Dr. Mark McClellan serves as one of Texas governor Greg Abbott’s advisers on safely reopening the state economy. McClellan and other health care experts have been on the phone with the governor several times a week this month.
McClellan is a native of Austin, a son of former Republican state comptroller Carole Keeton Strayhorn. He also served as FDA commissioner 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 a coauthor of “National Coronavirus Response, A Road to Reopening.” The plan laid out four prerequisites for safely reopening the economy: hospital capacity exceeds the expected number of hospitalizations; the number of newly diagnosed cases of the virus has gone down for fourteen days; testing has expanded enough for early detection of COVID-19; and contact-tracing systems are in place to find and quarantine those who might have been infected by those who have been newly diagnosed.
On Monday, Abbott announced a phased lifting of restrictions, with a promise that more testing and contact investigations will be available in the coming weeks. But McClellan told Texas Monthly that expanded testing and contact tracing should have been in place before the Texas economy was reopened.
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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. For the past two and a half weeks, the state has been reporting somewhere 850 and 900 new cases most days. And Texas is substantially behind other states in testing and contact-tracing capacities. Should we have had that expanded capacity before reopening?
Mark McClellan: Those are definitely what we regarded as ideal conditions for reopening. So while those are our primary considerations, excess capacity in the health system was also important. Texas at least [has] had a relatively good experience with COVID-19. I certainly hope it stays that way. There was a surge like in other states. The steps that the state took, that the people of Texas took, flattened the curve, which resulted in peaks that were substantially less than in many of the harder-hit areas of the country, including Louisiana and Arkansas.
But you’re right that in our report—following it to the letter—we would have had Texas doing [expanded testing and contact tracing] first and then reopening in two weeks.
TM: So the partial reopening of the state economy has occurred before testing and tracing was up to the level that it should be?
McClellan: The testing and tracing is getting up there, so it’s much better now than it was two weeks ago. In an ideal world, it would be at the level that [the governor’s plan] lays out for a couple of weeks from now, up to at least 30,000 tests a week with the capacity to trace [contacts for] every case that’s identified, the capacity to test a large share of people who might represent new cases. That’s the ideal laid out in our report. And again, there’s a very strong intent in the state to get there.
TM: If you lived in Texas now, would you go out to a restaurant?
McClellan: Seniors, older individuals, people with significant chronic diseases like heart disease or lung disease, I wouldn’t go to a restaurant or any kind of contained space. I’d be really careful still about going to grocery stores and other essential locations because there’s a higher risk of complications.
For people who are younger, I think they need to be careful. Not all businesses are, or should be, ready to reopen now. For those that do reopen, the medical advisory group laid out a lot of steps that the businesses are expected to have in place to prevent risk of transmission. It should look a lot like the experience that people have going to the grocery store. It shouldn’t be very crowded. There should be space between people indoors. You should be wearing a face mask. You should have the ability to wash your hands or use hand sanitizer.
Because I’m not in one of those high-risk categories under those circumstances, I think I would consider taking some steps back out. But again, this should be a really gradual process and we should wait. It takes a really a couple of weeks to know whether the steps you’ve taken are going to have significant consequences for infection.
TM: There used to be a state tourism campaign that described Texas as a “whole other country.” The number of COVID-19 cases is dropping in Dallas, but going up in El Paso, Fort Worth, and Houston. Fort Worth is listing the risk of community spread as “significant.” Is Texas just too big and diverse for a statewide order like Abbott’s?
McClellan: We’re not going to get rid of COVID-19 cases completely, but we can get to a manageable level, where if there is any new outbreak, we’d be able to detect it quickly through testing and then contain it through contact tracing and isolation and quarantine. So the outbreaks don’t get bigger. If that’s not happening, which could well be the case in some parts of the state, then new approaches, a more intense and different thing, would need to be put back in.
TM: What will Texas look over the next two years with COVID-19 still out there?
McClellan: I certainly hope the schools can be open in some form in the fall, maybe with more distancing, too, and with some staggered times and some education still from home and students eating their lunch in their classrooms rather than in a big cafeteria. Similarly, for events, sporting events with more distance and maybe performances with more distances. But we’re only going to get there if we take this step by step and don’t have another outbreak that gets out of control and really sets us back.
TM: Given the experience of New York City, does Texas need to reconsider housing density?
McClellan: Texas has some dense urban areas, but one of the reasons why it’s been less hard hit than others, at least in this initial surge, is because the state is a bit more spread out.
We’re going to see a permanent shift toward work that occurs more at a distance and maybe on more flexible schedules and probably some longer-term implications for how people think about travel, both for business and for leisure.
TM: Since 2000, we’ve seen the SARS pandemic, H1N1, MERS, the Ebola scare in Dallas. Is it inevitable that this will not be the last pandemic Texans face?
McClellan: This won’t be the last pandemic. The only question is: when is the next one and how severe it will be? And then a related question: how well-prepared are we going to be in order to make sure that something like what we lived through the past month doesn’t ever happen again?
Most health systems in the U.S. 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 very many cases, because some of them are so severe. Despite everything we’ve been through, the vast majority of people in Texas and around the country are not immune to COVID-19. So if we go back to what we were doing before, we’ll see the same kind of outbreaks happen again.
People talk about another potentially big or bigger wave of a pandemic coming back later on this year, maybe in the fall. We’ve really got to be careful to make sure that we don’t see our health care systems overwhelmed by so many deaths in the community. And I think we can, especially with strong testing and tracing and the other steps that we’ve talked about put in place. We can do a gradual reopening of the economy and then we’ll really want it both ways: an economy that functions pretty well and people who are not afraid to go out and live.