Q&A: As Texas considers how to reopen the economy, disease expert urges careful planning

As the global coronavirus pandemic has made its way to the Greater Houston area this month, many local residents are doing what they can to spread positivity throughout the community. (Hannah Zedaker/Community Impact Newspaper)
As the global coronavirus pandemic has made its way to the Greater Houston area this month, many local residents are doing what they can to spread positivity throughout the community. (Hannah Zedaker/Community Impact Newspaper)

As the global coronavirus pandemic has made its way to the Greater Houston area this month, many local residents are doing what they can to spread positivity throughout the community. (Hannah Zedaker/Community Impact Newspaper)

As coronavirus cases continue to increase in the Greater Houston area, Texas Gov. Greg Abbott announced in an April 13 news conference his intentions to begin evaluating the processes by which portions of the Texas economy could start to reopen.

Abbott did not provide a timeline for that plan, stressing the importance of being methodical and following guidance from public health officials.

In an April 14 interview with Community Impact Newspaper, Dr. Jill Weatherhead, an assistant professor of infectious disease at the National School of Tropical Medicine at Baylor University, said she thinks that process needs to be "very organized, planned and well-thought-out." Find a Q&A of that interview with Weatherhead below.

Where is the Houston area at right now in terms of the acceleration of the coronavirus and when we might reach a potential peak in cases?

There are many different modeling systems that are available that scientists, policymakers [and] economists are using to try to predict these peaks. One of the ones we use commonly is the University of Washington Institute for Health Metrics and Evaluation, and this is readily available online. This is a group that has been evaluating these peaks and trends not only here in the United States, but globally.

When you look at those metrics [and] what the predictions are, if we were to sustain the current system that we’re in with the stay-at-home orders, we would see hitting our peak medical resources around April 29, and the peak in terms of total daily death around April 30. It is a very slow process and we are still on the upward trend, hopefully, like other areas in the country, plateauing in the the next few days to weeks. With that plateauing, that’s great news. That means the stay-at-home orders that local, state and national policymakers have put into place are doing the job and the local people are doing their part to control the spread and transmission of this infection. These are all great signs that the interventions that are being done are impacting transmission. With that though are these thoughts of starting to reopen—starting to get people back to work and opening up the economy.

As elected officials begin looking at ways to reopen parts of state and local economies, what are some of the things they should be taking into consideration?

That needs to be done in a very organized, planned, well-thought-out process. We’re fortunate enough, living in the United States, to be able to see over the next couple weeks how other countries who are a few weeks ahead of us have opened up their economies and the processes by which they’ve done that. We’ll be able to see if those programs are working or if they’re starting to see a second wave of infection as they open up the public spaces.

It is going to take a significant amount of planning, observation and a very strong public health infrastructure to be able to monitor what is happening in real time as businesses and public spaces are opening up. As we get more into a maintenance and recovery phase, this is where the public health infrastructure is really critical. There is a lot of information about the virus that we don’t know that will be learned in the next few weeks to months. For example, understanding if this virus—like other respiratory viruses, including our typical endemic coronaviruses that cause our seasonal colds—if we will see decreased cases in the summertime. We’ll learn if people who have been infected sustained immunity, meaning these people who have had infection develop antibodies once they are infected which helps them prevent infection in the future—if that is something that occurs and if that is something that occurs over a long period of time or if that immunity wanes.

The biggest thing we all need to do is really invest in the public health infrastructure, having readily available, quick turnaround testing to identify cases and then doing contact tracing for a positive case to monitor for waves of new infection. Once one person is positive, having the infrastructure available to test people who that person came in contact with so those cases can be identified and controlled. And then, of course, the investment in therapeutics, both for post-exposure phophylaxis as well as treatment in terms of medications as well as vaccines. All of those measures—both the information we don’t know that we will learn, as well as the investment in public health infrastructure—are going to be critical in the next couple of weeks to months.

Are there any concerns about the adequacy of testing in Harris County right now as we look at the curve and try to identify a possible plateau?

The county is testing people [and] health care facilities are testing people who have symptoms and meet the criteria to test. That certainly leaves out a portion of the community who may have COVID-19 and are not being tested. That information, as we build up testing capacity within the county and within the state, will be critical to understanding the extent of how many people are truly infected in the region. The number of cases is likely not reflective of how many cases are truly here in the area. It’s reflective of the patients who have more severe symptoms. It may be just the tip of the iceberg.

However, as long as those criteria are not changing and you are not seeing increases in those numbers, that hopefully reflects that the entire community's numbers are going down as well. As they escalate testing capacity ... we will be able to monitor those other cases with less severe symptoms, with more mild symptomatology as well as potentially asymptomatic or pre-symptomatic patients who previously would not have known if they had infection or not. That’s part of the testing strategy—to have testing more readily available and a quicker turnaround time to effectively be able to isolate cases within the community so we have a good idea of new cases that are presenting in order to control new potential waves of infection.

In terms of figuring out how to reopen in the best way, have there been any lessons learned so far from countries like China or Italy that are worth taking into account in Houston?

I think it’s too early still. For example, if you look at China ... at their timeline by province, specifically Wuhan went into lock down on Jan. 23, and they just lifted their lock down on April 8. So this is very, very soon, and it will take some time to see if they start having increased cases again.

Of the changes we have made to our day-to-day lives, are there any that you think will be around for the long term?

It’s going to be a long process. When it’s time to start lifting some of the restrictions, it’s not going to be a day where everything goes back to normal. And it shouldn’t because we don’t know what that future holds with this virus. There are too many unknowns. It’s going to be taking small steps in very calculated ways to be sure that the public health is maintained and that we don’t have to go backwards and do lock downs or stay-at-home measures in the future. By doing small measures to lift restrictions in an organized, methodical way, the goal is to prevent having to swing way backwards, having increased cases and having to do shutdowns again. The day that Gov. Abbott and health officials decide to start lifting restrictions, we're not going to have large sporting events and massive concerts and things like that. It just wouldn’t be safe until we know more about if there are secondary waves of this infection and how our community is prepared to detect and isolate cases because there will still be cases that are occurring. We just don’t want it to spread throughout the community like it had this first wave.

The projected death toll at the national level has recently been revised downward. To what extent is that evidence that social distancing is working?

It’s certainly complicated. Based on the projections, based on how this organism is spread between people—we know that if you are not in direct contact with people, the risk of transmission is significantly lower—the impact of social or physical distancing from others likely played a large role in terms of flattening the curve of transmission as well as flattening the curve of predicted mortality level. I think the measures that the Houston public, the U.S. people, have put into play has certainly played a major role in that. Of course, the public health workers who are doing testing and isolating cases so that those persons know they have infection also play a major role.

Leaders in Harris County, as they were implementing the stay-at-home order, said they leaned heavily on the feedback from the medical community to shape those orders. Is that something you expect to continue to inform decision-making as we get closer to the point where parts of those orders are being lifted?

Yes. I think the Texas Medical Center leadership has been incredible in terms of their ability to work together to inform the public and to inform policymakers based on science and based on what they are seeing in our local hospital systems. Their input and their ability to evaluate the science and evaluate the impact this infection has had on the health care system is going to continue to be incredibly important for policymakers moving forward in terms of restrictions and monitoring of future waves of infection.

What would you say to people who are eager to reopen the economy and want things to move faster?

We all need to empathize with each other that this is an incredibly challenging time where people are losing their jobs and aren’t able to see their families and friends. There’s a lot of impact of social distancing and stay-at-home orders for individuals and for entire communities, and that should not be overlooked. However, the health of our community is critical. Without the health of our community, we don’t have an economy. We need to make sure we are taking every step possible that is planned and calculated to make sure the restrictions are lifted in a safe way so people’s lives aren’t at risk.

If restrictions are lifted too quickly and public health infrastructure is not ready for new cases, we could see an accelerated increase in cases again and have to go back on stay-at-home orders. I think most of us are in agreement that once these restrictions are off, it would be incredibly challenging to go back on stay-at-home orders, and that may be the solution if there’s an accelerated increase in cases. That’s not to mention the risk of persons getting very sick and dying, which obviously should be our very utmost concern—to save the lives of our community members.
By Shawn Arrajj
Shawn Arrajj serves as the editor of the Cy-Fair edition of Community Impact Newspaper where he covers the Cy-Fair and Jersey Village communities. He mainly writes about development, transportation and issues in Harris County.