Off the Kuff Rotating Header Image

PolicyLab

Abbott finally issues a mask order

Better late than never, but it’s pretty damn late.

Gov. Greg Abbott issued a nearly statewide mask mandate Thursday as Texas scrambles to get its coronavirus surge under control.

The order requires Texans living in counties with 20 or more positive COVID-19 cases to wear a face covering over the nose and mouth while inside 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 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 mask order goes into effect at 12:01 p.m. Friday.

The order represents a remarkable turnaround for Abbott, who has long resisted such a statewide mask requirement, even as the coronavirus situation has gotten worse than ever over the past couple 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 customers wear masks.

In recent days, though, 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.

Abbott on Thursday also banned certain outdoor gatherings of over 10 people unless local officials approve. He had previously set the threshold at over 100 people. The new prohibition also goes into effect Friday afternoon.

[…]

Abbott’s announcement came a day after the number of new daily cases in Texas, as well as hospitalizations, reached new highs again. There were 8,076 new cases Wednesday, over 1,000 cases more than the record that was set the prior day.

Hospitalizations hit 6,904, the third straight day setting a new record. The state says 12,894 beds are still available, as well as 1,322 ICU beds.

Abbott has been particularly worried about the positivity rate, or the share of tests that come back positive. That rate, presented by the state as a seven-day average, has jumped above its previous high of about 14% in recent days, ticking down to 13.58% on Tuesday. That is still above the 10% threshold that Abbott has long said would be cause for alarm amid the reopening process.

First-time offenders of Abbott’s order will receive a written or verbal warning. Those who violate the order a second time will receive a fine of up to $250. Every subsequent violation is punishable also by a fine of up to $250. The order specifies that no one can get jail time for a violation.

Remember that PolicyLab projection from May that said Harris County would go from 200 cases a day to over 2,000 by now? Thankfully, we’re still not close to that – the ReadyHarris dashboard has mostly shown us in the 600 to 800 cases per day range recently, though I suspect there’s some lag in the data because there’s no reason why this week would be lower than the two previous weeks. Point being, we most certainly could have seen this coming, and we could have done a lot to protect ourselves before this happened. You know, like having mask orders in place all along, and letting local governments have more leeway to control crowd sizes. Note here that Abbott’s order targets outdoor gatherings, but not indoor gatherings. You know, like this one. I don’t understand the logic here, but whatever.

The real question is after all this time and all that bullshit from Republicans like Dan Patrick, how much resistance do you think there will be to this new order? Like, remember when Dan Patrick called Judge Hidalgo’s mask order “the ultimate government overreach”? Also, too, Jared Woodfill and Steven Hotze are suing to basically stop emergency orders, and had previously sued to stop Judge Hidalgo’s mask order, before Abbott overruled it himself. Our state has plenty of people who will perform their rage over being asked to take the health and well-being of their neighbors into consideration. I’m curious, and more than a little afraid, to see how that segment of our population reacts to this. The Current, the Press, and the Dallas Observer have more.

UPDATE: My God, but Dan Crenshaw is a hack.

The COVID models remain pessimistic about Texas

Make of this what you will.

The coronavirus may still be spreading at epidemic rates in 24 states, particularly in the South and Midwest, according to new research that highlights the risk of a second wave of infections in places that reopen too quickly or without sufficient precautions.

Researchers at Imperial College London created a model that incorporates cellphone data showing that people sharply reduced their movements after stay-at-home orders were broadly imposed in March. With restrictions now easing and mobility increasing with the approach of Memorial Day and the unofficial start of summer, the researchers developed an estimate of viral spread as of May 17.

It is a snapshot of a transitional moment in the pandemic and captures the patchwork nature across the country of covid-19, the disease caused by the virus. Some states have had little viral spread or “crushed the curve” to a great degree and have some wiggle room to reopen their economies without generating a new epidemic-level surge in cases. Others are nowhere near containing the virus.

The model, which has not been peer reviewed, shows that in the majority of states, a second wave looms if people abandon efforts to mitigate the viral spread.

“There’s evidence that the U.S. is not under control, as an entire country,” said Samir Bhatt, a senior lecturer in geostatistics at Imperial College.

[…]

The Imperial College researchers estimated the virus’s reproduction number, known as R0, or R naught. This is the average number of infections generated by each infected person in a vulnerable population. The researchers found the reproduction number has dropped below 1 in 26 states and the District. In those places, as of May 17, the epidemic was waning.

In 24 states, however, the model shows a reproduction number over 1. Texas tops the list, followed by Arizona, Illinois, Colorado, Ohio, Minnesota, Indiana, Iowa, Alabama and Wisconsin.

When the R naught is below 1, it means the virus is hitting a lot of dead ends as it infects people. Someone who is infected but who follows social distancing rules or stays quarantined until recovering has a good chance of not infecting anyone else. The challenge is finding a way to reopen the economy with sufficient care to prevent the reproduction number from going over 1.

[…]

In Texas, Dallas County Judge Clay Jenkins said he consults with doctors and experts from area hospitals, “and what they tell us is that we’re reopening too fast, and we’re reopening in the wrong order.”

Local jurisdictions in Texas do not have the authority to issue more stringent restrictions than the state, which began aggressively reopening this month. So Dallas has focused on messaging. The county has a daily “covid-19 risk level” that is currently red, for “stay home, stay safe.” Officials are working on seals that businesses can display to indicate they are meeting local public health guidelines, not just state mandates.

The Imperial College estimates for Texas are in line with internal modeling conducted by university experts advising state leaders.

Rebecca Fischer, an epidemiologist at Texas A&M University and part of a team partnering with the governor’s office, said the daily caseload was fluctuating, but “it looks like we’re not cresting a peak and coming down the other side.”

The embedded graphic shows the probability (according to the model) that R naught is less than one in the given state. For Texas, that probability is close to zero, which means that the virus is still spreading at an increasing rate. This is consistent with the PolicyLab study, which uses county-level data. You can see the Imperial College study here, and a brief analysis of it by Josh Marshall here. There’s still a lot we don’t know, and if loosening restrictions is going to have a bad effect on the pandemic it’ll still be a couple of weeks before we really begin to feel it. Staying at home, social distancing, and wearing masks are still your best bet, but I doubt I will convince you of that if you’re certain you know better.

Are we headed towards a coronavirus spike?

One set of researchers thinks we may be.

Houston is one of several cities in the South that could see spikes in COVID-19 cases over the next four weeks as restrictions are eased, according to new research that uses cellphone data to track how well people are social distancing.

The updated projection, from PolicyLab at Children’s Hospital of Philadelphia, found that traffic to non-essential businesses has jumped especially in Texas and Florida, which have moved aggressively to reopen.

In Harris County, the model predicts the outbreak will grow from about 200 new cases per day to more than 2,000 over the next month.

“Some areas—particularly in the south—that have moved more quickly to reopen are showing a higher risk for resurgence,” the researchers wrote in a blog post. “If people in Houston and Palm Beach, Fla., for example, aren’t being cautious with masking in indoor crowded locations and with hygiene and disinfection, local governments may need to intervene again should they lose control of the epidemic.”

[…]

The PolicyLab research is tracking 389 large counties across the country with active outbreaks. It found that projections are best in places that are relaxing restrictions selectively in areas with fewer cases and less transmission.

“Given these cautious actions by our governments, we have already seen that the predicted resurgence has not occurred in most places that are beginning to reopen—rather, daily cases are either plateauing or falling,” the researchers wrote. “But the picture our models are painting for Texas and Florida provide ample evidence to others who would choose to move too quickly. We see these concerns even as we adjust for additional testing capacity that might have inflated our forecasts.”

See here and here for more on the predictions, and here for an earlier press release about their model. As far as I can tell, their model depends on “social distancing measures, defined by travel to non-essential businesses”. They say their data comes from a variety of publicly-available sources, but that’s about as much detail as I can find. I’m not an expert in any way, so I’m in no position to critique this. Fortunately, Dr. Peter Hotez is an expert, and he shared some thoughts about this in Friday’s Chron.

I understand the importance of opening up the economy. The worry that I have is that we haven’t put in place a public health system — the testing, the contact tracing — that’s commensurate to sustain the economy.

Some models show fairly dire predictions for Houston. I’m referring to the Children’s Hospital of Philadelphia model that shows that by the summer, if we’re only at about 50% of the social distancing, we’re doing now, Harris County could see a steep surge in the number of patients coming into the hospitals and intensive care units.

It’s a model. It’s only as good as the assumptions that it’s based on, and we know the assumptions are not robust. But it gives me pause for concern that unless we have that health system in place, we could be looking at an epidemic that’s far greater than the one we’ve gone through.

Let’s say we’re opening up as as we are now. The way a surge works is, it’s not as if we’re going to see a gradual increase in cases. The models say things will look good for weeks. At first, it’s a flat curve, then it’s flat, it’s flat, and only after all that do you start seeing a steep, steep increase.

That’s what worries me. In those flat weeks we’ll get this sense of complacency, and then people are going to start going into the bars. Forget about one quarter occupancy in the bars. Poison Girl, on Westheimer, is going to be full. And so are all the other places all across Houston.

So: How do we fix that? I think it’s having a health system that’s larger and more extensive than what’s being proposed. We’re going to have to do extensive testing in the workplace so that you’d know if your colleagues have COVID-19 — especially asymptomatic COVID-19.

The number of contact tracers has to be far greater than the numbers that I’m seeing. Gov. Abbott says that Texas has around 2,000 and plans to hire 2,000 more. But consider that Gov. Cuomo in New York State is hiring 17,000 contact tracers. A state that’s quite a bit smaller is hiring a much larger number.

We also still don’t have that syndromic-monitoring system in place that you and I have talked about — an app that would allow Houstonians to report how they’re feeling, or that would track temperatures, like the Kinsa electronic thermometer app.

We should be bringing in our best engineering minds out of the oil and gas industry, out of NASA, out of the Texas Medical Center to put in place an app-based system — maybe make a hybrid between the kinds of things being put out there by Apple or Google or Kinsa, or the kinds of things they’re doing in Australia. We can design one that works for our culture, works for our system. But we’re not assembling the engineers to put that in place.

We don’t even have an epidemiological model for the city of Houston. There’s one for Dallas, put out by UT Southwestern and the University of Texas. Austin’s put out one. But I haven’t seen one for Houston.

So I’m worried that if people are going to start piling into bars and restaurants, and we don’t see the numbers going up, within a couple of weeks from now, it’ll be business as usual. Everybody will feel good, will be saying, “Hey, I’m not seeing the cases go up.”

And it’s going to really accelerate starting in the fall. This is not only true of Houston; it’s true of cities across the U.S. It would happen right before the 2020 election, so I worry about a lot of instability and how we mitigate that.

So there you have it. Keep it up with the social distancing and staying at home, avoid crowds, and wear a mask. We all have a role to play.