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The Committee met to hear invited testimony from the Department of State Health Services, Health and Human Services, the Texas Education Agency, and local governments to discuss the state’s preparedness on the novel coronavirus, COVID-19.

This report is intended to give you an overview and highlight of the discussions on the various topics the committee took up. It is not a verbatim transcript of the hearing but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

Public Health and Emergency Response Panel

Dr. John Hellerstedt, DSHS

  • The fighting of COVID-19 is a something Texas has to take seriously
  • If we take steps to protect ourselves, we will all benefit
  • Renew and expand everyday practices of daily sanitation to fight COVID-19
    • Hand washing
    • Covering cough/sneeze
    • Staying home when sick
  • Optimistic that the spread of COVID-19 can be slowed if we take preventative measures he listed
  • Thompson- How prepared are we?
    • It is a novel virus, which means it can spread very fast. We are ramping up lab services and are inviting public health officials and city and county officials to talk about current situation and come to a common assessment of what we see. The ability to coordinate action is one of the most powerful tools we have
  • DSHS is leading the response with co-lead Chief Nim Kidd
  • Thompson-How many tests do we have available?
    • Cannot give firm number because there are two different forms of distribution (one from CDC and one from private/commercial labs)
    • People use kits to describe supply, but kit is capable of testing several hundred people, we are using supply CDC gave to public health first
    • Lab in Austin can process between 10-20 people a day
    • When you get kits, the lab has to go through verification test. We submit positive tests to CDC for verification but will begin to treat before we get confirmation back
  • Lucio- How are you disseminating info. to doctors, hospitals, etc. about who should be further tested? Are we isolating those that have traveled or have been potentially exposed?
    • We do not have confirmed sustained community wide spread of novel coronavirus in TX. That will be a milestone in how we have to test and handle
  • Lucio- It seems we have isolated to very specific circumstances, but at what point do isolate based on similar set of symptoms specific to COVID-19 (like strep/flu)?
    • Point of care testing is what is used for things like strep and flu. We don’t have that capability for COVID-19 yet, that’s why there is a difference in testing. Leading up to this, there was no COVID-19 in the U.S. and we had to look at what we could, specifically people that had travelled to places that already had COVID-19. I don’t know where they are with point of care testing, I think it is still some months off
  • Lucio- We are isolating those tests to tracking those who have had positive exposure?
    • Yes. We do a case investigation when there is a positive test. Then they do outreach to contacts as best they can
  • Lucio- At what point do we say there are specific symptoms for the coronavirus and disseminate info to providers based on that?
    • One of the difficulties is the symptoms of COVID-19, there is no way to tell the difference between flu and other respiratory viruses. The only clear way is with tests
  • Ortega- How long does it take to get tests back?
    • Swab test samples, if properly shipped to lab, take typically 4-6 hours and then results are electronically reported
  • Ortega- You mentioned certain cities have capability of doing the testing (El Paso Lab)?
    • I don’t want to misrepresent. When it hits the bench, will take about 4-6 hours. The collecting and getting it there takes longest
  • Ortega- How many in TX have been tested?
    • We know in terms of labs that have been sent to CDC.  We are also asking laboratory response groups and commercial labs, it will be in the hundreds
  • Guerra- Asked about position on cancelling public events. 
    • We want those decisions to be local decisions, we have county health depts that can provide good counsel
  • Thompson- What is the treatment for positive tests?
    • It is all supportive. 80% or more will have mild cases and it seems to be mild in children and healthy young people. If people can take care of themselves at home, we hope they will isolate at home. If they get sick enough, they can be admitted to a hospital that can offer other services like oxygen
  • Thompson- What if a man with 4 children is diagnosed and at home isolates?
    • That is a difficult circumstance, but we must rely on private and public services to help with this.
    • Family would need to take preventative measures like what I previously listed
  • Thompson- At what point do we declare State of Emergency in Texas?
    • I can’t give you a simple answer on that. Technical terminology is a “disaster.” I can declare a public health disaster. Those declarations don’t create any additional resources but do pave way for other forms of control measures of social distancing that wouldn’t be used in normal circumstances
  • Thompson- Nutrition changes?
    • I would recommend same kind of recommendations for someone with the flu, whatever can be tolerated and keeps you feeling the best, hydration is key
  • Lucio- Declaring State of Emergency would not qualify us for any additional resources from CDC?
    • Correct term is Disaster, and as I understand it, you are correct. Congress has dedicated additional funds
  • Lucio- Do you think we have adequate testing kits at this time?
    • Yes, I do. Testing is an index of what is happening on a broad scale in communities. It will help us see what communities have been hit harder. Now and throughout this challenge, we must do things we can do ourselves to prevent spread
  • Lucio- If you see upward trend in positive tests in Texas, what is next step? It seems like right now we are worried about testing and surveillance, but Texans are concerned about other things as well like quarantine.
    • Quarantine can be useful in certain circumstances. It can be done as a formal legal directive or can be done as a form of self-quarantine
    • Control orders are in Texas statute
    • People need to cooperate with doing what they can to slow the spread of the disease
  • Zedler- What is difference between COVID-19 and other viral outbreaks from over the years?
    • There are unique things about each of those. H1N1 was a global pandemic in 2009. We had more kids show up at the hospital but few needed to stay hospitalized. SARS was not easily transmitted, so over time it was going to burn itself out. COVID-19 is “highly contagious” and can cause secondary infections.
  • Zedler- So COVID-19 is a branch of coronavirus?
    • Yes, it’s a new member of the family of coronavirus
  • Zedler- I don’t remember having large gatherings or people entering the country being blocked during any other pandemic.
    • Yes, what is happening now is without precedent. I would say that the threat posed by this novel virus has warranted a new type of containment and mitigation
  • Allison- I understood you said there wouldn’t be any additional assistance if we declared a public disaster?
    • Correct. The declaration sends a powerful message but doesn’t automatically mean we will get more funding. It does allow for us to have more control measures
  • Wray- Mortality of COVID-19 comparison to other viruses? What cohorts are most impacted?
    • Older you are and the more underlying medical problems you have (hypertension, diabetes, immune disorders), are all at higher risk for severe case or fatal outcome
    • Case fatality rate- you can only get this with a really accurate numerator and denominator. We don’t have the most accurate numbers from China right now. COVID-19 has potential to be 10 times as fatal as seasonal flu
  • Wray- How many approximate deaths do we have from seasonal flu?
    • It is variable, up to 80,000 nationally on a bad year
  • Wray- What is average number of days someone could be sick?
    • Incubation period- when you contract and are able to reproduce the virus in others, is up to 14 days. How long you are sick has to do more with other factors like age and other underlying medical problems
  • Wray- If someone knows they were exposed and 14 days go by and they don’t demonstrate symptoms, it would indicate they are clear of the virus?
    • Yes, that is the current guidance
  •  Wray- Is the highest transmission likely through droplets?
    • Airborne and droplet transmission – true airborne is like TB because it can float in the air. They have special ventilation systems in treatment hospitalization (negative pressure isolation room)
    • COVID-19 was so novel that it was not really understood if airborne or droplet, droplet they are in air for a bit but eventually land and dry out and are destroyed in drying process
    • In an abundance of caution, highest precaution would be isolation for airborne, but is harder to provide than isolation for droplet
  • Wray- Do we know if it is airborne?
    • We are asking CDC to address that question; we don’t know for sure
  • Wray- Relative to the virus, what works and doesn’t work?
    • N95 Respirator masks are able to keep out airborne virus, but we are trying to preserve supply of those for healthcare workers. Regular surgical mask is not necessarily helpful. But if someone has symptoms, it will decrease amount of spread
  • Wray- Do you know when we will know if it is airborne?
    • We are asking the CDC everyday
  • Rodriguez- Is state responsible for providing masks to local healthcare clinics?
    • We are expecting them to use their own supplies
  • Rodriguez- Is there something that could be done to help with cost for that?
    • That would be a matter of policy; not currently in place

Chief Nim Kidd, COO, Texas Dept of Emergency Management

  • The way this state will respond to this novel virus is the same way we have always responded to emergencies and disasters, same people and protocols
  • We need to remind people to be prepared and not panicked
  • Preparedness is a journey, not a destination
  • We will continue to bring the Emergency Council of 38 state agencies together to discuss
  • Federal partners are working on proration of N95 masks based on need due to risk and population of state
  • Zedler- There has been misunderstanding concerning the masks
    • Surgeon General has stated that masks should not be worn by healthy citizens at this point. They need to be reserved for healthcare providers. Wearing those masks over mouth but not nose is not helpful. There is a procedure for properly wearing those masks and people that are taking care of patients need those to protect themselves

Stephanie Muth, State Medicaid Director, HHSC

  • Response to COVID-19 is informed by previous actors like Hurricane Harvey
  • Having daily calls with DSHS
  • We are talking with other states and trying to maximize use of telemedicine and telehealth. We are ahead of the game in this in TX thanks to recent legislation. Their existing Medicaid services may include telehealth
  • COVID-19 test is a covered benefit in Medicaid services
  • For our staff, we have a screening protocol prior to the staff going to homes
  • Ensuring there is not use of prior authorization or restrictions on access to supply
  • Monitoring prescription drugs that Medicaid recipients receive, especially those manufactured in China. We are identifying members that may be affected and identifying other drugs that could be offered
  • Thompson- What is state’s role in ensuring all health facilities are properly stocked?
    • Regulator can offer better response, we are payor
  • Thompson- What are we doing about uninsured?
    • They would get treatment the way they currently receive treatment. That would be outside purview of Medicaid and CHIP because our focus is on those eligible for those services
  • Thompson- What is HHSC planning to do to keep people from getting kicked off SNAP if their workplace closes?
    • That would be a question for Regulator

David Kostroun, Deputy Executive Commissioner, HHSC

  • Scope includes long term, acute care facilities, and child care operations
  • We have authority to conduct inspections, investigations at nursing homes and hospitals and can take enforcement actions as appropriate
  • We have been working in close coordination with DSHS to ensure staff in the field and providers we work with, to help prevent spread. At this time COVID-19 hasn’t been detected in any of the facilities we monitor and regulate
  • Listed precautions being taken in facilities and of their own workers which includes infection prevention practices
  • Understand the importance of having a healthy and trained workforce
  • Per CMS, we will be conducting unannounced inspections and surveys in facilities
  • This may slow our response to low risk complaints
  • Thompson- What steps are being taken to make sure people in nursing facilities are washing hands?
    • We have been reaching out to facilities to remind them of infection control and to screen visitors. We will be going to a large number of nursing facilities

Question and Answer

  • Sheffield- Testing done by nasal and drop swab. Blood testing?
    • Not to my knowledge yet
  • Sheffield- N95 masks. Are they available for public to buy?
    • Kidd- at one point, yes. But they are pretty hard to find now.
  • Sheffield- Does the state have these supplies?
    • Kidd- Yes, but just for personnel
  • Sheffield- State of TX Environmental Electronic Reporting System (STEERS) database, how does it apply to this?
    • Kidd- 211 runs system. It is for people that need to evacuate from flood, fire, etc.
  • Lucio- Disaster declaration, would that expedite or waive requirements from some facilities?
    • David Costner- Yes, that is correct.
    • Kidd- Declarations can also be made by mayor or judge at the local level and they become commander in chief for 7 days. When governor declares disaster, he becomes commander in chief for 30 day period over all state and local agencies. If there is not a local public health authority, DSHS is the authority
  • Lucio- How can we ensure facilities are in a place to respond effectively in an outbreak?
    • Hellerstedt- All hospitals meet qualifications for licensure to handle cases of infectious disease and surges. We know COVID-19 has momentum and there could come a point where there isn’t capacity. We are trying to slow it down and spread it over time so that the capacity of hospitals isn’t overwhelmed
  • Lucio- From a waiver standpoint, I think declaring a state of disaster could be helpful
    • Kidd- We know current facilities and capabilities and I think your question is what can we do with alternate care facilities that are on the fringe of licensing. We don’t want to waive regulation, but we do want to get everyone up to speed in a methodical way
  • Brennan- Are we experiencing shortage of masks due to shortage of production in China?
    • Kidd- Yes, but we are ramping up production in masks in the U.S. and we do not yet know full capacity of stock-pile we have in Texas
  • Allison- What factors do you look at before declaring public health disaster?
    • Hellerstedt- We have consciously tried to ensure communications and actions are in sync with the situation. We will make a move circumstantially
  • Allison-Do you see any need in declaring a public health disaster right now?
    • Hellerstedt- No, not right now. It is rapidly changing, my answer may be different tomorrow
  • Frank- Data on the grounds changing rapidly, truth is important. Where is the best place to get accurate information?
  • Thompson- Don’t you have a hotline?
    • Hellerstedt- Yes, but we want people to go through local public health first
  • Sheffield- Asked about 14 day quarantine.
    • Depends on situation, getting into phase of self monitoring
  • Sheffield- Are we going to experience a shortage with healthcare providers?
    • Hellerstedt- Current goal is to prevent a decrease in capacity
  • Lucio- State of Disaster, many of us have asked about that. Wants to know threshold that will cause it to be called

Education Response

Commissioner Mike Morath, Texas Education Agency

  • Gave handout
  • Communicating with the field giving memorandums of best practices for schools around the state- have sent 3 thus far
  • This is by and large and local decision-making process. Schools districts can make decision on whether they stay open or closed
  • We have gotten questions about funding for attendance, subsidized breakfast and lunch access, communication with parents, days for test administration
  • Thompson- What are we doing to take into consideration SPED students?
    • We have a good number of medically fragile students in schools and our priority is keeping students safe
    • If student not yet showing symptoms, being in school environment is often safer than not but there is a high degree of variation that exist from school to school
  • First guidance is to confer with local health authorities. If a student on campus hasn’t shown symptoms, there isn’t necessarily a reason to shut down. We are simply trying to inform the field on their options
  • Spring break is upon us and there is concern about what happens when people return from spring break
  • We have been providing guidance on how to communicate with parents on this. We have operating history with disaster and we use standard practices from prior disasters. For attendance purposes, we remove days used in calculating average daily attendance for funding
  • Lucio- Each school district has to individually apply for a waiver for those days?
    • Yes. We have to know which specific days they were affected
  • Lucio- There is tremendous pressure from my local school district to have kids come to school.
    • It is still local control. We are just trying to make sure everyone has access to the latest information to make well informed decisions
  • In the event of Governor declared disaster, would create an average daily attendance
  • We let districts know how decision making typically happens, we don’t typically see a school close unless we see attendance dip 25% but that could change if we have a student with a confirmed case
  • Other states have given us guidance that agree with measures we are taking. There are negative effects when schools close
  • Guerra- In McAllen ISD, the school board implemented program so people go into classrooms on the weekend to deep clean each school and sinks are outside of bathrooms so teachers can monitor hand washing. Their attendance has gone way up. Basic hygiene is working
    • Yes, we are recommending good hygiene practices for districts
  • Guerra- I am impressed with how McAllen ISD has handled this coming out ahead of the game. School districts have tremendous power in helping to slow the spread
  • Allison- Children on free/reduced lunch- have you had conversations with HHS about this?
    • Yes. We have been asked about this in the event schools close. USDA regulates this and we are looking for regulatory authority to help us with this. Other states that have had closures have not had an accompaniment of food services while school is not in session
  • Allison-If school closes for 14 days or longer, what about single parent homes where they work?
    • This is why it is a local school district decision. There is an economic disruption and significant ripple effects
  • www.tea.texas.gov/coronavirus 

Ray Martinez, Texas Higher Education Coordinating Board

  • Specific institutional needs will differ because of the diversity of institutions
  • The Coordinating Board is staying in close communication with institutions of higher education
  • Campuses are focused on having incident planning management in place, adopting policies to minimize risk esp. around international travel, and communication with state and local health authorities
  • We are taking guidance from CDC and disseminating information to campuses
  • We have been having weekly calls with the DSHS and as of yesterday, it is a daily call
  • Thompson- How will you handle a student/employee that misses 2 weeks of classes because of quarantine?
    • Yes, there was a Rice University employee that had been exposed and Rice decided to cancel classes this week. Spring Break is next week, and they are assessing how to continue to handle the situation
    • We are providing facts and information, but the decisions are being made by individual institutions
    • US Dept. of Education is implementing maximum flexibility when it comes to work-study situations and financial aid. We are taking a look at similar issues at the state level
    • We are full participants in the Emergency Council meetings that are happening twice a week, keeping our institutions of higher education informed

San Antonio & Houston Response

Ron Nirenberg, Mayor of San Antonio

  • We have not had any confirmed cases in the community of San Antonio or Bexar County. Only confirmed cases are those that have come into the city and are in quarantine
  • Risk of infection remains low in San Antonio.
  • Federal government has sent 2 cohorts to Lackland and a 3rd cohort is coming as early as today
  • A week ago, the CDC released a patient that later received a weakly positive result, after visiting a mall and hotel
  • I issued a public health declaration to prevent CDC from releasing any individuals early from quarantine
  • Since March 2nd, USDHHS has modified protocol so that no one with pending results would be released before results came back
  • We have taken extensive measures to ensure the arrival of additional people in quarantine will not lead to community spread.
  • We have requested all individuals being flown in for quarantine and testing, go straight to Lackland Air Force Base, requested protocol for release, HHS person on site to ensure this happening
  • Allison- County judge sent a letter similar to the Mayor’s testimony

Dr. David Persse, Public Health Authority for City of Houston 

  • Provides testimony from statement to the committee
  • Health depts in City of Houston and Harris County are complementary
  • We routinely bring members of healthcare community together on a collaborative level
  • COVID-19- have been meeting regarding this going back to January
  • Thompson- Concern about homeless?
    • Yes, we do have concerns about the homeless. They are a particularly challenging and vulnerable population
    • We are working with experts in that area
  • Thompson- How would you quarantine a homeless individual?
    • We could put them in a quarantined house. We have done this with patients from TB. As the public health authority, we can put them there, but sometimes law enforcement has to get involved. Concern is the volume, we don’t have capacity to quarantine many of them
  • We have a public health lab authorized to do COVID-19 testing. Testing someone who doesn’t have symptoms is a waste of the test. If we test too early, you can get a negative test (a false negative)
  • The idea of have testing centers everywhere is in theory wonderful, but could potentially be a waste of valuable resources
  • Unsure- quarantine. Positive- isolation
  • Goal right now is to slow spread so that the volume that need hospitalization at any given time is low
  • Thompson- We have a problem with human trafficking (sex and labor), especially in Houston area. What about spread in that way?
    • Yes, people are trafficked from all around the globe and it is another challenge area for us to have an impact on
  • We are utilizing public messaging
  • Thompson- How are you messaging the homeless?
    • They do have a community and we can disseminate information through resources they access. Many of them do have behavioral health issues, so it is another challenge
  • Thompson- Can you give out alcohol pads, would it be helpful?
    • It would probably not be helpful enough
  • In addition to public messaging, we have epidemiologists to help us identify and figure out how to best quarantine (no person to person contact for 2-weeks, it is hard for families)
  • We don’t need a new plan, we can tweak the plans we have in place
  • Local funding- how long will it take to get federal funds into our hands? Whatever you can to help that funding get to the local level quickly is very helpful
  • Thompson- Do we have enough hospital bed space?
    • In the off-season, in our area, hospital beds are typically 90% full
    • Mayor Nirenberg- We currently have capacity at TCID to offer most needed treatment for quarantined folks. Message to federal government is that we need hospital space conserved for those that need it in event of an outbreak
  • Lucio- What would a waiver do to the capacity issue in Houston?
    • The right waiver would allow long-term facilities to get paid same amount if people moved from there to acute care facility
  • Allison – Mayor asked about community hospitals, patients will go to TCID or CDC until they are full
    • TCID is not release value for federal government discretion, will need that facility 
  • Allison- The person that went into the SA community that was a weak positive, was their last
  • Allison – Asked about spread of personnel in Lackland who are processing evacuees
    • HHSC personnel and CDC, anyone who comes in contact will be put in investigation for testing or observation
    • Evacuee who was prematurely released, 2 state employees came in contact through TCID and are now being monitored for any symptom development
  • Test done within the 14 days?
    • Yes, 4 tests were given. Test 2 was inconclusive, test 3 was negative, test 4 was weak positive. Positive test result resets timeline for release

Dr. Umair Shah, Harris County Public Health

  • We have just hit day 71 of responding to COVID-19 in some way
  • Public health departments are the support to the healthcare system (clinics, hospital)
  • We have not invested enough as a nation into public health. When TB and measles has gone down, public health funding has been cut, then those rates rise again
  • We have responded previously to novel infectious diseases
  • Novel Coronavirus is concerning because it jumped from animals to humans, and we saw an onslaught of morbidity and mortality. We are now saying it’s not “if” or “when”, it is “now”
  • We have had Asian American children experience discrimination because of this
  • We need to be thinking down the road, when surge capacity exceeds resources
  • We are primarily concerned about epidemiology and communications, and continuity of community (ensuring community continues to move forward and thrive while also being prepared)
  • We are concerned about supply during a surge
  • At the local level, we are pushing information to schools, hospitals, etc. to help them be prepared
  • We need testing capabilities to be there. It has taken too long for us to have access
  • Agree that if someone is asymptomatic, don’t test. You may have false negatives
  • 211 system-critical need for it to address questions that are coming at public health systems
  • We don’t have time to wait on federal funds- need it now and they need to be shared equitably across the system
  • Frank- You mentioned an 18-month surge for H1N1. What time frame do you think we are looking at for COVID-19?
    • We may or may not start to see decrease when it gets warmer. We haven’t seen this virus and we don’t know what an evolving virus will do. Dr. Persse and I believe we have ability to slow spread in Texas. Right now, we can get the tests done
    • Persse- There are 7 coronaviruses that infect humans, includes SARS and MERS which have high case fatality rates. There is no herd immunity and we don’t know if you will have lifelong immunity after you have gotten it once
  • In response to question on concern of supply shortages, he noted personal protection items such as masks for healthcare providers, hand sanitizer, gowns, beds, gloves

Medical Schools

Jim LeDuc, Galveston National Laboratory

  • Facility designed to work with most dangerous pathogens known to man
  • Currently working on coronavirus
  • Have seen several versions, some were a cold
  • In early 2000s saw SARS, Middle East Respiratory, and new Coronavirus
    • All three have come from animals, most likely from bats
    • Originated in nature and jumped to humans
  • Signed major agreement with pharmaceutical company and testing drugs to see what can treat
  • Will look at druggable targets
  • Three separate candidates that develop vaccines, one partnership with Baylor they are reestablishing
  • Thompson – where do you get your funding?
    • Primary funding from NIH
  • Some unique tools they have developed include mouse model, virus in a petri dish, etc
  • Virus stability – work done on SARS, virus on solid surface survives 9-10 days not hours, 3-5 days on porous surfaces
  • Need to do better job of cleaning public surfaces
  • Virus infects gastrointestinal tracts so it can come out in stools and vomit which in the case of SARS lead to major transmission episode
  • Very durable virus
  • About 5% that contract will require ICU type of support, based on China data of 44k cases and in that as well less than 1% under the age of 19

Luis Ostrosky, UT Health in Houston

  • Testifying on role of medical schools
  • Medical schools have role of care education and leadership

Dan Leahy, Chairman of Molecular Bioscience at UT

  • Scientists at UT include world expert on vaccine design and experience on SARS and MERS
  • Working on stabilized protein to help develop vaccine, passive immunotherapy
  • Still at a minimum 12-18 months for vaccine, takes time to develop and scale up for production
  • Usual time course is 5+ years if everything goes well
  • Ability to recruit experts stemmed on support of legislature in CPRIT and other initiatives that support research

Tom Kowalski, President of Texas Healthcare and Bioscience Institute (THBI)

  • Investment by state has helped grown industry
  • Normally takes 10-12 years to bring drug to fruition and tough business to be in but they are now in position to expedite
  • Dealing with interrupted travel schedules
  • Shared what some biomedical companies in Texas are doing and some have made national news; working on vaccines, etc
  • Texas legislature plays an important role: need to preserve and foster Texas investments in this infrastructure, encourage R&D, support policies to keep small business and life sciences flourishing, fund research to ensure national competitiveness
  • Guerra – expand on development within confines such as funding and compensating companies
    • Smaller companies are biotech companies, any assistance is helpful as they develop and bring to market
    • Key ability to raise venture capital 

Amy Walker, Senior Manager for Infectious Diseases Policy at Biotechnology Innovation Organization (BIO) 

  • Many companies have announced products to address COVID19, several companies have national R&D partnerships which also include Chinese government and NGO
  • In vaccine space – work to address SARS and MERS is being used to test against COVID19
  • Clinical trials of therapeutics have also been addressed in U.S. fast tracking what is typically a decade long process
  • Thompson – heard about shortage of drugs, anything over the counter that can be used
    • Does not know other than in communications and working to identify, FDA best resource
  • Thompson – not capable in America to meet supply and demand?
    • There are some only made in China and FDA is monitoring and looking for alternative solutions but it will take time to set up that capability

Healthcare Professionals and Transportation

Thompson comments on www.airlines.org  – reads a statement on steps airlines are taking such as extensive cleaning and waiving change fees, she also refers people to website link  

Charles Lerner, Texas Medical Association

  • Symptoms make it indistinguishable from common things like flu
  • Influenza never disappears but expected to drop off in April
  • Disease appears to be mild in about 80% of cases, transmission seems to occur in those showing symptoms but it is possible to spread without knowing
  • Thankful for HB 48 but there is a shortage of protection needed for health care providers
  • Current strategies to address disease are resource intensive of health care providers
  • Physicians and nurses themselves are at risk
  • Those health care providers have increased risk of infection when treating and report burnout as frontline workers  
  • TMA requests the following strategies: ensure continued supply and procurement of personal protective equipment, enable expansion of telemedicine capacity especially those in rural area, provide emergency funding needed for community wide outbreak and quarantine needs refers to Davis bill from last session, and evaluation of availability of ventilators and ICU beds
  • Urgent need to be prepared now

Eric Martinez, President of Texas Academy of Physician Assistants (TAMPA)

  • Speaking as front-line health care provider
  • Working to limit exposure, restrict access points in hospitals
  • Thompson – are you seeing people in your ER with this virus and how many
    • Know they have some tested but don’t know how many
  • Continues to discuss ways they are working to limit exposure such as staffing plans and screening protocols
  • Would push CDC and state health departments to develop definitive screening tools and guidelines and funding
  • Guidance is that PAs use their judgment if test is needed but many are being discouraged to test because of limit of test
  • Need also protective equipment, Washington State hospital is already out of needed mask
  • Thompson – asked about supply of mask
    • For respiratory patients, they use them on patients
  • Frank – do you deplete mask everyday, are they disposable or not?
    • If face shield to cover mask can use for entire shift
    • Need to dispose of mask for each patient if not using shield
  • Thompson – do you have enough test
    • Told they have capacity to treat who they need to treat but not sure of exact supply

Jorge Cruz-Aedo, Corpus Christi Regional Transportation Authority

  • Doing extra enhanced precautionary cleaning
  • Deep cleaning in evening and spot cleaning throughout day
  • Use hand gel dispensers on bus and in stations
  • Move forward with awareness that cleanings must done appropriately and throughout the day
  • Experience shortages of basic cleaning chemicals they need
  • Changed HR protocol required staff to go home if ill

Allen Hunter, Texas Transit Association

  • Work closely to monitor and take best practices and communicate them to partners
  • Majority of agencies taking this precaution even without the threat
  • In some cases they are providing hand sanitizers in vehicles themselves or gloves for drivers

Hospitals and Health Plan Preparedness

Donna Boatwright, CEO of Rolling Plains Hospital

  • Had a busy flu season and interesting situation going into this time
  • Have had a lot of work in community discussing preparedness and prevent spread
  • Spent a great deal of time conducting inventory of supplies and resources
  • Do have negative pressure facility in her hospital but in some rural areas they do not
  • While in committee meeting received a text they cannot get any hand sanitizer but working with others to determine ways to access
  • May also get reduced supplies due to conservation going on
  • Some colleagues are experiencing higher prices on supplies
  • Thompson – that sounds like price gouging
    • Yes, appreciate leadership statement on this
  • 70% of counties in rural area, large area of state in precarious situations due to number of hospitals
  • Public is also feeling squeeze in purchasing so moving items behind registration desk to prevent them from being taken (ie masks, hand sanitizer)
  • Also have a concern with staffing, providers can be stretched thin
  • Security needs as well, in small hospital it is a definite concern as many small rural hospitals do not have this so how are needs addressed to make campus, patients and staff are secure in community spread issue
  • Turnaround time on test has not been a concern at this point
  • Do have number of beds if there is a surge
  • Looking for guidance on telemedicine opportunities and alternative screening sites
  • Want to protect ability to do surgeries they still need to do, there could be an impact to elective surgeries
  • Frank – are there any legislative barriers that would make it difficult to do telemedicine?
    • Defers to next witness
    • Part of telemedicine deals with equipment needs, envision value of putting AP on phone to walk through screening

Brent Kaziny, Texas Children’s Hospital

  • Variety opportunities to be engaged at disaster response of all levels
  • Using similar concept in H1N1, pediatric surge team response model
  • Reviewed training simulations, notes tremendous effort already underway
  • Concerns of availability PPE, personal protective equipment
  • Thompson – how do you clean?
    • All disposable
  • Seattle hospitals calling out to all hospitals for protective equipment
  • Massive multi-institute effort to enact testing sites to keep people away from hospitals but efforts have been stalled because of lack of personal protective equipment
  • Global spread of accurate and up to date information is a challenge
  • Thompson – do you have enough tests? Could you let adult populations use?
    • Provides possible example where health care provider is compromised 
  • Thompson – ask about panic concerns 
    • Expect may see something if there are local transmissions or a patient with unknown transmission and don’t know where they got it from
  • Can say every parent who comes in with child with fever and cough are asking about coronavirus, so they are thinking about it
  • Thinks institutions looking into telemedicine is a huge thing but need to look at reimbursements which could cause some problems if not addressed
  • Grant funding and funding needs to continue for preparing for the phases
  • Marathon like planning efforts are underway

Jamie Dudensing, Texas Association of Health Plans

  • Member plans are preparing for widespread of coronavirus
  • Working to ensure coverage and access to test
  • Working with public and private partnership so no financial barrier to those that seek testing and addressing and points to Gov Abbott’s announcement today
  • Working with health care providers to ensure treatment is available, telemedicine is an important feature
  • Educating individuals they serve about prevention of disease
  • Fully committed to working with agency partners
  • Frank – has there been any proactive information send out?
    • There is a plan and will get back to him all information going out to Medicaid patients

Carey Krall, Methodist Healthcare System

  • One of the hospitals to first treat Coronavirus patient
  • Methodical effort on resources to prepare
  • Protocol was activated prior to arrival
  • Care was provided in negative pressure room
  • Video surveillance was used to monitor and study
  • Employees volunteered to be part of care team
  • Hospital did see patients cancel care during this time
  • Coronavirus will put extreme pressure on health care system
  • Will continue to provide planned care and urgent care
  • Hospital space will need to be made available quickly, must not be depleted
  • Have launched a COVID19 task force – will work through pressing issues as they are identified
  • Needs include communication, messaging, etc
  • Allison – asked Personal Protective Equipment
    • Have been able to share resources in past
    • Concern on amount of product being manufactured
    • Will take innovation as manufacturers develop ways to produce
    • Sending out guidance on how to safely reuse and conserve
  • Thompson – asked about monkey pox
    • Kaziny – It’s another infectious disease