Texas reopens malls and restaurants. Why you won’t see many public health experts there
Texas Gov. Greg Abbott is partially reopening Texas on Friday. The stay at home order, he said Monday, “has done its job.”
Texas has just over 25,000 coronavirus cases, a number that has been increasing by about 700 to 900 per day in the last week. About 660 people have died, a number that continues to increase but by less per day than earlier this month.
Whether reopening is the right call, or whether Texas experiences a new wave of infections and death, will not become apparent for weeks. But three public health experts talked with the Star-Telegram shortly after Abbott’s announcement and expressed skepticism about the state’s readiness to reopen. They also offered tips for how people and businesses can create a safe environment. Here’s a rundown of the various pieces of Abbott’s plan, as well as his justifications for reopening, and the experts’ accompanying opinions.
And for the record, they don’t feel comfortable venturing out to a shopping mall or restaurant this weekend: “I can understand from the economic perspective why a governor would want to do this,” said Neale Chumbler, dean of the College of Health and Public Service at the University of North Texas. “But I will from a public health perspective wait a little bit until I see the cases go more on a downward spiral in terms of the infected population in Texas.”
Reopening plans and masks
On Friday, restaurants, movie theaters, malls and retail stores can reopen. They must limit their capacity to 25% of their full occupancy. Libraries, museums and single-person offices may also reopen but not bars, gyms, or hair and nail salons.
Chumbler said the May 1 segment of the gradual reopening plan could be safe — provided people wear masks over their faces in public. The state is recommending but not requiring masks. And an executive order from the governor prevents Harris County, the only county with a mask mandate, from punishing people who fail to comply.
“Because we have limited testing we have a lot of people who are what’s called silent carriers of the disease. I could feel very healthy and want to go to a shopping mall to shop or a store to shop and I could accidentally infect people if I didn’t have my mask on,” Chumbler said. “It’s more from a proactive public health standpoint. You’re limiting the spread of the germs that way.”
Benjamin Neuman, a virologist and the head of the biology department at Texas A&M-Texarkana, added: “There is probably a way to do this safely if everyone in these shops and all the customers is going to wear a mask. But if they are just going to open and not actually police it, I don’t think the social pressure is strong enough in Texas that it would happen safely.”
Neuman called the reopening a political decision not based on science. “The models all predict the more you social distance the faster it goes extinct and the shorter we social distance the longer it takes to happen,” he said. “It will stretch out the curve. I think what the governor is trying to do is a trade-off.”
For people who decide to visit the reopened establishments, Diana Cervantes, a professor of biostatistics and epidemiology at UNT Health Science Center, cautioned them to make sure the businesses follow social distancing and disinfecting guidelines and that they continue washing their hands regularly. And don’t expect to run into Cervantes out and about. “I’m not making any restaurant reservations for Friday,” she said.
Abbott and his panel of medical experts plan to study data before further reopening the state. If the spread of COVID-19 is contained, they may let restaurants, theaters and retail stores serve 50% of their capacity on May 18, and open other types of businesses. The timing of Phase 2 concerned Cervantes, who said two weeks of data gathering may not be enough time to evaluate the effects of the limited reopening, or to get the thousands of people needed to ensure a containment effort up to speed, particularly with regards to testing and contact tracing.
Testing and contact tracing
Yes, it’s time to talk about testing again. So much of Texas’ readiness to reopen still comes down to testing, which allows public health officials to better determine where outbreaks are taking place and how to control them. Texas has performed fewer coronavirus tests per capita than almost any other state. And the capacity Abbott said Texas would reach by early May, 25,000 tests per day, is barely half of the daily testing rate Harvard researchers have recommended the state needs.
“The numbers are improving but we’re still not to the level where we need to be to think we’ve gotten over the hump so to speak with this pandemic,” Chumbler said. “We might have some spiked cases over the next few weeks because more individuals will be out shopping and eating at restaurants and going to movie theaters. I think we still have a lot of work to do with the testing.”
Some 1,200 people have been working with the state on contact tracing, according to Abbott, and the number is supposed to increase to 4,000 within the coming weeks, allowing the state to “box in” the disease. Contact tracing involves reaching out to everyone an infected person has been in contact with since contracting the disease. Cervantes said at least 80% of a person’s contacts need to be reached by public health officials and told to isolate.
Neuman said the Texas A&M system was asked to help with the state’s contact tracing, and he expects other state universities to join the effort. Even with a mix of professionals and university volunteers working on contact tracing and testing capabilities increasing, he said it would’ve been more prudent to wait for the additional capacity to be functioning and then reopen the state.
“Paired with that aggression we can start easing back on restrictions but easing restrictions while waiting for those other things to kick in seems like it’s going to have negative effects,” he said. “It’s not going to be a smooth reopening and, if it’s not going to be a smooth reopening, people may demand the economy shut down.”
Cervantes was unsure the quantity of 4,000 contact tracers would be as important as the quality. She has trained people in contact tracing: It takes time to master the skill of finding and speaking with people who may potentially have a disease.“The public health department, they have contact tracers and volunteers and temps doing this, and this is a whole new job for them. If you’ve done contact tracing you know what it’s like to deal with people and how to communicate with them. It just takes a little time to be able to get that information from them,” Cervantes said. “Even though you may have capacity and numbers, are they trained effectively?”
Abbott said testing wasn’t the only metric he and his team used to plan the state’s reopening. He pointed to Texas’ low death rate and abundance of hospital beds as reasons for why he was confident in his new executive orders.
Cervantes said the state will need to keep looking at a number of factors: the hospitalization rate and the testing rate but also whether the percentage of people who test positive are declining and the number of people who show up at health care facilities with influenza-like illnesses.
Continued precautions at clinics and hospitals
Abbott emphasized that Texans over 65 should stay at home and included recommendations for care facilities to best limit the spread of coronavirus. He also said hospitals must continue to reserve at least 15% of their capacity for possible coronavirus patients.
These restrictions and recommendations pleased public health officials and hospitals. “This is a prudent and careful move by Governor Abbott,” said David C. Fleeger, president of the Texas Medical Association, in a statement. “Our hospitals were prepared for a large surge of COVID-19 patients. Thanks to most Texans abiding by social distancing requirements, we were able to avoid that surge. However, we must expand significantly our testing capacity, our ability to monitor new cases of COVID-19, and our ability to trace their contacts to prevent a rapid resurgence of this epidemic in Texas.”
