Rising cases and inadequate tracing put Texas at risk when reopening

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Texas has failed to meet key criteria designed to guide the state’s reopening, even as Gov. Greg Abbott lobbies to lift more public health restrictions, according to an analysis in the Houston Chronicle.

Mark McClellan, one of the chief medical advisers of Abbott’s strike force and a former Food and Drug Administration commissioner, listed in late March the key criteria for canceling the reopening, including the inability to properly trace the source of new infections, a sustained increase in cases for five days or patients with coronavirus overwhelming the hospital system.

Chronicle analysis of public data shows the state is in good shape in terms of hospital beds, but the number of new cases continues to rise. Since April 24, when Abbott began rolling back restrictions put in place to control the virus, Texas has seen a 55% increase in new cases per day.

And many major cities, including Houston, still lack the manpower to trace the source of all new infections.

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Abbott also placed great emphasis on the declining rate of positive tests, which fell to 5.2% as the state began offering testing to people without symptoms. And he cited the relatively low death toll in Texas, around 4.7 per 100,000, which ranks 41st nationally.

As the state enters phase two of reopening, Abbott said every decision has been backed by its team of medical experts.

“This commitment to data, to physicians, underpins today’s announcement,” he said.

Still, some experts say a more robust system is needed to support the economy as it reopens.

“I think we need to dramatically increase the number of tests in the workplace,” said Dr Peter Hotez, vaccine expert at Baylor College of Medicine. “A second problem is that our ability to trace contacts is incredibly limited.”

Here’s why benchmarks are useful, the limits of those goals, and where Texas stands to achieve them as Abbott plans to open up the state further:

Benchmark # 1: Sustained reduction in new cases for at least 14 days

Reasoning:

A sustained reduction in new cases would show that the virus is on the way to being contained. The decrease in the number of new cases means it is easier to track new hot spots and for hospitals to treat patients safely. Stricter restrictions on public travel could be relaxed.

Limits:

As testing increases, the number of new cases is also expected to increase. New epidemics can occur, causing an increase in the number of new cases after sustained decreases. Since April 24, Texas has nearly tripled its test rate per day from 10,430 to 28,188.

Abbott instead highlighted the positive test rate as the key metric guiding its decisions. The positive test rate is the number of confirmed positives divided by the total number of tests whose results have been returned to the state.

“Just taking the raw number of new cases doesn’t tell the whole story, you just have to look at the positivity rate,” Abbott spokesman John Wittman said in response to questions sent by mail. electronic.

Where are we :

Texas has never seen a 14-day reduction in new cases. A three-day drop in new cases has occurred twice so far. From April 24 to May 3, Texas experienced 10 straight days of increases in new cases per day. The report co-authored by Abbott’s advisor argued for a return to restrictions if new cases increased for five days or more.

According to data provided by the state, Texas has been trending downward for the past 14 days in the rate of positive tests. Positive test rate down to 4.48 percent, 19th lowest in US


Benchmark # 2: The ability to safely treat all patients requiring hospitalization

Reasoning:

Hospital space, staff and equipment are limited resources. If the virus spreads uncontrollably and a large number of patients require hospitalization, hospitals can be overrun and patients can suffer or die from lack of resources.

Limits:

Hospital resources vary by region, so a statewide average may not accurately describe the situation in more rural counties.

And official Texas hospitalization statistics only include confirmed cases. They do not include patients who have not been tested for COVID-19 or whose test results are pending.

Suspected coronavirus cases accounted for nearly 30% of hospitalizations in the Houston area, where 566 people were hospitalized on Sunday with confirmed coronavirus test results, and another 223 patients were suspected of having the disease.

Data on the state’s available beds rose sharply from early March to early May, but that was due to hospitals starting to report their numbers to the state, according to Darrell Pile of the South East Texas Regional Advisory Committee. , one of the agencies responsible for collecting data on hospital resources.

Where are we :

Overall, the state is nowhere near filling its hospital and intensive care beds or running out of available ventilators.

Pile said hospitals in the Houston area have enough beds, intensive care unit beds and ventilators to accommodate new coronavirus patients.

Benchmark # 3: The ability to test all people with symptoms of COVID 19 (30,000 tests per day on average)

Reasoning:

Experts say widespread testing is needed to determine how far the virus has spread and where hot spots may have occurred.

If there is a reduction in new cases even with an increase in testing, it shows that the virus is not spreading uncontrollably and gives policymakers a clearer picture of what to do next.

Limits:

The most common swab tests have a false negative rate of 30%. Reliable antibody tests are still under development. It is always difficult to get enough testing and analysis supplies to allow testing for anyone who wants it.

Even though the state has the capacity to systematically test 30,000 or more people per day, mixed messages from all levels of government could lead to confusion as to whether someone should get tested, Dr Umair Shah said. , executive director of Harris County Public Health.

Additionally, lack of information and mental fatigue regarding the virus are other reasons people would not go for testing, he said.

Where are we :

The testing capacity has increased steadily and has reached 30,000 tests per day three times so far. May 13 marked the first time the state has met and exceeded its benchmark, receiving test results for more than 49,000 people. The weekly average reached 28,000 tests.

Abbott also announced on May 11 that state agencies would test all residents and nursing home staff for the virus, which means the state will need to test around 230,000 people.

Texas rose to 41st in the nation in tests per 100,000 people, from the second worst in the nation on April 11.

Benchmark # 4: Ability to follow confirmed cases and their contacts (the objective is 4000 tracers)

Reasoning:

Identifying and tracking everyone who has been in contact with patients with COVID-19 allows the government to have a more targeted response to the pandemic.

Instead of widespread closures, specific areas of a community could be closed and resources could be deployed more efficiently.

Limits:

This practice – tracking and monitoring the contacts of an infected person to limit the spread of the disease – is called contact tracing. It is effective but difficult to do correctly when the number of cases is high.

For example, a new case in South Korea came in contact with more than 5,000 people at local nightclubs around the country, according to multiple media. Contact tracers could only reach about half of this group in an attempt to define the extent of the hot spot.

Where are we :

Abbott’s office said the state has deployed more than 2,000 tracers and expects to meet its target of 4,000 by the end of May. The National Association of County and City Health Officials estimates that 30 workers per 100,000 would meet the need for contact tracing during the COVID-19 pandemic. That would mean a tally of 7,700 plotters in Texas, a far cry from Governor Abbott’s 4,000 targets.

Despite almost double the number of contact tracers in Harris County at the start of the outbreak, public health officials were unable to track the spread of the coronavirus. They gave up contact tracing for every COVID-19 case in early April, instead focusing on populations at risk, such as nursing homes and healthcare workers.

They hope to revive the practice by the end of this month, when 300 contact tracers will be added to the county ranks.

Houston area city officials plan to add even more, bringing the total to 600.

Benchmark # 5: Death rate / mortality due to the virus

Reasoning:

The percentage of confirmed coronavirus cases ending in death shows the highest cost of the pandemic. A low death rate would indicate that the virus is not killing as many people per number of cases.

Limits:

Public health experts believe coronavirus deaths are likely to be underestimated. This may be because people die from the virus without first being tested.

Where are we :

Confirmed deaths from the virus remained low in Texas, compared to other states, at 4.65 deaths per 100,000. About 2.8% of confirmed cases in Texas have died.

“Texas has one of the lowest death rates in the country,” Wittman said.

Alex Stuckey and John Tedesco contributed to this report.

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