AUSTIN, Texas — On June 17, Austin Public Health (APH) answered questions in a COVID-19 Q&A as coronavirus numbers continue to rise.
Adrienne Sturrup, the acting public health director, announced that the city's nurse line is now active, allowing for those without internet access to get appointments to be tested for COVID-19 through a phone call. You can reach the line at 512-972-5560 to receive help in over 200 different languages.
Chief Epidemiologist Janet Pichette emphasized that if you don't want to share information about COVID-19 exposure for fear of retaliation, APH keeps your information private.
Question: When stay-at-home orders were first announced in March, leaders and health officials from across the metro came together because one voice in battling the coronavirus, that hasn't happened since. What level of coordination currently exists between cities and health authorities in the metro and even between Austin and other major cities in Texas? And how important is the high level of coordination, especially as we begin to see a surge?
Answer: I think we have a good level of unity is happening now, we work great with our partners from our surrounding jurisdictions. We work regularly with the state to coordinate efforts. We share case information and dialog with our neighboring health authorities and epidemiologists. You know, I think what we're seeing is political division happening, and that's concerning because public health should not be a political issue. The things that we're recommending from the city of Austin, Travis County are, you know, parts of the same thing that the governor is recommending. I saw in his press conference yesterday the stressing of the importance of both the economy and maintaining public health. He stressed over and over again the importance of masking and social distancing and the personal hygiene and staying home if you don't need to be out. Those things are important. Those things we agree on, and I think it's important that we stop the division that's happening publicly. We stop the misinformation that's happening by some groups who choose to create division, and we move forward together as a unified body, as a unified state, as a unified country so that we can get a handle on this. We simply cannot afford for political division at this stage.
Question: Our new cases and hospitalization is particularly severe in cities and counties with higher populations and more density. What trends are health officials seeing in smaller or are more rural counties? Is there an equal cause for concern in those places?
Answer: You know, we are seeing increases in trends throughout most jurisdictions statewide. And again, because we do have, from a population density standpoint, a large number of people who reside in those rural counties who come into the Austin-Travis County area to work, especially with reopening occurring, they may contract illness here and take it home to those communities. So, again, we try to stress the prevention message. That's your best defense against this virus. Those things that we've been stating all along. But, and if people develop illness, they need to follow up and get testing.
Question: Austin is now in the week when APH said that we'd see protests potentially impact the number of new cases. What are you seeing in regards to that? And does the contact tracing questionnaire cover protests?
Answer: We haven't really seen any increase that's been directly associated with protests. But again, it's our case investigation form. It's a case report form that we used that includes the contact tracing portion. But it does cover congregate settings, and so most, if not all, of the case investigators have been trained to when they get to that question about congregate settings, to ask if there are any situations like protests that they may have been involved in so that we can include that information and start tracking that. But today, we haven't really seen a huge impact.
Question: In the past week, we've seen a huge jump in the number of new cases. Experts have said that this is the result of Memorial Day weekend gatherings. Soon, we'll see more cases from the protests and we have Father's Day coming up around the corner. What's the plan to avoid a medical crisis here locally?
Answer: Again, this goes back to those several protections. You know, it's not exciting. I understand people are not getting excited about social distancing. They're not excited about masking or washing their hands. Well, that's how we control the size of this storm. We talked about this from the beginning, equating this to hurricane preparation. Except unlike a hurricane, we can't control the size of the storm by following those simple things. That simple advice: washing the hands and not touching your face; staying home when you're sick; masking in public; and social distancing. Those simple things are the best way we can protect each other, protect our community and protect our followers. And I'll tell you that within our City of Austin employees, we've had a number of people who have lost their fathers from COVID-19. We cannot let this continue. We have to protect those who are at risk and our fathers. My father is at risk. We have to. I know it's hard for us not to get together with our fathers who are older, it's hard for us not to gather together as families, but we have to understand, if we want to honor our fathers, we have to do it safely. We have to stay apart. And we have to follow those simple guidelines to protect one another.
We have to treasure and honor our fathers and we have to do this for them. And so a lot of churches have put together a visual or virtual celebration of dads that they'll play during their virtual services. We're encouraging folks to use Zoom to connect, to go back to the old school, three-way calling. That's how you can show your fathers, your father, appreciation this day. That is the best gift of love. This gift of separation. Social distancing, masking and proper hygiene.
Question: While hospitalizations and new hospital admissions are both on the rise at both the state and local level. The governor and others are saying we still have plenty of capacity and that it's not really a concern. Why are Austin Public Health and Austin-Travis County leaders so concerned with the upward trend in hospital admissions? And what would you say about the governor's argument that hospital capacity is not really a concern?
Answer: I agree with the governor's comments that hospital capacity is not a concern today. It's not a concern for us today. We have plenty of space. There's plenty of PPE in the hospitals right now. The workforce is healthy and present. That's not our concern. Our concern is three or four or five weeks from now, if this skyrocketing trend continues at that stage, our hospital capacity to be overwhelmed. Our ICU's could be overwhelmed. Our ventilator capacity could be overwhelmed. We could be facing a shortage of personnel because there are so many patients or because they themselves are being exposed. So we do not want to sustain a trajectory that we have right now because we can't. We've seen this happen over and over and over again across the world, that when we wait too long to sound the alarm, the alarm keeps ringing for weeks and weeks. Far surpassing our ability to care for people. And we're talking about the potential, if we wait too long, of exceeding hospital capacity by thousands of individuals in a single day. As far as needing hospital beds that we can't run, we cannot provide. But it's it's a nuanced message. The message is we've got to change our behavior today to affect that in the future. But we also must take care of those health conditions that we have been neglecting. We've got to get immunized if we've been putting that off. We've got to get our physical examinations done. We have to go get our medication refills. We do not delay those elective procedures or those diagnostic procedures that we may have been putting on because of our concerns for COVID-19. The hospitals are safe and healthy today. There are plenty of nurses and doctors and equipment and room for people. But that should not dispel the cautionary note that we must share, that we cannot maintain this trajectory. And we as individuals, we as a community, have to come together to alter the course of this curve. We've got to flatten the curve. We've got to downgrade the storm because we're in this for the long haul. We've got another year left of dealing with this. So we also need to find that right spot, that sweet spot where we can deal with the infection, but also as a life which is more normal than it has been over the past couple of months.
Question: Are we seeing new cases about health care workers or any clusters inside hospitals or clinics?
Answer: We have seen clusters in a few hospital settings. Again, we follow up with those clusters and those organizations to try to, you know, provide guidance or manage those types of outbreaks that might be occurring. Most of our health care systems are on top of it. They have infection prevention tests on staff who helped mitigate those types of issues. So, for the most part, I think they're being managed fairly wisely.
Question: Is APH looking into new approaches to influence individuals to act within the published guidance, including state agents like TABC and the State Park Police?
Answer: I was happy to hear the governor yesterday talk about TABC and the and the enforcement of bars. We do have an ongoing concern about the risk of a disease spread in bars, particularly bars who are not compliant with the state guidance on COVID-19. So, you know, I think that we as a city and county are also interested in how we can enforce those things that we can enforce. The governor yesterday talked about the nonenforcement of masking itself, but certainly indicated that enforcement of other aspects may be appropriate so that we can further stem the spread of COVID-19. So we are certainly in discussions on how we can look at the law and potential enforcement actions, so we certainly do not believe that there's any role for the criminalization of some of these items, but it is helpful for us to be able to inform restaurants and bars and other businesses that it's OK for you to require masking, that it's enforceable if you decide as your business to not allow people in without masks.
Question: There's a case in Dallas of a woman who tested positive for COVID-19 for a second time once in February and now again in June. How concerning is that? And have you seen any cases like that in Austin? And what's the status of the Latino task force?
Answer: We know that somebody may have the illness and then they can continue to shed virus or have virus present for an extended period of time. That does not necessarily mean they are infected again. It doesn't even mean that they are infectious still, because you can have dead virus, you can have low levels of virus that are present that do not indicate a substantial risk of spread. But also, it's important to know that there is variability in the immune response. We know this from other diseases. We've all heard of folks who had chickenpox twice. We've all heard of folks who had immunization for various things but still get it. There is variable immunity. Some people are going to mount a good immune response and develop lots of antibodies that protect them. Others are not. And that's just a simple fact of disease. So it's not surprising to us that that may be the case. It won't be surprising if somebody can get it again. This does not indicate that immunity is short ... we already know that immunity is variable. And we certainly expect to see circumstances where that could happen. Again, our advice to everybody, whether you've had COVID-19 or not, is to protect yourselves, protect your family through the measures that we've described.
Austin Public Health hosted a Facebook Live event that was for Spanish speakers. And we did offer interpretation for those who spoke English. And it really was an opportunity for us to hear from that community about the challenges as well as the successes and where they would like awesome public health to go as we continue to plan the response internally. We've done a good job of planning for our communities, but as we're learning that this pandemic is different from our typical risk response efforts. And so it will be an iterative process. And we want to make sure that our community engagement strategy captures all aspects and facets of our community. So, this past Saturday was the first conversation. We have another conversation planned for July 11 that will be focused on all communities of color and be open to speakers of other native languages, Spanish, Vietnamese. We've been talking to or with different leaders in the next community about what our next steps should be. And so, I think we've all had the time to do. But as Dr. Escott said, this will be a marathon. So now we're really taking an opportunity to do and plan and strategize in conjunction with our partners. And so as those conversations with the community and with key stakeholders develop, we will have a better idea of what type of body would be best served to make sure that there's that constant communication between the community and the planning efforts.
Question: How many case investigators and contact tracers do you think you'll need? And what goes into calculating how many you think you'll need and how many people are currently working in those roles?
Answer: I'm going to say 48 case investigators that are on staff. We have been onboarding people each week to support that effort. Our goal is to get to roughly about 115 case investigators/contact tracers and, you know, to follow up with cases. And the number that we use to calculate that is based on a CDC guidance document on contact tracing and case investigation, where they estimate that we should have roughly nine case investigators or contact tracers per 100,000 population. So that's what we have. In addition to what Austin Public Health has, we have inter-local agreements with the University of Texas Dell Medical School and CommUnityCare and Central Health, who will also be providing support in some of those efforts.
Question: Can you provide guidelines or protocols for business owners such as restaurants and bars when it comes to sharing information about a positive COVID-19 test among employees? Should they immediately shut down, tell customers, etc.?
Answer: We work with our environmental health services division. So we notify them so that they can follow up with that restaurant owner to follow up. You know, as far as, like, notifying them that they may have a positive case there. We also work individually with those cases to let them know that they will need to be under a control order and that they need to self isolate at home for a period of time until their symptoms are resolved and they're fever-free. But again, you know, we have we follow the CDC guidance that's out there and the guidance at the State Health Department is provided to respond to those types of cluster investigations and manage it as we as they come to us. And again, we try to stress that, everybody, if you're in the restaurant industry or working in a bar, you need to be following it. You know, those protective measures that we've been stating over and over today about social distancing and wearing your face mask, making sure that you use proper hand hygiene. And if you're sick, you need to stay home. I also do want to point out that the employers don't have a right to know the medical information of employees.
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