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Bioscience-Medicine

Did Texas Reopen Too Soon?

Visitors walk along the River Walk in San Antonio, Monday, June 15, 2020, in San Antonio. Many restaurants and business that have been closed due to the COVID-19 pandemic are reopened.
AP Photo | Eric Gay
Visitors walk along the River Walk in San Antonio, Monday, June 15, 2020, in San Antonio. Many restaurants and business that have been closed due to the COVID-19 pandemic are reopened.

In mid-April — about a month after Texas Gov. Greg Abbot declared a statewide disaster in response to COVID-19 — frustration was growing in Austin.

Outside of the state capitol building, protesters complained about stay-at-home orders.

“I’m sick of being told if I go outside and gather in a group of 10 or more that I’m gonna kill somebody or get killed,” one protester told KVUE News.

Soon after, Abbott made the decision to reopen. 

“We’ve shown that we can both continue our efforts to contain the coronavirus, while also adopting safe standards that will allow us to begin the process of reopening business in Texas,” he announced on April 17.

After that announcement, Phase 1 of the governor’s plan to reopen Texas kicked off, and every two weeks a new phase began. 

The beaches opened up at Port Aransas on May 1. Texas had almost 30,000 positive cases at the time. By Memorial Day weekend, the number of cases was over 50,000 and Texas kept reopening.

This past week saw record numbers of new cases. Those numbers aren’t just due to the increase in testing — because hospitalizations for COVID-19 are increasing, too.

Made with Flourish

Did Texas reopen too soon?

Tourists from big cities like Dallas and Houston often visit tiny Fredericksburg in the Texas Hill Country to get away from the hustle and bustle — and, now, the fear of COVID-19. 

Eric Lindberg from Dallas noticed a difference in the way people in Fredericksburg think about COVID-19 compared to people in the big cities. 

“There's a lot of people living with total tragedy on their face. And there's a lot of people in the United States that are living in places where there's nobody that's affected by it whatsoever,” he said. 

Fredericksburg has only 15 confirmed cases as of June 19. But many visitors come from COVID-19 hot spots.

Most tourists don't wear masks, and social distancing is difficult on the crowded sidewalk.
Credit Dominic Anthony Walsh | Texas Public Radio
Most tourists don't wear masks, and social distancing is difficult on the crowded sidewalk.

In Texas communities that haven’t borne the brunt of the virus, some people feel like now is the right time to relax social distancing and get back to normal.

And lawmakers have put that sentiment into action.

Lt. Gov. Dan Patrick made his priorities clear in an interview with Fox News Tucker Carlson.

“We’re crushing the average worker, we're crushing small business, we're crushing the markets we’re crushing this country,” Patrick said.

“Nobody wants to die. But man, we got to — we got to take some risks and get back in the game and get this country back up and running.”

Gov. Abbott repeatedly acknowledged the seriousness of COVID-19, and said that Texas needs to reopen safely. But in leaked audio obtained by the Quorum Report — a non-partisan newsletter on Texas politics — Abbott told a group of lawmakers something slightly different: 

“The fact of the matter is, pretty much every scientific and medical report shows that whenever you have a reopening whether you want to call it a reopening of business, or just a reopening of society, in the aftermath of something like this, that actually will lead to an increase in spreads, it's almost ipso facto, the more that you have people out there, the greater the possibility there is for transmission.

“The main thing that we look for — and this is the primary number that I’ve seen doctors and epidemiologists use — that we want to see is a reduction in the percentage of people who test positive.” 

But over the past month, Texas has seen an increase in that percentage. In metro areas, the increase is stark. 

The Greater Houston Area has seen a tripling of the rate, from 3% mid-May to about 10% mid-June. 

In Dallas, it’s a similar story. Researcher David Rubin said models have been showing an elevated risk for weeks.

“There was a brief period in May, it looked like things were stabilizing in Dallas, but now they’re heading north again,” said Rubin.

San Antonio on June 15 announced a spike in new cases, the most dramatic increase since the pandemic started. The number of hospitalizations here more than doubled in the last week. 

Any way you look at the numbers, reopening has not gone the way public officials said they hoped it would go. 

Too little, too late

Back in February 2015, Republican state senator Charles Schwertner outlined Senate Bill 538 at a press conference.

The bill would have done a few things, like allow the governor to declare an infectious disease emergency, and give powers to public health officials to quarantine individuals who may have been exposed.

It also would have created a stockpile of personal protective equipment (PPE) and evaluated new technology to track exposed contacts.

Schwertner is also a doctor, so he understands the importance of PPE. A state-managed stockpile sure would help right about now. But back then, some lawmakers had other priorities. 

“It’s unfortunate that the bill did not get through and there were a number of reasons why it didn't,” Schwertner said. “And putting, in this case $5 million, into stockpiling personal protective equipment — that at the time, I believe does have some expiration date — in the concern of a future undetermined event is not high on the list of a lot of people.”

One other issue popped up back then that may sound familiar.

“Some individuals were concerned about enforceable control orders or orders to quarantine,” he said. “And in their personal freedoms and liberties being undermined by a state of infectious disease emergency being declared — and that individual being told they cannot do X, Y or Z.”

Schwertner wasn’t deterred by this argument. 

He obviously wishes his bill didn’t die in 2015, but now in 2020, he said he supports the decision to reopen the economy with the information that was available.

“You're in a political no win situation. You either shut down the economy — tell anyone. ‘Stay home, social distance,’ — or, you know, you're seen as the Grim Reaper,” he said.

Political mixed messaging

Gov. Abbott previously said local leaders could not order their citizens to wear masks. Period.

So, Bexar County Judge Nelson Wolff and other local leaders tried to figure out a workaround. The idea: order businesses to require masks. 

Nirenberg-Wolff-Masks-Letter-PALACIOS-0512020.JPG
Credit Joey Palacios | Texas Public Radio
San Antonio Mayor Ron Nirenberg and Bexar County Judge Nelson Wolff prepare before Tuesday night's COVID-19 briefing.

On June 17, Wolff announced an order that commercial entities in his county must require masks. 

To the surprise of just about everyone, Wolff’s order got the governor’s blessing. Appearing on the Waco TV station KWTX, Abbott suggested that Wolff cracked the code.

“That’s what was authorized in my plan. That’s what the Bexar County Judge has now realized,” said Abbott. “And so what Bexar County is doing — and what every county is authorized to do — and that is impose requirements on business operations.”

But this situation hasn’t been confusing just for elected leaders. 

As a result of the governor’s steadfast determination to reopen more and more every two weeks, local businesses have become the sort of test pilots of this reopening plan. 

Ernesto Torres owns a small bar in San Antonio. He opened up his bar as soon as he was allowed to, on the Friday before Memorial Day weekend, and said he followed all of the governor’s recommendations for a safe reopening. 

“There were some stipulations for reopening. Of course we were at 25% capacity, employees had to wear face masks, you know,” he said. “People couldn't play pool. We removed several tables to make sure that we stay within 6 feet.”

At first, only a few customers trickled in. Torres was actually glad he didn’t have to worry about overcrowding. Most customers also wore a mask for the first week or so. But, as the days went by, people got a little more lax with their safety measures. 

“Face masks were encouraged but they were not required, at least for patrons,” said Torres. “Same thing with dancing. According to the governor, dancing was discouraged but not prohibited.” 

The governor’s order initially allowed bars to operate at 25% capacity, and later 50%. Customers couldn’t sit at the bar, they had to sit at tables, and they couldn’t be in groups more than six. 

“After the first week, it was that false sense, I guess, of security. You know that things are okay.” said Torres. “So people relaxed, including myself.” 

As the San Antonio bar scene came back to life — social distancing fell by the wayside. 

“This is when things went south. I received a call from another bar owner saying that some of his employees had tested positive (for COVID-19). And those employees frequent my bar,” said Torres.

Soon after, he posted on his bar’s Facebook page announcing that he was closing down the bar — again — just to be safe. The next day, he said people who had been to the bar recently should get tested for the coronavirus.

A photo of Ernesto Torres with a "Stay Home Save Lives" filter.
Credit Provided
A photo of Ernesto Torres with a "Stay Home Save Lives" filter.

“And I went to test myself on Saturday, and I tested positive,” he said. “Several customers have called me and said they went to test themselves, and they are also positive. Facebook is lit up right now, with people saying 'I'm positive, I'm positive, I’m positive.'”

The realization hit him: The suggested guidelines hadn’t worked. The virus had swept right into his bar. 

San Antonio Facebook groups have been circulating a list of two dozen bars and restaurants that were supposedly exposed to the virus.

How did we get here?

One reason cases and hospitalizations have risen faster than officials hoped, is because the Texas economy did not reopen as carefully as economists recommended

Vivian Ho is a health economist at Rice University in Houston. She explained in reopenings like this, states should open a little, you check the statistics, then decide if they’re doing okay enough to reopen a little more. 

“And what we've been doing (instead) is every week or every other week, we just keep opening up more and more and we're ignoring the statistics,” she said. “We see hospitalizations going up, we see the number of cases going up.”

Part of the problem, she says, is that she and other economists haven’t had access to detailed state or federal data on coronavirus patients, which is what they need to analyze how reopening is going. 

“What I would like is individual level data. So, for example, for every patient who was hospitalized for COVID: what was their age, gender, ethnicity and race, and their occupation,” said Ho. 

On the other hand, she said, relaxing government requirements and allowing businesses to set their own safety policies, like whether to require masks, is not working. 

“No one has experience in sort of doing business in the midst of a pandemic,” she said. 

Looking back to move forward

Some businesses that were opening have closed again. Some people predicted this. Not because they have any special abilities, but because they have a knowledge of history.

In 1918, while the U.S. was fighting World War I in Europe, a novel virus ravaged the world. It was H1N1 influenza, which is still around now, but in 1918 it was a new strain of flu, and it killed.

Louie Edward Mayberry moved to San Antonio in October 1918. He was 11 years old. The story of his life in Texas in the early 1900s is archived at the Baylor Institute of Oral History.

“I hadn’t gone to school but a few days, they had a flu epidemic in San Antonio and they turned the schools out,” he said.

alamo_plaza_2_0.jpg
Credit http://digital.utsa.edu/cdm/singleitem/collection/p9020coll008/id/10815/rec/3 / UTSA Libraries Digital Collection
This photo of Alamo Plaza in San Antonio was taken on October 26, 1918, during the city's first quarantine for the Spanish flu.

Schools, churches, lodges, and theaters closed on October 16. The city banned all public gatherings that same day. Too late, though. The epidemic was already raging.

Less than a month later, something that may seem familiar to us now happened. New flu cases were declining. So, on November 11 — the day World War I ended — the city declared the pandemic over.

"Then school started again,” said Mayberry.

He reported the city’s joy over the end of the war and its euphoria over the end of the pandemic. 

But pandemics don’t end just because citizens decide they’re over.

And in November 1918, with people back out and about, the flu came roaring back. Mayberry’s time in school that year was short.

“It went on for a couple of weeks and then it turned out again. We didn't get much schooling before Christmas," he said.

In early December, San Antonio started shutting things back down, and on December 9, everything closed again. 

Then, like now, when it was safe to reopen for good, some businesses didn’t. In some cases, the financial losses during the shutdown had been too much. But in others, the owners were dead. They died of the flu.

That was more than 100 years ago.

It’s Eric Epley’s job to make sure that doesn’t happen again. He coordinates emergency rooms for a portion of Texas the size of west virginia with San Antonio at its heart. 

He knows how many ICU beds there are, how many ventilators, how much PPE we have, how many healthcare workers we have and where. He said he’s concerned by this spike in hospital admissions.

“There’s still plenty of capacity in the healthcare systems, but the rate is concerning, to see a jump from two or three or two or four here and there, and then to jump to 15 to 20 per day and now to 26 per day is stunning,” he said.

Epley added these rising numbers can’t be blamed on increased testing capacity.

“Hospital admission numbers are hospital admission. It’s not more tests,” he said. “You’re either sick enough to go to a hospital or not, so it’s a really good, consistent indicator to see what the disease spread is in our community.”

One of the most important things people can do now, he says, is wear a mask.

Did Texas reopen too soon? Epley won’t say. It’s his job to prepare for what comes next. 

Clarification: Protesters complaining about COVID-19 safety orders were standing primarily outside the state capitol building, not necessarily throughout Austin city streets.

Contributors to this story include Matt Harab with Houston Public Media, Bekah Morr with KERA and Joe Palacios with TPR. 

Petrie Dish is produced by Ben Henry, Dominic Anthony Walsh and Michael Trevino. Our sound producer is Jacob Rosati. Our executive producer is Fernanda Camarena. Our news director is Dan Katz.