Public Health Impact

Exploring how COVID-19 impacted mental and physical health in Greater Houston

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The data

Mental health impacts

COVID-19’s rapid spread and significant death count are enough to negatively impact our collective mental health. Adverse mental health crises — fear of ourselves and loved ones catching the virus, perpetual anticipatory grief — add to the invisible health toll communities are facing. The simultaneous economic crisis has caused hundreds of thousands to lose their jobs, increased the risk of homelessness, and resulted in business and individuals bearing the brunt of massive financial losses. 

While public health strategies like social distancing reduce the risk of spreading the disease, they may also limit access to our social network and support system, causing feelings of loneliness.² As a result, most Americans have experienced increased levels of anxiety and depression since the onset of the COVID-19 pandemic.³ And it’s not just adults that are affected. Children’s lives have also been disrupted. Children often lack the ability to process and the tools to adapt to changes which negatively impacts their mental health. 

The proportion of adults in the Houston Metropolitan Area that have felt nervous, anxious, or on edge for at least more than half the days of a week has remained elevated in Year 1 of the pandemic, though it has ebbed and flowed as eviction moratoriums were instated and expired, the holidays came and went, and the winter storm in February 2021 exacerbated challenges.

Heading into Year 2 of the pandemic, a slightly larger proportion of adults report not experiencing anxiety symptoms. In the most recent Census Bureau survey, 27% of adults report anxiety symptoms for at least half the days of the week – similar to rates from the beginning the survey was conducted one year ago.

As previous data show, the pandemic-induced recession has hit lower-income Houstonians the hardest. This, in part, could explain elevated feelings of anxiety among those who earn between $25,000 – $75,000 per year, compared to those who earn more than six figures. 

COVID-19 confirmed cases

As of July 22, 2021, there have been over 515,000 confirmed cases of COVID-19 in Houston’s three-county region. There have been 60,720 cases in Fort Bend, 409,418 in Harris, and 45,312 in Montgomery counties.

From the beginning of March to mid-June, the daily case count in Harris County stayed below 400 per day. However, at the end of June cases began to rise. This increase coincides with what many reports have called the “Memorial Day spike” (a sharp increase in cases associated with holiday-weekend activities). It also coincides with the State of Texas’s order to allow restaurants to open at 75% capacity — previously, restaurants were open at half capacity. The next major increase occurred from September 20-22 was a result of a delay in counting backlogged cases, according to the New York Times. Cases in Harris County were on a steady rise from October 3, 2020 to January 14, 2021 and have been declining since. 

Fort Bend County also experienced a spike around June 15, as cases started rising at a higher rate, although the increase wasn’t as rapid as it was for Harris County. Fort Bend saw a sharp increase around August 3, due to the addition of backlogged cases to the tally. As with Harris County, cases in Fort Bend County were also climbing steadily in September, 2020 peaking in December and have been declining since mid-January 2021.

Montgomery County witnessed its steepest increase in COVID-19 cases between early June and mid-July. Positive cases have been fluctuating since. Montgomery County also saw a steady rise in COVID-19 cases in mid-November which started declining the beginning of February 2021.

Cases per 100,000 Residents

Between March 4, 2020 and July 22, 2021, Texas recorded 8,936 COVID-19 cases per 100,000 residents. Within the three-county region, Harris County leads with 8,686 cases per 100,000 residents. Fort Bend and Montgomery counties recorded 7,481 and 7,460 cases per 100,000 residents, respectively.

COVID-19 deaths

COVID-19 deaths have also been on the rise in Houston’s three-county region, where 7,991 people have died from COVID-19 as of July 21, 2021, including 710 deaths in Fort Bend, 6,669 in Harris, and 612 in Montgomery counties. 

Deaths per 100,000 Residents

Texas has recorded 178 deaths per 100,000 residents due to COVID-19 between March 4, 2020 and July 21, 2021. In the greater Houston area, Harris County has recorded 141 deaths per 100,000 residents. Fort Bend and Montgomery Counties have recorded 87 and 101 deaths per 100,000 residents, respectively.

COVID-19 Deaths by Race/Ethnicity

Overwhelming evidence supports the fact that Black, Hispanic and Indigenous people are contracting — and dying from — COVID-19 at a much higher rate than whites. While the virus seemingly doesn’t discriminate, underlying socio-economic factors and existing patterns of inequality contribute to the virus disproportionately impacting these racial and ethnic groups.

Black and Hispanic populations are more susceptible to dying from COVID-19 because they disproportionately work on the front lines, have lower access to health care, historically live in poor-quality environments, and tend to have a higher prevalence of preexisting conditions.

In simple terms, if the virus were to affect everyone in relatively similar ways we would expect each group’s proportion of cases and deaths to be comparable to their share of the overall population. However, that’s not what is happening — we see significant disparities in who is succumbing to the virus. 

For example, while Hispanics make up 25% of Fort Bend County’s population, they comprise roughly 32% of the county’s COVID-19 deaths. Black residents account for 20% of the county’s population but comprise 21% of COVID-19 deaths. 

A similar pattern exists in Harris County. While Hispanics make up about 44% of the county’s population, they comprise 47% of all COVID-19 deaths. 

These disparities are more evident among the Black population in Montgomery County. Black residents constitute 5% of the county’s population but 12% of the COVID-related deaths. Comparatively, whites make up nearly two-thirds of Montgomery County’s population, but 57% of the COVID-19 deaths.

In Fort Bend and Montgomery counties, Hispanic Houstonians are dying from COVID-19 at the highest rates. COVID-19 deaths per 100,000 Hispanic residents in Fort Bend and Montgomery counties are 105 and 213 per 100,000 Hispanic residents. COVID-19 deaths per 100,000 Black residents in Montgomery County is 421 per 100,000 Black residents — nearly triple the rate among whites in the county.

Vaccines

Vaccines started rolling out in mid-December 2020. Official vaccination figures tracked by Texas Department of State Health Services data are below.

As of July 21, 2021, 75% of Fort Bend County’s eligible population (12 years of age and older) has received at least one vaccine, with 66% being fully vaccinated. Vaccination rates in Harris and Montgomery counties are lower in comparison, with 54% and 48% of the eligible population fully vaccinated, respectively. However, not all residents have equal access to vaccines.

As of July 21, 2021, Asian Americans have the highest vaccination rates across all three counties and the state of Texas. Black residents are vaccinated at the lowest rates in Fort Bend and Harris counties as well as the state of Texas while Hispanic residents are vaccinated at lower rates compared to white residents in Harris County and across the state of Texas.

While income data on who has been vaccinated is not publicly available, we can use survey data from the U.S. Census Bureau to understand general trends. It is important to note these are not official vaccination rates.

Vaccination rates tend to correlate with income level as well. The higher a household’s income, the more likely they are to have been vaccinated. According to estimates from the most recent Household Pulse Survey, about 55% of adults in households that earn less than $25,000 per year have received a vaccination compared to 86% of households that earn more than $200,000 annually. Vaccination rates for all groups appear to have increased since the beginning of 2021.

Houston-area residents give a number of reasons for not receiving or planning to receive a COVID-19 vaccine. According to surveys conducted in May, the top three reasons for this are concerns over potential side effects (51%), wanting to wait and see if it is safe (40%), and residents don’t trust the COVID-19 vaccines (33%).