Seven weeks after Gov. Greg Abbott began allowing businesses to reopen, Texas exceeded another one of his key metrics Wednesday when the seven-day average positivity rate passed 10%, a level that Abbott previously called a “warning flag.”
The positivity rate is the ratio of positive cases to the number of tests conducted. The seven-day average has returned to 10.42%, a level the state hasn’t seen since mid-April, when Texas was under a stay-at-home order. In other words, for the past week, an average of about 1 out of 10 people tested for the coronavirus were positive.
It’s the latest in a streak of rapidly increasing indicators that have worried public health experts and local officials in Texas.
“The outlook is not good,” said Rebecca Fischer, an infectious disease epidemiologist at the Texas A&M University School of Public Health. “We are in a super dire situation.”
For 13 days in a row, the number of patients hospitalized with COVID-19 has reached record highs, soaring to 4,389 on Wednesday and more than doubling since the beginning of June. The daily count of new COVID-19 cases passed the 5,000 mark Tuesday and reached 5,551 on Wednesday — a 94% jump since June 1.
A spokesperson for the governor’s office did not immediately respond to a request for comment. Abbott told an Amarillo television station Wednesday that “there is a massive outbreak of COVID-19 across the state of Texas.”
The positivity rate is a metric he’d pointed to before, calling it “one of the most important data points” and one officials would watch as the state reopened.
“Anything below 7.2% is going to be a good number,” Abbott said at a May news conference. “If the positivity test rate is more than 10%, that’s one of those red flags that we begin to look at.”
Texas didn’t meet the guidelines laid out by the U.S. Centers for Disease Control and Prevention in May before moving to a phased reopening. The CDC suggested a downward trajectory of confirmed cases over 14 days, as well as a decrease in the positivity rate. The guidelines also recommended that hospitals shouldn’t be overwhelmed and that states should have a robust testing program, including the capacity to follow up with infected people using contact tracing.
Instead, Abbott chose to prioritize other metrics to track the pandemic, namely hospitalization levels and the positivity rate, which are both trending in the wrong direction. He also set a goal to hire 4,000 contact tracers by the end of May but remained 800 short of that target as of last week.
Abbott’s stay-at-home order expired April 30, and retail stores, restaurants, movie theaters and malls were allowed to operate at 25% capacity starting in May. Restaurants were permitted to ramp up to 50% occupancy on May 18, and child care facilities could reopen. Restaurants can now operate at 75% capacity, with tables of up to 10 people, and virtually all other businesses, including bars, can operate at 50%.
As the number of infections and hospitalizations started to increase at the beginning of June, Abbott said there was “no real need” to scale back business reopenings, citing the number of hospital beds available.
But earlier this week, he began striking an urgent tone, saying Monday that “COVID-19 is now spreading at an unacceptable rate in Texas” and urging residents Tuesday to stay home as much as possible.
Although health officials agree that wearing face coverings is one of the easiest methods to slow the spread of COVID-19, Abbott has so far refused to require people to wear masks in public. The governor issued an executive order June 3 banning local governments from imposing fines or criminal penalties on people who don’t wear masks in public.
After weeks of pressure from county and city officials asking permission to require mask-wearing, Abbott said last week that his plan authorized local governments “to require stores and business to require masks.” He had never publicly mentioned that option before. Many of the state’s largest cities quickly issued new orders, mandating that businesses require employees and customers to wear masks.
On Tuesday, Abbott allowed local officials to tighten restrictions on outdoor gatherings — limiting them to 100 people, a threshold he originally set at 500 people. He also said the state would impose new safety rules for child care centers, after making prior rules optional earlier this month.
The governor’s plan to reopen the economy, published in late April, does not identify a benchmark positivity rate that would prompt officials to reimpose stay-at-home orders or other restrictions.
It does say that rural counties that were allowed to reopen more quickly would have to slow down if certain conditions were met. High and steadily rising positivity rates were among them.
Shelley Payne, director of the LaMontagne Center for Infectious Disease at the University of Texas at Austin, said the increased positivity rate means “a higher percentage of [the] population infected.”
“The rates are really dependent on how many people you’re testing and who you’re testing,” Payne said. “So if you’re only testing people that you’re pretty sure have the disease, you’re going to have a high positive rate. If you test 10 times as many as people and many of those are not infected, then the positivity rate is going to go down.”
A&M’s Fischer said the metric can also indicate that the state is not testing enough.
“Some scientists have suggested that this 10% mark is really relevant as an indicator that testing is not widespread enough and … that we don’t really have a good handle on the situation — not just in terms of what we’re doing, but also what we know about it,” she said.
David Lakey, vice chancellor for health affairs and chief medical officer at the University of Texas System, said the growing number of people hospitalized and the rising positivity rate suggest that “we have more disease here in Texas right now.”
Hospitals and other facilities could also have stopped testing those considered unlikely to have the virus.
Chris Van Deusen, a spokesperson for the Department of State Health Services, said the agency is concerned with “any increasing rate of positive tests,” especially when the amount of testing is also increasing.
“That’s an indication that the number of cases in the community is growing, and it’s a clear signal that Texans need to take action to slow the spread of COVID-19,” he said.
Van Deusen advised Texans to wash their hands, disinfect surfaces, wear masks in public, and “heed the advice of leaders and stay home whenever possible.”
Patrick Svitek also contributed to this story.
Disclosure: Texas A&M University, the University of Texas at Austin and the University of Texas System have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.