Phase II of Open Texas Began Monday, May 18, 2020

Governor Greg Abbott issued Executive Order GA-23, relating to the expanded opening of Texas in response to the COVID-19 disaster.

By way of Executive Order No. GA-23, restaurants that opened under Phase I may expand their occupancy to 50% beginning May 22. Bars—including wine tasting rooms, craft breweries, and similar businesses—may open at 25% occupancy but like restaurants, these occupancy limits do not apply to outdoor areas that maintain safe distancing among parties. The following services and activities may open under Phase II:

• Child Care Centers (May 18)
• Gyms (May 18)
• Massage and Personal-Care Centers (May 18)
• Youth Clubs (May 18)
• Rodeo and Equestrian Events (May 22)
• Bowling Alleys, Bingo Halls, Simulcast Racing, and Skating Rinks (May 22)
• Bars (May 22)
• Aquariums and Natural Caverns (May 22)
• Zoos (May 29)
• Day Youth Camps (May 31)
• Overnight Youth Camps (May 31)
• Youth Sports (May 31)
• Certain professional sports without in-person spectators (May 31)

All sporting and camp activities are required to adhere by special safety standards, and minimum standard health protocols have been established for all newly-announced opened services and activities. Businesses located in office buildings may also open but must limit their occupancy to the greater of 10 employees or 25% of their workforce.

Opened services and activities under Phase II are subject to certain occupancy limits and health and safety protocols. For more information, please refer to the governor’s Open Texas page. All services, businesses, and activities that open under Phase I and Phase II may open with restricted occupancy levels and minimum standard health protocols laid out by the Texas Department of State Health Services (DSHS).

Things to Keep in Mind

As businesses, services, and activities begin to resume with minimum standards recommended by the DSHS, it remains vital to practice social distancing, proper hand hygiene, and to wear a face covering when in the public. Studies have shown that almost half of infections occur from carriers before they develop symptoms. In other words, almost half of infections occur from individuals who are not yet aware that they have COVID-19 (see graph below). The covering of one’s nose and mouth when outside their home or residence is necessary to help prevent the spread of COVID-19. When you wear your face covering, you are protecting other individuals. When others wear their face coverings, they are protecting you. This, along with maintaining the 6-feet social distancing guidelines and hand washing remain crucial steps to slow the spread of the virus.

Travis County Medical Society also recommends cocooning for people who are over 70 years of age and those who are medically vulnerable to COVID-19, by minimizing all interaction. This safety measure was established to protect people who could become very ill if they are infected with COVID-19. We recommend all patients who fall under this vulnerable population to practice cocooning.

We urge our patients to remain vigilant and to make their best judgments as more places begin to open and resume operation. Everyone has a role to play to maintain the slow spread of COVID-19 and to prevent hospitals from becoming overwhelmed. With the economy slowly re-opening, this is more important than ever. We want to remind our patients that at this time, there is no FDA-approved treatment or vaccine for COVID-19. Presently, clinical trials are underway. If patients have any questions on safe and preventive practice, please refer to our blog or contact our office and we would be happy to assist.

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.