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Baylor football players will be tested for COVID-19 weekly throughout the season, BU athletic director Mack Rhoades said. The NCAA recommends testing at least 72 hours before game time.


Education
Many Waco-area school districts delaying in-person classes until September

Some of the largest McLennan County school districts appear willing to heed the advice of the local health authority by postponing the first day of in-person instruction until after Labor Day, while others are set to open up their schools to students in just a couple of weeks.

In addition to the Waco Independent School District, both La Vega and Robinson school districts appear ready to start in-person classes Sept. 8, with La Vega ISD providing remote instruction starting Aug. 13. Marlin ISD in Falls County also will start remote instruction Aug. 17 before transitioning to in-person instruction for those who want it.

Meanwhile, Midway and China Spring ISDs plan to proceed with an August start date, as do some smaller districts in the area.

In McLennan County, health officials had prohibited in-person school activities until at least Sept. 8, and similar orders were in place in Dallas, Houston, El Paso and the Rio Grande Valley, but Texas Attorney General Ken Paxton soon scrapped those plans.

In an opinion letter, Paxton said local health officials in the state do not have the authority to close schools solely to prevent a future spread of the coronavirus, pushing that decision solely into the hands of school officials. Paxton issued a “legal guidance” letter on schools amid fierce debate among local governments, health officials, parents and teaches as to when and how schools should open in a state that has become one of the nation’s hot spots in the pandemic.

Paxton’s letter sent school districts scrambling to check its impact on their decisions. Officials in McLennan County decided Paxton’s opinion, in addition to new Texas Education Agency guidance that followed, render the local public health order “ineffectual,” so they rescinded it. The Waco-McLennan County Public Health District is still urging local schools to delay the start of classes.

In McLennan County, children ages 1 to 10 years old represent 4% of all 4,405 confirmed cases of COVID-19, while those between 11 and 19 years old represent 11% of all cases, according to the health district.

Texas officials clarified Friday that health authorities can shut down schools if a COVID-19 outbreak occurs on campus, and schools will still receive state funding as long as they provide remote instruction during the school closure, according to a press release from Gov. Greg Abbott’s office.

School boards also can close a campus for up to five days if someone there tests positive for COVID-19, giving the school time to disinfect the facilities. The schools would continue to receive state funding as long as they provide remote instruction.

Here are the plans known so far for reopening schools for some local districts:

Waco ISD

Waco ISD will start in-person and remote instruction Sept. 8, and the last day of school will be June 10. The school board approved the school calendar change July 24.

State guidelines allow students in any school district to change their choice of remote or in-person instruction after each full grading period, which typically lasts six weeks. Families in Waco ISD have until two weeks before the first day to make their choices.

The district chose to use an asynchronous instruction model, as opposed to synchronous instruction. Asynchronous instruction allows teachers to assign students activities they can do at their own speeds, while synchronous instruction involves live, interactive lessons between teachers and students.

All students and staff members must wear face coverings at school. All other districts listed here require face coverings for students older than 10 and for all staff members.

Midway ISD

Midway ISD will delay the start of school by a week to allow more time for staff training on virtual instruction, pushing back the first day of school to Aug. 24 for both in-person and remote instruction. The school year will end May 27. The school board approved the change Friday.

The school district also has chosen the asychronous instruction model but will use sychronous instruction components in certain grade levels. Students in prekindergarten through third grade must receive asychronous instruction if they choose remote learning, under state guidelines.

La Vega ISD

La Vega ISD posted reopening plans on its website July 28, before local health officials rescinded the order to delay the start of school, so it remains unclear if La Vega officials are considering changes.

La Vega ISD had planned to start virtual instruction for all students from Aug. 13 to Sept. 7, then give the option for students to return to campus.

China Spring ISD

China Spring ISD plans to start in-person and remote instruction Aug. 19 and continue with a normal school year calendar that ends May 27, according to the district’s website.

China Spring will use a combination of sychronous and asychronous instruction, using asychronous for the grades that require it.

Robinson ISD

The school board adopted a calendar July 22, with the first day of school set Sept. 8 and the last day May 26, according to the district website.

Marlin ISD

The board of managers adopted a school calendar July 23 in which all students will start remote instruction Aug. 17. After Aug. 31, students who want to return to campus can do so. The last day of school will be June 4.


Govt-and-politics
Evictions expected to surge across Texas as protections expire

Life had not been particularly kind to Eddie Estrada, even before he lost his $13-an-hour masonry job in March as the novel coronavirus started its spread across the nation in earnest.

The 49-year-old Lubbock native has spent a total of 27 years in prison on five separate trips, and his third wife just left him because, as Estrada puts it, “she just couldn’t take it anymore.”

After he lost his job, friends helped a bit with bills now and then, but Estrada fell about $2,000 behind in the $650-a-month rent he had been paying for a two-bedroom duplex in the 2500 block of McFerrin Avenue in Waco.

He had lived there 18 months, but last Tuesday, he got a knock on the door from McLennan County constables serving eviction notices from his landlord. They asked him to leave while workers removed his belongings and stacked them along the curb. By the time he returned, scavengers already had picked through many of his items and made off with the bulk of his worldly belongings.

“I was able to salvage a few clothes, but I’m basically starting over from scratch,” Estrada said. “I’m staying a couple of nights with friends, but I really don’t want to put my problems on them. I’m like a baby now, starting over and taking baby steps.”

A statewide eviction moratorium expired in June and a federal eviction moratorium expired July 24. So officials are gearing up for a potential surge in evictions as the COVID-19 pandemic continues to engulf the state.

The federal Coronavirus Aid, Relief and Economic Security Act, also known as the CARES Act, prevented landlords from taking new eviction actions against renters who have not paid their rent on certain federally backed properties through July 24. This includes affordable housing supported by federal government programs, including Section 8, the Low Income Housing Tax Credit and Housing Choice Vouchers.

While local justices of the peace who resumed issuing eviction orders in June said they have not seen much of an increase since the state moratorium was lifted, many expect to see more coming late this month because the CARES Act requires landlords to give tenants a 30-day notice before filing for evictions.

Sheryl Swanton, managing attorney at Lone Star Legal Aid, a nonprofit law firm in Waco that serves low-income residents in a seven-county region, said her office has not been flooded with clients facing eviction the way the Lone Star Houston office has been. But she said there definitely has been an “uptick” in eviction cases, and she expects more after the 30-day notification period expires Aug. 24.

“Some landlords have tried to work out an agreement to help them get caught back up so they can stay or to at least let them stay until the end of the month,” Swanton said. “A lot of them are trying to work with tenants. At least that has been my experience in the past. I don’t think they are trying to evict people. They certainly have to make a living, as well, but most will try to work out an agreement if they can.”

Swanton invites residents potentially facing eviction to visit her agency’s website at www.lonestarlegal.org for more information and to gain access to an online application for its services.

“We are doing our best to try to help out and make it easier for people to understand the process,” she said. “There are a lot more people now who have never faced this process before. COVID-19 has just put so many people in a bad spot.”

Staff photo — Jerry Larson  

A welcome mat and other items belonging to the tenant of this house on McFerrin Avenue are placed in the yard after an eviction was served.

Waco attorney David Dickson, who is board certified by the State Bar of Texas in residential, commercial and farm and ranch real estate, represents a number of commercial and residential landlords. He, too, has seen an effort by landlords to do the best they can to help struggling tenants, when that is an option.

“The longer people are out of work, the more evictions you will see,” Dickson said. “Most landlords that I have observed have tried to work with people and keep them in their house, even if it meant taking less rent or forgiving rent or working out a payment plan. The problem is those property owners, many of them, have mortgages and they depend on the rent to pay the mortgage. So if they can’t collect the rent, mortgages ultimately go into default and you will see an increasing number of foreclosures.”

Dickson said he also expects to see more evictions being filed with the expiration of state and federal moratoriums.

“The times we are in are novel,” he said. “However, the closest that I can recall in my practice that compares to these times are the times we had in the late 1980s and early 1990s, when all of the savings and loans in Texas failed and many banks and mortgage companies were changing hands. It was a time of economic turmoil in Texas, much like the turmoil we are having now.”

Milet Hopping is president and chief executive officer of the Waco Housing Authority, which is landlord to about 3,000 residents living in three Waco public housing complexes, Estella Maxey Place, Kate Ross Homes and South Terrace Apartments. The authority also oversees the Section 8 government voucher program for about 2,700 residents renting from other landlords.

While there was a moratorium on evictions for nonpayment of rent, the Department of Housing and Urban Development still allowed evictions for lease violations and criminal behavior, Hopping said. The Waco Housing Authority typically filed about 30 evictions cases a month before the pandemic, and she thinks it will file close to 100 a month now that the moratorium has been lifted, Hopping said.

Staff photo — Jerry Larson  

Items belonging to the tenant of this house on McFerrin Avenue are placed at the curb after an eviction was served.

Housing authority officials sent letters to tenants, whose rents are based on income, asking them to come in to explain why they were not paying rent. If they lost jobs or had cutbacks in hours, the housing authority adjusted their rent and paid the landlords the difference.

But many, about 80%, did not respond to the letters and now face possible eviction, Hopping said.

“Public housing is in the business of being leased up,” she said. “We are not interested in empty units and we want people to come in and work with us on it and then pay their rent, of course. It doesn’t matter if their income is less, because we will work with them, anyway. So there really shouldn’t be a fear of coming in. I have the funds available to say to someone ‘let’s work out a payment agreement,’ where private landlords don’t have that option because that is their income.”

Justice of the Peace James Lee, whose Precinct 2 includes the Estella Maxey and a portion of the South Terrace public housing complexes, said that while his office might see an increase in eviction filings, he is hopeful that tenants and landlords have reached agreements during the moratorium periods.

“I haven’t seen an increase yet,” Lee said. “Do I foresee these agencies or apartment complexes or landlords filing more? I don’t because I believe they took the opportunity to work with these individuals during the period of when they were under the CARES Act. I believe they understood the impact of those who lost their jobs and I’m hoping that they were able to get some of the issues resolved prior to the expiration of the CARES ACT. That’s a hope.”


Medicine
How a $175 COVID-19 test led to $2,479 in charges

As she waited for the results of her rapid COVID-19 test, Rachel de Cordova sat in her car and read through a stack of documents given to her by SignatureCare Emergency Center.

Without de Cordova leaving her car, the staff at the freestanding emergency room near her home in Houston had checked her blood pressure, pulse and temperature during the July 21 appointment. She had been suffering sinus stuffiness and a headache, so she handed them her insurance card to pay for the $175 rapid-response drive-thru test. Then they stuck a swab deep into her nasal cavity to obtain a specimen.

De Cordova is an attorney who specializes in civil litigation defense and maritime law. She cringes when she’s asked to sign away her rights and scrutinizes the fine print. The documents she had been given included disclosures required by recent laws in Texas that try to rein in the billing practices of stand-alone emergency centers like Signature Care. One said that while the facility would submit its bill to insurance plans, it doesn’t have contractual relationships with them, meaning the care would be considered out-of-network. Patients are responsible for any charges not covered by their plan, it said, as well as any copayment, deductible or coinsurance.

The more she read, the more annoyed de Cordova became. SignatureCare charges a “facility fee” for treatment, the document said, ranging “between five hundred dollars and one hundred thousand dollars.” Another charge, the “observation fee,” could range from $1,000 to $100,000.

De Cordova didn’t think her fees for the test could rise into the six figures. But SignatureCare was giving itself leeway to charge almost any amount to her insurance plan — and she could be on the hook. She knew she couldn’t sign the document. But that created a problem: She still needed to get her test results.

Even in a public health emergency, what could be considered the first rule of American health care is still in effect: There is no set price. Medical providers often inflate their charges and then give discounts to insurance plans that sign contracts with them. Out-of-network insurers and their members are often left to pay the full tab or whatever discount they can negotiate after the fact.

The CARES Act, passed by Congress in March, includes a provision that says insurers must pay for an out-of-network COVID-19 test at the price the testing facility lists on its website. But it sets no maximum for the cost of the tests. Insurance representatives told ProPublica that the charge for a COVID-19 test in Texas can range from less than $100 to thousands of dollars. Health plans are generally waiving out-of-pocket costs for all related COVID-19 treatment, insurance representatives said. Some costs may be passed on to the patient, depending on their coverage and the circumstances.

As she waited, de Cordova realized she didn’t want to play insurance roulette. She changed her mind and decided she’d pay the $175 out-of-pocket for her test. But when the Signature-Care nurse came to collect the paperwork, de Cordova said the nurse told her, “You can’t do that. It’s insurance fraud for you to pay for our services once we know you have insurance.”

Dr. Hashibul Hannan, an emergency room physician, lab director and manager at SignatureCare, told ProPublica his facility is an emergency room that offers testing, not a typical testing site. He said de Cordova should have been allowed to pay the $175 cash price. The staff members were concerned about being accused of fraud because they had already entered her insurance information into the record, he said. So they didn’t want it to appear she was being double-billed. Hannan also said he regrets that she was upset by the disclosure forms that are now required under state law.

Unable to pay cash and unwilling to take a chance on the unknown cost, de Cordova decided to leave without getting the results of her COVID-19 test.

Later that day, de Cordova couldn’t get past what happened. She wondered what happened to patients who didn’t read the fine print before signing the packet.

Then she realized she and her husband, Hayan Charara, could investigate it themselves. In June, the couple’s 8-year-old son had attended a baseball tryout. They thought the kids would be socially distanced and that precautions would be taken. But then the coaches had crowded the players in a dugout, with no masks or social distancing, and a couple days later the boy said he wasn’t feeling well.

So just to be safe, on June 12, Charara took their son to the same Signature-Care, the Heights location, for a COVID-19 test. The line was so long they had to wait for hours, go home, come back and wait for hours again in their car in the 100-degree heat. Charara, a poet who teaches at the University of Houston, said he didn’t take a close look at the financial disclosure paperwork. De Cordova wasn’t with them. It had been 10 hours of waiting by the time the boy was tested, so “I would have signed anything,” he said. (The child tested negative.)

Charara, de Cordova and their children are covered by the Employees Retirement System of Texas, a taxpayer-funded benefit plan that covers about half a million people. They hadn’t received any notices about the charges for their son. So they contacted the SignatureCare billing department and asked for an itemized statement. The test charge was indeed $175. But the total balance, including the physician and facility fees associated with an emergency room visit, came to $2,479.

The facility fee was $1,784 and the physician fee $486.

The couple were dumbfounded. Their son’s vital signs had been checked but there had been no physical examination, they said. The interactions took less than five minutes total, and the child stayed in the car. “You’re getting a drive-thru test, and they’re pretending like they’re giving you emergency services,” de Cordova said.

The SignatureCare charges shocked experts who study health care costs. Charging $2,479 for a drive-thru COVID-19 test is a “nauseating” example of profiteering during a pandemic, said Niall Brennan, president and CEO of the Health Care Cost Institute, a nonprofit organization that studies health care prices. “It’s one of the most egregious examples of giving the fox the keys to the henhouse I’ve ever seen and yet another example of the absurdity of U.S. health care pricing.

“Imagine a vendor in any other walk of life being allowed to bill a third party for whatever amount they wanted,” Brennan said.

Insurance companies in Texas typically pay between $100 and $300 for drive-thru COVID-19 tests, said Jamie Dudensing, CEO of the Texas Association of Health Plans. But the association’s members have seen hundreds of out-of-network COVID-19 test charges come in far higher, some in the thousands of dollars.

“There’s no excuse for that, especially in a public health crisis,” said Chris Callahan, spokesperson for Blue Cross and Blue Shield of Texas, which likewise has seen high charges for COVID-19 tests from out-of-network providers.

The reimbursement rates negotiated between insurance companies and in-network providers are much lower, but they still vary, according to data provided by the nonprofit FAIR Health, which tracks spending by private insurers. For the same test billed by SignatureCare, an in-network insurer pays a median price of $23 in Utah and $75 in Wisconsin, according to FAIR Health estimates.

Texas is notorious for its high-priced out-of-network emergency bills and free-standing emergency departments. Some of the facilities appear to be using COVID-19 testing to draw in patients so their insurance plans can be charged for additional services, said Blake Hutson, associate state director for AARP Texas, the advocacy organization for older Americans. “It’s not a surprise they would be racking up the charges and adding on everything they can and billing the health plan,” he said.

In some cases, insurers do pay the exorbitant out-of-network charges, Hutson said, but they typically get reduced. In 2019, Texas lawmakers voted to ban billing patients in state-regulated insurance plans for charges not covered by their policy, Hutson said, which is known as “balance” or “surprise” billing. But consumers may still be responsible for any deductibles and other cost-sharing under their health plan. And the costs covered by the health plan get passed back to the consumers over time in the form of higher premiums, he said. “It’s all problematic for the cost of care,” Hutson said.

Hannan defended SignatureCare’s high out-of-network charges by blaming insurance companies for refusing to give what he considers to be fair in-network rates. The charges are a starting point for negotiating a fair deal from out-of-network insurance plans, he said. He described SignatureCare, which has 18 locations, as “small players. When it comes to negotiating with insurance companies, we have no luck.”

The medical record portrays the visit as an emergency and contains details that are not consistent with how Charara and de Cordova describe their son’s condition. The chief complaint in the record is “body fluid exposure,” and elsewhere it says “confirmed COVID exposure.”

But that’s not accurate, according to the parents. No one had coughed or sneezed on their son, and they knew of no one from the tryout who had tested positive for COVID-19, they said. The child’s temperature is registered in the record as 102.8, which is high. But Charara said that could have been caused by sitting in the Texas heat, waiting for the test.

Shelley Safian, a Florida health care coding expert who has written four books on medical billing, examined the bill and medical records of Charara and de Cordova’s son at ProPublica’s request. She said the medical records don’t justify the charges. SignatureCare billed the case as if the exam were an emergency that required an “expanded problem focused history” and “medical decision making of moderate complexity,” she said.

In order to qualify for reimbursement of an exam at that level, the encounter would need to include examining the affected organ system, Safian said. But the medical records do not document any check of the respiratory system, which would be indicated for suspected COVID-19.

Much of the medical record appeared to be cut and pasted from other electronic records, Safian said. “This is boilerplate B.S.,” she said, “and I don’t mean ‘bachelor of science.’”

Hannan, the Signature-Care doctor and manager, stands by the charges associated with the child’s COVID-19 test. The facility has to treat every case like a possible emergency, and that requires an examination, he said. He pointed out that the charges are in line with what other out-of-network providers would charge in the area, according to FAIR Health, though they are far higher than in-network prices.

A doctor’s examination may not be as hands-on during COVID-19, but, similar to a telemedicine visit, a lot can be examined visually, Hannan said. Hannan said the company he uses for coding said COVID-19 requires a higher level of care and vigilance because it’s an infectious disease.

In light of the questions raised by ProPublica and Safian, Hannan said he asked his billing company to audit the charges. Sharon Nicka, president and CEO of Nicka and Associates, the billing company used by SignatureCare, took issue with Safian’s assessment and said the billing codes used were justified by the medical record. She said the charges are high for a drive-thru test, but those are set by SignatureCare.

ProPublica identified several apparent errors and contradictions in the medical record and billing documentation. For example, the notes in the medical record alternatively refer to the boy as “symptomatic” and “asymptomatic.” The record also says the physical exam showed a skin wound that “was not red, swollen or tender,” but the child had no wound of any kind, the family said. And the billing documentation shows a charge for an antibody test when the medical record showed that the patient actually received a diagnostic test, which is something different.

In response to ProPublica’s questions, a SignatureCare medical director reviewed the record. The error about the “wound” may have been caused by a software template adding something that was not in the physician chart, the reviewer wrote. The facility now uses a different template. The charge for the antibody test is likely a billing error, as the physician had ordered the correct test, the reviewer wrote. “We will continue to update and improve our (electronic medical records),” the reviewer said.

Hannan stressed that SignatureCare is upfront with patients about the possible fees associated with its treatment, including the disclosure paperwork and explanations on its website. It’s an emergency room, he said, so patients should expect emergency room fees. Patients who do not have a medical emergency should not come, he said, though the ER allows patients to book appointments a day in advance for a COVID-19 test.

Dudensing, the chief executive of the Texas Association of Health Plans, said she’s heard Hannan’s contention before and it’s true that freestanding emergency rooms have a license that allows them to charge more. But she still believes that they handle many nonemergency cases and are forcing facility fees of thousands of dollars on them. “They’re hiding under the guise of emergency rooms when they’re really dressed-up urgent care,” she said.

Diana Kongevick, director of group benefits for the Employees Retirement System of Texas, said the health plan had only recently received the bill for the 8-year-old’s test. It hadn’t been processed, so she could not speak to it directly. But, in general, the health plan will pay 100% of the cost of the test, in this case $175, she said. The claim would be processed using out-of-network provisions, she said. So for the other charges, the patient may be responsible for paying in the range of $600, she estimated, for the out-of-network copay and deductibles. “This is a nonemergent patient self-referral to an out-of-network provider,” Kongevick said.

Even if the Employees Retirement System of Texas determines that Charara and de Cordova should pay $600 for their son’s test, SignatureCare will not be sending the family a bill, Hannan said. He said insured patients are not being sent bills for COVID-19 treatment beyond what their insurance companies cover.

De Cordova never did get her test results, and she didn’t seek a test elsewhere. She felt better later and now believes she had just been suffering from allergies. But what if it had turned out to be COVID-19, she wondered. Might she have gone on to infect others, she’s asked herself.

From a public health perspective, the haggling about out-of-network charges and payments puts patients in the middle, and it might discourage them from getting tested for COVID-19 during the pandemic, said Stuart Craig, an economist at the University of Pennsylvania who studies health care costs. “It’s another part of the fragmentation of the health care system that makes patients’ lives miserable,” Craig said.

It’s especially frustrating, he said, because COVID-19 testing is so essential to making it safely through the pandemic. Craig said he believes there should be a nationally mandated price and government subsidies to make sure medical providers and manufacturers are motivated financially to provide tests. “Testing should be free,” Craig said. “In fact, we should probably be paying patients to get tested.”


Govt-and-politics
Waco would require bigger lots for septic tanks under Plan Commission recommendation

The Waco Plan Commission is recommending the city bump up the minimum lot size require for a septic tank, citing a desire to protect drinking water sources.

Because of the availability of sewer service inside city limits, changing the minimum from half-an-acre to an acre would primarily affect future subdivisions on the outskirts of the city, in what is known as the extraterritorial jurisdiction, Planning Director Clint Peters told the commission during a recent meeting when the Plan Commission approved the recommendation to the city council.

In recent decades, subdivisions of about 20 lots were the biggest going in seeking to use septic tanks in the city’s jurisdiction, and even developments that size were few and far between, Peters said. The requests were typically for one or two lots at a time.

“We’re starting to see larger subdivisions that come in with 40, 50, 60 lots,” Peters said.

The city’s primary concern is limiting the risk of runoff reaching Lake Waco, its drinking water source, Assistant City Manager Paul Cain said. Groundwater conservation districts created by the state have started to implement their own limits on septic tanks to control the risks they pose to groundwater, Cain said.

Groundwater and surface water protection through the extension of municipal sewer service was a driving factor in the city’s annexation of territory along Highway 84 on the western edge of town in 1998, he said. That area has since seen significant residential development at densities that would not have been allowed if septic systems were needed.

The risk of septic tanks causing contamination goes up as more are added, Peters said.

“For it to work on a half-acre lot, especially when you have a dense subdivision of half-acre lots, maintenance has to happen or you’re going to have issues,” Peters said. “To have across-the-board maintenance on a 50-lot subdivision of half-acres, over time, is almost impossible.”

The Texas Commission on Environmental Quality imposes a minimum lot size of half-an-acre statewide, and the Heart of Texas Builders Association likely will request the city stick with that, though the association has not formally reviewed the proposal or taken a position, Executive Officer Kay Vinzant said.

“If the state regs call for a half-acre lot, we don’t think the city should be more stringent,” Vinzant said.

If approved by the city council, the earliest the change could take effect is Sept. 1, and any land platted before then would not be affected, Peters said.

“Any future subdivisions where they’re creating new lots would have to be a minimum of 1 acre in size,” Peters said.

The 1-acre minimum is becoming more common in Texas cities, he said. Fort Worth, for example, uses that standard. Certain types of septic systems already require at least an acre of land in Waco.

The suggestion for the change came from a planning department team tasked about a year ago with rewriting the city’s subdivision ordinance, Peters said.

Public meeting issues

While the business session of the Plan Commission’s meeting Tuesday was broadcast and livestreamed on wccc.tv, the work session was not broadcast. City Secretary Esmeralda Hudson said city staff members are switching to the city Youtube channel to broadcast some meetings but were unable to make the system work as planned during the Plan Commission work session. An audio recording of the work session is available by request from the City Secretary’s Office.


Govt-and-politics
Another COVID-19 death brings McLennan County toll to 46

A 46th McLennan County resident has died because of COVID-19, the Waco-McLennan County Public Health District reported Saturday.

A 66-year-old Hispanic woman is the most recent resident whose death is attributed to the disease.

All but nine of the deaths have come since the start of last month, after the county saw a sharp increase in the spread of the novel coronavirus starting in mid-June. Local officials have said that spike has started to stabilize, with daily new case counts averaging in the high double-digits rather than triple digits. The health district reported 79 newly confirmed cases Saturday, bringing the total to 4,405.

The county’s rate of all tests coming back positive remains high, at about 16% as of Thursday, on a rolling 7-day average basis, but it is down from a peak of 23% in mid-July. The rate was at less than 1% for most of May and in early June. The statewide rate stood at 12% as of Friday, down from a peak of more than 17% in mid-July.

Waco hospitals were treating 74 patients with COVID-19 as of Saturday, including 16 who were on ventilators.

Demographic information about the people dying because of COVID-19 locally continues to show racial disparity. Of the 46 residents of the county whose deaths have been attributed to the disease, 13, or almost 28.3%, were Black; 13, or 28.3%, were Hispanic; and 20, or almost 43.5%, were white.

McLennan County’s population is about 260,000 people. About 55.4% are white, 14.8% are Black and 27% are Latino, according to the U.S. Census Bureau.