The Texas Department of State Health Services recently announced that 35,000 doses of the Covid-19 Pfizer-BioNTech vaccine were shipped from the federal government — but arrival is uncertain due to the hostile weather conditions. Moderna didn’t ship any vaccine doses at all to Texas, to avoid any potential losses.
COVID-19 vaccine shipments postponed. DSHS expects this week’s shipments to begin arriving Wednesday at the earliest. Deliveries will be subject to local conditions.
— Texas DSHS (@TexasDSHS) February 16, 2021
Postponed vaccinations will resume as soon as it is safe. #COVID19TX #HealthyTexas pic.twitter.com/NHMr0HpIqP
Seniors and persons with chronic conditions had precious appointments canceled as clinic administrators themselves dealt with power outages, staff emergencies and highway closures.
In Harris County, medical professionals had to scramble when a backup generator failed and thousands of doses had to be quickly administered despite dangerous conditions to avoid entirely losing what is now the most valuable asset in the country.
There is no doubt that the vaccination progress made over the last two months faces significant setbacks.
All doses were administered or properly stored, but there is no doubt that the vaccination progress made over the last two months faces significant setbacks as people are forced into warming shelters, motels and hotels, or (like my family) forced to pack into friends’ homes with small generators, which poses even more health risks.
The extent of the losses of vaccines and how many more cases of Covid-19 could occur are still unknown, but a recent investigation found that nearly 2,000 doses of Covid-19 vaccines were wasted in January, largely due to poor refrigeration or spoiled doses. Given the power outages as well as potential shipping issues, it’s highly possible that even more will go to waste.
Further delays due to hospitals losing water, clinics canceling vaccination appointments and people feeling nervous about driving in current weather conditions will inevitably result in further delays in achieving herd immunity, or even moving to the next phase of vaccination for the state.
Even more concerning are the thousands of Texans (along with millions of others in the Southeastern states) in warming shelters in closed spaces, setting up people for both catching and transmitting Covid-19 to others. With incredibly transmissible variants looming, these shelters could become superspreaders.
Political leaders in Texas, bolstered by Gov. Greg Abbott, have made careers out of shortchanging a number of things on the cheap — from public education to public access to health care to public health measures to contain Covid-19 — and millions of Texans have been left in the cold as a result.
With incredibly transmissible variants looming, these shelters could become hotspots of superspreader situations.
For Texans, the power outage was not as surprising as the once-in-a-generation below-freezing temperatures and snowfall. Texans have been here before, forced to bear the consequences of the conscious implementation of a statewide directive from the Electric Reliability Council of Texas (ERCOT), the independent agency responsible for the electric grid that provides 90 percent of the state’s power supply.
ERCOT has had negligible oversight from the Public Utility Commission of Texas and Texas Legislature and five independent board members, none of whom live in Texas (the agency removed their names from its website after they reportedly received threats, but will be restoring them).
The crisis is more or less a logistical one: Impending weather prompted a series of outages due to state adherence to an energy-only market, rather than a capacity market. That’s because in capacity markets, power agencies commit years in advance to pay energy providers for certain levels of power generation to ensure adequate supply. With an energy-only market such as that used by ERCOT, you pay as you go, day-by-day, based on what you need in the moment.
The only other major wholesale electricity entity that uses the energy-only market system is the Southwest Power Pool, which covers 14 states, from Oklahoma to North Dakota. For hundreds of Texans, this means going without the life-saving dialysis treatments that patients receive at home. Those who live in isolation exacerbated by the pandemic will die unnoticed for days — possibly weeks. Countless others will die a slow death from carbon monoxide poisoning due to desperate use of generators and other mechanisms to keep family members warm in the frigid conditions. At every possible turn, Texas officials have put a premium on short-term gratification, placing profits over people. Even as some power grids are getting back up and running, federal action is desperately needed, beyond the typical National Guard and emergency funds. The Biden administration and congressional members must provide targeted health care resources as hospitals and clinics have also been shut down. From FEMA to the Public Health Service Corps and Medical Reserve Corp, personnel and infrastructure will be needed to avoid multiple Flint, Michigan-like disasters along with trying to resuscitate vaccination efforts. During the recent surge, Texas was conducting approximately 150,000 Covid-19 tests a day; they will need to make sure that at least this amount of testing, if not more, is maintained to detect cases in real time. Safe Covid-19 screening tests for those who were displaced in shelters or other households should be widely available, with monoclonal antibody treatment and antivirals in plentiful supply for ease of use where appropriate. Once cases are diagnosed, coordinated efforts will be required to ensure that prompt access to treatments is possible. Monoclonal antibodies in particular have been underutilized nationwide, but can be administered in hospital or outpatient settings — the very locations hardest hit with water shortages and power related issues. We need to act with an abundance of caution; travel restriction and quarantine pre- and post-travel in and out of the state should be instituted if we want to survive a disaster like this. Just as evidence of more transmissible and possibly more deadly variants are clearly dominating the Covid-19 map, seniors, people with disabilities, children and even animals are forced to face the fact that at every possible turn, Texas officials have put a premium on short-term gratification, placing profits over people, leaving millions in the dark and susceptible to death by more than just the pandemic. The hubris of ERCOT and supporting officials should not translate to elderly people freezing in the dark while their food supplies spoil and their water collects deadly bacteria. It should not mean families have to huddle under tents in their living rooms for a few minutes of power that would enable them to prepare dinner — before being thrown into the darkness again.
Dr. Kavita Patel
Dr. Kavita Patel is a teaching professor of medicine, Division of Hospital Medicine, at Stanford University and a board-certified internal medicine physician. She served in the Obama administration as director of policy for the Office of Intergovernmental Affairs and Public Engagement in the White House. Her area of expertise is around the intersection of health policy, clinical medicine and innovation. She also spends time advising venture capital and is a medical contributor for NBC News. 
