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In March, Texas Gov. Greg Abbott let big-city mayors and county judges lead the way into lockdowns meant to slow the spread of the coronavirus.
Over the coming weeks, it’s unclear whether it will be Abbott or local officials who lead the way out. Abbott and San Antonio officials both have convened task forces to figure out how to reopen more businesses, but it’s not yet clear how a loosening of restrictions would work and what the timing might be.
It could all come to a head on April 27, which Abbott signaled in an April 17 press conference as a date to expect more details on “additional ways to open Texas.” The governor has convened an advisory group mostly made up of business representatives to work out the details. The group also includes five physicians to serve as medical advisors, led by John Hellerstedt, commissioner of the Texas Department of State Health Services (DSHS).
In San Antonio, Mayor Ron Nirenberg and Bexar County Judge Nelson Wolff have convened a nine-member task force of their own, made up entirely of doctors and public health professionals.
On Sunday, Nirenberg said the task force will present a “set of conditions and circumstances” the week of April 27 that outline how certain businesses and other entities can open.
Nirenberg drew a distinction between what types of restrictions will be loosened, which “are going to be in the governor’s hands,” and “how we go about opening,” which he called a local matter.
Wolff said it’s “extremely important” that the task force makes its recommendations around the time of Abbott’s April 27 announcement.
“We don’t know what the governor’s going to say, but I’m a betting man, and I bet that he’s going to open up a lot more,” Wolff said.
Two custom-built coronavirus models by University of Texas at San Antonio professors indicate that any increase in movement at this point would lead to a spike in coronavirus cases. Whether those cases lead to overcrowded hospitals and a shortage of ventilators is a different question.
All of this is unfolding under a set of guidelines issued by the Trump administration last week that says governors can begin to reopen states after seeing a downward trajectory of cases over a 14-day period.
Saying that Texas has “demonstrated that we can corral the coronavirus,” Abbott has already announced a series of initial reopening dates:
- Monday: Texas state parks reopen for day use.
- Friday: Business not listed as “essential services” that can offer pickup, delivery by mail, or doorstep delivery will be allowed to do so. In-person gatherings, bars, dining rooms, public events, and visiting nursing homes remain prohibited indefinitely.
- April 21 – May 8: Some medical procedures that aren’t deemed medically essential will be allowed, as long as they don’t deplete hospital capacity or personal protective equipment.
“Even more openings will be announced in May when it is determined that the infection rate continues to decline, that hospital capacity remains available, and when testing capacities are sufficient to detect and contain outbreaks of COVID-19,” Abbott said.
However, many have criticized Abbott for moving to loosen restrictions without a plan to ensure Texas doesn’t see a resurgence of the virus.
“Gov. Abbott’s response has almost directly mirrored President Trump’s response,” State Rep. Gene Wu (D-Houston) said in a media call following Abbott’s announcement. “Just as Trump is pushing this off on the states, Gov. Abbott is pushing all this off on the counties and on the cities.”
But for some Texas residents, the restrictions can’t be dropped fast enough. On Saturday, hundreds of protesters descended on the Texas Capitol demanding an end to state lockdowns. Most were not wearing masks or abiding by social distancing practices.
Health experts say there’s no question that lockdowns have been effective at slowing the spread. Also, Texas has not yet seen its health care systems overwhelmed by coronavirus cases.
As of Sunday, Bexar County had 555 available ventilators and 1,635 available hospital beds, according to the San Antonio Metropolitan Health District. Of the 191 people ever hospitalized for coronavirus in Bexar County, 97 have needed intensive care and 50 have needed a ventilator.
The question is whether lifting the lockdowns will cause a spike in hospitalizations, filling intensive care units and exhausting ventilator supplies over the coming weeks.
In San Antonio, one UTSA model predicts that even a 20 percent increase in mobility among Bexar County residents would more than double the number of active cases at the local peak in May from 700 to 1,500. Another UTSA model predicts a peak in July of more than 26,000 active cases will follow a 20 percent increase in mobility.
One reason the virus spreads so quickly is because of the high rates of people who can be contagious without showing symptoms. People are most contagious during the early phase of the disease, around the onset of symptoms among those who do show them, according to the World Health Organization.
Recent studies have shown that anywhere from 60 percent to more than 80 percent of younger, healthy populations who contract the virus don’t show any symptoms. Others might experience milder symptoms but choose not to seek treatment. Even if they do, their doctors might not recommend testing.
“The evidence keeps mounting: asymptomatics are the driver for this disease,” said Juan Gutierrez, an infectious disease modeler and chair of UTSA’s mathematics department who led a team that developed one of the San Antonio models.
In an interview last week, Gutierrez said that until a vaccine is widespread, the only way to combat the virus on a large scale is to limit social or at least physical contact.
“If we don’t do that, we will see very large numbers of people hitting the hospital very quickly,” he said.
One way to deal with this would be to dramatically expand testing so that those who are positive know so and can self-quarantine. At the national level, the U.S. has administered around 150,000 tests per day. Researchers at the Harvard Global Health Institute recently wrote that the daily number should be “at a minimum, 500,000, though we likely need many more.”
Even countries that have had much higher rates of testing have still seen resurgences of the virus after lifting restrictions. For example, after seeing new cases decline for months, Hong Kong, Taiwan, and Singapore all saw recent outbreaks that officials in those areas have tied to travel from abroad.
Pressed by a reporter on April 17 about how specifically Texas would expand testing, Abbott only said that additional testing would come from the “private sector” before deferring to Hellerstedt, the DSHS commissioner.
“We’re seeing very encouraging signs that more and more of those testing kits are on the way,” Hellerstedt said. “More testing kits are actually going to be able to enable us to maximize the use of the laboratory-based testing that we have.”
This lack of detail in part prompted U.S. Rep. Joaquin Castro (D-San Antonio) to say that the governor “at this point has become a ribbon-cutter.” In a media call following Abbott’s press conference, Castro called on Abbott to use the roughly $12 billion in Texas’ Rainy Day Fund for coronavirus response efforts.
“What is the governor bringing to the table, except passing through federal dollars?” Castro said. “He’s going to control the federal dollars and dole them out to the local governments, but he wants the local governments to make the most painful of his decisions. At that point, you’re not leading the state.”
San Antonio has been in a better position to ramp up testing than other cities around the U.S. The city was one of the first to deal with the coronavirus after evacuees from Wuhan, China, and affected cruise ships were quarantined at Joint Base San Antonio-Lackland in February.
As of April 19, roughly 11,600 tests have been administered to Bexar County residents, according to Metro Health. While local officials have worked to expand testing, they candidly acknowledge that not enough people here are still being tested.
“We are in the same boat in terms of testing capacity as most any other city in the state of Texas,” Nirenberg said Sunday. “We all need to see more testing.”