Gov. Greg Abbott says he is relying on data and doctors to gradually reopen the state beginning Friday, when Texans will be able to visit restaurants, malls and movie theaters in limited numbers.
The phased restart will be monitored through increased testing and tracking of new coronavirus cases, a move all experts say is necessary. By mid-May more businesses could open up, barring a sharp rise in COVID-19 cases, Abbott says.
But where the plan is long on hope, it’s short on goals or quantifiable triggers the state will use to decide whether to further relax social distancing or ramp it back up, experts say.
“Without that, we have no way to say ‘This is what success looks like,’” said Dr. Thomas Tsai, a surgeon and health policy expert at the Harvard T.H. Chan School of Public Health. “The most important piece that is missing is there is no transparency on what the goals are and how the government will react.”
While the state is aiming to test 30,000 Texans a day, the tally so far has broken 20,000 only once, last weekend. And experts cautioned that there will be little time before Abbott’s next scheduled decision — around May 18 — to identify any rise in cases resulting from Friday’s first wave of business openings.
Eyes are on Texas as Abbott leads the nation’s largest red state toward an economic reopening with praise from President Donald Trump. Abbott’s plan attempts to balance measures that will stimulate the injured economy while containing the spread of the virus.
“We are moving deliberately and will be watching closely every day to see if any new trends emerge,” Abbott spokesman John Wittman said. “Between the increase in the ability to test and additional contact tracing, we will have good insight into what’s happening with the disease in Texas and will make adjustments as needed.”
As experts around the country weigh in on ways to reopen the economy, everyone anticipates that relaxing social distancing will cause more cases.
The question is how to manage the spread — and how much disease the state will tolerate.
Abbott said his team would be monitoring hospitalizations, deaths and new cases, though the number of reported infections may rise with the growth in testing.
“As Texas ramps up its testing, there will be more positive cases, but importantly we must ensure the rate remains low,” Wittman said Tuesday.
Just how low is not specified. Abbott’s plan does not outline what changes in the number of cases might prompt him to push ahead with more reopening, hit pause or reinstate strict social distancing measures, something he can do county by county.
“There’s no real measurement that will tell us whether or not we are in a good place to move forward or not,” said Dr. John Carlo, CEO of Prism Health North Texas and a member of the Texas Medical Association’s COVID-19 Taskforce.
While the number of new coronavirus cases has leveled off for now, the trend is not equally reflected across all counties.
Dallas County announced one of its deadliest days Tuesday, reporting 10 deaths. Tarrant County reported over 100 new cases on six consecutive days last week — some of its highest numbers to date, according to its website.
“As the plan gets implemented, it may well be the case that there are outbreaks and more significant consequences in some areas than others, and I think as a general matter my advice is to respond to the local conditions,” said Dr. Mark McClellan, director of the Duke-Margolis Center for Health Policy at Duke University and one of Abbott’s medical advisers.
Abbott’s plan calls for ramping up to test 30,000 people a day in Texas. Neither the governor’s office or the state health department explained how they landed at that number as a goal.
McClellan said the figure fits with national recommendations, including his own.
“With that higher level of testing — 30,000 tests per day — you could get to the point where you are doing general testing of close contacts and people with milder symptoms,” he said.
Some public health researchers, however, say that number of tests could lead to more closures.
Under Abbott’s plan, only those identified through contact tracing and who show symptoms will be tested. Contacts without symptoms are to be asked to self-quarantine.
Danielle Allen, a professor at Harvard University and lead author of a comprehensive plan to reopen the U.S. economy using a massive increase in testing, said that Texas’ plan to rely heavily on quarantining asymptomatic contacts of people who test positive could result in isolating a lot of people who don’t have the disease.
But if those people who are quarantined are tested regardless of their symptoms, Allen said, it would be possible to see if any were silently carrying the disease. Then their contacts could be identified and tested too.
The failure to test those secondary contacts is likely to make it harder for Texas to tamp down the spread, she said.
The plan appears to acknowledge that, she said: Abbott has said that a resurgence of cases somewhere could result in imposing new stay-at-home orders for a particular region.
That means businesses could have to close back up, causing further economic pain.
“That’s our evaluation, and that’s a judgment call,” Allen said. Heavy testing — by her estimate several hundred thousand tests per day in Texas — could avoid that. “What our plan is doing is trying to avoid any need for even county or statewide stay-at-home advisories.”
Asked to comment on her opinion, Abbott’s office did not immediately respond.
Experts praised Abbott’s plan for paying special attention to nursing home residents. Abbott’s plan calls for boosting tracing and testing of contacts of nursing home staffers and residents who have tested positive for the virus, as soon as there’s an infection in a facility. It also sets out strategies for better infection control in Texas’ 1,220 nursing facilities. As of Monday, 43% of the state’s known COVID-19 deaths were linked to long-term care facilities.
The state plans to work more closely with facilities that have not detected a COVID-19 case to improve infection control, Abbott’s report says.
The Department of State Health Services did not immediately respond to questions about whether the state would launch large-scale testing of nursing-home staffers in homes where no residents or staff members have tested positive.
In Colorado, Connecticut and Washington such efforts have been underway, identifying asymptomatic carriers and isolating them so they will not spread the disease to coworkers or residents.
Over the last two months, a lab run by Colorado State University microbiology professor Greg Ebel tested 462 nursing home workers in Colorado to gauge whether workers without symptoms were silently carrying the virus. The lab identified 57 people who tested positive but had no symptoms.
“This kind of surveillance is extraordinarily valuable to these vulnerable communities to help reduce risks,” Ebel said.