Dr. Mark McClellan is one of Texas Governor Greg Abbott’s advisers on the safe reopening of the state’s economy. McClellan and other health care experts have been on the phone with the governor several times a week this month.
McClellan is from Austin, the son of former Republican state comptroller Carole Keeton Strayhorn. He also served as Commissioner of the FDA under President George W. Bush. He now works as a health policy expert at Duke University and lives in Durham, North Carolina. Last month he was co-author of “National Coronavirus Response, A Road to Reopening”. The plan sets out four preconditions for safely reopening the economy: hospital capacity exceeds the projected number of hospitalizations; the number of new cases of the virus diagnosed has fallen for fourteen days; tests have developed sufficiently for early detection of COVID-19; and contact tracing systems are in place to find and quarantine those who may have been infected by those newly diagnosed.
On Monday, Abbott announced a gradual lifting of restrictions, with the promise that more testing and contact investigation will be available in the coming weeks. But McClellan said Texas monthly that extensive testing and contact tracing should have been in place before the Texas economy reopened.
This interview has been edited for clarity and length.
Texas monthly: One of your standards for reopening the economy was fourteen days of declining cases. Over the past two and a half weeks, the state has reported some 850 and 900 new cases on most days. And Texas lags significantly behind other states in testing and contact tracing capabilities. Should we have had this increased capacity before reopening?
Marc McClellan: These are certainly what we considered to be ideal conditions for reopening. So, while these were our primary considerations, excess health system capacity was also important. Texas at least [has] had a relatively good experience with COVID-19. I do hope it will stay that way. There was a surge like in other states. The actions the state has taken, that the people of Texas have taken, have flattened the curve, resulting in spikes significantly lower than many of the hardest-hit parts of the country, including Louisiana and Arkansas.
But you’re right that in our report—following it to the letter—Texas would have [expanded testing and contact tracing] first, then reopening in two weeks.
MT: So the partial reopening of the state’s economy happened before testing and tracing was at the level it should be?
McClellan: Testing and tracing is improving, so it’s much better now than two weeks ago. In an ideal world, this would be at the level where [the governor’s plan] plans for a few weeks from now, up to at least 30,000 tests per week with the ability to trace [contacts for] each case identified, the capacity to test a large part of the people who could represent new cases. This is the ideal set out in our report. And again, there’s a very strong intention in the state to make it happen.
MT: If you lived in Texas now, would you go to a restaurant?
McClellan: Seniors, seniors, people with significant chronic conditions like heart disease or lung disease, I would not go to a restaurant or any type of confined space. I would always be very careful about going to grocery stores and other essential places as there is a higher risk of complications.
For the younger ones, I think they have to be careful. Not all businesses are or should be ready to reopen now. For those reopening, the medical advisory group has outlined many measures businesses should put in place to prevent the risk of transmission. It should be very similar to the experience people have when going to the grocery store. There shouldn’t be a lot of people. There must be space between people inside. You should wear a face mask. You should have the option to wash your hands or use hand sanitizer.
Because I’m not in those high-risk categories under these circumstances, I think I’d consider taking a few steps back. But again, this should be a really gradual process and we should wait. It really takes a few weeks to know if the measures you have taken will have a significant impact on the infection.
MT: There used to be a state tourism campaign that described Texas as “a whole different country.” The number of COVID-19 cases is decreasing in Dallas, but increasing in El Paso, Fort Worth and Houston. Fort Worth classifies the risk of community spread as “significant.” Is Texas too big and diverse for a statewide order like Abbott’s?
McClellan: We are not going to completely get rid of COVID-19 cases, but we can get to a manageable level, where if there is a new outbreak, we would be able to detect it quickly through testing and then contain through contact tracing, isolation and quarantine. Thus, epidemics do not grow. If that’s not happening, which may well be the case in some parts of the state, then new approaches, something more intense and different, should be reintroduced.
MT: What will Texas look like in the next two years with COVID-19 still there?
McClellan: I certainly hope that schools can be open in some form or another in the fall, perhaps with more distancing too, and with staggered hours and some still-at-home education and students having lunch in their classrooms rather than a large cafeteria. Likewise for events, sporting events with more distance and maybe performances with more distances. But we’ll only get there if we take it step by step and don’t have another outbreak that spirals out of control and really sets us back.
MT: Given New York City’s Experience, Should Texas Reconsider Housing Density?
McClellan: Texas has dense urban areas, but one of the reasons it was hit less hard than others, at least in this initial wave, is that the state is a bit larger.
We’re going to see a permanent shift towards working more remotely and perhaps on more flexible schedules and likely longer-term implications for how people think about travel, both for business and leisure.
MT: Since 2000, we have seen the SARS pandemic, H1N1, MERS, the Ebola scare in Dallas. Is it inevitable that this won’t be the last pandemic Texans will face?
McClellan: This will not be the last pandemic. The only question is: when is the next one and how serious will it be? And then a related question: how well prepared are we going to be to make sure that something like what we went through last month never happens again?
Most health systems in the United States have approached crisis-level care. Other health systems around the world have been overwhelmed, and that’s with infection rates of just a few percent. It doesn’t take a lot of cases, because some of them are very serious. Despite all we’ve been through, the vast majority of people in Texas and across the country are not immune to COVID-19. So if we go back to what we were doing before, we will see the same kind of epidemics happening again.
People are talking about another potentially big or bigger pandemic wave coming back later this year, maybe in the fall. We really have to be careful to make sure we don’t see our healthcare systems overwhelmed by so many deaths in the community. And I think we can, especially with strong testing and tracing and the other steps we talked about put in place. We can do a gradual reopening of the economy and then we really want it in both directions: an economy that works quite well and people who are not afraid to go out and live.