Coronavirus in Texas: Community spread could occur in Houston area

_{Editor’s Note: This story has been updated throughout.}

Local health officials said on Wednesday they were unsure how a Houston-area man who tested positive for the novel coronavirus this week had become infected, suggesting the first signs of community spread of the virus in Texas.

“This could very possibly be the first community spread,” said Alicia Williams, director of the Montgomery County Public Health District. If the virus is passed from person to person in the general population, it is much more difficult to contain.

The case raises questions about the number of unknown infections in Texas, given that the government’s testing capacity for the COVID-19 disease remains limited. Texas’ largest public health laboratory is capable of performing a maximum of 26 tests per day. It’s unclear how many tests a state network of 10 labs has performed so far, but that figure is likely “dozens” on Wednesday, Texas State Department spokesman Chris Van Deusen said. .

Local officials said they took the threat of community spread seriously, and Houston executives said on Wednesday they were canceling the remainder of the week-long rodeo event. Houston officials later said the man, who is in his 40s, attended a barbecue on February 28 at the city’s largest annual event, the Houston Livestock Show and Rodeo. But it is not known if he had any symptoms at the time he presented.

Public health officials have monitored dozens of Montgomery County residents, officials said, and the Montgomery Independent School District will cancel classes starting Thursday, before spring break.

When asked how the Montgomery County man could have contracted the virus, Melissa Miller said the case was still under investigation but he had not traveled outside of Texas . “At this time, I don’t have an answer to that question,” Miller, director of operations for the Montgomery County Hospital District, told reporters. “Everything is possible.”

Gerald Parker, associate dean of Global One Health at Texas A&M University, said confirmation of the community spread would place Texas at an “inflection point.”

“The things that we can do as individuals to avoid exposure and to avoid exposing others are still just as important a message as they were yesterday,” he said. “But it will also mean that we need to think more seriously about some of these social distancing measures and community mitigation measures.”

As of Wednesday afternoon, the number of confirmed COVID-19 cases in Texas was 33. Eleven of them are from people traveling overseas who have been forced by the federal government to self-quarantine at the air base. of San Antonio Lackland, where about 100 other people arrived to be quarantined on Tuesday evening. There have been other cases, related to international and domestic travel, in the Houston area, the Dallas-Fort Worth area and the Longview area in east Texas.

The Montgomery County case was first reported on Tuesday.

Lack of tests

Community spread in Texas will almost certainly increase the urgency of testing availability. State officials said they did not know how many tests have been done in total so far. They are also unclear about how many tests the state should ideally have access to each day.

Governor Greg Abbott told reporters on March 5 that over the next few weeks, the state lab network would be able to handle more than 125 tests per day. Texas’ testing capacity is limited due to a shortage of testing equipment and lab staff, Van Deusen said.

The lack of testing prevents officials from fully assessing the risks posed to Texans, said Dennis Perrotta, a retired Texas state epidemiologist.

“Obviously, the limited number of tests available right now is hampering our ability to understand what the epidemic looks like and where it is moving,” Perrotta said. “This is important from a public health perspective, and it is also important to give our cities, businesses and industries the information to enable them to make informed decisions about taking the appropriate precautions.”

But Van Deusen said he disagreed with the idea that availability of testing is an issue.

“We have a lot of capacity in our state lab and other public health labs at this point. Those labs have enough testing equipment to meet demand,” he said. “This capacity is increasing. CDC’s approval to test two samples from the same person together instantly doubles the capacity of the entire system, and the federal government is in the process of approving new equipment that will allow us to process even more tests in a shorter period of time. “

“There is no dearth of tests available in the public health system,” Van Deusen added.

Texas State Department Health Services Commissioner John Hellerstedt told state lawmakers on Tuesday that doctors and hospitals do not yet have access to tests on their own premises. For now, he said, public health labs are trying to expand their available capacity by testing samples from people who appear most likely to have been exposed.

There are 10 public health labs in Texas that are operational or soon online to test swabs from the nose and throat for the presence of genetic material from the new strain of coronavirus, known as SARS-CoV-2. . (COVID-19 is the illness caused by the virus.) The U.S. Centers for Disease Control and Prevention has said anyone can be tested for the virus as long as a doctor consents.

“As we move forward, if we expect to see a community spread of COVID-19, it will help to have greater availability of testing,” Hellerstedt said. “I don’t know where they are with the development of point-of-care testing, but I think it’s still a few months away.”

In an effort to track the growing number of infected Americans, the United States Food and Drug Administration has allowed some private labs to develop their own tests.

Texas doctors can order tests from at least two private labs, LabCorp and Quest Diagnostics, Van Deusen said, adding that he couldn’t speak to the cost of these tests to consumers, but DSHS “doesn’t charge. the tests we perform in our laboratory. “

A spokesperson for LabCorp said the price for the test had not been finalized and declined to speculate on its price. Quest Diagnostics expects to be able to perform tens of thousands of tests per week over the next six weeks, a spokesperson said. The lab has yet to finalize its pricing for uninsured patients, but its “goal is to allow wide access,” the Quest spokesperson added.

As more labs – public and private – gain the ability to test for the virus that causes COVID-19, federal health officials have broadened the criteria for determining who can be tested.

Local leaders demand more testing

Still, local officials said availability of tests is insufficient. It is “very possible” that there are more people in the Houston area who are sick with COVID-19, Harris County Judge Lina Hidalgo said on Wednesday.

“If we had the capacity to test more people, we would surely have more positives and maybe more evidence of community transmission,” she said.

But you don’t have to test every sick person to infer evidence of community spread, said Jessica Gullion, former infectious disease epidemiologist and associate dean of research at the College of Arts and Sciences at Texas Woman’s University.

“There is an assumption that every person with respiratory disease should be tested for the corona. This is not really necessarily true,” Gullion said. “If we know someone has been exposed, we may not have to test them because they probably have.”

The CDC urged doctors to “use their judgment” in deciding whether a patient deserves a test and said they should consider symptoms as well as travel history and the possibility of close contact with people who test positive.

Symptoms can include fever, cough, and difficulty breathing, similar to the seasonal flu. Doctors must rule out other causes of respiratory disease before ordering a coronavirus test, according to CDC guidelines.

San Antonio Mayor Ron Nirenberg said on Tuesday the city “needs a lot more testing, and we are calling for that as soon as possible.”

In El Paso, Darlene Tarango, head of the city’s public health department laboratory, said on Tuesday that the city had the capacity to test 400 people.

Mayor Dee Margo said the city can make a 24-hour request for additional test kits, if needed. But due to shortages in other cities, it may be necessary to test samples from outside El Paso.

“We may do more testing, but not for El Pasoans,” said Robert Resendes, director of the city’s health department. “If some of the other parts of Texas run out of kits or have too many cases, we’re like a backup for them.”

Julián Aguilar, Raga Justin and Emma Platoff contributed to this report.

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