As Texas prepares to start reopening Friday, the state is still short of key benchmarks outlined by Gov. Greg Abbott and one of his top advisers.
Over the past week, the state averaged about 15,000 coronavirus tests a day — half of what Abbott is targeting.
And a top medical adviser to Abbott has recommended states have a sustained 14-day decline in new cases before lifting social distancing requirements. That has not happened in Texas.
On Thursday, the state reported its biggest one-day increase in deaths, Dallas County reported a record number of positive cases and the city of Dallas reported declining hospital bed capacity.
In his plan to reopen Texas unveiled Monday, Abbott set a goal of 30,000 tests a day in the “near term” and that “in order to open Texas, we are testing widely and often.”
Asked Thursday when Texas would hit that mark, his office did not answer directly.
Abbott’s office also said infection and hospitalization rates are the important numbers, not the number of tests given. As Texas increases testing, there will be more positive COVID-19 cases, but the state “must ensure the rate remains low,” spokesman John Wittman said.
“The rate of positive tests to the total number of tests has decreased from above 10% to about 7%,” he said in a statement. “The hospitalization rate has remained steady and the fact remains that Texas has one of the lowest death rates per capita in the country, showing the success of our efforts.”
Some clinicians said Thursday they still are unable to test all the patients they think may be infected. Experts warn that if not everyone who has symptoms can get a test, the state is at risk of not being able to keep up with new infections.
“If you have a hurricane that’s coming, you want to make sure you have your weather satellites up in the air and ready to go to track your hurricane,” said Dr. Thomas Tsai of the Harvard T. H. Chan School of Public Health. “You don’t wait for the hurricane to come to launch your satellites.”
Dr. Mark McClellan, one of Abbott’s top medical advisers, said Texas is still working to ramp up testing.
“Texas has a robust plan to increase testing and contact tracing rapidly, and has already begun to implement it. Our recommendation is to have testing in place first, not because testing eliminates the risk of the virus, but because it helps detect and contain outbreaks quickly,” said McClellan, director of the Duke-Margolis Center for Health Policy at Duke University. “In an ideal world, that would happen first.”
McClellan said people should take extra precautions.
“It will be especially important for people to follow the guidelines carefully, like staying home if they have any symptoms and paying attention to distancing and handwashing if they go out,” he said.
Statewide, positive cases have leveled off, hovering around 800 in the past two weeks. On Thursday, the state reported more than 1,000 new coronavirus cases for the first time since April 10. The state also reported 50 deaths Thursday, the most in one day since the outbreak began.
In Dallas County, meanwhile, new cases were down last week, but jumped again this week.
“Things have either plateaued or even gone up a little bit,” said Dr. Philip Huang, director of the Dallas County health department. “It certainly hasn’t gotten to the downslope yet.”
The city of Dallas also reported 67% of its ICU beds were in use Thursday. Mayor Eric Johnson indicated the level is likely due to coronavirus cases, not the recent resumption of elective surgeries.
Area hospitals appear to be bracing for more patients.
“We will monitor our bed capacity as various retail establishments begin opening,” said Stephen Love, president and CEO of the Dallas-Fort Worth Hospital Council. “Over the next two to three weeks, we will monitor hospital bed capacity as more businesses open to ensure we are tracking consistently with expectations.”
On Thursday, Dallas County reported a record 179 COVID-19 cases. It comes after the county loosened testing criteria, allowing grocery and big-box store employees without symptoms to be tested at the county’s drive-through locations.
“What that really should tell us is there are a lot of people out there with coronavirus,” said Dr. John Carlo, CEO of Prism Health North Texas and a member of the Texas Medical Association’s COVID-19 Task Force. “If that’s the case, testing is critical to get a sense of what we’re seeing.”
When he unveiled his plan, Abbott said he reserved the right to reimpose social-distancing restrictions in any part of the state if conditions warranted. To make those decisions, Abbott has said he will watch not only new cases, but also hospitalizations and deaths. The hospitalization rate has remained steady, he said, and Texas hospitals are handling the patient load.
Experts caution that hospitalizations and deaths don’t give a real-time view of new infections because people who need hospitalization may have caught the germ weeks earlier.
“The tests are one week to two weeks ahead of the hospitalizations,” said Harvard’s Tsai.
As restaurants and retail stores begin to let some customers in on Friday, more person-to-person contact is sure to cause new infections.
Experts all agree that reopening should be done in phases. States need to be sure they have enough testing capacity and a quick turnaround in tests. Isolating infected patients and their contacts is key to snuffing out new clusters of cases, what is known as contact tracing.
Lisa Rigby, Executive Director of Woven Health Clinic, said getting all the supplies needed to test patients is still a problem. Though the Farmers Branch clinic was able to order swabs, the transport vials needed to send the sample to the lab are now on backorder.
“We are still prioritizing tests,” Rigby said. “It’s kind of like whack-a-mole with the supplies.”