County health director highlights balance in protesting, precautions
Dr. Umair Shah is executive director of Harris County Public Health, where he’s leading the county’s fight against COVID-19. We spoke with him Thursday afternoon. A few hours later, County Judge Lina Hidalgo tweeted that Harris County had now seen a statistically significant increase in COVID-19 hospital admissions in the past seven days.
Q: Weeks after we’ve started reopening, are higher infection rates showing up in the data you’re watching?
A: Case counts remain a challenging way to view things. Case counts very much depend on people getting tested. They also depend on labs then reporting back to health departments. There are still delays in the process. It’s not as ideal as I would like. It’s not, you hit a button and boom, it says, “Here’s the current number of cases.”
If you confirm number of cases today, that doesn’t represent what happened today. It represents what happened over the last five days, or seven days, 10 days, 14 days — or sometimes even longer, because a batch of lab reports will come in at the same time and sometimes are weeks old.
So the number of cases gives us an idea of what’s happening for transmission in the community; it gives us breadth. But what’s happening in the hospital system is equally important, because that gives us a depth: That tells us how many people were so sick that they required a hospital visit, required a hospital bed, required an ICU bed, required a ventilator.
On both the the breadth number — cases — as well as the depth number — hospitalizations and what’s happening in the health care system — we’re starting to see an increase.
We might be seeing more cases because more testing is happening. So that could be a good sign.
But in the hospital system, where the data has been more constant, we are starting to see an uptick of people that are being hospitalized and are going into the ICU. It’s not significant yet, but it’s measurable. That’s where the concern comes.
We are layering risks on top of each other. We layer reopening, layer Mother’s Day, layer Memorial Day, layer complacency, layer more reopening, layer activities such as the march a couple of days ago. And it’s summer, where people don’t want to think about wearing a mask or social distancing. Plus you’ve got graduations and other kinds of parties and events. All of that layers, one thing on top of another.
That’s where we start to get concerned from a public health standpoint.
xQ: What do the models show about how quickly an uptick could become a surge, if transmission gets out of hand?
A: We expect it to take a few weeks to see the result of any one of those layered activities — say, reopening restaurants at 25 percent capacity. For this virus, the incubation period is two to 14 days. That doesn’t mean that that first day of the activity you’re considering is when you start the 14-day clock. Not everybody’s rushing to the restaurants on Day One of reopening. Some people will let others go in first, then a few days later, they’ll think, now I’ll go. That’s why we’re saying it’ll take a few weeks to see results.
So if something happened two days ago, you wouldn’t see the effect of that for a few weeks. If you had a graduation ceremony where people were not following social distancing rules or wearing facial coverings, you would not see the results until a few weeks later. And so on and so forth.
That really gets us to the end of June/early July timeframe.
Q: On Tuesday, as many Houstonians were marching in protest of George Floyd’s death, Harris County Health released a public statement on racism as a public health threat. It said, “The ongoing pandemic we are continually facing is racism, violence, trauma, all rooted in systemic inequities.” In the same release, the county urged protesters to take precautions against COVID-19. Could you talk about about the statement, and about that tricky balance — protesting systemic inequities vs. taking health precautions?
A: It is a tricky balance, and I’m glad you highlighted that. There is not an easy way of getting a message out. Throughout this pandemic, for the last several months, I’ve found that every decision, every recommendation, has trade-offs. There are always competing interests to balance.
We felt it was very important to put out a statement on this issue. Quite a few things were happening at the same time. Let me try to unpack them. One is that we have seen racial ethnic inequities — disproportionate impact from COVID-19 — all across the country. We also have seen an increase in disproportionate impact even in our own counts and numbers here locally.
There are not just law-enforcement aspects to the horrific event that we all witnessed in Minneapolis, but there are also public health aspects too. Safety and well-being go hand in hand; public health has a role.
We said last year, in our “Harris Cares” report, that public health has a role in violence prevention, whether it’s policy or helping people through difficult times. We also recognize that there’s a mental health aspect for all of us: As we see images on TV or in social media, we all have a visceral reaction. We also recognize that COVID-19 has disrupted the economic balance in our communities. There have been comments made that the outcry was furthered by people having lost their jobs, having to stay home, and having to educate their kids in a very different way.
So we thought it was important for us to make a statement, but we wanted to make a public health statement on the prevention aspects. And the trickiness of it is that at the same time as we recognize the right for people to to protest and vote — to be part of the civic process — we also wanted to recommend that people do all those things safely.
Yes, we are in a pandemic, and we do not want any activity to lead to more transmission of COVID-19 in our community. So what we’ve been saying is: Do things, do activities, perform those activities, but stay safe.
Q: It seems likely that we’ll have another mass gathering for Floyd’s funeral next week. What precautions should people take?
A: There are ways that you can safely protest — from within your car, for example, or donating to organizations or doing things online.
If people decide that they want to demonstrate or march, we recommend that they wear face coverings, that they have hand sanitizers with them, that they avoid hugging and shaking hands, that they maintain social distancing. Those measures are to protect not just themselves and the people around them, but ultimately, our community.
We also recognize that there are certain activities, such as singing or speaking loudly or yelling, that may emit more virus. So instead, if you can, carry a written sign or use a noisemaker.
There is transmission risk in larger crowds. So we encourage individuals who are above the age of 65, or have severe medical conditions, not to go into those settings. If you’re 80 years old and on dialysis, or if you’re 75 and getting chronic chemotherapy, it is not the time to go into a crowd, regardless of how passionate you feel.
This is not about politics. This is not about right or wrong. This is about trying to prevent people from getting sick.
Q: How many contact tracers do we have? Do we have enough yet?
A: “Enough” is always a tale of two cities. You feel like you have enough for now, but you don’t know if you’ll have enough for the future.
We have brought in 300. As of May 22, we’ve onboarded 300 contact tracers. And we’ve got additional staff we’re bringing on — more than 300 of those contact tracers, along with epidemiologists and support staff, for another 100.
Our epidemiology group was about 25 before COVID started. It ballooned up to 100. Now it’s going to be 500. Think about that incredible growth in size over a short period of time.