There’s consensus among health care experts that Central Texas is weathering the COVID-19 pandemic well – our hospitalizations have been relatively low, and our regional hospital systems have not been overwhelmed. On average, 81 people have been hospitalized with COVID-19 over the past 18 days. But there’s also plenty of evidence to suggest that Gov. Greg Abbott‘s decision to lift public health restrictions and begin reopening the state on May 1 may be too much, too soon.
For one thing, we still don’t have all the data we need to know with confidence where Austin is in the trajectory of our local COVID-19 epidemic. We still cannot effectively track the virus’ spread through testing and still lack resources to perform contact tracing and provide all the support that our sick or vulnerable residents will need. Most experts agree those things are critical to ensuring that small outbreaks don’t explode into bigger ones once social distancing is relaxed. Delaying the lifting of restrictions would have bought us more time to prepare.
Area health care providers share the concern that we do not move too fast, even as they embrace the opportunity to resume treating patients for the many health care needs that took a back seat to COVID-19. Abbott’s March ban on elective procedures and surgeries (which expired April 22), and hospital and clinic systems’ strategies to conserve capacity and resources and safeguard workers and patients in the event of a COVID-19 surge, have created health care deficits that providers now hope to address.
One of those is Austin Regional Clinic, which delivers primary and specialty care across 12 Central Texas cities. ARC CEO Dr. Anas Daghestani told the Chronicle that since the response to COVID-19 may go on for months, we can’t delay all non-emergency procedures indefinitely without risking harm to patients. “We have to start thinking of this as a 6, to 12, to potentially 18 months of back and forth, with ups and downs,” he said, which means that delays in treatment can “become a real burden to patients.”
For instance, a procedure to treat a woman with an abnormal mammogram is considered elective, Daghestani said. “But that could delay a diagnosis of cancer. And sometimes 2-3 months of delay could have an adverse outcome.” Even a simple sports injury, such as torn cartilage in a knee, could become a real burden for a patient left unable to walk normally for months, he said.
Daghestani said he thinks an incremental, data-driven and measured approach to loosening restrictions makes sense now, but cautioned that we are in the early stages of a long-term fight. “I think it’s clear that Texas has flattened the curve at this moment in time,” Daghestani said, but careful monitoring and sufficient testing will be key to maintaining the gains we have achieved. “We just need to double down and remain disciplined and not celebrate too early.”
Dr. Jewel Mullen, associate dean for health equity at the UT Dell Medical School, said she takes a pragmatic approach to maintaining or relaxing restrictions. “Understanding that this is decision-making in the face of uncertainty, [we have to] really lay out all of what we are committing to, proceed with caution, reassess, and scale up or scale back by honestly assessing the impact of what we do,” she told us. Mullen also underscored the importance of safeguards for workers who may be especially vulnerable – ensuring access to testing, case identification and support for those “who not only are in the higher-risk professions, but also [those] from communities that have higher rates of disease and death.”
Protecting the vulnerable and striving for health equity has been an ongoing concern for Austin/Travis County Interim Health Authority Dr. Mark Escott, and the issue has been quantified by the UT-Austin COVID-19 modeling team led by Dr. Lauren Ancel Meyers. The team recently reported (and shared with the City Council on Tuesday, April 28) how failing to adequately shelter or “cocoon” vulnerable individuals from exposure to COVID-19 could bring catastrophic results as we open up our area to renewed activity. Those especially at risk who need to be protected from exposure include those over 65, those with chronic health conditions (whether living in institutional or other settings) and those who live with or care for them, said Spencer Fox, a UT research associate who is part of the modeling team.
This article appears in May 1 • 2020.