Governor Abbott Announces Phase One To Open Texas

On April 27, 2020, Governor Greg Abbott issued Executive Orders No. GA-18 and No. GA-20, relating to the expanded reopening of services and relating to expanding travel without restrictions as part of the safe, strategic plan to Open Texas in response to the COVID-19 disaster. This executive order supersedes any conflicting order issued by local officials, which means the Stay Home – Work Safe Order issued by Mayor Steve Adler is set to expire today, April 30, 2020.

By way of Executive Order No. GA-18, all retail stores, restaurants, movie theaters, malls, museums, and libraries are permitted to reopen on Friday, May 1, 2020, but must limit their capacity to 25% of their listed occupancy, and must operate under certain restrictions. The Department of State Health Services (DSHS) has recommended minimum standard health protocols for all individuals, all employers and employees, as well as industry specific protocols for retailers, retail customers, restaurants, restaurant patrons, movie theaters, motive theater customers, museums and libraries, and museum and library visitors, which can be found in the governor’s Open Texas report.

Under Executive Order No. GA-20, the mandatory 14-day quarantine period for individuals traveling from Louisiana has been eliminated. Under GA-20, the mandated 14-day quarantine for travelers from the following areas remains in place: California; Connecticut; New York; New Jersey; Washington; Atlanta, Georgia; Chicago, Illinois; Detroit, Michigan, and Miami, Florida.

Update from Partners in Health

The safety and well-being of our patients, staff, and the general public remain our highest priority. We are committed to doing everything we can to continue providing quality care to our patients while taking every precaution to limit the exposure of our patients and staff to COVID-19. We will continue to follow recommendations from the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), public health authorities, and federal, state, and local orders. Under the new orders issued by Governor Abbott, our schedule is now open for routine appointments. All routine appointments previously scheduled will proceed. Our appointments will be staggered to allow for time to thoroughly disinfect and sanitize each exam room. We encourage our patients to schedule and stay up to date with their annual wellness exams, as it remains a vital part of reducing your risk of getting sick and living a longer, healthier life. All patients will still be required to wear a face covering when entering our facility and temperature screening will be done upon entry. Visitor access will remain restricted. For your safety and ours, we ask that all caregivers, family members, and friends of our patients wait in their cars during the appointments. All consultations and illnesses will still be evaluated first through telehealth or other forms of virtual visits (Zoom, FaceTime, phone call, text, email, etc.) to minimize exposure to the public.

We are in the process of scheduling events for after the month of May. Please check our website regularly for events held through our online meeting platform, Zoom. Please keep in mind that we must all keep doing our part to help prevent the spread of COVID-19 by practicing social distancing and proper hand-washing hygiene. We highly recommend everyone to stay at home as much as possible, especially for those at higher risk, and to only leave their residences for essential and individual outdoor activities. To protect others around you, wear your face covering when you have to leave your home. Please check our blog and our COVID-19 page regularly for updates.

Austin Public Testing Enrollment Form Now Available

Austin Public Health launched the Austin Public Testing Enrollment Form, which allows the community to complete an online assessment for COVID-19. This new tool allows the public to be screened for COVID-19 symptoms without having to see their physician. Please be aware that criteria for testing must be met. Should any of our patients get tested, please notify our office. Please also notify our office with your results if you are tested.

Governor Abbott’s Strike Force to Open Texas

Governor Greg Abbott held a press conference on April 17, 2020 where he issued three new Executive Orders to begin the process of reopening the state of Texas while revising hospital capacity and certain social distancing guidelines. Within the orders, select activities and services that pose minimal to no threat of spreading COVID-19 are allowed to reopen beginning today, April 24, 2020, using a “Retail-To-Go” model. Certain restrictions on surgeries have been loosened, and schools will remain closed for the remainder of the 2019-2020 academic year. Within these orders, the Governor established the Strike Force to Open Texas – a team of nationally recognized medical experts and private and public leaders who will advise the Governor on safely and strategically reopening the state of Texas.

Texas State Parks Re-Open

Texas State Parks began reopening for day-use only on April 20, 2020 as part of a broader effort to begin reopening the state of Texas. New restrictions in effect include requiring visitors to make reservations and paying ahead of time, wearing face coverings, maintaining 6 feet distance from individuals outside of their party, and prohibiting the gathering of groups larger than five. Please see the Texas State Parks website for more information.

Reminder About Serology (Antibody) Testing for COVID-19

At this time, serology testing is not recommended. The majority of tests are still currently undergoing review by the FDA, and serology testing cannot be used to make a diagnosis of active COVID-19 since antibody production is not present at detectable levels until several days after symptom onset (see graph below). Only molecular testing should be used to make the diagnosis of active COVID-19. For more information, please see our blog post.

Please keep in mind that as the state of Texas slowly begins to reopen businesses, we still encourage our patients to stay home as much as possible, especially those who are over 70 and those with lung disease, heart disease, hypertension, and/or diabetes (also known as cocooning). Social distancing guidelines are still in place. Per city mandate, face coverings are required anytime an individual has to leave their residence. As the situation evolves, we will provide ongoing updates.

Earth Day began on April 22, 1970, as 20 million Americans (roughly 10% of the U.S. population at the time) joined together in a unified response to help save an environment in crisis. The response sent a wave across the globe with the U.S. leading the way for a call to action with landmark environmental laws: the Clean Air Act, Clean Water, and Endangered Species Act, and the Environmental Protection Agency (EPA) were all established.

While celebrating today is challenging, the event is still being held virtually all around the world to celebrate the 50th Anniversary‘s theme – “CLIMATE ACTION” – calling upon all citizens to help do their part in saving the environment. 600 Congress invites you to join us in celebrating and operating in an eco-friendly fashion.

Ways to Celebrate

Planting & Adding Greenery to Your Space

If you have a backyard, now is the perfect time to plant a garden! A small herb garden is easy to grow and maintain, and it provides fresh flavors for cooking. Adding greenery will also brighten up and boost your home or office.

Many local gardening centers are currently open with no-contact pickup available. 

Shop Sustainable Brands

Everyone loves shopping, so why not make your next purchase easier on the environment? There are many brands available today, from food to clothes, that offer items made from recycled materials and with eco-friendly production and packaging. There are even items for your fur babies!

Take a Walk through Nature

Look up native plants and trees in your area and see if you can pick them out on your next walk! The Zilker Botanical Garden and Lady Bird Johnson Wildflower Center are both currently closed but offer educational components online to help in learning about our native species. Right now is also Bluebonnet Season so make sure to get those photos in!

Watch a Documentary

Cure your cabin fever by watching a documentary on Earth’s majestical beauty. The classic Planet Earth is widely available and revered, but newer series include Netflix’s Our Planet as well as Disney+’s Elephant and Dolphin Reef.

Take a Virtual Field Trip

Many museums around the country are participating in Earth Day by hosting virtual field trips. The American Museum of Natural History in New York City is currently hosting virtual tours of their museum. Click Here to give their site a visit!

The following information is from Dr. Brian Metzger, MD, MPH on the current state of COVID-19 serology testing. Dr. Metzger is a member of the Austin Public Health COVID-19 Expert Advisory Panel and the infectious disease consultant to the Travis Medical Society ED/EMS Advisory Committee.

There is a growing concern about the current offering of serology testing for SARS-CoV-2, the virus responsible for COVID-19.

What is serology testing?

With the use of a blood sample, it can identify antibodies produced against the virus. Serology testing is different from molecular testing, which is used to diagnose active infection by detection of genetic material of the virus. As we have seen, this is typically done by a nasopharyngeal swab. Soon, serology testing will be used in the following ways:

• To help determine the prevalence of SARS-CoV-2 in the population
• Identify individuals in the community who are immune
• Help delineate the phase of the infection (recent past vs. distant past)
• Identify donors for therapeutic plasms
• Possibly help with return-to-work decisions

Serology testing can identify whether antibodies are being made and which type of antibody. The most common serology testing involves identification of IgM and IgG antibodies.

• IgM is the first antibody made following infection. This means that early after infection, only IgM will be present at detectable levels.
• IgG antibodies follow several days later. At this phase, both IgM and IgG will be present at detectable levels.
• IgM antibody production will begin to decrease, leaving IgG as the only detectable antibody.

What do we know about SARS-CoV-2 serology testing?

• Approximately 50% of patients are seropositive for IgM by day 7 after symptom onset.
• Close to 100% of patients are seropositive for IgM and approximately 50% are positive for IgG by day 14 after symptom onset.

Serology testing should never be used to make a diagnosis of active COVID-19 since antibody production is not present at detectable levels until several days after the onset of symptoms. Only molecular testing should be used to make the diagnosis of active COVID-19.

Serology testing is currently in development. As of April 14, 2020, the US Food and Drug Administration (FDA) has granted emergency use authorization (EUA) to one antibody test for the detection of SARS-CoV-2. In other words, there are no FDA-approved serology tests yet.

There is no telling the accuracy of serology tests that do not proceed through FDA emergency review authorization. We want to avoid the following consequences by waiting for more serology tests to complete the FDA EUA process:

• A negative result may be a result of a test being insensitive to detecting SARS-CoV-2 antibodies.
• A positive result may be a result of the presence of cross-reactivity with antibodies to more common, non-SARS-CoV-2 strains of coronavirus.
• A false negative result can be a missed opportunity to make a diagnosis.
• A false positive result can lead to misinformation that a patient is no longer susceptible to SARS-CoV-2 infection, resulting in discontinuation of social distancing measures and other means of protecting themselves from infection.

The good news is that there will be several serology tests that will have completed the FDA EUA process over the next few weeks. These tests will be more reliable since there will have been a review of their data, including the sensitivity (the ability to correctly identify all patients with the virus) and specificity (the ability to correctly identify all patients who do not have the virus) of the test. Serology testing will play a significant role in the COVID-19 pandemic, however that role is not now, and not with currently available serology testing.

At this point, we are not recommending serology testing in our office. As always, we are committed to updating our patients with the most recent information regarding this pandemic.

The city of Austin’s Stay Home – Work Safe Order has been extended through May 8, 2020 by Mayor Steve Adler and Travis County Judge Sarah Eckhardt. This Order requires residents to stay at home, except for essential activities and essential businesses to prevent further spread of COVID-19. In addition, the Order now requires the public to wear fabric face coverings when conducting essential activities or work.

Examples of Essential Activities as defined in the order include:

• Health and safety: obtaining healthcare, emergency services, medical supplies, or medications
• Necessary supplies and services: obtaining groceries and prepared take-out food, liquor stores, pet food, and supplies necessary for staying at home
• Outdoor activity and services: engaging in individual outdoor activity, such as walking (includes your pet), hiking, biking or running provided that individuals maintain at least 6 feet of social distancing
• Essential work and services: performing work at an essential business defined in the Order, which includes all services needed to ensure the continuing operation of critical infrastructure to maintain the health, safety, and welfare of the public
• Care for others: caring for a family member, the elderly, minors, dependents, persons with disabilities, or other vulnerable persons in another household

Examples of Non-Essential Activities include:

• Social gatherings regardless of the number of people together who do not reside in the same household
• Indoor/outdoor on-site restaurant dining
• Visiting bars, entertainment venues
• Exercising at gyms and fitness centers

Face Covering Information: The city now requires all individuals to wear a fabric face covering when leaving their residences, along with physical distancing. This is due to the findings consistent with the Centers for Disease Control (CDC) and Austin-Travis County Health Authority that a significant percentage of individuals with COVID-19 do not have any symptoms. An infected person can also transmit the virus to others before showing any symptoms. The covering of one’s nose and mouth when outside their home or residence is necessary to help prevent the spread of COVID-19. Keep in mind that when you wear your face covering, you are protecting other individuals, and when others wear their face coverings, they are protecting you. This is not meant to be a substitute for maintaining the 6-feet social distancing guidelines and hand washing, as these remain vital steps to slow the spread of the virus. Medical grade (N95) and surgical masks should be reserved and used only by medical professionals and first responders. Please see this flyer for how to make your own cloth face covering, or see this video for easy instructions. Parents and guardians of children under the age of 10 are responsible for appropriately masking children when outside of their residence.

All individuals over the age of 10 must wear some form of covering over their nose and mouth, such as a homemade mask, scarf, bandanna or handkerchief when:

• Entering into or inside of any building open to the public (including medical offices)
• Using public transportation, taxis, or ride shares
• Pumping gas
• Outside and 6 feet of social distancing cannot be consistently maintained between the person and individuals outside of their household

Cloth face coverings should:

• Fit snugly, but comfortably against the side of the face
• Be secured with ties or ear loops
• Include multiple layers of fabric
• Allow for breathing without restriction
• Be able to be laundered and machine dried without damage or change to shape

Face coverings are not required when:

• Riding in a personal vehicle
• Alone in a separate single space
• In the presence only of other members of their household or residence
• Doing so poses a greater mental or physical health, safety or security risk such as anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the cover without assistance
• Eating

What Else Can We Do?

As a household, you can plan and make decisions now that will protect you and your family during this pandemic. Along with following all current guidelines, the CDC and the Travis County Medical Society recommend the following to ensure that your household is prepared:

• Stay up-to-date about local COVID-19 activity from public health officials (please see our COVID-19 page for more information).
• Create a list of local organizations you and your household can contact in case you need access to information, healthcare services, support, and resources.
• Create an emergency contact list including family, friends, neighbors, carpool drivers, healthcare providers, teachers, employers, the local public health department, and other community resources.
• Plan ways to care for those who might be at greater risk for serious complications.
• Take everyday preventive steps (see here for more information) and watch for symptoms. Stay home and speak to your healthcare provider if you develop a fever, cough, or shortness of breath. If you develop emergency warning signs for COVID-19 (trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, bluish lips or face) seek medical attention immediately.
• Choose a room in your home that can be used to separate sick household members from those who are healthy. Identify a separate bathroom as well, if possible. Learn how to care for someone with COVID-19 at home.
• Prepare for possible illness. Most people who contract COVID-19 will have mild illness not requiring hospitalization. Should anyone in your household need hospitalization, it is important to write down vital health information ahead of time. Take the time now to write down your health history and include any legal documents, such as power of attorney and medical directives. Bring this information to the hospital in the case of hospitalization. A convenient form developed by the Travis County Medical Society can be filled out.
• Take care of the emotional and mental health of your household members. Outbreaks can be stressful for adults and children, and children respond differently to stressful situations than adults. Talk with your children about the current situation, try to stay calm, and reassure them that they are safe.

As we are all experiencing, the pandemic has changed our daily lives and since we’ve never dealt with anything like this before, we are all learning as we go. The most important goal is to avoid a large number of people needing hospitalization at the same time, raising the possibility that health care resources will not be adequate to care for everyone. We must all do our part to slow the spread of COVID-19 to prevent this from happening. Enormous efforts in Central Texas alone are underway to manage the effects of COVID-19 on our health care system and our economy. From the words of the Travis County Medical Society, “This pandemic will pass, and life will return to normal. Some things may change. But rest assured, Austin will still be weird, and a great place to live.”