Like the rest of the country, Texas, the second-largest state both in population and land area, is in the midst of a public health crisis.
In the state's largest counties, the number of confirmed cases of the novel coronavirus is rising drastically each day. Gov. Greg Abbott has shut down all but a few categories of businesses and ordered people to stay home. The state's elected officials and public health leaders warn those measures may not be enough to keep hospitals from being overrun.
But even as the number of confirmed cases in Texas marches steadily upward, Texas' numbers paint a somewhat less bleak picture than those in California, the most populous state in the nation. So are those numbers reason for hope, or even cautious optimism, in Texas?
Maybe, said Cherise Rohr-Allegrini, a San Antonio-based epidemiologist. But there are a lot of caveats.
California reported its first case of COVID-19 well before the virus arrived in Texas. On Jan. 26, the California Department of Public Health reported its first case of coronavirus, an Orange County man in his 50s. A month later, the state saw its first case of community transmission.
On March 4, more than a month after California reported its first case, Fort Bend County Health and Human Services reported a county resident, a man in his 70s, had tested positive for COVID-19 after traveling abroad. The man was Texas' first confirmed case of the virus, not including a group of Americans who were evacuated from China's Hubei province and the Diamond Princess cruise ship who were placed in quarantine at Lackland Air Force Base in San Antonio.
Within days, public health officials in Montgomery County, which includes Houston's northern suburbs, reported the state's first case of community transmission of the virus. The patient, a Montgomery County man in his 40s, hadn't traveled outside Texas recently, public health officials said. The man had attended a cook-off at the Houston Livestock Show and Rodeo in late February. Days after the man's diagnosis was announced, public health officials reported three more cases of coronavirus related to the rodeo.
On Thursday, Dallas County public health officials reported 100 new cases of COVID-19, the disease caused by the coronavirus.
Texas' per-capita infection rate remains well below California's. On Wednesday, the California Department of Public Health reported 8,155 confirmed cases of COVID-19 there, or about 20.64 cases per 100,000 California residents. On the same day, Texas Health and Human Services reported 3,997 confirmed cases in the state, or about 13.78 cases per 100,000 residents.
Part of the problem with comparing numbers from one state to the next is that neither state is testing as many people as it should, Rohr-Allegrini said. Most places in the country are only testing for COVID-19 in places where they're most likely to find it, she said — people with known travel histories or those who have come in contact with someone who's known to have an infection.
That leaves out people who are infected with the virus but have only mild symptoms, Rohr-Allegrini said. Those people aren't likely to show up at a hospital or testing site, she said, and they may even keep going to work or to the grocery store. Without mass public testing efforts, like the one that South Korea instituted, public health officials have no chance of catching those kinds of cases, she said.
To complicate matters further, California has a massive backlog of COVID-19 tests waiting to be processed. Of the roughly 90,000 coronavirus tests that have been administered there, about 65% are pending, according to data from the COVID Tracking Project.
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Texas, meanwhile, has no testing backlog. While that's good news, Rohr-Allegrini said it doesn't necessarily mean Texas has a more accurate picture of its own coronavirus outbreak than California does. While the state's testing capacity has increased since the early days of the outbreak, it still isn't enough to show the full picture, she said.
"Texas' results are a better reflection of people we've chosen to test," she said.
Despite that uncertainty, Texas has reason for guarded optimism, Rohr-Allegrini said. The state's mortality rate and hospitalization rate are lower than some other places in the country, she said. Also, the state is still fairly early in its outbreak, meaning it's still in a position to take action before its public health infrastructure gets overwhelmed. But that won't be the case for long, she said.
"We're not at worst-case scenario yet," she said. "We will be if we don't do anything."