With Texas at a coronavirus plateau, what happens next?

AUSTIN — It’s been more than three weeks since Gov. Greg Abbott shuttered bars and mandated masks in most of the state, and while health experts say there are some promising signs that those decisions helped level off new coronavirus cases and hospitalizations, they might not be enough to substantially slow the spread of the disease.

Abbott has cast the plateau in hospitalizations and a declining percentage of positive cases as “glimmers of improvements” but warned that the virus is not leaving anytime soon.

“The only thing this points out is that there are improvements coming as a result of more people adopting this practice of wearing face masks, staying at home if at all possible, but if you do go out, keeping your distance from others,” Abbott said in a Wednesday interview with KSAT-TV in San Antonio.

Parts of the state have seen a dip in new cases, including Austin, where modeling suggests that the city’s June 17 mask order for businesses decreased the virus’ transmission rate. However, statewide hospitalizations remain high, and experts warn that will continue pushing the virus death toll upward.

One of Abbott’s top medical advisers said Thursday that more must be done to slow the spread of the virus, including greater enforcement of statewide orders and more flexibility for local governments to implement and enforce their own, more restrictive orders.

“It’s not enough to just stop the growth in cases at this very high level,” said Dr. Mark McClellan, a former U.S. Food and Drug Administration commissioner and one of three outside health experts advising Abbott on reopening the state’s economy. “It’s a very difficult situation for health care organizations.

It makes it hard — if not impossible — to reopen schools. Further steps are needed, hopefully through more people wearing masks and following the guidelines, but more steps are needed to get the cases down.”

The incubation period for the virus is between one and 14 days, meaning that the number of new cases provides a delayed picture of the spread of the virus.

Hospitalization and death come weeks after initial infection.

“Just like good policy or good behavior is reflected two weeks later, the same thing is true for bad behavior,” said Dr. Rajesh Nandy, a University of North Texas professor of biostatistics and epidemiology, who studied the effectiveness of masks across the country. “By the time we see the effects of lack of social distancing or masks, it’s already too late.”

Health experts warn that those numbers remain too high for the state’s health care system to manage. “We’ve stabilized at a high number,” Nandy said. “We’re hanging in the balance right now.”

The number of new cases statewide reported each day over the past week has declined slightly from the previous week, with the seven-day rolling average slightly below 8,900 new cases per day. The Texas Department of State Health Services reported 8,701 new cases Friday.

And the percentage of those testing positive among all Texans being tested on a given day declined to 13.7 percent Thursday. A day earlier the rate was 13.9 percent, the first time that number had registered below 14 percent since July 6. However, Abbott has said anything over 10 percent is cause for concern.

Nandy said it’s too early to know whether this is evidence of a decline in the prevalence of the disease in Texas.

Abbott and health experts warned that the number of new COVID-19 deaths would increase through July, a prediction that has come true.

On Friday, state health officials reported 196 new COVID-19 deaths, one shy of the record 197 deaths set Wednesday. As of Friday, the average daily death toll over seven days was 140.

Nandy and his University of North Texas team studied the effectiveness of Dallas’ mask mandate for businesses and found that the transmission rate in the Metroplex slowed.

The study showed that states with a mask mandate effective in May had a decrease in the average number of daily new cases. Most states without a mask mandate in May, including Texas, saw an increase in new cases.

“It was pretty clear that the counties with a (mask) mandate are doing much better compared to the counties that were not doing a mandate,” he said.