Two weeks have passed since Gov. Greg Abbott allowed Texas retail stores, restaurants, movie theaters, malls, museums and libraries to open at 25% capacity.
In that time, Texas has seen a modest but steady increase in the growth of new coronavirus cases, and the state is not meeting all benchmarks for reopening set by White House officials or even Abbott himself. The state set new daily records this week for both new cases and deaths.
State officials have pointed to other metrics, such as the continued availability of hospital beds and a gradually declining rate of tests coming back positive, as cause for optimism in the fight against the virus. And they say the state urgently needs to allow businesses to reopen to help millions of Texans who have lost jobs.
So far, “the state’s performance has been good,” said Peter Hotez, a preeminent infectious disease expert and dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston.
“When we saw things going badly in New York, we enacted social distancing,” he said. “That was the difference between letting transmission go on for six weeks versus three or four weeks, and that extra period made all the difference” in keeping Texas hospitals from being overwhelmed.
But Hotez worries the state will see a resurgence in new infections in the summer and fall if millions of employees return to work without proper precautions, such as widespread workplace testing and robust surveillance of fever and other symptoms.
“I understand the importance of opening the economy, and I do empathize with the governor,” he said. “But I’m worried that we have not put a health system in place that’s commensurate with the needs to open up the economy.”
With Abbott scheduled to announce another round of reopening plans Monday, here’s a closer look at the data measuring Texas’ response to the COVID-19 pandemic.
The raw number of coronavirus cases continues to rise
For states to consider reopening, the White House recommends they see either a downward trajectory of COVID-19 cases over 14 days or a downward trajectory in the percentage of positive test results over 14 days.
The former hasn't happened in Texas. The number of new cases reported each day has grown from an average of about 918 during the week ending May 1 to about 1,227 this week.
“These data are evidence of likely increased spread among community members and more widespread disease,” said Rebecca Fischer, an infectious disease epidemiologist at the Texas A&M University School of Public Health. “We may also expect an increase in hospitalizations to follow in the next five to 10 days and an increase in COVID-19-related mortality to follow.
“We are at an exquisitely vulnerable juncture in Texas,” said Fischer, adding, “if anything, now more than ever we have greater risk because there are more in the community that are affected.”
This week, Anthony Fauci, the nation’s top infectious disease expert, warned Congress of a possible resurgence of the virus as more people come into contact with each other. If states allow business to reopen too quickly, he said, “there is a real risk that you will trigger an outbreak that you may not be able to control,” which could result not only in “some suffering and death that could be avoided, but could even set you back on the road to trying to get economic recovery.”
The number of tests is growing but still misses key benchmarks
One reason that Texas officials are recording higher numbers of coronavirus cases may be that they’re simply doing a better job of finding them.
The number of tests administered to Texans with coronavirus symptoms has grown steadily week over week, despite a rocky start in which Texas lagged behind almost every other state’s rate of testing after accounting for population size.
Still, the number of tests falls short of Abbott’s own recommendations. His framework for reopening the Texas economy established a “goal to reach 30,000 per day,” while the state ran an average of 20,700 tests per day in the past two weeks.
The testing data itself is muddied. The Texas Department of State Health Services now includes antibody tests — which can detect whether a person previously recovered from COVID-19, the disease caused by the new coronavirus — in its daily testing totals. But the state reports do not differentiate those figures from standard nasal swab tests, so it’s impossible to know how many tests show active infections and how many show previous infections.
And while the state has reported topping 30,000 daily tests twice so far, on Wednesday and Thursday, those totals may be more reflective of delays in private labs’ reporting to public health officials than sudden increases in testing capacity.
A lower threshold of 25,000 tests per day, which Abbott recently said the state would soon “easily exceed,” has been reached only three times.
“The only thing we can do to prevent this disease is stop the transmission, and testing is one of our only tools we have to do that,” Fischer said. “If we’re going to control this and contain it, it’s so important to be testing more widely, and that’s a paradigm shift from where we started.”
To supplement testing efforts, epidemiologists have called for a large workforce of disease detectives who can perform contact tracing, which involves tracking down any person whom a coronavirus patient may have exposed to the virus.
Abbott’s initial reopening announcement laid out a goal to begin mobilizing a "contact tracing workforce of up to 4,000” by May 11. The state is about halfway toward that goal. A Texas Department of State Health Services spokesman said Thursday there were more than 2,000 contact tracers working around the state — with more coming soon.
“We’ve already embarked on the next phase of hiring that will get us up to 4,000 in the coming weeks,” the spokesman, Chris Van Deusen, said in an email.
Daily rate of positive tests
For states like Texas that have seen an increasing number of tests administered, White House guidelines lay out another metric that can guide reopening efforts: the percentage of coronavirus tests that come back positive.
If a state’s raw coronavirus case count is increasing, officials can still consider allowing businesses to reopen if the state reports a downward trajectory of the rate of positive tests over a 14-day period, according to the Trump administration guidelines.
In the two weeks since May 1, when the initial phase of reopening began, the percentage of tests coming back positive has gradually declined, which Abbott has touted as a success.
Abbott has said that he would consider additional reopenings if the state saw a declining or stable positive rate and that a steady rate around 6% is an encouraging sign.
"The Texas positivity rate has trended down since April 13, our high water mark, and has trended down slightly since we began to slowly and safely open up the economy on May 1,” said John Wittman, an Abbott spokesman. “We haven’t seen any spikes [in the positivity rate], and our hospitalizations have remained steady."
The governor has said that state strike forces are prioritizing high-risk populations for testing, such as employees of meatpacking plants, nursing home residents and prison inmates, which could skew the positive rate higher. (The Texas Department of State Health Services does not count all cases from jails or prisons.)
The new status quo includes roughly 34 new virus deaths each day
State officials also see hope in the state’s hospitalization rate. Unlike other parts of the country such as New York, Texas has yet to see hospitals overwhelmed by a crush of coronavirus patients. The daily number of hospitalized coronavirus patients in Texas has remained relatively flat, under 2,000 per day.
Still, experts believe the state has yet to see a peak in its death rate.
On Thursday, Texas officials reported 58 new deaths from the coronavirus, the state’s highest daily death rate so far. More than 1,200 Texans have died from the virus, while the nation’s death toll is above 86,000.
Data delays make it difficult to measure the effect that Abbott’s reopening order has had since May 1, Fischer said. For example, a person sickened by the coronavirus may not show symptoms for several days, and it may take time to set up a testing appointment or get test results back.
“That’s just not enough time to really gauge what the result is,” Fischer said.
She said she hopes Abbott will postpone the second round of reopening until more data can be collected on the impacts of the initial phase. “That would be nice to see.”