The 15-percent rule

Hospitalizations Are the Key to Texas Reopenings, Abbott Announces

Regions with low Covid-19 hospitalization rates can begin expanding reopenings immediately.

By Catherine Wendlandt September 17, 2020

A photo of a social distancing sign

Hospitalizations will be the key to reopenings in Texas, Gov. Greg Abbott announced today.

In a press conference from Austin Thursday afternoon, the governor touted the falling Covid-19 numbers in Texas. As of September 16, the state had 674,772 confirmed cases, according the Texas Department of State Health Services, but the two-week new-case average has hovered around 4,000 per day. Yesterday the state reported 3,309 new cases of Covid-19, and the number of hospitalizations was the lowest it’s been in the past three months, Abbott said.

"Texans are taking Covid seriously." 

At this point, it’s not possible to actually get rid of the presence of Covid-19, the governor said. On Wednesday the Centers for Disease Control and Prevention predicted that it won't be until late 2021 when the country can return to some semblance of normal (or, as we like to call it, the Before Times). Instead, the state’s goal has always been to contain the disease and minimize its harm.

Hospitalizations and Reopenings

However, as the state moves forward with reopening, it needs "a fair and reliable metric" to determine if we are on the right path, according to the governor. The solution? Hospitalizations. 

Hospitalizations provide the most important information on the severity of the pandemic, and it's generally more accurate on a daily basis, Abbott said. The state will rely most heavily on hospitalizations and a standard of 15 percent to determine reopening.

If more than 15 percent of hospitalizations are from Covid-19 in a Trauma Service Area region—Texas has 22—then that will serve as a warning, and the region will have to hold back on reopenings. However, if the region's hospitalizations are less than 15 percent for seven consecutive days, that region can start moving toward reopening. 

Currently there are 19 regions, including the Houston area, where the current hospitalization rate is 6.9 percent*, that can move forward with reopening.

Effective immediately, hospitals can begin performing elective surgeries again. 

Beginning Monday, September 21, retail stores, restaurants, offices, gyms, museums, libraries, and manufacturing can expand occupancy from 50 percent to 75 percent. 

Beginning Thursday, September 24, nursing homes, senior living facilities, and all other assisted living facilities can reopen for visitations and essential caregiver visits, provided they follow certain safety standards. Under the rules, residents can designate two essential caregivers who may visit their rooms, eschewing social distancing, so long as PPE is worn. Additionally, the caregiver must have tested negative for Covid-19 within the past two weeks. Nonessential visitors are allowed non-contact outdoor visits, open window visits, or indoor with plexiglass barrier visits. 

On March 15 of this year, the governor shut down visits at all Texas nursing homes to protect the elderly residents, a population among the most vulnerable and susceptible to the coronavirus. On August 6, he loosened the rules to add some visitations in nursing homes and assisted living facilities for visitations—with heavy restriction and safety precaution rules. Today’s announcement serves as a further loosening of the March order.

Despite these reopenings, the governor did not reprieve every industry. Even though restaurants can expand occupancy, at this time bars still cannot reopen since they are "known spreaders of Covid-19," according to the governor. Read more about restaurant and bar openings here.

Reversing previous orders

Today's announcement serves as somewhat of a reversal of Abbott's June 25 order to pause reopening the state. The governor first began reopening Texas on May 1 with his Phase 1 plan. At that point, all restaurants and retail centers, including malls, movie theaters, and shopping centers, were allowed to reopen on May 1 if they kept their occupancy to just 25 percent. Libraries and museums were also allowed to reopen, but bars, hair salons, barbershops, nail salons, and gyms were excluded from his order. 

Phase Two began on May 18 with staggered reopenings over the course of two weeks. Essentially though, gyms, offices, child care services, zoos/aquariums, amusement parks, massage parlors, and other personal-care and beauty services could reopen at 25 percent capacity and previously reopened businesses could expand to 50 percent. 

But after Phase 3 began on June 3, Covid-19 cases counts exploded, and the governor was forced to backpedal. For context, on May 1, the first day of the Phase 1 plan, the state reported 29,229 total cases. On May 18, the first day of Phase 2, the state reported 48,693 total cases. By June 25, cases topped 125,000. (Texas's worst day was July 15, when the state reported 10,791 new confirmed cases, a one-day high.)

So, on June 25, Abbott announced a temporary pause in the state’s phased reopening, while also suspending all elective surgeries at all hospitals in Harris, Bexar, Dallas, and Travis counties to free up beds.

Furthermore, in a move that surprised many, the governor on July 2 issued a statewide face covering order, requiring masks to be worn in a commercial space or public space, or any outdoor space that does not allow for at least six feet of social distance between people in any counties with 20 or more COVID-19 cases. It was a sharp reversal for the governor, who had previously avoided issuing any state-mandated mask orders—going so far as to block local mandates, as he did in Harris County on April 27—and had not been wearing masks himself in press conferences to that point. 

This isn't the all-clear

There are some Texans who believe the state should completely reopen and are behaving "as if Covid is no longer a threat," Abbott said. "The reality is Covid hasn't suddenly disappeared in Texas." 

While Abbott and company once routinely appeared at these conferences sans masks, today Abbott came in wearing one, only taking it off to speak. Even as the governor further reopens the state, somehow the fact that his mask was there and ready to be put back on as soon as the conference was over spoke just as clearly as the measures he is currently allowing to go into place.

Throughout the conference, the governor and other officials, including Lieutenant Governor Dan Patrick, Texas House Speaker Dennis Bonnen, and Texas Department of State Health Services Commissioner John Hellerstedt, stressed the importance of “personal vigilance,” echoing the message they’ve repeated at just about every presser since the pandemic hit.

Hellerstedt emphasized personal actions like social distancing, mask wearing, and safe health practices as the best way to prevent further spread. "I have three health priorities," he said. "Prevention. Prevention. Prevention.

The state is moving in this right direction because of personal vigilance, like wearing a mask, social distancing, sanitizing hands, and staying at home when sick, Abbott said. "Those safe practices remain the best defense" until a vaccine is available.

Read the full order here.

*This percentage has been updated to reflect a new rate that was announced by the Houston Health Department after the story published.

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