Texas misses benchmarks for reopening
PHASED PLAN: Abbott’s push to restart state’s economy falls short of medical adviser’s data
As he moves to reopen the state Friday amid the coronavirus pandemic, Republican Gov. Greg Abbott has cited data and science as his guiding lights.
But Texas has yet to meet most of the benchmarks for easing restrictions set by Abbott’s most prominent outside medical adviser.
The governor is using a phased re-entry plan that seeks to balance a need to restart the economy while also preventing a second wave of the outbreak. On Monday he told Texans: “Because of your efforts, the COVID-19 infection rate has been on the decline over the past 17 days.”
While the rate of positive tests is indeed declining, the state doesn’t know the true infection rate — how many people have been infected out of all those at risk of exposure — because it has only tested about 1 percent of the population since the outbreak began.
There are still a lot of indicators the state can track. For help, Abbott has turned to medical advisers including Dr. Mark McClellan, a former Food and Drug Administration commissioner under President George W. Bush.
McClellan — the son of former Texas comptroller Carole Keeton Strayhorn — directs the Duke-Margolis Center for Health Policy at Duke University and co-authored a paper last month that laid out four prerequisites for states to meet as they reopen their economies. It has helped inform the Trump administration’s guidelines for states
as the pandemic plays out.
In an interview, McClellan said Texas took effective early steps to avoid the overwhelming outbreaks that have hit New York and other states.
He also acknowledged that Texas has not met all the benchmarks he and his colleagues envisioned, and said the state will have to work hard in the coming days to boost testing and train people to track down the contacts of those infected, to slow the spread of the virus.
Here are the four goals McClellan helped outline, and where Texas stands on each:
Sustained reduction in cases for at least 14 days
The number of new daily cases has hit a plateau, a sign that the outbreak is not expanding rapidly. But the number of cases is also not clearly trending downward.
The state is still reporting hundreds of new cases each day — 883 on Wednesday. The share of those new cases as a percentage of Texans tested for the virus, a measure known as the “test-positivity rate,” is declining overall. That rate doesn’t tell us everything about the outbreak because only a fraction of people are being tested, but it does help experts begin to track its spread and determine whether enough testing is being done.
The positivity rate for the country as a whole was 18 percent in the past week, on average — high compared to other countries. In some states it has been as low as 2 percent. Texas has been in the middle, at about 10 percent, and has been on an ebb-and-flow decline since April 12. As of Tuesday, it was at 8.5 percent.
That signals that the state is slowing the outbreak, but hasn’t stopped it entirely.
“It’s kind of a long plateau,” McClellan said. He added that as the state increases testing for the virus and begins to reopen, “you need to aim for an ability to contain cases at that level.”
The state has averaged 850 new daily cases in the past seven days. That’s about 60 percent of the the highest single-day tally — 1,441 on April 9. South Korea, viewed as a model among health experts for its response to the pandemic, only loosened restrictions after it had reduced the number of new daily cases down to single digits.
“Ideally you’d see a steady downward trend in cases,” McClellan said. “Short of that, the numbers to watch are the numbers of hospitalizations and the number of deaths.”
Ability to safely treat all patients requiring hospitalization
The state appears to be meeting this benchmark; it has plenty of hospital beds and doctors are not reporting the same widespread shortages in personal protective gear that they were weeks ago.
The number of confirmed COVID-19 patients who are hospitalized has remained under 2,000 in recent weeks. Currently the state has about 20,000 total beds available and 2,000 intensive care beds.
The daily average death toll from the virus over the past week has been 27 people, up slightly from 26 the week before.
“The hospitalization rate has remained steady and the death rate is on the downward trend,” Abbott’s spokesman said.
Capacity to test all people with COVID-19 symptoms
The governor’s plan calls for daily testing to increase to 30,000.
The state is not even halfway there.
There were 14,000 tests reported daily in the state over the past week, on average. The state’s peak in reported tests was on Saturday, at 20,000. It hasn’t come close to reaching that since.
McClellan said it would be ideal if the state had already hit its goal by the time it begins to reopen on Friday, but is encouraged that the governor has committed to getting there quickly.
Abbott has said the private sector will provide the bulk of the expansion. Companies such as Walmart and Walgreen’s have set up drive-thru test sites, and the state has dispatched more than 3,000 Texas National Guard members to staff some two dozen mobile testing sites, especially in remote areas with low access to health care.
Those have helped boost access in the past week, but the state, like others, is still scrambling to get all the supplies it needs to conduct tests, including cotton swabs and chemical reagents.
Dr. John Hellerstedt, who leads the Texas Department of State Health Services, said on Monday that the Trump administration has committed to “solving some of the supply chain problems that have been limiting some of our ability to test.”
Even if it does, Abbott’s goal may not be enough. In order to have a complete picture of the outbreak, experts at the Harvard Global Health Institute have recommended a daily testing rate of about 152 per 100,000 people. Texas is testing on average 46 people per 100,000.
To reach the Harvard benchmark, Texas will need to expand to about 46,000 tests per day, more than a threefold jump from where it is now.
McClellan said 30,000 would be in “a good range to cover most of the testing recommended by the (Centers for Disease Control).”
Capacity to monitor confirmed cases and contacts
Easing restrictions makes it easier for the virus to spread. To prepare for that, the state will need “contact tracers” in place to track down the contacts of those infected and get them to isolate. It will need several thousand more than it has now.
The Department of State Health Services said last week that it had about 800 people doing contact tracing, most of them on the local level. On Monday Abbott said the number was 1,100. He said another 1,000 would be added in the next two weeks, and an additional 1,900 by the end of May.
Abbott’s plan says tracers will be pulled from public health schools
and include community health workers, medical and nursing students, and school nurses. It does not say how much they will be paid, and with what money.
In Massachusetts, Republican Gov. Charlie Baker budgeted $44 million to hire a team of 1,000 tracers. They will work virtually and be paid the rate of federal census workers, about $25 an hour.
The state health agency said on Wednesday that, “at this point, we don’t expect the state workforce to be volunteers.” The governor’s office said they will be contract workers.
At least some of the tracers in place now are on loan from their primary workplaces, and it’s unclear how long they can continue pitching in. In Tyler, for example, the Northeast Texas Public Health District has been relying on aid from employees of the local district attorney’s office and offices for local public safety officials.
“We’ve beefed up our own internal staff,” said CEO George Roberts. Going forward, he said, “we’ll still need the help.”
So far Roberts’s staff has been able to do tracing on every case. Other, harder-hit areas of the state have said they lack the resources to do that. In Harris County, health officials expanded their team of 25 tracers, but still had to stop tracing every case as the city became inundated. Instead, they’ve focused only on outbreak clusters and atrisk populations such as health care workers and nursing homes.
Whatever the force, it will likely need to be in place for at least several months, until a vaccine or effective treatment is in place.