Coronavirus cases on the rise in Texas. Public response will determine where it’s headed
Daily COVID-19 cases and hospitalizations have been hitting record levels in Texas. While the increase in cases wasn’t entirely unexpected, public health experts say that key metrics indicate the numbers could be at a critical juncture.
The number of hospitalized COVID-19 patients hit all-time highs Monday, Tuesday and Wednesday, and on Friday it reached a record of 2,166 patients, Texas Department of State Health Services data showed. On Wednesday, Texas also reported a single-day high of 2,504 new cases.
On Thursday, Tarrant County reported 225 new cases — its third-highest single-day total. And after declining over the course of May, hospitalizations have begun to rise in the Fort Worth area as well.
“We are indeed at a very delicate equilibrium in the sense that it can tilt in the worse direction quickly if we are not cautious enough. But we are not there yet,” said Rajesh Nandy, an associate professor of biostatistics and epidemiology in the UNT Health Science Center’s School of Public Health.
Nandy has been closely tracking Tarrant County’s data on hospitalizations, cases and mobility over the course of the pandemic, and he said that it’s too soon to say whether the uptick is the beginning of a surge in cases. It will be important to monitor levels to see if they continue to rise and lead to a consistent pattern over the next week, Nandy said.
“We don’t know if this is the tip of the iceberg or the peak of the iceberg, but there’s more of the iceberg for sure,” said 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.
Inching upward
Both state leaders and virologists warned that as businesses reopen and Texans begin to venture out more, a rise in cases was likely to occur. Gov. Greg Abbott allowed the state’s stay-at-home order to expire on May 1, and since then the state has continued with its reopening process — with virtually all businesses allowed to operate at at least 50% capacity.
Neuman said that the recent increase in cases is likely, in part, due to people gathering to celebrate Memorial Day weekend, in addition to increased activity as more people venture out.
The infection rate — how many cases are positive out of the number tested — has been trending upward since late May. The state’s seven-day average infection rate was at 4.27% on May 26. It was at 7.05% on Thursday.
“It does demonstrate that the social distancing efforts did make a difference. So we’re seeing the result of having more personal interactions,” said Marilyn Felkner, a clinical assistant professor at the University of Texas at Austin’s public health program.
And we likely haven’t seen the full effects of hundreds gathering daily across the state to protest police brutality, experts said, since it takes about two weeks from any particular event for infections to arise. Public health officials in Austin have recommended all residents who participated in protests get tested for COVID-19, even if they’re not showing symptoms.
“Anybody that’s going to a restaurant, anybody that is outside at all without a mask, is basically in the same boat and should be getting tested,” Neuman said.
In Tarrant County, residents have begun to visit more stores and restaurants than they did earlier in the pandemic, Nandy said.
Based on Google’s community mobility reports, travel to stores, restaurants and recreation locations in Tarrant County was at about 14% below pre-pandemic levels on June 5. That figure hit 50% at times in late March and April, Nandy said.
Officials have attributed a rise in cases to an increase in testing, especially mass testing in hot spots, like nursing homes, meat packing plants and prisons. The state has yet to consistently meet its goal of 30,000 tests a day.
Of the single-day high in cases reported Wednesday, 21.4% came from Jefferson County — which may be related to Texas Department of Criminal Justice testing, Chris Van Deusen, a spokesman for DSHS, wrote in an email Wednesday.
Hospitalizations have also been on the rise, mostly in urban areas, Van Deusen said, noting that the Houston area has seen a steady increase, and that in the last few days the Metroplex saw an increase after being relatively stable.
COVID-19 Hospitalizations over Time
Coronavirus daily hospitalization counts in Texas and the larger Trauma Service Areas, beginning April 8, 2020. Data provided by Texas Health and Human Services.
In May, Tarrant County saw some of its highest levels of hospitalizations of COVID-19 patients, with more than 230 being reported some days. After declining in late May and leveling off in early June, the number has started to increase, with over 200 COVID-19 patients hospitalized as of Thursday.
But that data may not be the full picture. Hospitalizations on the county’s dashboard only reflect information reported in the last 24 hours — which may not include every hospital in the area. Hospitals that don’t report aren’t included that day.
Richard Hill, a spokesman for Tarrant County’s Public Health Department, wrote in an email Thursday that the department would not release how many hospitals had reported each day even though that would help put the numbers into context.
“So the data may not show the full picture,” Hill wrote. “But even though the absolute numbers may not be complete, the trend shown on that data is reliable, as on average about 84 percent of the hospitals are actually reporting this information on a routine basis.”
Despite reaching record hospitalizations statewide, officials emphasized there are still over 14,000 hospital beds, over 1,500 intensive care unit beds and more than 5,800 ventilators available. Van Deusen noted that hospitals can increase their capacity if needed, in addition to setting up pop-up facilities. Abbott has also pointed to reinstating restrictions, like temporary bans on elective medical procedures, to increase bed capacity.
Neuman warned that waiting on hospitalizations to increase shouldn’t be the only guiding factor.
“By the time you see a rise in hospitalizations, it’s too late to do anything about it,” Neuman said. “Because you’ve got two weeks more potential hospitalizations coming your way that are already infected before any changes you have will actually work its way through the system.”
Restrictions may have to return if hospital capacity is in danger of being exceeded, Felkner said.
How to keep yourself safe
As numbers rise, Texas is still moving forward with the reopening process. Restaurants are allowed to increase their capacity to 75% after the third phase of reopenings went into effect.
Citing the time it takes for cases to double, the infection rate and available hospital beds, Abbott told KYTX-TV in Tyler on Friday afternoon, that there’s “no real need for us to ratchet back on the opening up of business.”
And ultimately, he said, it’s up to Texans to decide whether they will choose to venture out or stay home.
“It’s incumbent upon every individual in Texas to make sure that they are doing all they can not to either get or transmit COVID-19 as we do open up the economy,” Abbott said. “You have your own control upon whether or not you will be getting this disease.”
A recent study worked on by researchers from Texas A&M University and UT Austin suggests that wearing a face mask is one of the most effective ways to prevent the transmission of COVID-19 — something you can’t do while eating in a restaurant or drinking at a bar.
The Centers for Disease Control and Prevention has said it’s riskier to be in indoor spaces where it’s harder to stay apart and there’s less ventilation. Neuman recommended sticking to curbside or to-go. That way people can avoid riskier settings, while still supporting the economy and local businesses.
As summer gets underway and people mull whether to take vacations, Felkner recommended choosing situations in which you will continue to have control over social distancing — such as a short road trip with members of your household.
“But if you’re going to, for example, a park where you might be in a line or you might be inadvertently in some kind of activity where you couldn’t socially distance, well you’d want to think twice about that,” Felkner said.
The most important numbers you should be paying attention to are your local county data, Felkner said, and letting the level of spread locally inform your day-to-day decisions.
“We do have to accept a level of responsibility and say, for example, ‘No matter what the governor has decided about opening business — and rightfully so that that’s good for the economy — my personal decision is that I’m not going to be out and about as business as usual,” Felkner said. “’If other people need to make that decision, they may be basing it on other considerations, but here’s my decision.’”
This story was originally published June 12, 2020 at 4:08 PM.
