Austin has flattened the curve. Now what?

Screen Shot 2020-05-05 at 1.31.43 PM
The green line represents the rate at which confirmed COVID cases have increased each day. The yellow lines are the new cases each day. The red lines are the cumulative total.

The rise in the number of positive COVID cases in Travis County has slowed as a result of a sharp reduction in person-to-person contact, Mark Escott, interim head of Austin Public Health, told City Council this morning.

The rate at which new confirmed cases are doubling is now at about 20 days, even though testing has ramped up significantly in the last couple weeks. In more encouraging news, of the first 735 people who signed up for tests through APH’s online portal, only 16 tested positive (2.18%). Remember, that’s only a fraction of the tests being conducted countywide (many through private providers), but it’s a big drop from the 10% positive rate among those who had been tested up until last week.

We still don’t have the capacity to do widespread testing of those without symptoms, which would be ideal because it would allow us to get a sense of how many asymptomatic cases are floating around. Right now we’re still only testing those who report symptoms or those who have been in close contact with somebody who was infected.

“This is really reflecting of this community’s efforts to flatten the curve,” said Escott. “We need these efforts to continue. It’s critical that we continue to remind folks that this is not the result of luck.”

Those experiencing severe symptoms are disproportionately black and Hispanic. Latinos account for about 35% of Travis County’s population but 51% of local COVID hospitalizations. African Americans are about 8% of the population but 12% of hospitalizations.

Lots of constructions workers getting sick
Although the city and county stay-at-home orders initially restricted construction to projects deemed “essential,” Gov. Greg Abbott’s deemed all residential and commercial construction essential. Like me, CM Kathie Tovo said today that she had seen job sites that were not complying with social distancing guidelines and had heard constituents voice the same concerns.

Escott said among the infected there have been “a significant number of construction workers as well as families of construction workers.” It is “one of the dominant industries” among those infected, along with the grocery and health care sectors.

In other words: “The people getting sick right now tend to be the people who are working right now.”

Should we be optimistic? Ehh…
Where we go from here depends on how behavior changes in the coming weeks. We certainly are nowhere near the testing and contact tracing capacity to practically stamp out the disease, ala South Korea. The absolute best case scenario will be a steady, slow burn of hospitalizations and death until a vaccine arrives.

The slow burn will be possible only if people continue to interact at a far lower rate than usual. And frankly, I think it’s a good bet that person-to-person contact will continue to be far under normal levels. A national poll released today by the Washington Post shows that 63% of Americans are at least “somewhat” worried about getting ill and only 22% say they’d feel comfortable going to a restaurant at this point. There are sharp partisan divides, but even a majority of Republicans say they’re ready to dine out yet.

But there’s definitely going to be increased interaction. That’s for sure. And that is going to lead to an increase in transmission.

What is unclear to me is what the governor will do if hospitals around the state become overwhelmed in June or July. Will he reimpose restrictions or is he going to let us ride this out? Both outcomes seem plausible to me. The United States has failed to contain the virus and is now in the process of giving up the fight in the hopes that we will eventually achieve herd immunity.

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Experts tell Council: Get ready for COVID chaos

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Credit: Wikicommons

Moves to “reopen” Texas could very likely prompt a surge in COVID infections that will overwhelm area hospitals and lead to thousands of deaths, two experts told City Council yesterday.

Lauren Ancel Meyers, a UT professor of biology and statistics who has been modeling the progress of the disease in the Austin area, attributed Austin’s relatively low body count to its success in reducing person-to-person interaction over the past five weeks. She estimates that interactions are down 95%.

If we drop back to a semi-normal situation, where interactions are only down 40% from their usual level, the model projects that area hospitals will exceed their surge capacity in early to mid-June. If no additional social distancing measures were ordered to reverse the trend, Austin will experience a “catastrophic” three months that would Meyers said would resemble the chaos that engulfed Italy and New York City in recent weeks.

However, the death toll in that scenario will vary widely depending on how effectively we “cocoon” high-risk populations: the elderly and those with certain health conditions. If overall interactions are reduced by 40% but the at-risk population is able to avoid 95% of interactions, her model projects 2,900 deaths in the metro area by September. If, however, the at-risk group’s interactions only stay 80% below normal, deaths would shoot up to 6,500.

For what it’s worth, it’s hard for me to imagine how a change in most of our behavior would not also impact the behavior of those in at-risk groups. It’s one thing to tell retired people to stay at home, but many people at-risk are younger people who are not able to get out of work, despite underlying health conditions. So far the governor has not suggested that those people will be eligible for unemployment or disability.

Assuming no measures were taken to counteract the catastrophic scenario Meyers described, the community would reach “herd immunity,” at some point in September, which would significantly reduce the spread of the disease.

The prospect of another lockdown
Meyers also offered another scenario, in which state government responds to a major surge in cases by putting in place another lockdown.

For instance, if the goal was to reduce overwhelming hospitals, a logical “trigger” for another lockdown would be 100 COVID hospitalizations per day. If we only reduce interactions by 40%, we’ll hit that point in mid-June and then lock down for another three months, likely forcing schools to delay opening until mid-September.

The good news, she says, is that the second lockdown would probably be the last. Drastic measures will not be necessary after that due to herd immunity.

The consequences of exceeding hospital capacity
Clay Johnston, dean of the Dell Medical School, said that Meyers’ model likely understated the limits on hospital capacity. There are only about 1,000 available hospital beds in the metro area right now, he said. The 3,200 beds in her model is the “surge capacity” that would involve doubling up of beds and putting people in hallways and the emergency room.

Johnston also noted that Meyers’ model does not assume that the death rate will increase as hospitals overcrowd. In fact, patients will be far more likely to die in that scenario because they won’t be getting adequate care, said Johnston.

So what do we do? 
If we don’t dramatically increase testing capacity and boost contact tracing, it won’t make much of a difference whether we reopen now or some time in the future, says Meyers. The benefit of continuing the lockdown for at least a couple more weeks is that it will “buy us valuable time” to ramp up testing, she said.

Travis County still has a far higher testing rate than the other major urban counties in Texas. At about 66 per 10,000, we’re way ahead of Harris, Dallas, Bexar, El Paso and Tarrant. It appears that most people who report symptoms of the virus can get scheduled for tests within 24 hours, but the testing capacity is still nowhere near what it would need to be at to effectively manage the spread of the disease through testing and contact tracing.

Until we have a vaccine, the most likely way to prevent a catastrophic spread is to conduct widespread testing, including of people who don’t have any symptoms, so that those who test positive can quarantine.

What will people do?
It will take a few weeks before we see whether the grim scenarios Meyers’ discussed come to pass. Her model cannot predict exactly how people will behave in the coming weeks. She had to make an educated guess about how people will act in a situation that we’ve never experienced before; therefore her model assumes that in the coming weeks the average Austinite will be engaging in 40% fewer interactions than they would be in the pre-COVID world.

It’s very possible, however, that interactions will not increase that much. Or that they’ll increase even more. Only time will tell.

This is just a small sample of what you get every weekday if you subscribe to the Austin Politics Newsletter

The disturbing findings in the report on APD

The initial reactions to the report on Friday were reminiscent of the response to the Mueller report. In both cases, cheerleaders for the accused seized on the inconclusive nature of the report as vindication or exoneration while ignoring many of the report's troubling revelations. 

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