, we have more data safeguards than other states, but definitely needs to be updates
  • Sen. Perry – Selling data is another conversation we need to have after the DMV breach; not sure why we need identifying information connected to test results
  • Chair Kolkhorst – Heard that diagnosis on colon cancer, breast cancer, etc. dropped significantly during the pandemic, is that true?
    • Sable – Yes, baseline has dropped 46% for breast, colon, lung, esophageal, others
  • Chair Kolkhorst – Following up on secondary impacts tomorrow and potential deaths resulting from actions taken to respond to COVID-19

 

Georgia Thomas, Memorial Hermann Health System

  • Discovered numerous issues with data reporting earlier on, automated many of the processes with a look to what the desired outcome of the data is and if it is actionable and how it assists with managing the entire patient population
  • Highlights assistance from SETRAC, lab assistance from them has been invaluable
  • Some of the data barriers included definition, frequency of changes
  • Duplication is hard issue to tackle, trying to make sure all stakeholders have vital information and duplicated data takes up time and resources that could be used for care
  • Mandating portals can cause confusion, portals can often be severely outdated which complicates data entry and reporting
  • Did a lot of work with Ebola, systems were able to be built off of this work, but still a big lift to get data systems prepped for demands of COVID
  • Sen. Perry – Was the data portal mandate a state infrastructure issue?
    • Thomas – From my understanding we were to be reporting through ImmTrac, which is the same data set HHS gets through TeleTrack, we stuck with this because it was more automated
    • New proposed portal will not require manual entry so positive news coming our way

 

Dr. Brett Moran, Parkland

  • No influenza cases hospitalized at Parkland, flu positivity rate is .36%, 46x times lower than last year; significant benefit from people distancing and wearing masks regarding influenza
  • Chair Kolkhorst – Thank you for this, remarkable number
    • Moran – Hopefully, it will hold true through the winter
  • Parkland has been hit hard by COVID, adjusting to data needs was difficult & parkland needed to expend effort consolidate many different reports
  • Parkland has collaborated with city and county partners to create a semi-automated contact tracing app; manual contact tracing is virtually impossible with the current rates
  • Parkland developed an in-house dashboard, but had difficulty collating data as other entities did not collect similar info; used dashboard to develop index for likelihood of catching COVID and index for patients likely to experience a more severe COVID
  • Interventions for vulnerable populations have been hampered by delayed or inaccurate data
  • Many entities do not have the ability to receive digital data, negatively impacting the ability to respond to COVID in vulnerable populations
  • Standardizing electronic case reporting would greatly assist in response
  • Chair Kolkhorst – You went live on November 11 and it’s going fairly well?
    • Moran – Yes, Dallas County Health Department is live for electronic case reporting on December 8
    • Earlier Sen. Perry mentioned concerns that not all health systems can do this type of data integration, but a significant number of larger systems can and can help drive real-time
  • Sen. Perry – I don’t disagree, but if we make decisions on inaccurate information it is just as harmful
    • Maron – I agree, but these types of data systems and integration can remove human error, can also provide web-based forms for entities to submit data so that faxing and transcribing is not necessary
  • Sen. Perry – If there is a standardization it would be helpful, some sort of internet entry portal or locked excel sheet could work & can bridge between the ideal of automated data integration and current practice; centralized data can be helpful, but exposes us to other problems
    • Maron – At Parkland, our system has a 3-12 hour turnaround time average for tests, max is 36 hours before we can look at it; our health department needs to collect data from many different sources and turnaround is 9 days
  • Chair Kolkhorst – In these systems that we’re developing, what is the future use of these?
    • Maron – Beauty is that these systems are real-time, as soon as the case is coded is gets transmitted up the chain; safeguards exist, only authorized personnel can access
    • Can see trends in a real-time manner, all of this information can be de-identified and linked back where necessary
  • Chair Kolkhorst – Sometimes data can be used against people to take away their freedoms and there needs to be safeguards put in, balance is very important
    • Maron – Agree, I favor auditing, appropriate infrastructure and safeguards, but it would be unfortunate if we don’t use this data to help with public health issues and pandemics
    • Rather than blocking on the frontend, I would be more in favor of auditing on the back end

 

Dr. Mujeeb Basit, UT Southwestern

  • Providing an overview of UT Southwestern’s COVID models and how local entities in DFW have used this information to respond to COVID
  • Data from local, state, and federal sources, including ImmTrac, has been valuable in determining COVID trends, capacity, etc., many sources of data have gone into the UT Southwestern model
  • Model includes, analytics, ad hoc, reports, etc. to help transform data into actionable information
  • Continuing to focus efforts on accurate regional and statewide model, including hospital projections; looking to collaborate with other models and regions to improve the data model
  • Chair Kolkhorst – As it relates to accuracy, in the beginning we saw the John Hopkins model predicting millions of deaths and deaths have been far below these early models; do you predict deaths in these or just infections? And can you speak to the inaccuracies in the models at the beginning of the pandemic?
    • Basit – Models assume there will be no changes to NPI when forecasts are made; we had a fairly effective lockdown right after the models came out that invalidated the early models because the underlying conditions completely changed
    • Models will have to be re-executed as the NPI measures are put into place
    • We retrospectively calculate how effective those NPI measures were historically; if we had not done any NPI measures, we may have reached these numbers within the error bounds
    • You really need the details of the model and the assumptions used by the modeler
  • Chair Kolkhorst – What is NPI?
    • Basit – Nonpharmaceutical Interventions, includes stay at home orders, masking, increased handwashing, etc.
  • Chair Kolkhorst – Some models did assume these factors with lockdowns and masks and still were inaccurate; lethality of COVID was predicted as much higher in the beginning as well, is that true?
    • Basit – True, early on Italy showed some of the worst mortality rates and it was because they exceeded the capacity of the health system
    • You need to look at access to sufficient resources, with sufficient resources morality rate is good, without access it is not so good
    • Issue with this is that it is not scalable, factors in other areas are not necessarily transferable to the US
    • With the CDC models, some were probably overestimates and some were underestimates
  • Chair Kolkhorst – Another complication of China not having the transparency when this started and it transferring to Italy, you’re correct; Sweden had no lockdowns and their mortality rate is similar to other countries
    • Basit – I think the story on Sweden hasn’t fully played out yet
    • They did have some restrictions, Sweden is a very unique country with low population density; Swedish health officials expected the population to listen to recommendations and that tended to be the case
    • But, cases in Sweden are now rising, they’re suffering because the messaging has changed and now the health officials are recommending staying home, distance, etc. and the population isn’t listening as much
    • If you compare Sweden to its neighbors which are comparable countries, Sweden had 4 times the mortality rate; we’ll need to wait to determine
    • In comparison, certain Asian countries like Thailand have had one case in the last two months
  • Chair Kolkhorst – Why is that?
    • Basit – They have better border control policies, mandatory testing at all airports, the single case was someone crossing illegally from Burma
    • Countries in this region already have a very strong culture of mask wearing, there wasn’t much barrier to this and every adapted easily to masks and social distancing
    • Not everything was smooth, Japan had two Lockdowns in Kyoto
    • Cultural differences might be the biggest driver of this and future generations will spend a lot of time researching this
  • Chair Kolkhorst – That will be helpful in future decades; are countries like Pakistan and India with low infection rates doing things differently than the U.S.?
    • Basit – Not sure we will ever know what the correct rate is from India or Pakistan; population doesn’t have health care access or capacity to do testing at scale and many do not trust physicians
    • The only measure we will probably have is excess death rates
  • Chair Kolkhorst – Some of the countries that have occurrence of malaria and take HCQ, seemingly have less spread, is there any correlation?
    • Basit – It’s too early to tell, broad antibody and genome testing will give us better insight; could be due to receptor bias
    • Countries with malaria also tend to have poor health care networks and therefore we also won’t know actual prevalence until we study this after the fact
  • Chair Kolkhorst – With the vaccine, I’m hoping we get to a better place, fully open up America, and continue to research countries that have lower infection or mortality and learn from this about pharmaceuticals that could be helpful in the future
  • Sen. Perry – What is the level of testing accuracy you used in your models?
    • Basit – We used a testing accuracy of 75%
  • Sen. Perry – So if we get false positives and false negatives 20% of the time, you’re within your tolerance?
    • Basit – Sorry, we assumed we don’t get 25% of the results
  • Sen. Perry – What about an inaccurate results?
    • Basit – The false positive and false negative rate has been an issue and it’s difficult depending on the test discussed
    • Our model would potentially over or underestimate
    • Model is not so sensitive to testing though, model is largely based on hospital numbers and community prevalence is back-calculated rather than using community testing numbers as this is dependent on who decides to go get tested
  • Sen. Perry – So hospitalization is more your foundational metric?
    • Basit – That’s exactly right
  • Sen. Perry – That’s a fair metric; when did you change your modeling from high fatality rates, do you take direction from people that may or may not be excited about hanging the narrative?
    • Basit – We never really had a high fatality number, focused solely on the data and forming the data
    • Only time we were really concerned about it was July 4, if it had created a large spread event we could’ve been in trouble
    • Didn’t focus on deaths as this is usually a delayed measure
  • Chair Kolkhorst – We’ve spoken about John Hopkins data, we saw a recent article that deaths for elderly individuals have not increased overall since COVID, what do you attribute this to?
    • Basit – Not a outcomes researcher, but there is some effect where you gain deaths in one category and lessen deaths in other categories
  • Chair Kolkhorst – I think it’s important that we de-aggregate numbers and not count deaths from other causes as COVID deaths; information and lack of trust has led to these deaths
    • Basit – I think this is an interesting opportunity to look at this because it is a rock and hard place; either you don’t do anything, exceed capacity, and have a lot of deaths, or you do something about COVID and assume other risks
    • Up to the health care systems to create innovative solutions to tackle other risks like scheduled lab appointments, virtual health care, etc.

 

Dr. Eric Boerwinkle, UTHealth School of Public Health

  • Models are used to predict future trends and predict impact of possible interventions
  • Current modeling is focused on impact of rollout of vaccine
  • Models are trained over time from local experiences and over time they get better
  • Modeling the virus is easy, modeling human behavior is very difficult, need to better understand human behavior to understand the COVID pandemic
  • Presents model of Harris County that helped inform location of mobile testing, model development helps to understand impact of virus on Harris communities
  • Modeling testing, hospitalizations, and moralities shows the rate and lag of COVID effect
  • Modeling is showing increase and acceleration, shows waves of COVID activity beginning in the Northwest of Texas and moved outward, now have increases in Houston and Harris County
  • Control of COVID in the next four or five months will depend on people obtaining immunity from having COVID, people with immunity from the vaccine, contact tracing/case investigation, and continuation of good public health practices
  • Constantly developing trend models and meeting with others in UT system and stakeholders to provide updates
  • Also need to think about how we never get in this situation again, need an efficient and cost-effective way of pandemic preparedness; need to look at things like national guard to build out a public health workforce that can be activated when needed
  • Took too long to get health care response and data systems, need to have these systems in place for the next event
  • Chair Kolkhorst – What would the pandemic workforce do when there isn’t a pandemic?
    • Boerwinkle – Using model of national guard, these are people with jobs in the workforce and training on weekends to keep up their skills; these individuals can be mobilized when the need arises
    • Concern is that we will have an initial enthusiasm for pandemic preparedness, but cannot keep the full workforce annually; important to have the trained workforce, but that they have a role in society beyond pandemic preparedness
  • Chair Kolkhorst – You mention that we carry on in with best practices from the pandemic, what do you see after vaccines and herd immunity?
    • Boerwinkle – I’m looking at the window between the introduction of the vaccine and the time late Summer/early Fall where we get to Phase 3 of vaccine distribution when it is being given to the general public
    • I do worry that people see a vaccine on the horizon and they let their guard down; important to continue to message about the need for masks and distancing while the vaccine is being rolled out

 

Closing Comments

  • Chair Kolkhorst – Will be hearing from different advocates on long-term effects of COVID on communities at the next meeting