On Friday, our governor held a press conference from Austin in which he laid out a long-range plan to reopen the economy. Retail to-go came first, giving stores the ability to sell products curbside. He closed schools through the school year. He reopened state parks with some caveats and loosened restrictions on elective medical procedures.
If the economy is going to open further, he said we’ll need a massive increase in testing. That is correct. However, the deployment of testing resources indicates nothing other than the scarcity of the materials. Based off interviews with public officials and an analysis of per capita testing rates in Texas counties, there appears to be no concrete strategy determining where the testing kits end up. Capacity will need to multiply by many times before public officials will be armed with enough data to make a decision to open the economy. And everyone’s in this boat, fighting for their counties to get testing materials.
Our providers and first responders also remain in dire need of personal protective equipment. On Friday, the governor said, “we have a solid supply chain for PPE.” That does not appear to be the case.
“No, it’s not my experience,” County Judge Clay Jenkins told me over the weekend. “I can tell you that from our standpoint and what our hospitals and first responders need, we don’t have nearly enough. It’s N-95 masks, it’s shields, it’s surgical masks, it’s gowns, it’s just a whole host of things.”
On Friday night, county representatives were on the phone past 10 p.m. trying to buy about $3 million worth, Jenkins says. That fell apart in the last minute. The seller tacked on a $650,000 shipping fee and the buyers—which included Dallas County, Parkland Hospital, and Harris County—didn’t all want to pay that. County officials have been working on the deal for more than a week.
The Trump Administration’s “air bridge” policy orders FEMA to prioritize 100 hot spots for supplies, basing that list on things like total hospitalizations. Those areas get priority for protective equipment. If a region isn’t on that list, you’re forced to enter the marketplace and compete with other local governments, hospitals, and care providers. That’s what Dallas County is doing. It has started a fund to raise money to buy as much PPE as it can to equip its caregivers and first responders. A lack of this equipment affects testing, too. The person administering the test must be head-to-toe in PPE.
You have to buy in bulk. This is a world of intermediaries who build deals that often pair local buyers with sellers in China. Stateside manufacturers still haven’t created enough equipment to penetrate the market. So locals team up to match the seller’s needs, which are often big, high-dollar purchases. That $3 million buy probably would’ve been too much for Dallas County alone, but it’s not when you bring others in. That presents another challenge. Those other buyers may be acting in good faith but have other priorities that could make a deal go sideways. If one party doesn’t agree to that shipping charge, for instance, the whole thing is off.
“That’s not an unusual story, sadly,” Jenkins says. “We’re having better luck at the little dinks than the big deals, but you’ve got a lot of people, and this (deal) was just the government and the hospitals. We haven’t even dug down to law enforcement agencies, fire departments … you’ve got the nursing homes, and they need to be in full PPE and gowns and masks.”
The county has already created its own supply chain for hand sanitizer, providing distilleries with the materials necessary to make it. They’re doing so at a loss. Other volunteers are 3D-printing masks and shields. County employees are working for weeks on deals that blow up in the 11th hour, wasting precious time during a pandemic.
“Obviously, we don’t have a strong supply chain,” says U.S. Rep. Colin Allred, a Democrat from Dallas. “Ninety percent of the production of our PPE equipment is from abroad.”
Testing exists in a similarly precarious situation. Dallas County has seen its capacity tick up, but it’s not happening fast enough and the results are taking too long to be returned. Without that information, officials can’t begin the process of contact tracing, believed to be key in stopping the spread of the coronavirus. Allred and U.S. Rep. Eddie Bernice Johnson, D-Dallas, co-signed a letter to FEMA asking to be provided with the materials necessary to conduct and process thousands of daily tests.
Parkland has the machines that can turn a test around in a day. It needs swabs and the reagents, the chemical that identifies the presence of COVID-19. Jenkins has filed a formal request with the state to turn UT Southwestern and Parkland into testing centers, capable of processing 6,600 tests per day from care sites all over Dallas. (What has to happen after filing that formal request? “You just bug the living crap out of them,” Jenkins said.)
That would be an enormous increase in capacity, considering Dallas County has only tested slightly more than 13,000 people in more than a month. The two drive-thru testing centers doubled their daily allotments from 250 to 500. Walgreens added a free testing center in South Dallas with the ability to test 160 people per day. The Texas Health and Human Services Commission also approved a mobile lab for the county, a van that can be deployed to a hot spot and test up to 100 a day. That would’ve been useful for the nursing homes and the Dallas Life Homeless Shelter, which saw an outbreak last week.
Testing rates in Texas counties vary wildly, but they all share a similarity: they’re abysmal. In El Paso County, 2,573 of the more than 700,000 residents have been tested, a rate of .35 percent. Harris County has tested nearly 20,000 people—a measly .41 percent—but its northern neighbor, Montgomery County, has tested just 2,082 people, a rate of .20 percent.
North Texas has a similar story. Dallas County has tested 13,130 people, about .49 percent of its population. Collin, the fastest growing county in the nation, has tested 3,464, a rate of .33 percent.
“Five hundred tests isn’t going to make a big difference,” Jenkins said. “I use the analogy of: you’ve got a burglar and the burglar is robbing homes. Testing gives you a glimpse into where the burglar is going tomorrow or tonight as opposed to having you focus on looking at what’s left of what the burglar stole yesterday. You’ve got to get ahead of this thing.”
Gov. Abbott said he would make an announcement in two weeks about other sectors of the economy that may be able to reopen. He said he expected a “massive amount of testing capability coming to Texas by late April or early May,” but didn’t detail why.
Allred and Jenkins both believe we lack the necessary data to inform that decision. Testing is still too poor, and neither saw a path to it being bolstered enough in such a short period of time based on current conditions. Allred’s description of what needs to happen is strikingly different than what is currently happening. The county is loosening the prerequisites to be tested at the public sites, but you still have to be an essential retail worker, be 65 or older, have a comorbidity like diabetes, or have a fever with a cough or shortness of breath. Allred said we need full-on community testing, where everyone can be tested and the public health department can better react to the spread. We’re still on a metered approach as to who is tested and who is not.
“I think it’s remarkable that we’re talking about the economic impacts of this and how we can reopen Texas, how can we reopen the country, but we’re not talking about how we’re testing a fraction of our people,” Allred said. “We have basically no understanding of how widespread this virus is right now.”