2020 Coronavirus Pandemic In Texas

The COVID-19 pandemic in Texas is a part of the ongoing viral pandemic of coronavirus disease 2019 (COVID-19), a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The state of Texas confirmed its first case on February 13, 2020, among U.S. nationals evacuated from China to Joint Base San Antonio–Lackland beginning in early February; however, retrospective analyses have suggested a much earlier origin than previously thought. The first documented case of COVID-19 in Texas outside of evacuees at Lackland was confirmed on March 4 in Fort Bend County, and many of the state's largest cities recorded their first cases throughout March. The state recorded its first death associated with the disease on March 17 in Matagorda County.

, Texas has the second-highest number of confirmed cases in the United States, behind California, and the 26th highest number of confirmed cases per capita. It has the third-highest number of deaths related to the virus, behind New York and California, and the 24th-highest count of deaths per capita.

Although Texas had a higher concentration of cases, it had fewer deaths. As of late May 2021, there were 50,198 COVID-19 related deaths reported in that state. The death rate in Texas was 175 for every 100,000 people, while national COVID-19 death rate was 179 per 100,000.

As of April 3, 2021, vaccination in Texas lagged behind the US average, with rates lower than in three of four neighboring states, having administered 12,565,129 COVID-19 vaccine doses, equivalent to 43,334 doses per-100,000 of the state's population.

Timeline

The initial origin of community spread in Texas remains unclear, but numerous anecdotal accounts by those later confirmed have included onset dates as early as December 28 in Point Venture, and retrospective analyses have found unexplained statistical increases in deaths during this time. Testing capacity across the state remained extremely limited until after the first recorded cases were announced.

Research from Austin Public Health conducted in May found 68 COVID-19 patients in Central Texas who began reporting symptoms dating back to around the beginning of March. On March 2, San Antonio Mayor Nirenberg issued a public health emergency after an individual positive for the virus is mistakenly released from quarantine at JBSA–Lackland. Two days later, the Texas Department of State Health Services (DSHS) reported a presumptive positive test result for COVID-19 from a resident of Fort Bend County in the Houston area. A man in his 70s was the first known positive case of the disease in Texas outside of those evacuated from Wuhan and the ''Diamond Princess'' cruise ship. The patient had recently traveled to Egypt and was hospitalized. DSHS commissioner John Hellerstedt called the confirmation a "significant development" but indicated that "the immediate risk to most Texans is low."

On March 5, at least eight cumulative cases, including both positive and presumptive positive cases, were identified in the Houston area. The cases involved individuals in the counties of Fort Bend and Harris counties. All individuals with confirmed cases were part of a group that traveled to Egypt in February, including the first confirmed case in Fort Bend County. The travel group rode aboard the Nile River cruise ship '' MS A'sara''. Additional individuals are also investigated as possible carriers in the Houston area in connection with the Egypt trip. The state announced six public health laboratories within its Laboratory Response Network capable of testing for COVID-19.

On March 8, JBSA–Lackland received approximately 100 evacuees from the cruise ship ''Grand Princess'' following a localized outbreak on board. Rice University became the first university in the state to enact significant cancellations, suspending in-person classes and undergraduate labs during the week in response to an employee testing positive in connection with the viral cluster that traveled to Egypt. The next day, the cumulative number of confirmed cases in Texas reported by the DSHS surpassed 10. That same day, a resident in his 30s of Frisco, a suburb of Dallas in Collin County, received a presumptive positive test for the virus, having recently traveled to Silicon Valley in California. He was the first case identified in the Dallas–Fort Worth metropolitan area. His wife and 3-year-old child later contracted the disease, with the latter among the youngest confirmed to have the virus in the U.S.

On March 11, local health officials reported a positive test for COVID-19 in Montgomery County, and identified as the first possible case of community spread—not directly related to travel or known contact with positive travelers—in Texas and in the Houston area. The patient's attendance of a barbecue at the Houston Livestock Show and Rodeo on February 28 was reported as a possible but unconfirmed source of the virus. The city of Houston ordered the Houston Livestock Show and Radio to close after announcing an emergency health declaration. Montgomery Independent School District in the Houston area and Alvarado Independent School District in the Dallas area were the first two public school districts in Texas to temporarily close classes over COVID-19, affecting approximately 12,400 students across 17 schools.

On March 13, Governor Abbott declared a state of disaster for all counties in Texas, invoking emergency powers for the his administration, and ordered state employees to remote work. Day cares, nursing homes, and prisons were asked to limit visitations. The state's first mobile testing center for COVID-19 opened in San Antonio. Colleges and universities throughout the state extended spring breaks with some transitioning to online instruction, including Baylor University, the University of Houston, the University of North Texas, the University of Texas at Austin, Texas State University, and Texas Tech University. School districts also announced temporary suspensions of classes statewide.

On March 17, DSHS reported that a man in his 90s in Matagorda County died of COVID-19 after being hospitalized, becoming the first official COVID-19 fatality in Texas. The Texas National Guard was activated, making Texas the 21st U.S. state to activate its National Guard; the security force was not yet deployed. Abbott granted waivers to hospitals to bolster unused bed capacity without applying or paying added fees. Abbott also asked the Small Business Administration to declare an Economic Injury Disaster Declaration for the state, with eligibility granted three days later.

On March 19, the cumulative number of confirmed cases in Texas reported by the DSHS surpassed 100. The DSHS declared a public health disaster, marking the first such declaration since 1901. DSHS Director Hellerstedt issued the disaster declaration as the disease "has created an immediate threat, poses a high risk of death to a large number of people and creates a substantial risk of public exposure because of the disease's method of transmission and evidence that there is community spread in Texas." Abbott issued four executive orders to ban gatherings of more than 10 people; discourage eating and drinking at bars, food courts restaurants, and visiting gyms (and close bars and restaurant dining rooms); proscribe visitation of nursing homes, retirement centers, and long-term care facilities with exception of providing critical care; and temporarily close all Texas schools.

On March 26, the cumulative number of confirmed cases in Texas exceeded 1,000, and Abbott mandated visitors flying from Connecticut, New Jersey, New York, and New Orleans, Louisiana, to self-quarantine for 14 days. A team of researchers at the University of Texas at Austin projected that the healthcare capacity of Greater Austin would be exceeded if "extensive social distancing measures" were not implemented. Their findings indicate that a 90 percent compliance scenario would maintain hospitalizations within capacity through August 17.

On April 17, Abbott announces the start of his plan to reopen the Texas economy, citing a "semi-flattened curve" of COVID-19 cases in the state. The reopening was outlined in three executive orders allowing for state parks to open under social distancing regulations on April 20, limiting nonessential surgeries at hospitals beginning after April 21, and product pickup at retail stores beginning April 24. The reopening process also established the Strike Force to Open Texas, an advisory panel to Abbott for reopening economy. The panel was led by James Huffines with Mike Toomey as chief operating officer; its consulting members are all members of the Republican Party. The panel also consisted of a medical team and a special advisory council. Abbott also called for public schools to remain closed for the rest of the 2019–2020 academic year. Ten days later, pursuant to the executive order establishing the Strike Force to Open Texas, Abbott released the ''Texas Governor's Report to Open Texas'', putting forth a phased approach to reopen the state's economy.

On May 5, Abbott modified his earlier reopening timetable, allowing barbershops, hairdressers, and nail salons to begin reopening on May 8 while maintaining social distancing. Gyms and exercise facilities were allowed to reopen beginning May 18 while operating at quarter occupancy. On May 18, Texas entered Phase 2 of the governor's reopening plan. On June 3, Texas enters Phase 3 of Abbott's reopening plan.

On June 23, the state reported more than 5,000 new cases of COVID-19 in a single day for the first time, documenting 5,489. Hospitalizations related to COVID-19 also reached a record high with 4,092. Abbott gives approval for mayors and county judges to enact restrictions on outdoor gatherings with more than 100 people, reducing the size limit from 500. Abbott also indicated that respirator enforcement is within the purview of local officials. Abbott ordered the HHSC to reinstate COVID-19 health and safety standards at child care centers, reversing the agency's lifting of those requirements on June 12. Two days later, a record-high number of new COVID-19 cases, 5,996, was set for the third consecutive day in Texas; the three days contribute over 17,000 cases to the cumulative case count. Abbott paused the reopening of the businesses in the state as hospitalizations deaths and new COVID-19 cases begin to quickly rise, though prior relaxations of COVID-19 restrictions remain in place.

On June 26, Abbott began rolling back some of the lifted restrictions from his earlier state reopening plan, issuing an executive order that promptly closed bars except for takeout and curbside pickup and closed rafting and tubing businesses in addition to restricting indoor dining at restaurants to 50 percent capacity. The order also required most outdoor gatherings with at least 100 people to seek approval by local governments. Harris County Judge Lina Hidalgo evaluated the county as having reached the highest threat level, indicating a "severe and uncontrolled level of COVID-19", and called for the reinstatement of a stay-at-home order for the county in addition to prohibiting outdoor gatherings with more than 100 people in unincorporated parts of the county.

On July 2, Abbott mandated the wearing of face coverings in public spaces, with fines for non-first time offenders. Counties with 20 or fewer active cases, children under 10, and persons with interfering medical conditions were allowed to opt-out of the order, as well as people attending church, voting at polling places, or exercising outdoors. Austin Mayor Adler issued an executive order restricting gatherings with more than 10 people outside of child-care services, religious gatherings, and recreational sports.

On August 11, 2020, Texas became the third state in the U.S. after California and Florida to exceed 500,000 in total number of reported cases. On a per capita basis Texas ranks 12th among US states, with Louisiana, Florida, Arizona, Mississippi and Georgia leading the list. By October 29, 2020, larger hospitals in Amarillo, Lubbock, and El Paso did not have space available to accept transfers of seriously ill COVID patients from rural areas.

During the fifth wave of infections in August 2021, demand for ICU beds in at least 50 Texas hospitals reached or exceeded 100% of ICU capacity. A surge in hospitalizations among children caused Houston and Dallas to run out of pediatric ICU beds, with Houston resorting to an air lift evacuation in one case. Dallas County Judge Clay Jenkins told parents that "if your child is in a car wreck, if your child has a congenital heart defect or something and needs an ICU bed or more likely if they COVID and need an ICU bed...your child will wait for another child to die. Your child will just not get on a ventilator." On August 17, 2021, it was announced that Governor Abbott had tested positive for COVID-19. He had been fully vaccinated against COVID-19 and began taking Regeneron's monoclonal antibodies.

Epidemiology

The first positive test result for COVID-19 in Texas, outside of the evacuees quarantined at JBSA–Lackland from China and the ''Diamond Princess'' cruise ship, was reported by the DSHS on March 4 and involved a resident of Fort Bend County. The patient was a man in his 70s and had traveled on the Nile River cruise ship '' MS A'sara'' in Egypt. A total of 12 positive test results were reported in Fort Bend and Harris counties from travelers aboard the same ship. The first case of possible community spread—where the source of infection is unknown—was reported by public health officials on March 11, involving a man in his 40s in Montgomery County; he had recently attended a barbecue at the Houston Livestock Show and Rodeo on February 28. The first death in Texas identified in connection with COVID-19 occurred on March 14 from a man in his 90s at the Matagorda Regional Medical Center; Matagorda County officials reported the death on March 15 and the DSHS confirmed it the following day. According to the DSHS, the state exceeded 100 total cases of COVID-19 by March 19 and 1,000 cases by March 26. By the end of March 2020, there were 3,266 known cases of COVID-19 and 41 fatalities in Texas, with nearly half of the state's counties reporting at least one case. An analysis of the first month of COVID-19's spread in Texas, published in the ''Journal of Community Health'', found that while the total case counts were highest in the state's metropolitan areas, the highest incidence rates of the disease per capita occurred in Donley County, with 353.5 cases per 100,000 people. The case fatality rate (CFR) was 10.3 percent in Comal County; high CFR counties had "a higher proportion of non-Hispanic Black residents, adults aged 65 and older, and adults smoking, but lower number of ICU beds per 100,000 population, and number of primary care physicians per 1000 population."

The cumulative number of COVID-19 cases confirmed by the DSHS reached 10,000 on April 9 and 100,000 on June 19. The number of confirmed fatalities eclipsed 100 on April 4 and 1,000 on May 9. Counties that adopted shelter-in-place orders early showed a 19–26 percent decrease in COVID-19 case growth 2.5 weeks following the enactment of those orders according to an analysis published in the National Bureau of Economic Research. The same analysis found that such orders in urbanized counties accounted for 90 percent of attenuated case growth in the state by May. A surge in new COVID-19 cases began in June with large increases in the state's major cities and within a younger population compared to the beginning of the pandemic.

Responses

State responses

The government of Texas did not have a coordinated, statewide response to the early stages of the COVID-19 pandemic, relying mostly on local policies. Governor Abbott declared a state of disaster on March 13, 2020, giving him powers to order state-wide public health measures, and prohibited large social gatherings and dine-in service at bars and restaurants on March 19. On March 31, Abbott issued an executive order requiring all residents to remain at their homes unless conducting essential activities, and to minimize gatherings with people from outside of their immediate household. Abbott specifically avoided use of terms such as "shelter-in-place" or "stay-at-home order", as he felt that they did not adequately reflect his goals. A suspension of elective medical procedures faced legal disputes for effectively prohibiting abortions.

In May 2020, Texas began to lift its initial restrictions via a phased timetable, via executive orders superseding all local health orders, the process was paused on June 25 due to a surge of cases, and Abbott rolled back some of the orders the next day, including reducing restaurant capacity to 50%, closing bars, and prohibiting unapproved gatherings of more than 100 people. On July 2, Abbott announced that the wearing of face masks would be mandated in enclosed public spaces in counties with a minimum number of cases, and gatherings of more than 10 people without government approval would be prohibited. On September 17, capacity limits for businesses were raised to 75%.

On March 2, 2021, as COVID-19 vaccines began to be administered throughout the country, Abbott announced the final phase of reopening. All remaining COVID-19 restrictions in Texas would be lifted effective March 10 via an executive order that supersedes all local orders. It only allowed the reinstatement of restrictions on businesses in counties where COVID hospitalizations accounted for more than 15% of their local bed capacity for at least seven days. However, business capacity could not be lowered below 50%. In addition, all mask mandates were lifted, and all jurisdictions are prohibited from enforcing mask mandates. Abbott stated that residents had " "mastered the daily habits to avoid getting COVID", and thus enforceable public health orders were no longer necessary. The action was considered premature by President Joe Biden and other health experts. The city of Austin continued to enforce its mask mandate, resulting in a threat of legal action by the Texas Attorney General

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