» Virus data settles zero arguments.
Health officials fight to warn of rise even as restrictions lift
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GEORGETOWN — Entering Williamson County’s 110-year-old courthouse last week, Derrick Neal, a naturally fast walker, had an extra bounce in his step. No administrator likes asking the bosses for extra money for operations. But as the director of a public health agency in the middle of a historic pandemic, he liked his chances.
Williamson County, a rapidly growing and politically conservative suburb of Austin, hasn’t been hit as hard by the novel coronavirus as some Texas communities. But Neal’s office had begun seeing concerning signs the virus was gathering steam since Gov. Greg Abbott began lifting business and movement restrictions a month ago.
The virus had for the first time found local EMS workers; 20 paramedics were quarantined. Local nursing homes and construction sites, too, had seen case surges. Confirmed infections had nearly doubled in the county since the state relaxed business and personal sheltering restrictions.
“We don’t even see a bending of the curve,” Neal said. “I’m nervous about July. It won’t take long to reach hospital capacity.” Among other expenses, he was requesting money to pay the team of contact tracers his office was assembling.
Surveying the same landscape, however, Williamson County’s elected officials reached a very different conclusion. Judge Bill Gravell Jr., the county’s chief administrative officer, had prepared a mission-accomplished speech for Tuesday’s meeting.
“Williamson County was brought to its knees,” he said on Zoom. But “I do believe our county is standing again.”
A few minutes later, commissioners voted unanimously to end the disaster declaration, and put off funding Neal’s emergency re
quest.
Back at their Round Rock office, Neal and his staff struggled to digest what happened.
“I feel almost like we’re not living in the same reality,” said Justine Price, deputy director of the Williamson County and Cities Health District. “It’s surreal. The virus is growing at a faster rate, and yet the message is, ‘It’s all over, we’re going back to normalcy?’”
“I’m not angry,” Neal said. “But I’m disappointed.”
‘A polarized virus’
The global response to the novel coronavirus has generated more granular statistical data than any public event this side of professional baseball. Regularly updated case numbers, mortality rates, growth figures, victim demographics and medical histories, hospital capacity and ventilator use for every level of government are instantly available. Research results are flying out of laboratories every day.
Yet the more numbers and information that is churned out, the less people agree on its meaning.
“There has not been a consistent voice out there where you can figure out what the heck is going on,” conceded Dr. Peter Hotez, a virus expert and dean of Baylor College of Medicine’s National School of Tropical Medicine.
A steady rise in Texans testing positive for the coronavirus can be tracked daily on state and local health department dashboards (it has dropped in the past week). But what does it mean? Epidemiologists say it’s an ominous signal the state should slow its return to normal. Gov. Greg Abbott and other state leaders say the increase is not a problem, merely evidence more people are being tested.
With the interpretation of public health information so subjective, citizens have been cast adrift without clear guidance on how to behave. How safe is it to go to a restaurant? Is it riskier to drive or fly when traveling? When are masks necessary? In the end, each person is left to become his or her own COVID researcher and expert, personally responsible for arranging the flood of data points into usable information.
The stakes couldn’t be higher. With states removing enforceable orders restricting personal and commercial activity, the battle to contain the virus has become a collective but voluntary effort. How people interpret the numbers can determine their commitment to the cause.
“We make the assumption that people will be able to make personal safety decisions based on the same facts,” said Scott Knowles, a history professor at Drexel University whose research focuses on people’s risk perception during times of disaster. “And I’m not sure that’s true anymore.”
Some reasons for the inconsistency are easy to grasp. Compared to other natural disasters, the bug is a ghost. The damage caused by a tornado or hurricane is visible in roofless houses, toppled trees, upended cars. A clearing sky signals the danger has passed.
But the virus is everywhere and nowhere. “It’s the disaster you can’t see,” said Tim St. Peter, who was directing a drive-thru testing site last week at a Georgetown middle school. “It would be great if you could see it on a radar.”
Individual risk perception also drives conflicting interpretations of the same information, said James Kendra, director of the Disaster Research Center and a professor at the University of Delaware’s Biden School of Public Policy and Administration. What is unacceptably dangerous to one person is worth the risk to another.
Such determinations can be informed by a person’s political views, Kendra added. “People who lean to the right tend to be more concerned about economic risks; those who lean to the left tend to be more concerned with social welfare risks,” he said. Those divisions have been exposed by the virus, which has hit Democrat-dominated cities harder than Republican-centric rural areas, he added.
Politicians attuned to the divide may exploit it for their own purposes, further clouding risk judgments. “It’s such a polarized virus,” said Hotez. “Even something like which medicines to use has become polarized.”
In Texas, a splintered emergency response system has also produced mixed messages. Early on, county administrators each decided when the coronavirus had arrived, what social limitations to impose and which businesses could remain open.
As the pandemic has dragged on, conflicting or ambiguous rules and signals from the state have added another layer of confusion over how citizens should calculate their personal risk.
Knowles said when public officials use cues to promote social behavior it is known as framing. “But when people watch public officials behaving differently, one of the conclusions they seem to be drawing is that none of them know what they’re talking about,” he said.
In April, after several cities and counties mandated citizens wear masks to prevent viral spread, Abbott prohibited them from enforcing the orders, making it optional. At press conferences, some officials — Harris County Judge Lina Hidalgo — have worn the masks. Others — Abbott and Lt. Gov. Dan Patrick — have not.
Beginning June 1, courts across the state will be permitted to resume in-person hearings. The Office of Court Administration has advised against them unless essential, said administrative director David Slayton. But some judges have already indicated their intention to conduct them, raising the possibility that nearby courtrooms could have different protocols — more static citizens must fine tune for themselves.
“The messaging has been all over the place,” Hotez said. “It’s the worst public health communication I’ve ever seen.”
Virus will have ‘final say’
Neal was at Jackson State University in Mississippi on a track scholarship when he volunteered for a community program handing out condoms to combat HIV. He fell in love with public health, which he came to see as essentially an education profession. People could improve their lives dramatically simply by being given, and then acting on the best available information.
After a brief stint as a firefighter, he moved to Illinois, where he ran another HIV program focusing on minorities. After stops in Houston, Abilene and Victoria, he landed in Williamson County early last year.
Neal said he realizes that politics and public health will always be uneasy dance partners. Although he tries to stay in the science lane, it’s not always simple. “I have to be aware of politics,” he said. “But it’s a danger to play them.”
The pandemic revealed unexpected pressure points. Early on, he said, workers at the county’s Emergency Operations Center resisted his call to start social distancing.
“It’s like I was on crack, like it was a big hoax,” he said. “They were living on top of each other for three, four weeks.” Eventually they came around.
More recently, he’s been trying to rein in the urge to race back to pre-COVID behavior, from restaurants desperate for customers to politicians eager to get the courts moving again. “Sometimes it’s like the Wild West,” he said. “Somebody’s got to be the voice of reason.” It’s his opinion the county is moving too fast.
A spokeswoman said Judge Gravell wasn’t available for an interview. But she explained that in ending the COVID disaster declaration, county leaders decided the main benefits of the designation, enacted March 14, were to request state assistance and use its emergency purchasing authority. Neither was necessary any longer, Connie Odom wrote in an email.
Commissioner Terry Cook said although she supported the decision, she understood Neal’s anxiety. “I view this opening up as a political and economic decision,” she said. “It has nothing to do with medical science.”
“The economics are real,” she added. “But to call it ‘over’ is so dangerous.” After seeing only a smattering of facemasks during recent visits to Chipotle and Home Depot, she said she fully expects to see a dramatic spike in new local cases.
Whether it happens or not, Neal, Price and their staff will continue the daily grind of fending off a pandemic: coordinating nursing home inspection teams, carrying out the plan to find and train debt collectors to become contact tracers, managing testing, working with local restaurant owners and Taylor Rodeo officials on how best to conduct their businesses in the presence of a mysterious and threatening disease.
“The virus is going to have the final say,” Neal said, “no matter what everyone else says.”