When Gov. Greg Abbott on Sunday announced that he was not prepared to issue a shelter-in-place order, he declared that “more than 200 counties” of Texas’ 254 counties “have zero cases of COVID-19.”
But scientists studying the rapid spread of the disease say Abbott is likely wrong — and making the same mistake politicians have made around the globe, waiting until cases are detected in their country, state or city before taking stringent action.
The contagiousness of the new coronavirus — coupled with a lack of widespread testing — means that policymakers like Abbott have a weak grasp on just how many people the disease has infected, even in remote areas of Texas, they say.
“We’re totally flying blind because we’re not testing enough,” said Claus Wilke, a University of Texas biologist who studies the evolution of viruses. “The problem with this disease is that infection to death takes three weeks roughly. And so the decisions we make today we will see in the morgue three weeks from now.”
“There very likely are more cases than we know because we’re not testing enough,” Wilke said.
The governor’s office did not respond to a request from the American-Statesman about how many tests have been administered in the more than 200 counties that the governor mentioned.
In a Sunday news conference, Abbott couched the spread of coronavirus in urban versus rural terms.
“The public knows that cases of COVID-19 are increasing in places like Dallas, in Houston, in Austin, and several other urban areas,” Abbott said. But, he said, “what may be right for places like the large urban areas may not be right at this particular point in time for the more than 200 counties that have zero cases of COVID-19.”
A more accurate statement would have been that there are zero “known” cases of the disease in those rural counties, according to scientists.
“Time and time again we’ve seen that by the time you detect your first case (of COVID-19) in a city, you probably already have many more cases in the city,” Lauren Ancel Meyers, an expert in infectious disease epidemiology at the University of Texas, who is working on a model of disease spread in Texas, told the Statesman.
And even once disease is detected, “a critical unknown quantity at this point” is how many other people are likely to have the coronavirus, Meyers said. “We don’t know if it’s one other case, 10 other cases or a 100,” she said, though she pointed to some findings in Seattle that the disease may have been spread to at least 1,000 people, undetected, before it was identified in the area.
“Sometimes transmission (of the coronavirus) is silent, even before someone (sick) has symptoms.”
Her examination of data from China found that in more than 10% of cases people were infected by somebody before that person had felt ill.
“The heart sinks at knowing there is so much disease that’s undetected and that we have to continue our control efforts,” she said. “But the one positive is that the more cases we’re able to detect, the denominator gets bigger and bigger” — meaning the ratio for survival goes up and up.“
A ̔bad surprise’
Abbott said that before he would issue a statewide shelter-in-place order, he wants to see if the limits he put in place Thursday show results.
Since Thursday, however, coronavirus cases have continued to rise statewide, and especially in the state’s largest cities.
“Given the limited amount of testing we have done, I’m not sure how reliable these numbers are,” Wilke said. “And so we’re looking at a possible scenario where there’s a bad surprise in two or three weeks. This has happened in every country around the world that hasn’t taken this seriously.”
The disease is “sufficiently benign in many cases that it can spread easily, but it’s sufficiently lethal that it causes a lot of damage if we don’t squash it decisively,” he said.
People can start spreading the coronavirus before they feel sick — and if they’re paid by the hour, they have a strong incentive to keep working as long as they can, epidemiologists have observed.
“When you spread Ebola, you’re already so sick, you’re essentially dying,” Wilke said, “and it’s very easy to control in that sense. It’s much easier to contain a disease when people are seriously ill.”
Still, Nim Kidd, chief of the Texas Office of Emergency Management, told the Statesman that Abbott’s Thursday order “seems like it’s working, seems like it’s being adhered to.”
“As we do more testing, we know numbers are going to increase. But just seeing more tests positive doesn’t mean the governor’s order wasn’t effective. We’re looking to see if enough is enough, or if it was too much. Kind of see how that would play out,” Kidd said.
“A lot of the state of Texas that doesn’t have one case: 208 have no confirmed cases at this point,” he told the Statesman on Monday. “It’s really hard for people that don’t understand it’s at their doorstep to understand why they have to have the same restrictions as someone who has a pretty good cluster of localized outbreak.”
Dire projections
Officials in at least dozen Texas counties have decided not to wait for any further orders from the governor, ordering residents to stay at home except for essential errands and exercise.
Citing models promoted by CovidActionNow.org, a website spearheaded by a former Google executive and put together by engineers in partnership with public health experts to encourage policy-makers to take more stiff action to stymie the disease’s spread, Dallas County Judge Clay Jenkins ordered residents starting Monday night to stay in their homes except for essential work and errands. Austin mayor Steve Adler and Travis County Judge Sarah Eckhardt followed suit on Tuesday.
Over the weekend, Steve Love, president and CEO of the Dallas-Fort Worth Hospital Council wrote an email urging his hospital officials to press the governor to impose a shelter in place order. “Thank you for your immediate action as we want the governor to take this urgent action statewide rather than individual counties or cities,” he wrote, according to The Dallas Morning News.
That email also contained a graphic from CovidActionNow.org that showed that hospitalizations in Texas could peak at 250,000 by mid-May with social distancing — keeping at least 6 feet apart — as a sole strategy.
A statewide shelter-in-place strategy for three months, on the other hand, would peak at 6,400 hospitalizations by July 1.
The model also predicted 430,000 deaths from the disease in Texas over the next three months with social distancing as a sole strategy and 5,000 deaths if a shelter-in-place strategy was mandated statewide.
Asked by the Statesman about the CovidActionNow model, Kidd said: “I don’t know how much I trust it without knowing the background of how this was built and where it came from.”
“I would rather rely on our professionals at the CDC, at the Department of State Health Services, at the local public health offices and at the hospitals that are starting to report back than trying to centralize around some model that I have no history with,” Kidd said.
The CovidActionNow.org model is a mash-up of studies by Imperial College in London and U.S. demographic data and hospital capacity information.
The Imperial College simulations suggest COVID-19 spread will lead to the overwhelming of hospitals many times over unless stringent action is taken. (But even then, after actions are loosened again in the simulations, the spread of the virus spikes once more.)
The modeling and website were put together because “we’re not sure policy-makers and regular people realize the explosive power of exponential disease growth,” Jonathan Kreiss-Tomkins, who helped buildthe site and is a Democratic member of the Alaska Legislature, told the American-Statesman. “We had the realization looking at COVID data, especially in other countries, that this is super-scary, that these trends are really alarming, and we feel we need to do something about it.”
Asked about Abbott’s decision to decline a statewide shelter-in-space order, Kreiss-Tomkins said: “Testing across the U.S. has been such a mitigated disaster compared to other countries like Taiwan, South Korea and Singapore, that it’s hard to know what the actuals are. I’d be shocked if it’s true that more than 200 counties in Texas do not have COVID right now. The data is really lagging behind the reality in so much of the country.
“The second thing I’d say is that generally, everything is fine and well until it’s not, and that’s the nature of exponential growth. You might say, these are relatively petty double digit numbers, and the next thing you know you’re at tens of thousands of people and approaching a point of no return, Italy style, Spain style, New York City style.”
Elected officials, he said, have a hard time making decisions like the one Abbott could. “It feels like inflicting all this self-pain as a prophylactic gesture against something not right in front of you and weeks away.”
Staff writer Jonathan Tilove contributed to this report.
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