The Texas Tribune
Gov. Greg Abbott issued a statewide mask mandate July 2 as Texas scrambles to get its coronavirus surge under control.
The order requires Texans living in counties with more than 20 coronavirus cases to wear a face covering over the nose and mouth while in a business or other building open to the public, as well as outdoor public spaces, whenever social distancing is not possible. But it provides several exceptions, including for children who are younger than 10 years old, people who have a medical condition that prevents them from wearing a mask, people who are eating or drinking, and people who are exercising outdoors.
The order went into effect Friday at 12:01 p.m. It immediately applies to all Texas counties, but counties with 20 or fewer active cases can be exempted.
The mask order represents a remarkable turnaround for Abbott, who has long resisted a statewide requirement, even as the coronavirus situation has gotten worse than ever over the past couple of weeks in Texas. When he began allowing Texas businesses to reopen this spring, Abbott prohibited local governments from punishing people who do not wear masks. As cases began to rise earlier this month, he clarified that cities and counties could order businesses to mandate that customers wear masks.
In recent days, Abbott had held firm against going further than that, saying he did not want to impose a statewide requirement that may burden parts of the state that are not as badly affected by the outbreak.
Tracing the pandemic in Texas
On March 4, the Texas Department of State Health Services reported Texas’ first positive case of the coronavirus, in Fort Bend County. The patient had recently traveled abroad. A month later, on April 4, there were 6,110 cases in 151 counties. As of July 10, there have been 240,111 cases reported in 247 counties, 3,013 deaths across the state.
Since June, the number of new cases each day has trended upwards. Since July 3, Dallas has reported over 1,000 new cases almost every day. Houston has had 13 days of over 1,000 new cases since June 20, with record highs of 2,344 on June 24 and 2,082 on July 2.
The rate of cases per 1,000 residents is especially high in the panhandle’s Moore County, where infections are tied to a meatpacking plant. In May, a large one-day spike was reported after testing was done at meatpacking plants in the Amarillo region.
The rate of cases is also high in counties with state prisons such as Walker and Jones. In other rural areas where the presence of the virus has yet to be confirmed, testing has been scarce.
Abbott linked these increases to more Texans under the age of 30 testing positive for the virus. He said it’s unclear why this is happening but has speculated that it could be from increased activity over Memorial Day weekend and other social gatherings.
Experts say there’s a lag before changes in people’s behaviors, like more social interaction, are reflected in coronavirus case data. It takes about 9 to 16 days to see increased infections and generally another 5 to 7 days to see changes in the numbers of people hospitalized, said Rebecca Fischer, an infectious disease epidemiologist at the Texas A&M University School of Public Health – some individuals are only diagnosed once they make it to the hospital.
In mid-June, Abbott touted the state’s abundant hospital capacity. Since then, hospitalizations have continued to rise, doubling in just two weeks.
On April 6, the state started reporting the number of patients with positive tests who are hospitalized. It was 1,153 that day and 8,181 on July 5. This data does not account for people who are hospitalized but have not gotten a positive test.
On July 5, the state reported 13,307 available staffed hospital beds, including 1,203 available staffed ICU beds statewide. COVID-19 patients currently occupy 14.6% of total hospital beds. In late April, Abbott ordered hospitals to reserve 15% of beds for COVID-19 patients.
According to DSHS, these numbers do not include beds at psychiatric hospitals or other psychiatric facilities. They do include psychiatric and pediatric beds at general hospitals, and pediatric beds at children’s hospitals.
Regional differences exist in the availability of beds – some hospital officials have reported that intensive care units are near or over capacity. In the Rio Grande Valley, for instance, the increases have stretched hospital staff. And in late June, some local officials began reviving plans to make backup medical facilities available if hospitals become overwhelmed.
The first death linked to the coronavirus in Texas occurred March 16 in Matagorda County. As of July 5, there have been 2,637 reported deaths of people diagnosed with COVID-19.
Testing and the positivity rate
Gov. Greg Abbott said he is watching the state’s positivity rate – the percentage of positive cases to tests conducted. The average daily positivity rate is calculated by dividing the 7-day average of positive cases by the 7-day average of tests conducted. This shows how the situation has changed over time by de-emphasizing daily swings. Public health experts want the average positivity rate to remain below 6%.
In early May, Abbott said a rate over 10% would be a “warning flag.” The state exceeded that mark in June for the first time since April.
The positivity rate differs from the infection rate. In order to obtain an infection rate, everybody would need to be tested, said Hongwei Zhao, an epidemiology professor at the Texas A&M University School of Public Health.
As of July 5, Texas has administered 2,371,709 tests for the coronavirus since March. Expert opinions differ on how much larger that figure needs to be. We do not know the number of Texans who have gotten a test because some people are tested more than once. – Tests from private labs, which make up the majority of reported tests, are not deduplicated. The state’s tally also does not include pending tests.
The DSHS data also might not include all of the tests that have been run in Texas. The state has said it is not getting test data from every private lab, and as of mid-May only 3% of tests were coming from public labs. The state has since stopped differentiating between tests reported by public and private labs.
Even as demand for testing has increased, both public and private labs continue to prioritize Texans who meet certain criteria, but every private lab sets its own criteria.
On May 21, DSHS disclosed for the first time that as of a day earlier, it had counted 49,313 antibody tests as part of its “Total Tests” tally. That represents 6.4% of the 770,241 total tests that the state had reported on May 20. Health experts have warned against counting antibody and standard viral tests together because they are distinctly different tests. Antibody tests detect whether someone was previously infected, while standard viral tests determine whether someone currently has the virus.
Antibody tests are typically reported a day late.