Nearly two months into the reopening of Texas businesses, coronavirus cases are rising fast. State officials expected this.
As early as April, when he announced the state’s plans to reopen businesses in phases, Gov. Greg Abbott acknowledged that doing so would mean more Texans falling ill — leading to, as he left unsaid, more Texans in critical care and more Texans dying. Since then, as that deadly prediction proved out, he has remained committed to keeping businesses operational.
Texans have already shown that we “don’t have to choose between jobs and health — we can have both,” Abbott said this week. “We can protect Texans’ lives while also restoring their livelihoods.”
As cases surge, the question has become: How many Texans’ lives?
Already, 2,296 people in Texas are known to have died of COVID-19, a figure experts agree is an undercount. Some of the thousands currently hospitalized with the virus will surely join their ranks in the coming weeks.
After the Memorial Day weekend, a month into the state’s reopening, infections are soaring in Texas, particularly in major cities like Houston and Austin. The number of coronavirus patients in Texas hospitals has more than doubled, setting new records every day for two weeks. And the state’s positivity rate — the share of tests that come back positive — now far exceeds 10%, a number Abbott identified as a “warning flag.”
Abbott’s strategy has largely revolved around increasing Texas’ hospital capacity — focusing on the state’s ability to treat the sick, but not using every tool at his disposal to limit their numbers. This week he took some steps to mitigate the spread of the virus, strengthening safety rules at child care centers and once again barring elective surgeries in four urban counties.
But he maintains that closing businesses “will always be the last option.” He won’t allow businesses to reopen any further, he said Thursday, and plans to re-evaluate those that are already open if the spread does not slow over the next few weeks. He recommended that Texans wear masks, but stopped short of requiring it. He exhorted Texans to stay home, but did not shutter the bars and shops they flock to. Most businesses are permitted to be open at 50% capacity.
Faced with twin crises — a pandemic that has upended daily life, and the resulting economic collapse that brewed the state’s highest unemployment rate on record — Abbott has chosen a mandate not to preserve life at all costs, but to keep illness and deaths at manageable levels. He closed Texas businesses in April, when cases were lowest and fears highest. But now those trend lines have reversed, putting the state in its direst situation yet, and Abbott has been loath to reinstate the harsh measures that helped avert initial disaster even as another threatens.
Meanwhile, some public health experts say they have seen enough. They warn that the thousands of hospital beds and ventilators currently available in the state will go quickly if current trends continue.
“We have to intervene now and we have to be very aggressive,” Dr. Peter Hotez, dean of the National School of Tropical Medicine and a professor at Baylor College of Medicine, said on CNN this week. “If it were up to me, we would do exactly what we did towards the end of March which is implement a full lockdown and social distancing. That’s the only way that I see that we’re going to start to bring those numbers down.”
Abbott has a difficult balance to strike. Full economic shutdowns, experts warn, may minimize the risk of COVID-19 transmission, but they carry significant other risks, like the potential loss of employer-based health insurance and a dire toll on mental health.
“I think it’s important to recognize that we don't really have much of a choice when it comes to doing this — it's really one health care issue versus another health care issue,” Dr. John Zerwas, the executive vice chancellor for health affairs at the University of Texas System who is advising Abbott on coronavirus response, said in an interview earlier this month.
It’s “kind of like threading the needle,” Zerwas said, borrowing a phrase from Texas Department of State Health Services Commissioner John Hellerstedt. “We’re in a phased way threading a needle here, and what our hope is is that as we thread that needle with each phase, the eye of the needle gets bigger, and it gets easier to thread.”
But Abbott’s critics, particularly local leaders and Democrats, say the governor has prioritized the state’s economic health over its physical health — and tied their hands so they can’t respond adequately.
The opening plan never adequately accounted for public health needs, said Cullum Clark, an economist and the director of Southern Methodist University’s Economic Growth Initiative at the George W. Bush Institute.
“The phased approach was an honest effort to plan ahead and we needed an honest effort to plan ahead,” Clark said. “But I do think we have to note the phased approach did not really have public health triggers for the subsequent phases. It's not like we said real clearly: ‘The next phase only happens if and when the following public health goals have been met.’ We did not say that. We simply said: ‘After a certain amount of time, we’ll go to the next phase.’"
Criticism has mounted as Texas’ troubling trendlines fall under the national spotlight. Earlier this week, the hashtag #AbbottResign trended on Twitter; on Wednesday, a CNN analyst asked, “Can this Republican governor admit he made a mistake on coronavirus?” Earlier this spring Texas imposed travel restrictions on individuals coming from New York, New Jersey and Connecticut, as cases in those places surged; now, those states have done the same to Texas.
Some local officials are calling on Abbott to slow the spread of the virus before hospitals get overwhelmed.
“We can't have such disregard for human life & our economy as to say let’s fill all our base & surge ICU beds before taking meaningful action,” Harris County Judge Lina Hidalgo said on Twitter Thursday. “Let's not get there. Let’s have respect for the lives of everyone in our community. Minimize all contacts.”
Local officials, particularly in large cities, have panned Abbott for not requiring Texans to wear masks in public. In May, Texas Attorney General Ken Paxton threatened to sue cities that mandated masks. Earlier this month, the governor seemed to relent, allowing a roundabout method: Local officials could require businesses to require masks.
Sam Frenkil, a 69-year-old retiree in Carrollton, understands those competing interests better than most: When his great aunt died of the coronavirus earlier this year, he felt he couldn’t risk traveling to the funeral to say goodbye. But as the pandemic stretches on, he’s also watched his son, who is unemployed, search in vain for a job.
Frenkil, who said he voted for Abbott in 2018, acknowledged it is difficult to strike the right balance between health and economic recovery. But he said a mask mandate is a common-sense solution — making facial coverings optional is “reckless and unacceptable.”
Meanwhile, economic progress has been modest. A record unemployment rate of 13.5% in April fell slightly to 13% in May, when Abbott’s phased reopening of Texas businesses began, according to figures from the U.S. Bureau of Labor Statistics. Sales tax revenue is down, heralding budget problems for the state and local governments.
Economic experts say pitting economic recovery against virus mitigation is a false choice: The economy won’t fully recover until consumers feel comfortable engaging in it.
“When everybody has confidence that this pandemic is behind us — that's when the economy is going to recover strongly,” said Dr. Howard Koh, who served as assistant secretary for health during the Obama administration.
In the restaurant industry alone, of 1.2 million people employed before the pandemic, nearly 700,000 have lost their jobs, according to the Texas Restaurant Association. A statewide mandate on minimum health standards — are masks required or not? — would help businesses reopen by making regulations clear to customers, said Emily Williams Knight, the association’s chief executive officer.
Some workers are afraid to return to work, where they risk contracting the virus. And some businesses are closing voluntarily as cases continue to spread — including among their staffs.
“We’ve clearly established all around the world that you can’t make the economic recovery happen faster than the underlying public feels safe living,” said Clark, the economist at the George W. Bush Institute. “You won’t get to 100% or 90% of the old level of attendance at restaurants unless 90% or 100% of the people feel safe going there. And how do you convince 90% of the people to feel safe? Probably not by ridiculing them for wearing a mask or something of that nature. Probably by solving the public health problem.”
For now at least, Abbott has made his priorities clear.
“Together,” he said at a Monday press conference, “we can keep Texans safe. Together, we will keep Texas wide open for business.”
Perhaps the verbs were ill-chosen or accidental. But one was a possibility, the other an imperative.
Mitchell Ferman and Shannon Najmabadi contributed to this report.
Disclosure: Southern Methodist University, the George W. Bush Institute, the University of Texas System and the Texas Restaurant Association 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.