Local hospital, political leadership stand out in Texas COVID response

 

Article was originally posted April 8.

On Saturday, March 21st, the Texas Dept. of State Health Services put the total number of confirmed COVID cases in the state at 304, with 5 confirmed deaths.

It wasn’t clear to every policy maker at that point that by April 8th, Texas would have the 11th highest number of cases among states in the US. April 8th was the day that Texas overtook Washington State in total cases. Washington was the state with the first confirmed case and for weeks had the highest number of cases of any state in the country.

Texas is now nearing almost 1,000 new cases per day, while Washington State had fallen to less than 300 new cases per day.

But on March 21st, some voices were sounding the alarm.

 

 

Among those were Steve Love, CEO of the Dallas Fort Worth Hospital Council.

We essentially raised our hand as a good partner with all stakeholders regarding what some models were reflecting regarding hospital volume… While we know all models have differing input and results, they indicate increased COVID-19 volume if we take no new action.

In the days running up to Saturday March 21st, the hospitals of the DFW area began to speak up about what could be coming to their region and the state.

Love said the projected numbers signaled the need for policy makers to act.

As we looked at projected volume increases, we felt it imperative that we suggest ways to flatten this curve. We wanted to reduce the spread and number of infected residents, prevent deaths and protect first responders and healthcare workers.

At the time, the state response to COVID was mixed. On March 17th, Gov. Abbott activated the National Guard and requested an Emergency Declaration from the US Small Business Administration.

On March 18th, Gov. Abbott waived regulations making it easier for Texans to get alcohol during the crisis. In a statement, Abbott said the move was to support the hospitality industry.

“The State of Texas is committed to supporting retailers, restaurants, and their employees,” said Governor Abbott. “These waivers will allow restaurants to provide enhanced delivery options to consumers during this temporary period of social distancing.”

On March 19th, Gov. Abbott issued orders directing Texans to limit their social engagements.

In accordance with the Guidelines from the President and the CDC, every person in Texas shall avoid social gatherings in groups of more than 10 people…  In accordance with the Guidelines from the President and the CDC, schools shall temporarily close.

The March 19th order came three full days after President Trump had issued his guidance to limit groups to fewer than ten participants.

These varying emergency actions didn’t send a clear message about how serious Abbott believed this crisis to be to Texans.

Abbott said he was reluctant to issue any “Stay at Home” order, explaining that his orders still allowed Texans to engage in services they deemed essential, and that those services would largely be based on the determination of the individual. From a press conference a few days later, Abbott explained:

“A stay-at-home strategy would mean that you have to stay at home, you cannot leave home under any circumstances. That obviously is not what we’ve articulated here.”

Love said his group reached out to Gov. Abbott that week asking him to issue a “Stay at Home” order. They also signed a letter from DFW area mayors to the Governor asking him to issue such an order.

We made an urgent request to Governor Abbott to issue a “Stay at Home” order, similar to what Dallas County Judge Clay Jenkins did on Sunday, March 22, 2020.

Dallas County Judge Clay Jenkins said Love’s guidance and counsel helped inform his decision and his approach to coordinating resources through this crisis. From a text message to State of Reform, Judge Jenkins said:

Steve Love is a tremendous leader and strong partner. I rely on Steve and his members for critical guidance and collaboration as we lead through this once in a century crisis.

Jenkins previously won national praise for his leadership during the ebola outbreak in Dallas County.

According to pool reports from Abbott made Monday April 6th, he has not spoken with Judge Jenkins during this crisis, in spite of Dallas being one of the areas of outbreak in the state.

Abbott said he’s had multiple conversations with Denton, Tarrant and Bexar County Judge and mayors in the state. Says have had zero phone calls from the Dallas County judge about COVID-19.

Jenkins has said he has reached out to the governor’s office but not gotten his call returned.

The DFW hospitals said they made three asks of the governor that week of March 21st, in addition to the request to issue a “Stay at Home” order. From Steve Love, CEO of the Council.

Our second request was to draw the maximum federal aid available to help during this crisis. We also wanted the Governor to waive some requirements for physicians and nurses related to clinical rotation and virtual certifications. We thank Governor Abbott for waiving many of the nursing licensure requirements which helps North Texas hospitals increase their workforce.

Abbott’s action to waive licensure requirements for nurses was made on March 21st.

 

 

DFWHC’s second request to draw down the maxium aid available has seen mixed performance by Gov. Abbott.

Abbott’s administration did request and was granted an 1135 waiver to allow for greater flexibility in managing existing Medicaid funds. No consideration has been given to draw down approximately $100 bn in new federal funds over ten years already available to Texas by expanding Medicaid.

The Trump administration has said they won’t open up a special enrollment period for anyone who may need to purchase their own indiviual health plan in Texas.

So, those individuals that can afford to buy a health plan in this crisis won’t be able to because of the federal position to not open a special enrollment period for the individual market.

Those individuals that cannot afford to buy health insurance won’t be able to be covered as a result of the state position on Medicaid expansion.

While the politics of health care seem to impinge on innovation at the state and federal level, local officials continue to address COVID in their communities.

By Sunday, March 29, Abbott said “Stay at Home” orders issued by local governments had essentially precluded the need for any additional statewide order from his office.

My decision with regard to the standard established by the state of Texas as an entity is based upon the advice and the instructions by the CDC, by Dr. Deborah Birx in consultation with Dr. Hellerstedt about what is appropriate for the state as a whole for the best interest of public health and safety.

About 75% of the state of Texas is under the umbrella of what would be categorized as a stay-at-home policy.