When Texas Governor Greg Abbott announced that businesses in the state could fully reopen and residents could remove their masks, health experts objected and President Joe Biden declared it “Neanderthal thinking.”
Since the March 10 order, however, COVID-19 has been on the wane in the Lone Star state, even as infections climb in places where tougher restrictions remain. Fewer Texans are getting infected, becoming seriously ill, and dying than at any time since a surge that strained the state’s hospitals last summer. On April 5, as hospitalizations dropped below 2,800, Abbott said in a tweet that the state had only three COVID deaths that day.
There are a variety of reasons Texas has averted a viral rebound despite doing away with its curbs on commerce, health experts say. Though masks are no longer compulsory, many Texans are choosing to wear them anyway, and many businesses still require them. The state’s move to widen vaccine eligibility early on appears to be paying off. And warm weather in much of the state has moved activities and socializing outdoors, where there is less chance of transmission.
One of Abbott’s top coronavirus advisers, John Zerwas, attributes the drop in cases to the state’s “very aggressive” vaccine rollout, together with a “very strong” public health message about continuing to wear masks, wash hands and maintain distance.
Still, Texas may not be in the clear. For one, testing has declined, which means the state may lack visibility into asymptomatic infections. Further, viral variants are ascendant, with highly contagious B.1.1.7 — first documented in the U.K. — now the dominant strain across the U.S.
The return of gatherings could also lead to new outbreaks. The Texas Rangers welcomed more than 38,000 fans to their home opener on April 5, at a time when other Major League Baseball teams are adopting much tighter limits on crowd size.
Additionally, there is concern that an influx of undocumented migrants at the border may trigger a resurgence. Abbott demanded Tuesday that the Biden administration shutter a San Antonio coliseum sheltering underage migrants, alleging that in addition to suffering neglect and sexual abuse, healthy kids and COVID-19-positive cases aren’t being segregated.
Yet for a state hit hard by COVID, the lack of a surge upon reopening is hugely welcome news. More than four months ago, on Nov. 11, Texas became the first U.S. state to record more than 1 million cases. In January, the state recorded more than 2 million cases, and more than 32,000 fatalities. That provoked a tweet from its Department of State Health Services, saying it was greatly concerned about hospital capacity, and warned that intensive care units “cannot take much more.”
James Musser, chair of the Department of Pathology and Genomic Medicine at Houston Methodist, said it’s “unusual” that cases are dropping in Houston with the prevalence of B.1.1.7 in the city, yet noted the successful vaccination campaign along with adherence to wearing masks and other health measures. Plus, there is natural immunity from previous spikes, he said.
Here are the factors that experts say have helped Texas contain cases even with the reopening:
Mask wearing is a heated issue in Texas. Earlier this year mask opponents protested outside a Houston burger restaurant that had refused service to someone not wearing a mask. In a counter-protest, mask supporters retaliated by flooding the restaurant with orders. Yet post-mandate, Texans are continuing to wear masks.
Ana Fernandez, the health and safety director for Legacy Restaurants, which owns and operates The Original Ninfa’s and Antone’s Famous Po’ Boys in Houston, said they’ll continue to require masks while people aren’t eating or drinking. And though Legacy is running vaccine drives for its employees, masks after immunization will be required. “People feel more comfortable when you see people with masks, and interacting with others that way,” she said.
Jaleh Salle, the owner of Léránt, a luxury gift store in Houston, said she still requires masks in her store, although her staff doesn’t have to wear them when there are no customers around.
“There are quite a substantial amount of people who are still very scared, so there’s no need to feed into their fear by not wearing a mask,” Salle added.
Zerwas, who along with being Abbott’s adviser is executive vice chancellor for health affairs at the University of Texas System, said while mask wearing isn’t ubiquitous statewide, many are still masking up “because of the public health messaging of this.”
Texas’s success in vaccinating residents has brought an unwelcome downside: Demand for testing has declined amid a growing feeling that the fast-moving immunization campaign has the virus on the ropes.
“The sense of security people feel when they’re vaccinated is having an impact on testing numbers and the number of cases,” Angela Clendenin, an instructional assistant professor at the Texas A&M School of Public Health, said in a phone interview. “We’re still very cautious about making any broad announcement that we have a decline in cases and that we’re in the clear.”
Texas faced unprecedented cold weather in February, which left millions without power. Since then, data shows a significant drop in COVID testing rates.
Texas was the first state to administer one million doses of the COVID-19 vaccines. As of Thursday, 14 million doses have been given in the state, enough to vaccinate 24% of its population.
The state went against the Centers for Disease Control and Prevention’s vaccine rollout recommendations by focusing on those most vulnerable to COVID, including young people with co-morbidities that put them at an increased risk of severe disease or death.
Natural immunity should also be considered as Texas had earlier been hit with huge spikes in cases, said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. People who are most likely to spread the virus could have some natural immunity from prior infections.
Texas has wildly varying climates across the state and throughout the year, from subfreezing temperatures seen in February, to stifling summer highs. Zerwas said the state is currently in a grace period between “the cold and the severely hot” where many people prefer to be outdoors.
“If unmasked activities are going on outdoors, it may be less likely that it leads to transmission,” Adalja said.
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