When Governor Abbott opened up Texas ahead of a downward trajectory in COVID-19 cases, the expectation was that social distancing and masking would still take place. While walking around the neighborhood, I was surprised to see unmasked diners at restaurants. There were couples and families, but also groups that did not seem to live together. As the weeks went on and restaurants were allowed to increase their activity, I saw indoor and outdoor tables with patrons back to back and yet masks were not donned. I wondered, when would we see the effects? 

We need to normalize wearing masks and social distancing outside of the home. We know that a significant portion of those who have COVID-19 do not have symptoms. This means that the virus can spread from talking, even if there is no coughing or sneezing. Watch this video showing what a difference a mask can make.

As the video above shows, wearing a face mask and maintaining 6 feet from people outside of the home are simple ways to prevent spreading the virus. Masks are an effective tool to slow the spread of infections both inside and outside of the hospital setting. They must be worn correctly to be effective: 

• Only use the elastic or cloth ties to put your mask on or take it off.
• You should not touch the front of the mask or your face while putting it on or taking it off because viral particles could be on it. 
• You should wash your hand with soap and water for at least 20 seconds or use hand sanitizer before placing it on and after removal. 
• Cloth masks should be watched regularly. COVID-19 spreads mainly among people who are in close contact with one another, so staying physically distanced is important.

With these measures, a single person can make a difference. Check out an illustration that shows the impact of wearing a mask.  

Texas has seen a startling increase in the number of COVID-19 cases and hospitalizations. On June 30, Texas had 6,975 new cases. Compare that with May 30, when Texas had 1,332 new cases. We may have more positive test results because we are testing more; however we can look at other numbers for more details. 

The positivity rate looks at the average percentage of tests that were positive over the last 7 days. The WHO recommended that the positivity rate be 5% or lower prior to reopening. On June 29 Texas was 14.02%. At the peak of NY, this number was nearly 50% and now it is down to 1%. 

Hospitalizations are rising too. On June 30, 6,533 COVID-19 patients were hospitalized across Texas. One month ago, on May 25, there were 1,752.

Across Texas, we are lucky to have the opportunity to change our behavior and avoid the 50% positivity rate. It is not realistic to expect everyone to stay inside forever, but we can frame our decisions with the mindset of harm reduction in an effort to help individuals protect themselves, their families and their communities.

I hope that the next time I go on a walk, I see more masked up Texans at restaurants. I hope when I see groups of people in parks, they are wearing masks and sitting 6 feet apart. Lastly, I hope that by renewing our commitment to keeping ourselves and our communities healthy, I see the number of cases in Texas go on a downward trajectory.

–Anjali Vora, MD/MPH

References:

1. Anfinrud, Philip, et al. “Visualizing Speech-Generated Oral Fluid Droplets with Laser Light Scattering.” New England Journal of Medicine, vol. 382, no. 21, 2020, pp. 2061–2063., doi:10.1056/nejmc2007800.
2. Chu, Derek K, et al. “Physical Distancing, Face Masks, and Eye Protection to Prevent Person-to-Person Transmission of SARS-CoV-2 and COVID-19: a Systematic Review and Meta-Analysis.” The Lancet, vol. 395, no. 10242, 1 June 2020, pp. 1973–1987., doi:10.1016/s0140-6736(20)31142-9.
3. “Daily State-by-State Testing Trends.” Johns Hopkins Coronavirus Resource Center, coronavirus.jhu.edu/testing/individual-states/new-york.
4. Desai, Angel N., and David M. Aronoff. “Masks and Coronavirus Disease 2019 (COVID-19).” Jama, vol. 323, no. 20, 2020, p. 2103., doi:10.1001/jama.2020.6437.
5. “How Coronavirus Spreads.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 16 June 2020, http://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html.
6. Marcus, Julia. “Quarantine Fatigue Is Real.” The Atlantic, Atlantic Media Company, 14 May 2020, http://www.theatlantic.com/ideas/archive/2020/05/quarantine-fatigue-real-and-shaming-people-wont-help/611482/.
7. “Recommendation Regarding the Use of Cloth Face Coverings.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 Apr. 2020, http://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html#studies.
8. Roberts, Siobhan. “You Can Help Break the Chain of Transmission.” The New York Times, The New York Times, 19 Mar. 2020, http://www.nytimes.com/2020/03/19/health/coronavirus-distancing-transmission.html.
9. “Texas Case Counts COVID-19.” ArcGIS Dashboards, Texas Department of State Health Services, 2020, https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/ed483ecd702b4298ab01e8b9cafc8b83