Editor’s Note: Hours after this story was published, the county and the city reached an agreement with the federal government to keep testing going at the two drive thru sites. Parkland will process and run the drive thru testing center in Red Bird, while a private vendor will test at the University of Dallas. The latter replaces the American Airlines Center.
New cases and hospitalizations from COVID-19 are setting records each day in Dallas County. Meanwhile, the state government has so far refused to codify many of the recommendations that the governor provided when he began reopening the economy.
Contact tracing remains so poor that large urban counties are funding and developing their own programs and opting out of the program the state stood up. The feds have said that on June 30 they will exit the remaining community testing sites that they have paid for and supported since March. Two of the 13 are in Dallas County. Another four are in Harris County, whose Texas Medical Center reached 97 percent occupancy for ICU beds on Wednesday. What began as 41 sites across the country is down to 13 in five states, with seven in Texas.
City, county, and congressional leaders are scrambling for support from their state and federal colleagues, whether that be statutory or with additional materials, to help curb the spread of coronavirus before hospital systems are overrun with patients.
It’s been a different story in Texas since May 1, when the economy began reopening. There were just over 1,000 daily cases of the virus when the governor issued his executive order, which preempted any more stringent policy from county judges or mayors. Abbott did not wait for the two-week decline in cases and hospitalizations that public health experts say is necessary before reopening. Attorney General Ken Paxton was his attack dog, sending cease and desists when someone went crosswise, like issuing an order for residents to wear a mask in businesses. In Dallas County, more than 80 percent of hospitalizations are frontline service workers—the people who opened the economy and are coming into contact with people. (The protesters are not fueling this rise, public health officials say.)
The governor has repeated a variation of the line that we will need to “coexist” with the virus, but now it is spreading widely across the community as his policies allow Texans to basically come and go as they please. He paused reopening, and on Friday he ordered bars to close. Restaurants are going from 75 percent capacity to 50 percent. Patios still have no limits. “It is clear that the rise in cases is largely driven by certain types of activities, including Texans congregating in bars,” Abbott wrote in a letter.
Now seven weeks after reopening, the state of Texas added 5,996 new cases of COVID-19 in a single day on Thursday. The positivity rate is now over 10 percent, the trigger point for Abbott to take some sort of action. Over the last week, Dallas County alone is averaging 411 new cases per day, up 136 percent from one month ago. The county’s hospitalizations have increased 88 percent since June 1. Abbott has chosen to scold and lecture, but now he’s inching into acting. Elective procedures at hospitals have been suspended. Gatherings of 100 or more people must be approved by local governments. Bars are closed as of noon today and rafting and tubing businesses must close. The rest remains the same.
“The state’s gonna have to lead on this because they’ve yanked all the authority from the counties do the things that worked so well up until May 1,” said County Judge Clay Jenkins on Thursday afternoon. “It starts with listening to the doctors in Houston and Dallas and Travis County and Bexar County, the people on the ground who are fighting this and the business communities there.”
On Thursday, U.S. Rep. Colin Allred heeded the county’s call and asked U.S. Health and Human Services Secretary Alex Azar to supply the reagents and testing kits that would’ve been used at the federal drive-thru sites. The letter, which was also signed by U.S. Rep. Eddie Bernice Johnson, says the county can process those with machines at Parkland and UT Southwestern. He’s asking for enough to process 2,500 each day, which would be split between the two hospitals. It should drop the turnaround time for results from about five days to no more than two, a major plus for contact tracing efforts.
U.S. Sens. Ted Cruz and John Cornyn also wrote to Azar, but they asked to keep the federal testing sites operational as they are now. Even if the feds pull out, Jenkins said vendors are on call to pick up the slack. Neither of those solutions would accelerate the processing of test results.
“It takes a heck of a lot of sick people statistically for one person to be in the hospital.”County Judge Clay Jenkins
Demand is high for testing. Waits of up to five hours are common at the federal sites, and many private providers—like Walgreens and CVS—quickly run out of reservation spots. No matter what happens, the testing sites will have to move. The American Airlines Center location will move to the University of Dallas in Irving. The site at Ellis Davis Field House will move to Red Bird Mall.
“Our fight against COVID-19 will require continued cooperation and coordination between federal, state, and local governments and we hope the federal government can continue to support the Dallas region’s testing efforts,” Allred writes in his letter.
It’s been like this since April. At the end of each month, the feds threaten to pull their support for these sites. The locals rally and petition, then the federal government lets it go another month or six weeks. That doesn’t appear to be the case this time—the Trump administration admitted it early in the week, not long after the president said he wanted to “slow” testing.
The increase in testing is not the reason we’re seeing so many more cases, said Dallas County Health and Human Services Director Philip Huang. He insisted that the virus is spreading through the community and testing still isn’t sufficient. Huang told employers to stop requiring negative tests before allowing employees to work: “These tests are for diagnostic purposes at this time,” he said.
Contact tracing is also insufficient. The governor made hiring contact tracers a core tenet of his reopening plan. But the state hasn’t hired enough. According to the Texas Tribune, we’re about 1,000 short of the 4,000 that Abbott hoped to have working by June 1. State officials said it would be enough to track the new cases; back then, we had about 4,500 fewer—1,649 in one day—than we had on Thursday. Most large counties, including Dallas, did not opt into the state’s contact tracing program. (Collin County did, however.) It also requires quick action, which makes testing turnaround time important. If you get your positive test back a day later, the county can swoop in and help you stop seeing people. If it takes five days, as it currently stands, the work to reach all of those who have been exposed is far greater.
Haung says a contact tracer typically needs to reach out to a dozen contacts per person. Do the math. The county has commissioner approval and funding through the CARES Act to hire 260 tracers, but only about 60 have completed the background check; the rest are in the queue. That still won’t be enough. To help, the county unveiled a new program from Parkland that will automatically text message positive COVID-19 patients and have them fill out a survey to help identify anyone who they were within six feet of for more than 15 minutes. It’s been sent to just under 1,000 people and about half have responded.
“It would take 1,300 contact tracers to do the work, with each working 12 hours per day, 7 days per week,” says Dr. Brett Moran, Parkland’s Chief Medical Information Officer. “It’s just unsustainable and there has to be some other solution. … Given the pandemic we’re in, we hope this solution will give us a better grasp and ability to contact people in a timely manner.”
Across the 19-county spread that makes up the North Central Texas Trauma Advisory Council, there are about 1,100 people hospitalized with COVID-19. That’s an increase of 86 percent since June 1. About 10 percent of patients in hospital beds have the disease, according to Steve Love, the president of the Dallas-Fort Worth Hospital Council. Hospitals start to get nervous when that number crests 15 percent. Public health leaders are already nervous. This is a disease with a long lead time. It takes an average of five days for symptoms to show up, then testing results can take days to return.
“It takes a heck of a lot of sick people statistically for one person to be in the hospital,” Jenkins says. It will take about two weeks to see whether policy changes had any impact on the spread of the virus.
Mayor Eric Johnson says he met with the hospital council and the county to discuss standing up the pop-up hospital at the Kay Bailey Hutchison Convention Center. It would take about 10 days to do so. The hospital council said they did not feel it was appropriate yet.
And so we wait and we hope. Doctors are forced to focus on COVID-19 patients, postponing anything elective—that could mean living with significant pain. Bankers are now raising concerns that this second spike could be more damaging financially than the first. Meanwhile, counties still cannot legally tell their residents to wear a mask. (Businesses, however, are now fined in Dallas County if they don’t mandate their customers wear masks.) And it’s still legal for you to go sit inside a restaurant for a few hours—governor’s orders.