Infectious disease experts fear coronavirus will spread as more Texas businesses reopen
Salons and barbershops have joined the list of Texas businesses that can partially reopen their doors to in-person customers. But some public health experts worry it’s too soon.
Epidemiologists said they are encouraged Gov. Greg Abbott is assessing data and consulting experts to inform a gradual reopening of Texas’ economy. But they cautioned that for an incremental approach to be effective, sufficient time is needed between each phase to assess its effects on the spread of the virus.
Abbott’s announcement Tuesday that barbershops and hair, nail, tanning and cosmetology salons may reopen provided they follow a strict set of rules came four days after the first phase of businesses, including malls and restaurants, were permitted to begin operating in-person at a limited capacity.
His decision came sooner than anticipated, as he had previously pointed to May 18 as a possible date for a second phase of reopenings.
During a press conference Tuesday, Abbott defended his decision to move forward rather than waiting to assess two weeks of data. He pointed to approval he has received from the medical experts advising him, in addition to Dr. Deborah Birx, the White House coronavirus task force coordinator.
“How do I know that we are on an adequate trajectory and this plan fits within that trajectory? Dr. Birx herself has said it. All these other doctors have said it,” Abbott said at a press conference from the Texas Capitol. “And so, there’s always going to be a difference of opinion among doctors.”
Catherine Troisi, an infectious disease epidemiologist at the UTHealth School of Public Health in Houston, said there has not been enough time to evaluate how many new cases might be cropping up as a result of the first set of businesses being allowed to reopen.
The Centers for Disease Control and Prevention has said it could take as long as two weeks for COVID-19 symptoms to appear after someone is exposed to the virus. And from there, they still need to go through the steps of getting tested and receiving their results.
“It’s that second week of infection that people seem to be having more serious consequences. So I would suggest you’d want to wait at least three weeks,” Troisi said, “but certainly two — not one.”
Benjamin Neuman, the head of Texas A&M University-Texarkana’s biology department and a virologist who has worked with coronaviruses for over two decades, said that while he understands Abbott is trying to strike a balance, easing restrictions will likely contribute to an increase in the virus’ spread.
“It seems as though this is going to be better for the coronavirus than for the people,” Neuman said.
In the past, Abbott has acknowledged that relaxing restrictions could lead to a resurgence in cases, but he has stressed that the state is prepared to quickly respond to outbreaks. He unveiled the formation of “surge response teams” earlier this week, the newest tool that he said will be able to tackle flareups across the state, such as in meat packing plants, jails and senior centers.
Abbott allowed the statewide stay-at-home order to expire last week saying that it “has done its job to slow the growth of COVID-19.” But he has said that if outbreaks arise, he could reinstate restrictions in certain areas.
Rodney Rohde, an epidemiologist and associate dean for research for Texas State University’s College of Health Professions, said that the state needs to have all available tools at its disposal — including reintroducing stay-at-home orders if needed.
“Because we still don’t have a vaccine in that toolbox. And we still don’t have effective antivirals in that toolbox,” Rohde said. “Really all we have is our public health education and prevention methods and precautionary methods. And that’s what we’re relying on.”
The day the first set of “nonessential” businesses were allowed to partially reopen came just after Texas reported a single-day high of 50 COVID-19 related deaths and 1,033 new cases. As of Friday afternoon, the Texas Department of State Health Services reported 1,004 total fatalities across the state.
Abbott has said it’s expected that more cases will be reported as testing increases, and he has emphasized that he’s focusing on downward trends of the rates of hospitalizations and positive cases.
And while both rates have declined since April, experts say a dramatic increase in testing is still needed to ensure they can be meaningfully interpreted.
“It’s hard to say what it means if you’re not testing everybody who should be tested,” Troisi said.
Abbott has set a goal of at least 25,000 tests per day. While testing has increased since the start of the outbreak, the state has not yet consistently hit that daily goal — with May 2 the only day the state has surpassed it at 28,873 tests, according to the Houston Chronicle’s tracking of tests. Texas still ranks near the bottom nationwide in per capita testing.
And it’s important testing is targeted in the right areas. Vulnerable populations and essential workers at greater risk of contracting COVID-19, like grocery store cashiers and bus drivers, need to be among those receiving tests, Troisi said.
“If you were to increase testing and start testing people that you know are definitely not positive, you can push down the positive rate,” Neuman said. “But that doesn’t mean the infection is going away or that anybody is getting better, it just means you’re looking in the wrong place.”
At the start of the outbreak, testing was initially limited to those who met strict criteria — with some Dallas-Fort Worth residents unable to get tested despite showing symptoms. Some cities, like Houston, have begun to expand testing to people who aren’t exhibiting symptoms, and Birx stressed during Abbott’s visit to the White House on Thursday that there is a need to identify and test asymptotic cases.
And coupled with an increase in testing is a need for a robust force of contract tracers — people who reach out to everyone an infected person has been in contact with since contracting the disease.
Last week, Abbott unveiled a phased plan aimed at expanding the state’s contract tracing efforts. The third phase is set to begin Monday, and aims to have 4,000 people mobilized to assist in its efforts.
And while it’s encouraging Texas is taking those steps, Neuman said it would have been preferable to have that infrastructure in place before restrictions were relaxed.
“We’re going up on the tightrope, because the circus is on and because the people have showed up, but we don’t have the net built yet to catch anybody,” Neuman said. “And so this is rather risky.”
Rohde stressed that there is still much that’s unknown about the virus and how it spreads, and that there may be a need for increased restrictions down the road.
“It’s just not something that’s going to be a black and white answer,” Rohde said. “And I know that’s frustrating.”
As the state begins to partially reopen, public health experts echoed Abbott’s calls for Texans to continue to follow best practices and social distancing guidelines, like wearing face masks and keeping six feet apart.
“Every time you limit your exposure, it’s not just about you. You’re helping the general community because you’re giving that virus one less person to jump to,” Rohde said.
And measures like those will help ensure the virus can ultimately be corralled, Neuman said.
“I just don’t think there’s an acceptable amount of coronavirus spread that we can tolerate if we’re trying to get rid of the virus,” Neuman said. “And I think that’s still a realistic goal and a goal we should pursue.”
This story was originally published May 8, 2020 at 12:36 PM.
