Kerr County bars must shut down until further notice and other businesses are ordered to step back their reopening efforts from 75 percent down to 50 percent capacity, effective Wednesday, Dec. 30, because local COVID-19 hospitalizations have become too high.
Closing, Reduction of Operation Capacity
“We have been notified by the Department of State Health Services that we are about to reach 7 days of what they call a ‘high hospitalization rate’,” said Kerr County Judge Rob Kelly during Monday morning’s commissioners’ court.
The judge received a letter from Texas Health and Human Services Commissioner John Hellerstedt, MD, stating that Gov. Greg Abbott’s Executive Order GA-32 deems that no elective surgeries may be conducted during this time and retailers must scale back their reopening efforts to half their capacity.
Another notification – this one today, Dec. 28, by the Texas Alcohol and Beverage Commission -- the judge was informed that Kerr County’s high hospitalization rate also means bars (any establishment whose sales consist of 51 percent or more of alcohol) must also close until further notice.
The most current data available – that from last Wednesday, Dec. 23 (since Thursday and Friday, Dec. 24-25, were holidays,) shows that the county had: 475 active cases of COVID-19, 1,901 recoveries, 33 deaths attributed to the virus and 25 inpatients at Peterson Regional Medical Center receiving treatment for the pandemic-causing virus, according to Kerr County Emergency Management Coordinator William B. “Dub” Thomas.
Part of Thomas’ responsibility is reconciling state agency and local numbers so that local officials have the most accurate, up-to-date data possible. He usually distributes that information in semiweekly statements to the press and public.
At Monday’s meeting, Thomas told commissioners that the county has exceeded its hospitalization capacity with more than 15 percent of available hospital beds taken by COVID-19 patients, “so we, officially, go back under the governor’s mandate to 50% operating capacity.”
“It sounds like a lot of numbers, but these numbers mean something,” Kelly said. “What they’re telling us is that … at the beginning of October, we had some 30 active cases and they doubled by the end of the month. November came and we started with 60 or 70 cases and they doubled again in the first two weeks. And they doubled again the week of Thanksgiving. The first week of December, we doubled again – in one week – in active case.”
“What we’re looking at here, and what Dr. Hellerstedt emphasized to me, is that with the vaccine, there is light at the end of the tunnel. Genuine light,” Kelly said. “They’re very optimistic about being able to contain COVID. But it’s going to get kind of dark in January and February, and we kind of have to be prepared for that.”
Case Counts Rising
Locally, the high numbers continue to climb. On Monday, Peterson Regional Medical Center set another new, unwanted record with a high of 32 COVID-19 patients hospitalized there. That figure puts the hospital at, roughly, 36-37 percent of its capacity, according to Cory Edmondson, hospital executive director, who was on hand to address the court.
“I was looking yesterday at STRAC, which is the South Texas Regional Advisory Council – our trauma service center. Most rural hospitals (in the region) are … well over the 15% of patients being treated for COVID,” Edmondson said.
Of the 88 beds at Peterson Regional Medical Center considered for STRAC purposes, some 26 are used for the facility’s acute rehab unit (ARU), while the rest are medical, surgical and ICU beds, Edmondson explained.
“We recently converted 4-5 beds from ARU to be medical beds, so we can continue to take care of our county and the patients being admitted,” Edmondson said. “The last thing we want to do is divert patients or say we can’t accept any more and divert patients to San Antonio.”
“We want to take care of as many people as we can,” he added.
Earlier in the pandemic, the hospital was accepting patients transferred from San Antonio. Now, “we do not have the capacity to accept patients from outside areas,” Edmondson said.
When people show up at the emergency room, they are tested for COVID-19 if they have symptoms of the virus. If they are asymptomatic or feel they’ve been exposed to someone who was positive for the virus, then they are referred to the hospital’s outreach clinic for testing. Those who have mild cases may self-quarantine at home.
Getting Questions Answered
What exactly is tracked?
Commissioner (Pct. 1) Harley David Belew asked for specifics on exactly what cases the county is counting for its COVID-19 totals, because he had read on the Centers for Disease Control website that it was lumping pneumonia, influenza and COVID cases all into one category.
“We are counting what’s on the DSHS’ website, which is not anything but COVID-19 cases,” Thomas said.
“The positive cases that Peterson reports on are strictly COVID patients – positive results that we get from those that we test and that’s what we submit to Dub,” Edmondson added.
He also noted that the state’s figures visible online can lag by as many as 5 days or more. “What we report on is real time, and that’s to give us, as a community, a good business decision perspective, versus waiting on the state and being delayed from that perspective,” Edmondson said.
What About Financial Incentives?
Belew also questioned if PRMC gets financial incentives from the government for each COVID case it reports.
Edmondson responded that the hospital gets a 20 percent bump on reimbursement only for COVID patients on Medicare. “Still, even at that, that is not really an incentive to accept more, treat more or to say we want to have more COVID patients. The reality is that it doesn’t even cover the cost of taking care of a COVID patient.”
Belew asked if the hospital received emergency grant funding for the pandemic.
PRMC did receive some funds early in the pandemic to help with the expenses of additional personal protective equipment, hiring additional staff, etc. Those funds are gone now, Edmondson said
Yet, Edmondson said the Kerrville medical facility considers itself fortunate, because it is one of the very few hospitals in the region to do antiviral and antibody IV therapy drug treatments, and it was able to receive received ample inventory from the state to continue doing so. Treating COVID-19 patients with IV therapy can help keep them out of the hospital, he said.
Where’s the Flu?
Commissioner (Pct. 4) Don Harris passed on a question he’s heard from his constituents: “Where’s the flu this year?”
Edmondson explained that the southern hemisphere, that had its winter and flu season back in July, saw very few cases. The same was predicted and held true for the northern hemisphere.
“I can probably count on 2 hands how many flu cases we’ve had during this flu season,” Edmondson said. “It’s out there – it’s just not as prevalent as it was.” It is thought that all the safety precautions people have been taking to protect themselves and others against COVID-19 -- wearing face masks, social distancing, frequent hand washing and disinfecting home and workspaces, etc. – has all but stopped the flu in its tracks.
Edmondson also dispelled rumors that flu cases are being lumped in with COVID cases to hike up the pandemic’s numbers. The distinction between the two and other illnesses is maintained, he said. “We test (for them) differently. There’s a COVID test. There’s a flu test. There’s a pneumonia test. There’s a strep test…,” he explained.
Reconciling the Data
When discussing the county’s method for record keeping between the state agency and local hospital, Kelly said that what the county was doing right now gives officials the best estimate of the situation, although it’s not absolute.
“You’re talking about guessing about something that’s going to shut down somebody’s business,” Belew said. “We don’t need guesses. We need really accurate, good information. You’re talking about cutting off somebody’s livelihood.”
“This is the best information available, commissioner,” Kelly said.
“What’s pretty important to me right now is that these numbers are absolutely blowing up,” Kelly said. The 500 cases we have now will become 600 or even 1,000 cases by the first week of January. “Active cases that are within, any margin of error, reasonably expected positive COVID cases, and we have to deal with them.”
The Bottom Line – Public Safety
“The state’s told us we’re blowing up. And we’re reporting back to the people, so they know it’s blowing up. And, it’s going to be a pretty bleak January and February, I’m afraid. I don’t think Dub or Cory would disagree that it’s going to get worse before the vaccine can slow this thing down,” Kelly said.
Kerr County Sheriff Rusty Hierholzer added, “The numbers you’re looking at are the hospital’s – only the people in the hospital. So, those are not guesswork. Those are known numbers. And that’s exactly what they’re looking at to shut down businesses.”
“Yes, it is the actual hospitalizations that have rolled us back from 75% capacity to 50 percent capacity.”
Commissioner (Pct. 3) Jonathan Letz said the county needs to continue with its current method of aggregate reporting so that legitimate trends can be recognized in the data. He’d also like to see easy-to-read graphs. “We, as elected officials, get a lot of questions and it really helps if we have accurate numbers daily,” Letz said.
The judge reiterated that the state’s hinge point is 15% or more of a hospital’s capacity in COVID hospitalizations for 7 consecutive days.
“My math tells me that 15% of 88 (beds at PRMC), if we go by the DSHS certifications, is 13 hospitalizations. And we’re at 32. That’s a fact of life. We’re almost 3 times what the state allows us to be at this point,” Kelly said.
“What that portends in the future is that we could have our medical facilities overwhelmed with COVID and not be able to treat the public for anything but COVID. And that’s what we’re trying to avoid,” he said.
The State’s Call
The state made the call to close the local bars and reduce operations of local businesses, the judge said.
“We’ve got to do this. We’ve got to cut back. We’ve got to reduce the activity. We’ve got to re-emphasize all of these safety protocols from the CDC and everybody else so that we don’t have our hospital overwhelmed. We’ve got to try to get this under control so that we don’t have our hospital overwhelmed. And we’re working hand-in-glove with the hospital, which has done an excellent job. What we’re trying to do is keep the public safe. Keep the people safe.”
PRMC received Moderna vaccinations last Wednesday and began vaccinating its health care employees the very next day on a voluntary basis.
The predictions are that once the frontline workers, emergency providers and teachers are vaccinated, then the vaccinations will be made available to the at-risk and elderly population, then the general population – sometime in the spring.
“I tell you, the staff is fatigued and overwhelmed with the volume and intensity that these patients require in treating them,” Edmondson said. “It’s a little concerning to me as a CEO for the staff, to make sure they stay healthy and that we rotate them so they get their time off and rest. But they’ve been doing a phenomenal job of caring for our community and our county.”