AUSTIN, Texas — Editor's note: On July 20, city leaders said there is not a need for the convention center to accept patients at this time.
During Austin Public Health's weekly live Q&A on July 15 to give the latest COVID-19 updates in the Austin area, health officials confirmed that the "field hospital" at the Austin Convention Center will open next week.
During the press conference, Dr. Jason Pickett, Austin-Travis County Alternate Health Authority, said he expects to see an uptick in COVID-19 deaths as cases rise. The City is also setting up its alternate care site "field hospital" – set to open July 21 at the Austin Convention Center – to help ease the burden on area hospitals.
"The data we have currently with regards to deaths shows a recent significant increase in excess deaths, 23% above what is the expected number of deaths for this time of year," Pickett said. "So, with the recent surge in cases, we do expect to see a surge in deaths at the same time."
Pickett said he hopes the City will not need to take a single patient to the field hospital, but it will be ready for use if needed. He also said officials do not plan to run an ICU set up there because patients in need of intensive care “are better served at a hospital.”
Pickett also said there has been a "slight leveling off" of hospitalizations in the past few days. He said it is unclear at this point whether or not the upward trajectory of hospitalizations in recent weeks will continue or if the plateau seen in the past few days will hold out.
Pickett said the area hospitals were "stretched" and have been needing to find assistance with staffing. He added that the City has requested resources from the State on behalf of the area hospitals to help them.
This comes one day after Dr. Mark Escott said during a Travis County Commissioners meeting that all school districts and private schools in the county should delay reopening on-campus instruction. The emergency order was issued in response to a growing number of COVID-19 cases in the region and is effective immediately.
Escott added that in-person classes could lead to anywhere between 40 to more than 1,300 deaths among students in Travis County alone.
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Austin-Travis County's Health Director Stephanie Hayden started the press conference with a moment of silence for the 179 people who have died from COVID-19 and their families who have been affected.
Hayden said the City is continuing to do targeted testing for construction workers. She also encouraged essential workers to continue to utilize the City's COVID-19 testing sites.
When asked about the City's guidance on entering Stage 5 of its COVID-19 response, Pickett said the benchmark of a seven-day average of 70 hospitalizations per day is one of many factors looked at in making that decision. The rate of change, as well as hospital bed status, also plays a role in the City's decision to move from one stage to another. Austin is currently still in Stage 4 despite eclipsing the 70 hospitalizations per day average mark.
On July 14, Escott issued the following rules that align with Austin City Council's actions:
- Wear a mask or face covering where you're required to, like inside businesses
- Practice social distancing with people you don't know and keeping groups to 10 or fewer
- Stay within Austin if you test positive for COVID-19
- Mention to your health care provider or a first responder that you're positive for COVID-19 if you come in contact with them
The full list of rules can be found here. If you're caught breaking any of these rules, you could face a fine of up to $2,000.
AUSTIN PUBLIC HEALTH MEDIA Q&A:
Question: APH has previously said hospital capacity isn't a concern yet. But you were worried about the rate at which patients were being admitted and that we could get into a more dire situation. What's your assessment now of how we're doing on hospital capacity and especially ICU capacity?
Answer: Right now, the hospitals are stretched. They're needing to find additional staffing and they are finding ways to care for more patients within the hospital with the limited number of staff that they have. Right now we are competing for resources for those hospital staff from many other areas. And so this is the true definition of a national or global pandemic and that the resources are stretched thin everywhere. We continue to make those requests. But right now, those hospital beds are edging towards the maximum number that can be staffed and patients that can be taken care of. This is why, we a few weeks ago, decided to push forward with opening our alternate care site to help to take the burden off of the hospitals.
Question: How is the newest construction order different than the one before? Are you still doing targeted testing for those workers? And are those clusters getting bigger or smaller?
Answer: Currently, with the new order, we are really giving specific information about the screening of employees, as well as ensuring the social distancing, cleaning the tools, but also making sure that if individuals are testing positive or have any symptoms, making sure that they are not working. We are continuing to to test and do that targeted testing in the construction industry as well. We are continuing to monitor those numbers as well. And so we're seeing a reduction in our numbers. But what we want to make sure is, is that the message is getting out to individuals that if they go to work and it is fine for them to be tested. We don't want them to just feel obligated to go into work. And they know that they're not feeling well or they may have a family member back home that is COVID-19 positive. So we want them to be able to isolate as well with their families. So we will continue to do that targeted testing with our community partners and then also encourage essential workers to go to our community testing sites as well.
Question: How involved were local school districts in the decision making process to require virtual learning only until Sept. 8? Can you give us a sense of how often APH met with superintendents leading up to the decision and how those discussions went?
Answer: We have met with superintendents throughout this process. We have a few superintendents that sit on our policy group. And so we have been meeting with them since the inception of this COVID-19 response. Dr. Escott held a meeting just recently. He does meet with them monthly but he also held a meeting with them on Monday to talk about and get their perspective things that they were working on. So it's important for us to know that this is a collaborative process. We will provide to them our public health expertise, but because are school officials, we are depending on them and work with the information and guidance that's been provided from TEA. But we are ultimately depending on them to implement those practices. We've had representation from the school districts on our policy calls, as Director Hayden said. That policy board meets several times a week. So from the very beginning of this response, they have been there at the table with us, with the city leaders, with hospital leadership and helping us to craft this response.
Question: If we're running short on staff at hospitals, how will staffing not also be limited at the Austin Convention Center as an alternate site? Will the alternate site also drain resources?
Answer: We are competing for resources like not only are health care systems locally, but also health care systems in other areas. We are asking for resources from the State as well as from other states. We want to make sure that we're good neighbors, that the hospitals have adequate staff, that we are not taking resources from them to staff the alternate care sites. But it is a challenge. And I think that we are seeing challenges in the the types of staff that we can source for those different environments. But we are in constant contact with the hospital systems, understanding their needs, and we want to make sure that we're not stepping on those requests. But in fact, advocating for those requests from the hospitals to augment their staff.
Question: Austin had the highest COVID-19 positivity rate in the country two weeks ago. Can you update us on the positivity right now?
Answer: The best source of information regarding our local positivity rates will be from the Texas Department of State Health Services. The reason for that is because we have so many entities out in the community that are doing testing at the current time. It's hard for us to determine how many people have actually been tested in our community. We can calculate our positive activity rate based on our specific testing, but we can't for other entities because we don't know the number of negatives that they've had reported back to them. So I would go to the Texas Department of State Health Services for that information.
Question: Have any fines or penalties been levied for people or businesses that have violated local orders yet other than those given by TABC? Why should people think new penalties will be enforced when they haven't been before?
Answer: The orders were recently passed last week in our council work session to put those in place. In addition to that, the orders were posted yesterday. Prior to the orders being posted, internally, our staff met with city staff from across the city of Austin that work in enforcement areas. We are going to, as you know, a lot of the complaints are driven by the public. So when individuals will call 311 to report that even for compliance, we will have the ability to go to locations where we receive those reports and we will be able to. Initially, our goal is to get voluntary compliance. That is our hope with everyone. And so we started in place of voluntary compliance and work with them about how to implement those changes. In the event things are not implemented, we will move forward and provide a citation to them and take those individuals to court. So the process has been in place and we have the the the approval from our city council to move forward in that space.
Question: For more than a week, we watched the dashboard data indicate that we were in Stage 5, yet there was no announcement. Yesterday evening, Dr. Escott declared schools could not open as usual based on data. What data is this? The same data supporting the dashboard.
Answer: The data that Dr. Escott is referring to is, is that, you know, that we monitor data on a daily basis. We look at the data from the number of individuals positive, our positivity rate ... we look at the number of individuals that are in the hospital, that are in ICU beds. And so this is a collaborative process. When we look at this particular zone, it's from cases from 70 to 123. And so as we meet with our health authority, as well as our individuals that are providing health care in our community and our elected officials ... collaboratively, we make a decision about when to transition to the next level based upon every individual's data, as well as the modeling that has been provided. To add to what Director Hayden said, there are several factors that contribute to where we assess our stage to be currently. The running new hospitalizations, that 70 number, is one of those factors. But there are other things, such as the rate of change, as well as hospital bed status that help to contribute to when we believe that we're moving from one stage to another.
Question: Are you expecting deaths to increase because of the recent surge? Or are they leveling out?
Answer: The data that we have currently with regards to deaths shows a recent significant increase in excess deaths – 23% above what is the expected number of deaths for this time of year. So with the recent surge in cases, we do expect to see a surge in deaths at the same time.
Question: With the new school year around the corner, many school districts are already deciding to go 100% with virtual classes for the first three weeks of the school year. How bad is the situation have to be in order for you guys to recommend doing virtual classes for the rest of the school year?
Answer: It's difficult for us to model beyond just a couple of weeks from now because individual behavior influences the spread of the virus within the community. How people are adhering to the social distancing and the masking. And this is something that we model week-after-week to see where we might be a little bit of time from now, a few weeks from now. But unfortunately, our ability to see into that future is very limited. It's really only accurate within a couple of weeks, a few weeks from right now. So we evaluate this on an ongoing basis to see what the disease is doing in the community, how our cases are rising or are plateauing or falling off to make recommendations for policy. So, unfortunately, we just can't say what things will be like in October because we just don't know.
Question: Have there been any new indications on the rate of transmission over the past week?
Answer: The rate of transmission, obviously our case counts continue to increase. I would venture to guess our rate of transmission is also increasing. Again, I think when we start seeing that the epidemiologic curve starting to flatten again will show that transmission is reducing. That's why we are asking every community member to be sure to make sure there's following orders as far as wearing their masks, social distancing and practicing those prevention and hygiene method activities to reduce transmission. Ideally, we'd like to squash and flatten the curve where we can. And those are the activities that are going to make that happen. To add to what Janet is saying, we're hamstrung somewhat by the increase in turnaround time of the test results that we're getting. All of the labs in Texas are also stretched and overwhelmed. And so our test turnaround time – the amount of time it takes from obtaining the test to getting a result –has increased drastically. Because of that delay, then it's difficult for us to say where we are yesterday with regard to the test results in the community and in the new cases within the community. Yeah, and again, that's why it's so important for individuals who are tested, because there could be a lag of five to seven to 10 days to get your test results back. If you are tested, you know, we're asking people who have been tested to remain home until they get their test results back. So they're not actively transmitting disease, should they have it and not be aware of it.
Question: What will a three-week delay in opening schools actually get us?
Answer: It gives them more time. It gives them more time to prepare and to develop their plans and put in place their methods for mitigating the spread of the disease. TEA and the CDC have come up with some great recommendations with regard to how to distance within schools and spreading out the desks, wearing the masks on, uncrowding the hallways so that kids can be farther apart. These are all great suggestions, but we do not have them in place right now. And we cannot increase the physical footprint of the schools overnight. So, it gives the schools the time to work on those plans, to continue develop them and to work with us in public health and recommendations of how we can better keep our kids as well as our teachers and staff safe.
Question: Yesterday, Dr. Escott said that between 40 to 1,300 AISD students could die from it if schools reopened. But what numbers suggest that is realistic? The CDC reported on July 4 that of the first 100,000 COVID-19 deaths, only 179 were below the age of 25. The entire state of California still hasn't had to COVID-19 death below age 18.
Answer: Locally we've not had any deaths in children from this disease. So we have to go with data that we get from other areas have been harder hit: places like China. And so what we see is that the death rate for children or for those under the age of 19, is very low. But once you multiply those low numbers by the nearly 200,000 students that we have in Austin-Travis County, then now you start to see a much larger increase. So from data from China, we estimate that the death rate in that age group is somewhere around 0.18%. That death rate may range from 0.03 % to 1.02%. But again, once you multiply that by the numbers of students that we have and if we assume, as we should, that not having any natural immunity to this virus, that 70% of our population is going to get this virus, then now we start to see those deaths stack up. And that's where those numbers come from.
Question: What is the status of the field hospital? Will that still be used? And if so, at what point would it start accepting patients?
Answer: Our planned go-live date for that hospital is July 21. So next Tuesday. And when they start taking patients, that's largely up to the hospitals where they feel they need to start offloading patients. The emphasis with the alternate care site is that we are taking care of patients with lower-acuity disease, what would be referred to as a med-surge-level acuity. Though, that's a bit like your garden variety hospital bed level acuity. We're not planning to run an ICU in the convention center. We don't think that's practical. And folks who are critically-ill, that need that level of care, are best served in the hospitals where the quality of that care will be the best. So it's, as I mentioned before, the hospitalizations, the hospitalization numbers have leveled off for the past few days. So, I don't know if we're going to take patients from the hospitals on day one of the alternate care site being open. But I know that we will be ready to do so.
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