Houston health leaders are putting in place a nuanced coronavirus reopening strategy that probably points to sometime in mid-May as a realistic commencement, roughly 10 days later than the start date Gov. Greg Abbott is expected to announce Monday.
The leaders pointedly dismissed talk of dates, instead emphasizing certain benchmarks — the number of coronavirus cases, the availability of diagnostic tests and the capacity to conduct contact tracing — that need to improve significantly before the Houston region would be able to manage continuing cases of COVID-19, the illness caused by the virus. Those benchmarks seem unlikely to be attained by Monday, May 4, the day Abbott hinted in a radio interview Wednesday he will reopen “massive amounts of businesses” that have been closed since March 31.
“The last thing we want is to waste all the great foresight and decisions we’ve made by ignoring the data and prematurely reopening wide,” said William McKeon, president of the Texas Medical Center. “It would be terrible for the community to respond so well, averting what happened in New York, and then find ourselves in a situation where we’re in our surge capacity and not able to offer citizens a bed, ventilator and care they deserve.”
Dr. Paul Klotman, president of Baylor College of Medicine, added that plans should be based on “what’s happening with the pandemic, not dates we want to reopen. We can’t control this,” he said. “We can’t mandate arbitrary scheduling to a virus.”
Roadmap to reopening
The Houston health leaders, who are informally advising local government officials, say the number of Houston-area COVID-19 cases need to head in a sustained downward trajectory and drop from the current total of 200 to 250 new cases a day to under 100; the amount of testing conducted daily needs to at least triple; and local health departments need to bring on and train more than 1,000 additional employees to find people who came in contact with individuals infected with the virus.
Efforts to develop a road map to reopening come as Houston and Texas appear to have fended off COVID-19’s initially attack reasonably well. Houston-area hospitals never had to invoke plans to enlist freed-up beds because a surge of patients never came and a prominent COVID-19 model now projects that the disease will claim 957 deaths in Texas through Aug. 4, down from a previous projection of 6,000. The health leaders credited area residents’ stay-at-home and social distancing practices for the strong showing.
But the model’s projection assumes the state’s current stay-at-home order will continue through the end of May, a timetable that infectious disease experts such as Peter Hotez says would ideally position Houston to contain any spread of the virus. But Hotez says he knows that will never happen because of pressure to open up the economy.
Last week, a coalition of 350 local businesses urged Mayor Sylvester Turner and County Judge Lina Hidalgo to begin easing stay-at-home restrictions beginning May 1, warning that many firms would not be able to survive additional weeks of forced closures.
Hidalgo, who Wednesday ordered that residents wear face masks outside, has said she wants to wait until the virus has peaked and widespread testing is available before lifting the restrictions, but an Abbott executive order would supersede hers.
In an interview with WBAP-AM in Dallas-Fort Worth, the governor said businesses will have a week to get ready to reopen after he announces the order, which is expected to come Monday. He told the station that Texans will be allowed to go back to movie theaters, hair salons, dine-in restaurants and church services under the order.
Abbott added that the order would ensure “there are safe standards in place” and not be a one-size-fits-all set of rules. Noting counties with no COVID-19 cases won’t have the same restrictions as harder hit areas such as Dallas and Houston, he said “we understand the need for flexibility. Larger, more challenged counties will have to go a little bit slower.”
Such is the thinking of Houston health leaders, who are recommending that when the area begins opening, it do so in stages, beginning with the health care sector, Houston’s biggest employer, which is already well practiced in using safety measures amid COVID-19. Next to follow would be employers like the hotel industry and apartment buildings, which they note, function like hospitals, managing people and beds. Businesses where people cluster, such as restaurants and movie theaters, would come last.
‘Shift the conversation’
Eric Boerwinkle, dean of the University of Texas School of Public Health, said the key thing going forward is to make sure businesses reopen in a safe way, continuing the practices people have adopted in the past month once they’re back in the workplace.
“We have to shift the conversation away from the idea that the virus is going to disappear, that we’ve beaten it,” said Boerwinkle. “We now have learn to live with the virus, to space staff, stagger shifts, disinfect surfaces, take people’s temperatures as they arrive at work. People shouldn’t expect to ease back to business as usual, they should expect to return to a new normal at work.”
Boerwinkle is chairman of a UTHealth task force that will launch a massive education campaign for Houston businesses, providing guidance to different sectors on how each can safely return to work amid the COVID-19 pandemic. To that end, the task force divided the business community into five groups: those at low COVID-19 risk, such as retail and manufacturing; those at high risk, such as restaurants and entertainment venues; personal care services, such as salons and barber shops; places of worship and indoor events; and the health care industry.
Boerwinkle said the educational campaign is not yet finished. He emphasized that everyone needs to be making plans before the economy is reopened.
The task force has produced a report — currently just for government officials, not the public — that recommends a number of milestones be met before reopening. They mostly overlap with those highlighted by Texas Medical Center leaders.
For the coronavirus numbers milestone, Boerwinkle calls for 14 consecutive days of declining cases or percent positive test results and Klotman calls for getting the number of cases to between 50 and 100 a day, measures that go hand in hand, the two agreed. The peak in cases, only really evident after the downward slope is established, is expected in the coming days. The curve began flattening last week.
Testing and tracing
The availability of testing in the Houston area has improved gradually since the outbreak’s early days, when it contributed heavily to the virus’ exponential spread.
Klotman said the area’s amount of testing needs to go from an estimated 5,000 a day now to tens of thousands when businesses are opened up so public health officials can prevent out-of-control spread and isolate individuals infected and those they came in contact with.
Boerwinkle said he’s confident testing will ramp up to needed levels, noting it’s close to happening in doctor’s offices and retailers like Walgreens.
The greatest challenge in the milestone involves contact tracing, a public health measure shown to effectively contain outbreaks such as tuberculosis and measles and considered a more surgical method than a population-wide stay-at-home order. But one major reason COVID-19 got out of control in March was a lack of manpower at local public health departments. Harris County Public Health, for instance, currently only employs 10 people to do such often painstaking work.
“Everything happened so fast,” Dana Beckham, director of Harris County Public Health’s office of science, surveillance and technology, said about why contact tracing failed the first time. “We were flying by the seat of our pants, getting in place, responding on the cuff, not getting ahead of the ball. When the next wave comes, we’ll be ready.”
Beckham said Harris County has funding to hire and train 300 people by the end of May, a task officials say should be attainable given the suddenly large unemployed workforce and students.
Klotman estimates the area needs as many as 2,000 such workers, though Boerwinkle is hopeful that new technology, such as app-based surveillance tracking, can reduce the number to 1,000.
Klotman downplayed concerns that an Abbott order could make some of Houston health leaders’ work moot.
“Even if the governor declares all things open, I think businesses and people are looking for rational guidance,” said Klotman. “And municipalities can have independent policies.”