Photograph: Go Nakamura/Getty Images

When Brittany Bankhead-Kendall received the Covid-19 vaccine in a beautiful executive boardroom at University Medical Center in Lubbock, Texas, the small jab finally gave her a dose of hope that she and her family would be safe.

But she still knew that downstairs, patients were fighting for their lives and dying every day, relying on surgical tubes and ventilators just to breathe.

“It’s a huge juxtaposition, and it’s a really precarious situation to have so much hope and so much heartache, kind of, all in the same walls,” said Bankhead-Kendall, a trauma surgeon and ICU doctor with the Texas Tech University Health Sciences Center.

A year into the pandemic, more than 13,500 Covid-19 patients are languishing in hospitals across Texas. With only 586 ICU beds left statewide and some regions already running out of space, “hospitals can’t take much more”, the Department of State Health Services (DSHS) recently tweeted.

Yet Covid is still raging: about one in six molecular tests in Texas comes back positive right now, well over the 10% threshold Greg Abbott, the state’s Republican governor, once viewed as a “warning flag” for high community spread.

“The Covid-19 pandemic is at its worst in Texas,” DSHS wrote online earlier this month, and “it’s likely never been easier to catch”.

A medical staff member exits the Covid-19 intensive care unit at a hospital in Houston. Photograph: Go Nakamura/Getty Images

In a perfect world, Bankhead-Kendall said, Texas would take a page from other states, where leaders have strategically used economic shutdowns to give healthcare workers a break.

“If you’re not gonna be in our hospitals, helping take care of our patients, then you can at least be outside our walls and doing your part to back off in other ways,” she said.

But Abbott has categorically rejected another lockdown, a successful but blunt instrument that would undoubtedly cause him political grief. And, though he has instituted business occupancy reductions and bar closures in regions with high hospitalizations, those restrictions have proven half-baked and mostly ineffective.

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In fact, other than championing therapeutic treatments and boasting about the state’s vaccine rollout, Abbott’s administration has made shockingly little effort to mitigate the virus’s carnage in recent months, even as a new, highly contagious variant threatens further devastation.

“Republican politicians are acting like it’s business as usual,” said Abhi Rahman, communications director for the Texas Democratic party. “They’re acting like the pandemic never existed in the first place.”

Last March, Dan Patrick, Texas’s lieutenant governor, stoked widespread backlash when he advocated for a swift reopening, insinuating that the nation’s elderly were willing to put their lives on the line to save the US economy. But despite Texas’s hasty emergence from lockdown in May, its struggling workforce has failed to bounce back, with the unemployment rate still lingering at 7.2% as of December, compared to 3.5% the year before.

People watch the 2020 election results roll in at a bar in Austin, Texas. Photograph: Sergio Flores/AFP/Getty Images

Instead, Texas’s hands-off approach has rallied the virus, killing more than 33,700 Texans, leaving children orphaned and forcing doctors to make painful decisions about rationing care. Now, after months of suffering, the pandemic has reached another hellish chapter, with hundreds dying daily.

“Elections have consequences, and this is the direct result of Republican leadership,” Rahman said.

In Fort Worth, criminal justice organizer Pamela Young balked at the city’s invitation to pile into a room for seven hours of face-to-face interview panels with the top candidates for police chief this January.

After witnessing near-constant, high-profile instances of police brutality in Fort Worth, she knows how much the police chief job matters. So she asked the deputy city manager if he could facilitate a virtual option for the panels, similar to the remote meetings other local officials have been holding.

But the city insisted on in-person interviews, seemingly ambivalent to the fact that they were forcing Young to either put her life on the line or be boxed out of high-stakes conversations on an issue she had been advocating around for years.

“It’s frightening to think that our city government and staff leadership – whatever – have such a disregard for human life in the midst of a global pandemic,” Young said.

Other Texas cities and counties – especially urban hubs that lean more Democratic – have strayed from the state’s example and tried to implement policies to curtail infections at the local level. But since last summer, Abbott and his colleagues have undermined other officials’ authority, sabotaging attempts to save lives in hard-hit communities.

“The state is driving the car,” explained the Houston mayor, Sylvester Turner. “We are passengers.”

In December, Abbott – backed by Texas attorney general Ken Paxton – went so far as to encourage businesses in Austin to thwart a local curfew and ring in the new year late into the night.

Emboldened crowds gathered outside of open bars. Inside, revelers danced and hugged while bartenders went maskless, a deadly recipe for the surge upon a surge that health experts warned would happen if Americans didn’t stay home for the holidays.

Meanwhile, Bankhead-Kendall has watched as patients who survived even mild or asymptomatic Covid-19 cases deal with collapsed lungs or blood clots, likely because of the virus.

Since the introduction of a vaccine, the general public in Texas has grown lax, she said, “feeling like it’s almost over”. But so far, only around 5% of the state’s roughly 29 million residents have received at least a first dose, and widespread availability is still presumably months away.

“They don’t understand the immediate or the potential long-term consequences or sequelae of the disease,” Bankhead-Kendall said.

“Most people live, and so that’s what a lot of people hang their hat on.”

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