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Analysis: Texas reopenings tied more to COVID-19 severity than to spread


Visitors to the Pearl's weekend farmer's market in San Antonio wear masks as they stroll among the vendors. - SANFORD NOWLIN
  • Sanford Nowlin
  • Visitors to the Pearl's weekend farmer's market in San Antonio wear masks as they stroll among the vendors.
If you want to know what’s happening with business reopenings during the pandemic in Texas, watch your local hospital.

Gov. Greg Abbott said Thursday that COVID-19 hospitalizations are the most important number in his decision-making about how many people to allow in restaurants and other businesses in the state.

He made the announcement a few days after the state’s health department rejiggered its calculations of “positivity rates” — a measure of how many people tested for COVID-19 are infected, and the governor’s old favorite metric.

Instead of concentrating on the spread of the virus, the state is now concentrating on the severity of the spread. It’s not primarily about how many Texans are infected, but about how many of them get sick enough to go to the hospital.

As long as that COVID-19 hospitalization rate — the percentage of occupied hospital beds that are occupied by coronavirus patients — remains below 15% for at least seven days in a row, the governor said Thursday, businesses dependent on crowds can admit more customers. That excludes only three of the state’s Trauma Service Areas — Laredo, Rio Grande Valley and Victoria — which means that most of the state’s businesses will be on longer leashes starting Monday.

What businesses? The governor specified restaurants, retail stores, office buildings, manufacturing facilities, gyms and exercise facilities, museums, and libraries. Elective surgeries were reauthorized. Bars, which remain closed unless they’ve transformed themselves into restaurants, didn’t make the cut.

Texas schools and colleges remain as they were, most operating a mix of virtual and in-person classes. Whether and how much those reopenings have sped the spread of the coronavirus is still not clear.

Abbott said hospitalizations are the primary metric, but not the only one. Hospitalization rates will tell you what share of the people in Texas hospitals — by district — are coronavirus patients.

But the governor’s new standard is a lagging indicator of COVID-19 cases. Epidemiologists say it takes nine to 16 days to see increases in infections from social interactions and another five to seven days to see changes in the number of people hospitalized. That means someone infected at a particular social gathering might not show up at the hospital for two to three weeks.

The hospitalization number misses a lot about how things are going. It won’t tell you how many people have died and whether deaths are rising or falling. It won’t reveal the spread of the virus, whether case numbers are going up or down, and it won’t provide any information about how many infected Texans have symptoms and how many are asymptomatic. It doesn’t tell you anything about how a patient contracted the disease.

One piece of news got buried in state leaders’ conversation about metrics and reopenings, and that’s because they didn’t say it directly: This amounts to a declaration that June’s coronavirus numbers aren’t as scary as they seemed in June, when attention was more on the rising numbers than on the numbers themselves.

After a summer spike in the coronavirus in Texas that followed Abbott’s first round of reopenings — whether you measure that rise by positivity rates, hospitalizations, deaths or something else — state leaders have adopted June numbers that revealed that surge as normal enough to justify more social activity.

The trends are encouraging. Just look at the Texas Tribune’s coronavirus tracker: On Wednesday, the number of people hospitalized for COVID-19 was down 355 from the previous week to a number not seen since mid-June, and 5.5% of occupied hospital beds were being used by people with the virus, at June levels and down from a high of almost 20%.

Those are less ghastly numbers than the July and August tallies, but that’s no consolation to the Texans wrestling with the virus or at risk of being infected. The trends might even be reason for optimism, but not too much: Abbott was emphatic about the continuing need for masks, social distancing and hand washing.

But with those numbers on the status board, state officials have set their acceptable level of ongoing damage from the pandemic — the numbers of new cases, hospitalizations and deaths that justify looser restrictions on people getting together in large groups for business and commerce, sporting events, and in-person public and higher education.

Watch the hospitals. In two or three weeks, we’ll know how this new standard is working out.

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