AUSTIN — The statewide shutdown has thrashed Texas’ economy. More than 1.5 million Texans have received unemployment benefits. And protesters from Republican Gov. Greg Abbott’s own party — as well as Lt. Gov. Dan Patrick — are pressuring him to put Texas back in business.
Abbott promises an announcement Monday that will allow for the reopening of a “massive amount of businesses,” in a safe way that is guided by data and doctors. But while for now, newly reported cases of the coronavirus have slowed somewhat in Texas, more is needed to stage a safe reopening.
Experts across the nation, including one of Abbott’s own medical advisers, say avoiding a new surge of cases while lifting social distancing orders will require robust testing and rapid contact tracing, areas where Texas has lagged.
Under some projections, that could mean testing 40,000 Texans a day. So far, the state’s highest daily tally has been just over 20,200, according to the COVID Tracking Project, a clearinghouse that has become a go-to for nationwide statistics on the virus.
The state has plans to bring on 1,000 new people to track down those who have had contact with people carrying the virus — more than doubling the current contact-tracing workforce. Some local public health agencies said last week that their contact tracing has been delayed by the wait for test results, which can be over a week.
“What the state is working hard on right now is working out how to have test and trace capacity that matches the other steps that go along with reopening,” Dr. Mark McClellan, director of the Duke-Margolis Center for Health Policy at Duke University and one of Abbott’s medical advisers, told The Dallas Morning News last week. “This is a very much intense work in progress right now.”
Abbott’s office has declined to release details of his plan — such as where he will allow reopening and what types of businesses — but he has suggested that reopenings could be tied to the size of a region’s outbreak and could start in May. He has hinted that restaurants, hair salons and movie theaters could open with appropriate distancing between people, though he said it wouldn’t be necessary to require everyone to wear a face mask in public.
So far, more than 23,700 people have tested positive for COVID-19 in Texas. More than 600 Texans have died. Last week, state data show, an average of 780 Texans tested positive for the disease each day.
Numbers of new cases reported daily in Texas are not currently climbing steeply, following stringent stay-at-home orders that restricted movement of most people.
As the epidemic has unfolded in the United States over the last two months, various groups of experts have published lengthy plans on what a safe reopening would look like. McClellan, who led both the U.S. Food and Drug Administration and the U.S. Centers for Medicare and Medicaid Services under President George W. Bush, has helped write two of the plans.
Public health experts agree that controlling the virus will be an unprecedented undertaking, requiring vast improvements in the ability to figure out who is infected.
Dr. Mark McClellan, Director of the Duke-Margolis Center for Health Policy at Duke University and one of Gov. Greg Abbott’s medical advisors on his coronavirus strike force. Also led the U.S. Food and Drug Administration and the U.S. Centers for Medicare and Medicaid Services under President George W. Bush.(Courtesy)
All the plans start with ramping up testing – not only to diagnose people who show symptoms but to find those who don’t. The plans McClellan helped write have called for testing more than 750,000 people a day across the country, about five times the current pace. But in an interview last week, he said that number may not be high enough.
“The more active cases you have, the more testing you are going to need to do to identify the cases early,” he said, noting that parts of Texas have quite low rates of infection.
University researchers who have behind ideas for how best to reopen offer a range of how many tests Texas would soon need per day. They start around 45,000 and reach as high as 350,000. Results would need to come back in minutes or hours. Infected people would need to isolate; people they’ve come into contact with would have to be tested or isolated, too.
The state’s public health agency has not yet said how testing will be ramped up, but spokesman Chris Van Deusen said those plans are underway.
Speed is still a problem. The city of Houston and Collin County health officials told The News, for instance, that sometimes they get back a batch of positive results from tests that were taken more than a week earlier.
Dallas County’s health department does tracing on all cases, according to its medical director, Dr. Phillip Huang, and can process its own tests quickly. But averaging in tests from outside labs, its statistics show, four days pass between the times when a test is collected and when the result is reported.
Any delay in test results makes it that much harder to identify everyone a patient has come in contact with at work, out grocery shopping or hiking at a state park. Tracking down someone’s web of contacts involves lengthy questioning followed by a round of phone calls.
The lower the prevalence of the disease when the economy begins to reopen, the easier it will be to track potentially infected contacts and usher them into isolation.
“The goal of social distancing is to suppress transmission and incidence to levels that are low enough that, through testing and contact tracing, you are able to snuff out any outbreaks that may emerge,” said Topher Spiro, a health policy analyst at the Center for American Progress, a progressive think tank in Washington D.C. “You can’t do that strategy if there is still widespread transmission or moderate or high incidence.”
One estimate, from researchers at Johns Hopkins University and a national association of public health officials, has suggested that the country will need at least 100,000 people to work as contact tracers. That number is based on what has worked in countries that have been able to contain the virus well, such as South Korea, Singapore and New Zealand.
Texas, like the rest of the country, doesn’t have a precise count of how many people have been infected. Tests have mostly been reserved for people with symptoms, so many people who don’t feel sick are going uncounted even though they may be fueling the epidemic. That has begun to change – Dallas County recently announced that grocery store workers, first responders and health care workers can get tested even if they’re not showing symptoms.
A healthcare worker screens the passenger of a vehicle at a Dallas County drive-thru COVID-19 testing center outside Ellis Davis Field House on Thursday, April 9, 2020, in Dallas.(Smiley N. Pool / Staff Photographer)
Texas is doing better than the country at large in detecting cases. In the state, about 10% of tests have come back positive; the national figure has hovered closer to 20%. The lower that number, the better, experts say, because it means you’re getting closer to testing widely enough to see the full scope of the disease.
Last week, a team of scientists, economists and health policy experts led by Harvard University unveiled a plan that aims to control the disease to the point that it’s in constant decline as the economy opens back up in phases. Nationally, the plan anticipates needing 5 million tests per day by early June and 20 million a day by late July.
At the request of The News, Danielle Allen, the political scientist who led the effort, calculated numbers for Texas.
Under the plan, Texas would require 350,000 tests per day by June and up to 1.5 million per day by the end of July, Allen said. Those numbers could change depending on disease prevalence as time goes on. That scenario assumes contact tracing that’s quite good, Allen said, but not perfect. If Texas’ goal was to keep the number of new cases level, instead of in decline, fewer tests would be needed.
Other plans that call for fewer tests – on the order of 45,000 per day – rely more heavily on contact tracing.
Allen’s plan also incorporates routine testing of open sectors of the workforce.
“Forty percent of the economy is already open,” she said. “In some sense, the first order of business should be testing all the open workers. And it’s really important that those testing programs test asymptomatic people.”
Sectors that have begun to open, such as state parks in Texas, could have employees tested routinely, she said.
“If Texas could achieve that and, with every sector that’s open, incorporate them into a routine testing regime,” she said, “that would be a very powerful model.”
The Texas Parks and Wildlife Department is not testing employees for the virus, spokeswoman Stephanie Salinas Garcia said. Employees who feel ill are expected to stay home and contact their doctor, she said.
In Dallas County, an effort to target high-risk groups started last week. Parkland Memorial Hospital staff went to a nursing home known to have a handful of cases, tested all the residents and staff, and found even more, Huang said.
Even in counties that have a low incidence of disease, things can change quickly. Researchers at the University of Texas at Austin, for instance, have estimated that in a county with just one case of COVID-19, there’s a 50-50 chance an outbreak is already underway.
Abbott has said Texas will need to test at least 25,000 to 30,000 people a day to monitor communities for potential outbreaks. That’s more than last week, when the average daily number of test results reported to the state hovered around 12,400.
Abbott has projected a “vast amount of increase” on the private-sector side. And by the end of last week, he said, 25 Texas National Guard teams were to fan out across the state to test up to 3,500 people a day. Saturday marked the first time over 20,000 test results were reported in a single day.
“The bottom line is, according to information provided to me by the assessments by the advisers in the White House, they believe that Texas is going to have all the testing capability that we need,” Abbott said.
Several major testing companies — including Quest Diagnostics and Abbott Laboratories — would not say how many Texans are being tested with their products each day.
Though Abbott announced earlier this month that Walgreens would open drive-through testing sites in Texas that could process up to 3,000 people a day, a company spokesman clarified that that figure is the pharmacy’s testing capacity nationwide. Walgreens testing locations that have opened in the Dallas and Houston areas are testing about 150 people a day, spokesman Phil Caruso said.
“I am concerned the testing capacity is not yet there, although it is ramping up,” said Jose E. Camacho, executive director of the Texas Association of Community Health Centers.
Divisions are emerging at the local level on whether to lift or continue social distancing restrictions. Last week, Dallas County extended its stay-at-home order into May. Meanwhile, Colleyville Mayor Richard Newton in neighboring Tarrant County moved to resume outdoor dining at restaurants and visits to salons and gyms in certain cases.
Both McClellan and Abbott have said reopening in Texas will be gradual.
“Initial steps are not going to be everyone going back to restaurants at full scale,” McClellan said.
Reopening at the right time in the right way gives the public a certain comfort level, said Spiro, of the Center for American Progress.
Americans still overwhelmingly favor restrictions to limit the spread of COVID-19, according to a survey by The Associated Press-NORC Center for Public Affairs Research released last week.
“You can allow business to reopen and public places all you want,” Spiro said. “If you have not driven incidence low enough, people are still going to be living in fear. And that affects the broader economy.”