Coronavirus cases rise in Fort Worth, yet limits are relaxed. How does that make sense?
Each day when Tarrant County releases new coronavirus data, it prompts questions and speculation, often leading to heated debates on social media: There were more new cases today than yesterday, so that must mean we’re opening too early. But we’re also testing more, so of course we’ll see more positives. Our hospitals aren’t overwhelmed, so why can’t I go to the salon?
A statement by Vinny Taneja, Tarrant County’s health department leader, on Wednesday illustrated what seems like a contradiction when he said the county has “flattened the curve” but in the same sentence added cases of novel coronavirus “are still growing.”
Doctors and public health officials aren’t looking at the headline-grabbing numbers like new cases and deaths. Instead, they’re focused on the data showing when a test was taken.
Experts agree that even though the hospitals are not overwhelmed it doesn’t mean that the coronavirus pandemic isn’t as bad as projected or that we can resume life as normal. It means that social distancing is working and we should continue to stay home.
“If we had not stayed home and stayed away from interactions that we usually do, there is a very high probability that our hospitals would have been overwhelmed,” said Bijal Balasubramanian, an epidemiologist and regional dean of the UTHealth School of Public Health in Dallas. “That was the exact reason for these restrictions. It’s a little counterintuitive to say nothing happened, because that’s what prevention is all about.”
The Star-Telegram asked four epidemiologists what they saw in the coronavirus data from Tarrant County and its public hospital.
BEHIND THE STORY
MOREHow we did this story
The Fort Worth Star-Telegram sent COVID-19 data from the Tarrant County Public Health Department and John Peter Smith Hospital to four state epidemiologists. The newspaper asked them to interpret the data and explain what it means in terms of reopening the state.
What is flattening the curve and has it happened?
Taneja’s statement was confusing. How can the curve be flat if the cases continue to grow?
That day, 61 cases were added to the county’s total count in addition to three deaths and 205 hospitalizations. On Friday, the numbers rose again: 142 new cases and 225 hospitalizations, up from 205.
On Friday, Taneja explained why it makes sense that the curve can be flattened as cases increase.
“A curve is never flat, but flattening means that instead of getting a very large spike and suddenly you have hundreds of cases occurring, it’s instead more of a gradual and gentle slope,” he said. “We have had a gentle increase of cases, relative to a lot of places, like New York. When you look at that and look at our data you’ll see that we bent or flattened the curve.”
Texas began to flatten the curve in the last few days, Balasubramanian said.
“What I’m not sure about, based on the recent numbers, is whether we’re starting to see a bit of an uptick in the last few days in some regions,” she said “I’m still trying to make sense of what’s going on to have that uptick.”
Both Tarrant and Dallas counties reported their highest daily case number in the last week. It’s possible, Balasubramanian said, some cases could be attributed to increased interactions on Easter Sunday.
What data should I pay attention to?
To get a proper picture of how the virus is spreading across Tarrant County, people need to look beyond the number of new cases a day and also analyze the percentage of positive tests, the number of daily hospitalizations, and the amount of tests collected per day, said Diana Cervantes, director of the UNT Health Science Center’s epidemiology program.
“You don’t want to just look at one day and say, ‘Oh that was bad,’” she said. “It’s good to keep it as a big picture time frame. In the last week or two what has generally been the trend? Are we seeing things leveling out?”
Every day, more and more people are being tested for the novel coronavirus. New testing sites recently opened in the county, with a capacity of about 400 tests per day, Taneja said. He expects those testing sites will be able to increase their capacity later.
Cervantes said this is why it’s important to look at the percentage of cases that are positive, not just the daily total. However, that data has been hard to collect and isn’t readily available because private labs don’t always report their negative tests to the health department.
There have been 315,000 tests conducted in Texas (one of the lowest rates in the country) with 8% coming back positive. Taneja said this number has decreased with more testing, which is a good sign.
Of the tests done at John Peter Smith Hospital, 20% came back positive.
“The number of cases reported a day is giving you an idea of the burden on the health department,” Cervantes said. “If you’re getting a hundred plus new cases a day, imagine how hard it is to do contact tracing on all of those cases.”
The county health department has been releasing data every afternoon at coronavirus.tarrantcounty.com. Instead of looking at daily totals, Taneja suggests people look at the specimen collection date, which is a more accurate reflection of cases because it represents when a test was collected by the health department.
“There’s going to be a lag in the daily total,” he said, explaining that someone might not get tested for days after they feel symptoms. Then there’s a lag in the test results, another lag in getting the results to the department and then a delay to get them online.
Someone’s results might appear as a new case when she was actually sick a week earlier.
On Wednesday, seven test results were reported to the county — one of the lowest rates since early March. The most tests were collected on April 20 with 112.
Should I continue to stay home?
Murray Cote, an associate professor at Texas A&M’s School of Public Health, strongly encourages the public to continue social distancing and staying home.
“When we don’t see the numbers that were initially forecast in late February, early March that were very apocalyptic, if you will — this is a good sign,” he said.
Taneja said the plan to reopen Texas needs to be treated with caution.
“It’s not a mandate to go rejoice in the streets and we need to reiterate that,” he said, adding that people should only go out if they absolutely need to. “I would highly advise that everyone should wear a mask ... I could be a healthy person in the early stages of shedding the virus and not know it. If I’m standing in line next to someone who has cancer, I might be safe, but that person might get ill and die. Why would I not care about that? We should all care about that.”
Gov. Greg Abbottsaid he’ll re-evaluate the restrictions in two weeks.
The experts differed on whether two weeks was enough time to see the results of lifting restrictions. Cervantes had concerns.
“You won’t see a huge increase all of a sudden,” she said. “You need more time to assess what’s really happening in those first days.”
It will take about seven to 10 days for a positive case to show in any data set, making it possible that if someone gets sick during the week of May 10, it might not be counted until after the governor has reviewed the data.
Balasubramanian said she has noticed that people began to leave their homes before the restrictions were lifted.
“I think that people have been indoors for a long time and have been practicing social distancing, which because of this, we started seeing some of the flattening, the cases aren’t doubling as fast,” she said. “I don’t know if people are feeling more comfortable because the hospitals aren’t overwhelmed or if they’re just tired of being indoors.”
She said the number of tests taken between May 15 and May 18 will be the best indicator on how these lifted restrictions affected the curve.
More people are being hospitalized. What does that mean?
At 10 a.m. each day, JPS releases its COVID-19 data to the public, which includes the number of daily hospitalizations, the overall count of how many people have died, and how many tests it has conducted.
The hospital has reported an increase of patients each day since April 25. On Friday, it was treating 69 people. The lowest number of reported hospitalizations was on April 7. The hospital started publicizing its data on April 6.
The number of hospitalizations gives the public an idea of only how many serious cases there have been, said Tiffany Radcliff, the associate dean at Texas A&M’s School of Public Health.
JPS had treated 200 patients for the coronavirus as of April 22.
“The trend of hospitalizations has been consistent over the last few weeks,” Radcliff said, analyzing the percentage of positive cases that led to hospitalization, which was its highest on April 29 at 46%.
She said that while the number hasn’t dropped, the fact that it hasn’t increased tremendously is a good sign.
“Fort Worth and Tarrant County have done a really good job at doing the things that are necessary in not overwhelming the health system,” she said.
This story was originally published May 3, 2020 at 8:00 AM.
