Texas A&M pandemic expert: Reopening brings new challenges
Dr. Gerald Parker is the director of biosecurity and pandemic policy at Texas A&M’s Bush School and associate director of Global One Health. When we talked with him last month, he outlined what he believed will be the five stages of the COVID-19 pandemic.
Phase 1 was containment: The stage when known cases began to show up, but were not yet spreading in the U.S., Texas or Houston.
Phase 2, mitigation, began as the virus was known to be loose in those places, and extreme measures, such as Harris County’s stay-at-home order, were required to slow its spread, getting the Houston area past the peak of infections and hospitalizations and giving public-health authorities time to gear up for Phase 3: a new, more difficult phase of containment.
We’re entering that phase now. As of Friday, Gov. Greg Abbott loosened restrictions all across Texas — for instance, by allowing the restaurants, movie theaters and malls to operate at 25 percent capacity.
On Wednesday, I talked with Parker about this new, second round of containment — the phase in which we try to restart our economy and learn to live with the virus.
There’s a lot of concern across Texas about lifting the shelter-in-place orders and entering what you’ve called Phase Three of the pandemic, the new round of containment. You’ve said that it’s harder to open back up than it was to shut down. Why is that?
For a number of reasons. There’s a lot of concern across the state and across the nation. On one hand, there’s fear. There’s worry about the seriousness of the SARS-COVID-2 virus, and people are not sure we’re ready yet.
But on the other hand, there are those that want to flip the switch and reopen our economy — our businesses and our industry — as though we’re returning to the normal that we knew before the COVID virus.
In reality, we are going to have to slowly converge into a new normal. We’re going to have to also assuage some of the fears and the concerns as we move forward. We’re going to have to mitigate risk as best we possibly can from the virus.
But we also have to recognize that continuing to shelter in place is not sustainable. The economic impacts of continuing to shelter in place are taking a toll on public health, mental health and other medical conditions.
So it’s not a question of either/or. We have to learn how to live with the virus. That’s why it is essential to begin to reopen our economy in a safe, measured way, phased in a responsible manner.
Is Texas at the point where it’s safe to reopen the economy?
I think we are at the precipice now of being able to safely reopen.
Some prerequisites have been stated in several of the roadmaps. They include that we are on a downward trend of disease severity. There are several measures of that downward trend. That could be anything from new cases on a daily basis, to decreased hospitalization, to decreased ICU admissions.
In many communities in Texas, the data shows that we are on a downward trend of seeing a decrease in the number of new cases, or at least a decrease in the ratio of positive tests over total tests that are being run on a daily basis. That’s not for all communities; some communities are on an upward trend. But for the state as a whole, we are on the downward trend.
As for things that we have to have in place as we begin to move forward and reopen our economy, we have to have testing capacity. We have to have the ability to do contact tracing. We have to have protocols in place to isolate new cases, treat those new cases, and do the contact tracing they generate. Our health care systems have got to have the capacity to deal with new cases and treat effectively those who get severe disease.
All those prerequisites have to be in place. I think we’re making very good progress.
But we may not be ahead of the curve on all those things. In the last couple of weeks we have rapidly expanded testing. We have the capacity now to do 20,000 tests per day, and we continue to expand that capacity. And importantly, we are increasing our network to do that testing and provide results in a more timely manner. But we’re not where we need to be yet.
We are also planning to hire workforce needed to do contact tracing. The plan calls for rapidly bringing on board up to 4,000 people to support contact tracing, and that’s also going to be supported by people deployed by the CDC to help in training and guidance.
We’ve really been in good shape with our hospital capacity. We’ve been able to maintain our hospital operation, and we have plans in place in case we need to surge.
So we’re making good progress. I believe that we are on the precipice of, if not already meeting, those prerequisites across Texas.
Should we expect to see resurgence of the disease? to see the numbers climb again?
We must anticipate that we will see new cases. That’s only natural. As we begin to relax some of our shelter-in-place requirements, and as we have more human activity in our communities, we should expect to see an increase in cases.
We’re also going to see an increase in cases as we increase testing. So it’s going to be important to be able to differentiate, both at the community level and at the state level, the difference between a spike — a dangerous level of new cases — versus an increase due to increased testing.
Our job is to manage the curve now. We flattened it by staying home. Now we have to manage it — have to make sure that we can avoid a dangerous spike in new cases.
I hope we don’t see a dangerous new spike in new cases, but we should expect it. We should watch for it. We should be ready. It should not be a surprise.
If we see a spike, I assume that would trigger a new stay-home order or something similar. What sorts of triggers should we be watching for?
Each community is going to have to develop triggers independently of guidance that’s coming from the state — triggers appropriate for the level of risk in their community.
Some triggers are going to be straightforward, like the things I just spoke about — say, an increase in new cases. But even then we’re going to have to predetermine each community’s needs to say what would signify a spike in new cases — what the threshold is for a spike, and not just an expected increase because we’re testing more.
A better trigger as we move forward — particularly with enhanced testing — is going to be that ratio of positive tests over the total number of tests each day. Each community needs to establish a threshold that they’re comfortable with, calibrated with their hospitals and ICUs’ abilities to handle patients, and their ability to transfer patients to other communities.
Other triggers would include hospital admissions, and also fatalities, but we have to recognize that hospital admissions and fatalities are lagging indicators. After a person is infected, it may be seven to 10 days before they get sick enough and require hospitalization, and they might not die until three weeks to a month after an infection.
With lagging indicators, we may not know how we’re doing until we’re about a month into the reopening.
That means it’s important that we not wait for those lagging indicators. We need close monitoring by local public health. State public health is going to be essential.