5.17.20 – Dallas Morning News – By Sue Ambrose, Holly K. Hacker and Anna Kuchment
With gyms and more businesses set to reopen Monday, Texas is closer to reaching some of its goals for fighting the coronavirus.
The number of daily tests has grown. The percentage of tests that come back positive has shrunk. The state now has 2,000 people in place to track down those who may have come into contact with infected people. Texas has some of the lowest death and infection rates in the country, and hospitals have never come close to filling up.
As part of the first wave of states to emerge from its lockdown, Texas will also be on the forefront of seeing the effects of loosened coronavirus restrictions. This week, health officials could get their first indication of how the epidemic will grow during the summer months.
Challenges remain. The state has yet to consistently run 30,000 tests a day, a goal Gov. Greg Abbott set at the end of April. And the state still needs to hire more contact tracers.
Researchers plan on closely watching the effect of the reopening, although incomplete data makes that difficult. Some parts of the state are faring better than others. Many experts expect a surge of cases this summer and say the state needs a more detailed, tailored plan to make sure the return to work is safe.ADVERTISING
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“I’m trying not to put a lot of emphasis on jumping up and down and saying, ‘We opened the state too early,’” said Dr. Peter Hotez, an expert on infectious diseases and vaccines at the Baylor College of Medicine in Houston. “That’s been done, and now it’s gotta be all hands on deck.”
Closing in on goals
For the month of April, the state’s main strategy to stem the spread of COVID-19 was to keep almost everyone at home. Now that businesses are allowed to reopen at limited capacity, the state will rely more heavily on testing, tracing contacts and isolation of people who have been exposed.
Texas first met Abbott’s goal of 30,000 tests a day on Wednesday, when the state reported 49,000 tests. The state also met the testing goal on Thursday and Saturday. The previous seven days had averaged about 16,000 daily tests.
It’s unclear how Abbott arrived at the target of 30,000, why the state has not reached it regularly, or when officials expect to. His office and state health officials did not respond last week to questions from The Dallas Morning News about the number of tests.ADVERTISING
The state has rapidly added people who will track down those who have been exposed to the virus.
On April 27, when Abbott announced his plan to reopen Texas businesses, the state said it had 1,150 people in place. It now has more than 2,000. The state aims to reach 4,000 in coming weeks, a spokesman for the state health department said.
Contacting people takes a lot of time and can be difficult, said Diana Cervantes, an epidemiologist at the University of North Texas’ Health Science Center.
Workers have to interview each newly infected person, a process that can take 30 to 45 minutes, she said. Then the worker has to call everyone who came into contact with the infected person, let them know they were exposed and check with them periodically for signs they caught the virus.
“A lot of people don’t answer,” she said. “Sometimes people call you back and sometimes they don’t.”
Dallas County leaders say it takes about 14 days to start seeing the effects of relaxed restrictions. So loosening rules every one to two weeks as Texas has done makes it hard to measure the effects of each phase. And data show that people started venturing out more in late April, before the stay-at-home orders expired.
“The situation keeps changing,” said Dr. Philip Huang, the county’s health and human services director. “It’s a moving target.”
So far, he said, the state and county have not seen a sustained 14-day drop in new cases – a key benchmark the White House recommended states reach before they begin to reopen. Many states have not followed that guidance.
Data still patchy
Abbott has said that he and state health officials are closely watching the percentage of tests that come back positive for the virus. The lower the number, the better.
Texas’ percentage has been declining, recently hovering between 5% and 6%; health officials say under 10% is desirable.
Still, it’s hard to get an accurate read on the current spread of COVID infections due to incomplete or lagging data.
For instance, each day Dallas County and the state report the number of new cases and deaths from COVID-19. But it can take anywhere from one to several days for test results to appear. So any given day’s report is a snapshot of an undetermined window of time.
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The News asked the state for testing numbers and results based on the day they were given, not reported. The state said it was unable to provide that.
In addition, the total number of tests given may be larger than what is reported.
“With many more labs bringing COVID-19 testing online, we are still learning of labs that aren’t reporting negative test results to us. As we do, we reach out and let them know what they need to do to report,” said Chris Van Deusen, a spokesman for the Department of State Health Services.
Nor does Dallas County have complete numbers from private labs. Based on the county’s available data, about 13% to 15% of tests each day have been positive, County Judge Clay Jenkins said Thursday.
Another problem: It’s hard to understand the severity of outbreaks in specific neighborhoods without more detailed data. Dallas County, for instance, has reported case counts by ZIP code but not the number tested.
“You can’t know the hotspots by case counts alone,” said Stephen Linder, director of the Institute for Health Policy at the University of Texas Health Science Center at Houston.
In pushing to reopen, Abbott’s office has noted that Texas has one of the lowest infection rates of any state. But the rates across the state’s 254 counties vary wildly.
As of Saturday, 32 counties, most of them small, still had not reported a single infection. But Moore County, where the virus hit workers at a meatpacking plant, has the state’s highest rate of 21 cases for every 1,000 residents. Nearby Potter County, where Amarillo is located, has the second-highest rate at 11 cases per 1,000 residents.PUBLIC HEALTH
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The summer ahead
Some North Texas hospitals are seeing a plateau in COVID-19 patients; others a decline.
Dr. Miguel Benet, chief medical officer of Medical City Healthcare, said the effects of the reopening would become apparent in the coming days but are hard to predict. He said his and other hospitals would be monitoring admissions data closely.
“The big unknown is really understanding the link between the differences in social distancing measures and what that means in terms of numbers of cases,” he said.
Baylor’s Hotez believes a resurgence of cases will follow loosened restrictions in Texas.
To keep people safe as the economy reopens, Hotez said each Texas city should have a detailed epidemiologic model to track and forecast infection rates, a system of rapid workplace testing, including saliva tests, and a massive increase in contact tracing, among other measures. “There just doesn’t seem to be the organization or political will to make that happen, unfortunately,” he said.
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As a result, cases may jump in late summer, once the virus has had time to move through the population, Hotez said. “We could be in a very difficult situation as we move into the fall,” he said.
Lauren Ancel Meyers, who leads UT Austin’s COVID-19 Modeling Consortium, said she expects community transmission to continue for the next year. The rate of the spread could be high enough that the elderly and those at greater risk of severe COVID-19 symptoms might have to continue sheltering in place, she said Thursday during a panel discussion organized by The Academy of Medicine, Engineering & Science of Texas.
For counties with low and declining infection rates, though, the governor’s reopening came at the right time. Testing has been wide in Galveston County, and less than 1% of those tested have been positive, said Philip Keiser, Galveston’s local health authority and an infectious disease expert at the UT Medical Branch.
“It’s clear that this is a disease of outbreaks, and so each region has to look at what’s going on in their own community,” he said. Still, he anticipates an uptick in cases in Galveston as restaurants, stores and other businesses reopen.
“We’re trying to encourage people to be careful and be mindful of what they’re doing as they’re going out and about,” he said.
In the past week he and his wife dined out for the first time and felt pleasantly surprised.
“We saw people doing a good job,” he said. “Tables were spread apart, the staff were wearing masks and were following all the governor’s recommendations. And I didn’t feel threatened in any way, I didn’t feel packed in. At this point I feel optimistic, but I’m still cautious and worried. We just have to take it slowly and carefully.”