We all want businesses reopened as soon as possible, but we have to follow doctors' orders for it to be safe to do so. That starts with better testing.

THREAD on testing - what Gov. Abbott has said, what the data shows, and what his and other experts recommend (1/28)

#txlege
... @Senfronia4Texas, the TX House Chair of Public Health, made it clear:

"We have not even been able to scratch the surface of testing. We're all ready to get out of our houses and go back to work. But we don't even know what's out there"

https://www.expressnews.com/politics/texas/article/Gov-Abbott-again-restricts-press-access-for-15207829.php#

#txlege (2/28)
Gov. Abbott again restricts press access for today's major COVID-19 announcement

Today is the third time since the outbreak began last month that Abbott has barred a majority of media outlets from attending during major announcements.

https://www.expressnews.com/politics/texas/article/Gov-Abbott-again-restricts-press-access-for-15207829.php#
...Texas regularly ranks between 48th and 50th in the country in per capita testing, and everyone on the front lines -- doctors, nurses, hospitals, local officials -- say we need more tests

Better testing is the top priority, so we are following it closely...

#txlege (3/28)
...This THREAD examines:

1) What Gov. Abbot and his experts say about testing

2) The data we know and the data we lack

3) Are we following best practices, and what can we learn from outside TX?

First, what Gov. Abbott has said on testing the past few days...

#txlege (4/28)
...Since the @TexasHDC press briefing last week making it clear that testing must be the top priority, Gov. Abbott has had two press conferences to discuss testing

At each press conference, he failed to offer clear metrics or plans on the future of testing...

#txlege (5/28)
...Last Friday (4/17), Gov. Abbott, "insisted at the news conference that Texas was preparing to dramatically increase its testing capacity, but he did not provide details beyond suggesting a timeline of 'late April or early May.'"...

https://www.texastribune.org/2020/04/17/texas-reopening-greg-abbott-coronavirus/

#txlege (6/28)
Texas Gov. Greg Abbott announces team to restart the economy, loose...

The reopening will happen in phases, Abbott said, and will be guided by data and doctors.

https://www.texastribune.org/2020/04/17/texas-reopening-greg-abbott-coronavirus/
...and yesterday (4/21), Gov. Abbott “said the state’s testing capacity was increasing, though that is hard to track because the state has given little information on its overall testing capacity.”...

https://www.dallasnews.com/news/public-health/2020/04/21/as-texans-struggle-financially-gov-greg-abbott-pitches-500000-open-jobs-in-the-state/

#txlege (7/28)
As Texans struggle financially, Gov. Greg Abbott pitches 500,000 open jobs in the state

This is a developing story. Please check back for updates. AUSTIN -- Texas Gov. Greg Abbott said he is working on a plan to slowly open up Texas’ economy...

https://www.dallasnews.com/news/public-health/2020/04/21/as-texans-struggle-financially-gov-greg-abbott-pitches-500000-open-jobs-in-the-state/
...The lack of info from Gov. Abbott is troubling. His experts have ideas, though.

Mark McClellan of @DukeMargolis, a well-respected expert, leads the TX health care task force. A recent paper by him and @ScottGottliebMD provides guidance for Texas on testing...

#txlege (8/28)
...Better testing is the central tenet of the plan McClellan says is necessary "to mitigate the current COVID-19 pandemic wave and to limit and suppress future outbreaks"

https://healthpolicy.duke.edu/sites/default/files/atoms/files/covid-19_surveillance_roadmap_final.pdf

His paper lays out specifics for what Texas needs to do next...

#txlege (9/28)
...1. Rapid case detection: quickly test anyone high-risk or showing symptoms, set up data collection systems

2. Get local data efficiently, share all state info w/ national Syndromic Surveillance system to better track spread of COVID-19...

#txlege (10/28)
...3. Test for exposure and immunity markers, which lets us learn who can’t get the virus and why

4. Get capacity to conduct rapid-response contract tracing, testing, and quarantine

Reminder those 4 steps are what Gov. Abbott’s top health adviser recommends...

#txlege (11/28)
...Where is TX in those 4 steps?

We are likely still early in Step 2, with no clear metrics for testing now or in the future, and as we rank so low in per-capita testing

Which is why the 2nd big item we are following is the data we know and the data we lack...

#txlege (12/28)
...Per @TexasDSHS, as of 12pm today, Texas has conducted 205,399 tests to date. Of those tests, there are 20,196 cases reported.

https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/ed483ecd702b4298ab01e8b9cafc8b83 #txlege

That is a 9.83% positivity rate -- which is staggeringly high, and a clear sign of an epidemic...

#txlege (13/28)
…Looking at the data, @ScottGottliebMD - one of McClellan's fellow experts - has demonstrated how high positivity rates in Texas and the U.S. demonstrate a high rate of infection and under-testing...

https://twitter.com/ScottGottliebMD/status/1252253958741135361

#txlege (14/28)
...For context, here's the data on positivity rates in tests *only* within high-risk populations of other diseases:

-Tuberculoisis, 1-2%
-Zika, 0.5-1%
-HIV, 0.4%

And positivity rates for COVID-19 in other countries:

-S. Korea, 2%
-Australia, 2%
-Germany, 7%

#txlege (15/28)
...Texas’ ~10% positivity rate is far above what we see in other diseases and in other countries with COVID-19, and is therefore nothing to celebrate

And remember - that's while we rank near last in per-capita testing...

#txlege (16/28)
...Two other data points to highlight on testing:

1. 25% of those w/ COVID-19 show no symptoms, and therefore are unlikely to be tested

2. As many as 15% of the "quick test" Abbott ID tests come back with a false negative...
https://www.npr.org/sections/health-shots/2020/04/21/838794281/study-raises-questions-about-false-negatives-from-quick-covid-19-test

#txlege (17/28)
Study Raises Questions About False Negatives From Quick COVID-19 Test

New research suggests the Abbott ID NOW test, which produces results in less than 15 minutes, is the most likely among common tests to reassure people they are not infected when they really are.

https://www.npr.org/sections/health-shots/2020/04/21/838794281/study-raises-questions-about-false-negatives-from-quick-covid-19-test
...To summarize what the data shows:

Texas ranks near-last in per-capita testing; our ~10% positivity rate is still dangerously high; and some private testing coming on board now has more than a 1-in-8 chance of saying you don’t have COVID-19 when you do…

#txlege (18/28)
...Finally, the @TexasHDC is closely tracking whether or not we are following the guidance of experts, and what other states are doing

The key question is: how many tests do we need, and how are we doing on the other steps Gov. Abbott's experts have laid out?...

#txlege (19/28)
...The question for how many tests we need can be looked at in two ways:

1. How many daily tests do we need to *start* to safely re-open the economy?

2. How many daily tests do we need to *fully* be safe to re-open the economy?

#txlege (20/28)
...On the first question, this piece from @keranews cites a study that just to *begin* re-opening the economy, Texas likely needs to do at least 44k tests/day

The most Texas has done in one day so far? 14,419...

https://twitter.com/keranews/status/1252601770234257411

#txlege (21/28)
...On the second question, experts say we may need 5 to 20 million tests per day nationwide to fully re-open

That would be 450k to 1.8 million tests just for Texans alone

Again: the most Texas has done in a day so far is 14k...

https://abcnews.go.com/US/road-map-recovery-report-20-million-coronavirus-tests/story?id=70230097

#txlege (22/28)
'Road map' to recovery report: 20 million coronavirus tests per day needed to fully open economy

The United States has conducted 3.7 million tests for COVID-19.

https://abcnews.go.com/US/road-map-recovery-report-20-million-coronavirus-tests/story?id=70230097
...While we are orders of magnitude behind where experts say we need to be to safely re-open the economy, we are also behind on the next steps Gov. Abbott’s advisers have already laid out for states to follow…

#txlege (23/28)
...As a reminder, Gov. Abbott’s expert, McClellan, made clear recommendations that states must act on to contain the virus' spread, especially contact tracing

On updates w/ Members & staff, @TexasDSHS has provided no indication a tracing program is underway...

#txlege (24/28)
...A few counties are setting up their own testing & tracing programs, including Hays County:

https://www.fox7austin.com/news/hays-county-releases-procedure-for-covid-19-contact-tracing

The concern there is - like with stay-at-home orders - counties step up to lead, then the state comes in late and brings confusion...

#txlege (25/28)
Hays County releases procedure for COVID-19 contact tracing

Confirmed cases are asked to provide names and phone numbers of people they have been around in the past 14 days and those people will be contacted.

https://www.fox7austin.com/news/hays-county-releases-procedure-for-covid-19-contact-tracing
...That we are so far behind on testing, and have nearly nothing to show on tracing, is only the start of concerns on Texas’ lack of a proper health response to COVID-19

We also need to expand coverage, secure more PPE supplies, and fix the nursing home crisis…

#txlege (26/28)
...As @Senfronia4Texas and many others have said - we have done so few tests, we don’t even know what's out there

TX needs better testing, more transparency, and clear metrics - based on experts’ advice - on when we will have enough tests to get back to normal

#txlege (27/28)
...I look forward to working with my colleagues in the @TexasHDC and everyone in the #txlege to stay focused and committed to solving Texas' COVID-19 testing crisis so we can begin to safely re-open our economy (28/28)
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