Local, State Health Leaders Try to Keep Up with COVID-19

Health care workers with Baylor Scott & White screen patients for COVID-19 on March 15. (photo by John Anderson)

With federal leadership still halting at best, state and local officials have doubled down in the last few days to try to head off what may be a looming healthcare crisis in Central Texas and across the country, driven by the coronavirus that causes COVID-19.

As of noon CT today (Monday, March 16,) there are more than 3,800 known cases of COVID-19 nationally and at least 67 deaths, but many warn this is just the tip of the iceberg. Based on the massive impacts now being seen in Italy and elsewhere, experts are increasingly emphasizing the need for everyone – even the young and healthy – to stay put and avoid contact with others to the extent possible. Anyone can transmit the disease unknowingly, and it can travel along a chain of unaffected people until it hits an unlucky victim, such as someone who is elderly or has an existing health condition like diabetes or heart disease.

The Texas Department of State Health Services reported that confirmed cases had grown to 57 as of Monday, across 17 counties. Gov. Greg Abbott said in a Friday (March 13) press conference that just 220 people had been tested in the state for COVID-19 since the outbreak began, and that 75 were currently being tested. While lab capacity is supposed to be expanding this week as a result of both public- and private-sector efforts, the state’s numbers do not likely represent the extent of infection.

The city of Austin responded to its first known cases on Friday, announcing two cases at 6am; the city and county ended the weekend with six cases. Local officials announced new measures, including a ban on gatherings of 250 or more, that became effective 2:00 am on Sunday and will last at least through May 1. This morning, the City of Austin announced it would close all city libraries pools, golf courses, athletic programs, recreation centers, and cultural centers through at least March 30, although some Spring Break camps will stay open through Wednesday.

The federal Centers for Disease Control and Prevention the nation’s leading public health agency, also issued guidance Sunday night that “for the next 8 weeks, organizers (whether groups or individuals) cancel or postpone in-person events that consist of 50 people or more throughout the United States.”

Meanwhile Austin area healthcare providers have been steadily updating visitation and admittance policies, as Dr. Mark Escott, the Interim Health Authority for the city and county, ordered them to adopt new measures. On Friday, he issued an order that required all healthcare facilities in Travis County to screen patients, visitors, employees and volunteers for COVID-19 symptoms and to have a plan for isolating healthcare workers, if needed. Workers must also monitor their temperatures before and during their shifts.

Separately, Escott provided “critical advice” to individuals who know they have been in contact with someone with COVID-19. He asks that such individuals “self-monitor” (i.e. take their own temperature) as well as generally self-isolate, and advised them to contact health care professionals if symptoms develop. With the heightened concern that COVID-19 may be silently circulating in the community, restaurants have also been given orders to sanitize key surfaces hourly and implement policies to take workers offline who have a fever.

At least one of the persons who tested positive for COVID-19 is hospitalized at St. David’s Medical Center in critical condition. In a statement released on Friday, hospital president and CEO David Huffstutler said that the hospital is screening everyone who enters their facilities and ensuring staff wear personal protective equipment as needed, and that patients suspected of having COVID-19 are isolated and separated from others. “We are also continuously evaluating our supply of personal protective equipment, and we are confident in our inventory,” his statement said. St. David’s has also implemented new visitor restrictions, allowing just one visitor per patient, and allowing an overnight visitor only in cases involving pediatrics, the Neonatal Intensive Care Unit (NICU), laboring mothers, patient advocates for pre and post surgery and end-of-life care. More information about the hospital’s procedures and preparedness is available here.

The Central Texas Veterans Health Care System also announced new procedures for its facilities. Mandatory screenings at clinics and medical centers for those who have symptoms of respiratory illness will begin this week, a statement from public affairs officer Deborah Meyer said. Residential facilities will also be strictly monitored and a temporary “no visitor” policy has been adopted for some campuses, with exceptions for veterans in last stages of life on hospice units, the statement said. More information is available at www.centraltexas.va.gov/.

Many area providers are urging patients to use tele-health where possible and warning them that all visitors to clinics and hospitals will be screened. Testing decisions are still being made on a case-by-case basis and people who do not mean certain criteria will likely not be tested.

Central Health and Ascension Texas (which operates Dell Seton Medical Center) have established a COVID-19 hotline at 1-833-919-1680, which they say is available from 6 a.m. to midnight. “The hotline is staffed by registered nurses who will respond to public questions and implement the most up-to-date screenings and protocols to guide patients to the most appropriate care setting, including staying at home and/or virtual options,” their website reads. Virtual care is being offered for $20 per visit. In addition, people with no insurance and no established provider who are experiencing coronavirus-like symptoms can call CommUnityCare at 512-978-9015.

Austin Regional Clinic issued a statement on March 14 saying its providers are developing plans and are “preparing to offer telemedicine options”; FAQs and a trove of helpful information is available from the ARC clinic system here.

The Austin Independent School District notified families on Sunday about several resources, including a virtual health care visit that is available without a copay, and options for tele-mental health services for students and families. Like many organizations, the district has created a special website for this issue. Go to www.aisd.org/coronavirus. We're expecting to hear more from Austin ISD at a midday news conference.

In a a tele-town hall on Sunday evening, state Rep. Eddie Rodriguez, D-Austin, brought experts together to answer questions from the public; Central Texans called in to inquire about how COVID-19 is spread and how contagious it is, how prepared the region is to deal with it, and how bad it might get. Rodriguez's panelists included ARC President and CEO Dr. Anas Daghestani, DSHS Associate Commissioner Dave Gruber, Austin Public Health Director Dr. Stephanie Hayden, and Dr. Donald Murphey of the Texas Medical Association COVID-19 Task Force. You can listen to the whole discussion here.

The experts were less able to definitively answer some questions, noting that outcomes will depend on many factors and there are things we still don’t know about how the virus, such as whether it will become less active in summer. But there was strong agreement that social distancing (staying 6 feet from others and reducing contact in general) will be key to mitigating the worst-case scenarios, even as callers worried that young people are still not taking the issue seriously. One caller wondered if she should even be concerned about getting sick if she had not traveled recently or been around someone who had. In response, Dr. Daghestani acknowledged that we are “beyond that point now” and that it’s pretty clear that there is now community spread.

As of Monday morning, Austin Public Health was still reporting that the county remains in Phase 3 of its five-phase pandemic response plan, with confirmed cases but no person-to-person spread. The Texas Tribune reported on Sunday that community spread has occurred in Brazoria, Matagorda, Dallas and Montgomery counties. Social distancing remains the most important thing we can still do – along with scrupulous hygiene practices and not making unnecessary trips to the doctor or hospital – to avoid the worst this virus can dish out.