A8 0 N THE NEW YORK TIMES, MONDAY, JUNE 29, 2020Tracking an OutbreakOn the Front Lines
reopened as patients filled new coro-
navirus wards.
Gov. Greg Abbott, speaking in Dallas
on Sunday, said the virus had taken a
“very swift and a very dangerous turn”
in Texas and the increase in the rate of
positive coronavirus tests, to over 13 per-
cent in the past month from less than 4
percent, was an “alarm bell.” He made
the grim assessment after meeting with
Vice President Mike Pence and Dr. Debo-
rah L. Birx, the coordinator of the White
House’s coronavirus task force, who
joined the governor in urging all Texans
to wear masks and avoid close contact in
crowds.
Mr. Pence, appearing at a Dallas rally
celebrating religious freedoms, threw
his support behind Mr. Abbott and his ef-
forts to reopen the state’s economy —
even as the governor made an about-face
on Friday in his phased plan by ordering
bars closed and capacity at restaurants
cut. Many young people had socialized in
them, standing close together, not wear-
ing masks, some expressing skepticism
that they could become infected.
During the virus’s first peak in April,
the majority of patients testing positive
in the Methodist hospital system were
older than 50. Now the majority are, like
Ms. Estrada, relatively young. Nearly
one-third of intensive care patients are
now under 50, much higher than in the
initial coronavirus surge.
The stress on medical institutions
burst into public view last week, when
Texas Medical Center — a downtown
cluster of Houston’s major public and pri-
vate hospitals, including Methodist —
announced that the baseline intensive
care unit capacity across its hospitals
was full, with 28 percent of beds occupied
by virus patients. That was nearly twice
a threshold established by the state,
which called for I.C.U.s to have a maxi-
mum 15 percent of virus patients for hos-
pitals to resume elective services.
The hospitals typically operate with
nearly full I.C.U.s, and had planned to in-
crease the number of critically ill pa-
tients they could treat. But the next
morning, the governor issued an execu-
tive order that again restricted elective
surgeries in Harris County. The order,
however, allows hospitals to continue
performing surgeries and procedures
that will not deplete their capacity to
care for coronavirus patients; some hos-
pital executives, including ones at Meth-
odist, said they were able to continue
providing those services, which they
viewed as particularly needed after be-
ing halted during the initial shutdown.
The Texas Medical Center hospitals are
collectively treating about 1,500 coro-
navirus patients, according to figures re-
leased on Saturday.
During the previous surge in mid-
April, Methodist’s system had at most
just over 200 coronavirus patients. On
Sunday, it had nearly 400 inpatients with
the virus, and about 150 more were being
tested for it. Some models predict a peak
in two to three weeks.
Roberta L. Schwartz, an executive
vice president and chief innovation offi-
cer at Methodist, who is serving as the
coronavirus incident commander,
walked from unit to unit on Saturday
“trolling for beds,” as she described it.
She spoke with nurses and doctors, trou-
bleshooting to solve problems that could
delay sending patients home or transfer-
ring them to lower levels of care when
they were ready. She informed nurses in
an intermediate care unit that it would
soon transition into an I.C.U. for coro-
navirus patients.
She visited a huge laboratory with
more than $3 million of new instrumen-
tation that she referred to as the “Taj Ma-
hal,” a former academic lab that was re-
purposed to process virus tests, and took
her first look at two recently purchased
machines that can run 1,000 tests a day.
In some parts of the country, laborato-
ries, including Methodist’s, have experi-
enced testing backlogs in recent days as
demand and new cases have increased.
The hospital is hiring traveling nurses
to bolster its staff and offering bonuses
as incentives to some employees to take
extra shifts. In recent days, hospital beds
and mobile computers were rolled into
an empty, 34-bed unit that had been shut-
tered and will now be used for coro-
navirus patients. “This is why I don’t
have to put trailers out front and mobile
hospitals out front,” Dr. Schwartz said.
The changes were also part of the hospi-
tal’s efforts to maintain capacity to safely
treat its many nonvirus patients.
The Methodist hospital system, with
nearly 2,400 beds in service, includes six
community hospitals across greater
Houston and the flagship academic med-
ical center downtown.
It sits near other renowned medical in-
stitutions including Baylor College of
Medicine, MD Anderson Cancer Center
and Texas Children’s Hospital, which is
opening a unit to treat adult coronavirus
patients. Methodist and several other
private hospitals have also agreed to ac-
cept virus patients from Harris County’s
inundated public hospitals, part of the
Harris Health System.
Tritico Saranathan, a charge nurse on
one of Methodist’s virus wards, said she
had noticed that patients were younger
than those first hit by the coronavirus
several months ago. “We’re seeing a lot
of people in their 30s — they’re out there
partying and not wearing their masks,”
she said. “As soon as the city opened up,
they were very eager to go to the bars, to
the clubs, to the restaurants, just to hang
out in groups. And no one was social dis-
tancing or wearing a mask.”
“What I’m seeing is that they’re pretty
sick — the younger ones are pretty sick,”
she said. “They’re struggling a lot withrespiratory issues. They’re having a
hard time breathing,” she added, “just
feeling like death.”
One of the newest coronavirus pa-
tients, Jessica Rios, 36, a mother of four
with pneumonia, was transferred to
Houston Methodist by ambulance from
an urgent care center on Saturday. She
said her husband was being treated in
the hospital, too. She worried about her
children and was frequently using Face-
Time to call them. Her 18-year-old was
looking after her 12-year-old, who has se-
vere asthma and has also tested positive
for the virus, and 5-year-old twins, one of
whom has cerebral palsy and has tested
positive, too. “It’s kind of hard to be here
when I have them at home struggling,”
she said.
Ms. Rios had not been out partying.
She said she thought she had contracted
the coronavirus while working as a clerk
in a dialysis unit for children. She said
that she has allergies that make it diffi-
cult to wear a mask, and that she would
sometimes take her mask off at the unit,
where one child later tested positive for
the virus. “I couldn’t tell you if every time
I talked to her I had a mask on,” she said.
In another room nearby was Curtis
Ezell, 37. He had come to the hospital tobe treated for heart failure, but tested
positive for the virus when he had a rou-
tine test upon admission. He sometimes
does deliveries for DoorDash, a food de-
livery service, and recently moved to
Houston, staying at hotels.
He said that he had no idea how he had
contracted the virus, and that he was not
experiencing common symptoms of the
infection. “If you know someone with
Covid, everyone should get tested,” he
said.
An even younger pneumonia patient,
Alexander Nelson-Fryar, 25, was in a
new ward for 15 coronavirus patients
that just opened last week. He said that
he worked training employees at a medi-
cal clinic nearby that sometimes saw vi-
rus patients. Mr. Nelson-Fryar said that
he had worn the same mask at work ev-
ery day, which he would keep in his car,
and that he did not know how he had be-
come infected. “I go there and I go
home,” he said. “I think I got a little un-
lucky.”
He said he feared that people his age
were not taking the illness seriously
enough, as he himself had not. “I thought
younger folks are not going to get symp-
toms; if I do get it, it’s not going to be a
big deal,” he said.That was not true in his case. “It hit me
like a truck,” he said. “Even if you are
young and not at risk, it’s pretty scary.”
At Methodist, the majority of the coro-
navirus patients are in designated medi-
cal wards, not in the I.C.U.s.
That might be because of the increas-
ing proportion of younger, healthier pa-
tients. Hospital leaders say they are also
getting better at treating patients, avoid-
ing the need to transfer them to I.C.U.s.
The length of hospital stays for virus pa-
tients at Methodist is about a day and a
half shorter this month than it was in
April and May.
It remains possible that the proportion
of patients in the I.C.U.s could rise, be-
cause of the time lag between when a pa-
tient first gets sick and develops critical
illness.
On Saturday evening, after making
rounds, Dr. Faisal Masud, the medical di-
rector for critical care across all of Hous-
ton Methodist’s hospitals, described the
younger virus patients in the I.C.U.s.
“Typically there are definitely 30-year
olds, 35-year olds,” he said, adding that
the most severely ill young people often
are obese or have medical problems such
as diabetes, kidney disease and high
blood pressure. One young patient was
on an external heart-lung machine
known as ECMO.
During the first surge, Dr. Masud said,
some young virus patients came to the
hospital extremely sick and died soon af-
ter they arrived. Now, he said, they are
coming earlier, but more often.
“I think that there was a sense of being
invincible or this is not their problem,
even if they caught it, no big deal,” he
said. That attitude has changed in the
past few days, he said, including among
his own three daughters, who are all in
their 20s. “They’re now paying atten-
tion,” he said.
Ms. Estrada, the mother of three who
was being treated for the coronavirus,
said she worried that there would be
more patients like her.
“They opened up our city way too
quick — our governor didn’t want to let
the bars be closed and the restaurants
and functions, and they just wanted us to
get back to normal,” she said, adding, “I
knew it was a bad idea.”HOT SPOT
Houston’s Surge Is Filling Hospitals With Young Patients
“I don’t understand how I got this
bad,” said Melissa Estrada, 37,
above, receiving oxygen at Houston
Methodist Hospital as she recovered
from Covid-19. Staff at Methodist,
left, including Tritico Saranathan,
center, a charge nurse, and Roberta
L. Schwartz, at right, are preparing
for a peak in two to three weeks.PHOTOGRAPHS BY ERIN SCHAFF/THE NEW YORK TIMESStaff are wearing protective gear, left, and receiving thank you cards as cases surge in Houston. Houston Methodist Hospital has repurposed a lab to run tests with machines that can
process up to 1,000 tests a day. Gov. Greg Abbott of Texas described the increase in positive tests, to over 13 percent in the past month from under 4 percent, as an “alarm bell.”
From Page AMitch Smith and Michael Shear contrib-
uted reporting.