Oct. 8, 2020
Dear Members of the Baylor College of Medicine Community,
It is never a good sign when I am writing my Wednesday message on Thursday morning. My intent this week was to write about bar openings. However, events have evolved so quickly, two versions of this message are already obsolete. Instead of rehashing the recent news, I will refer you to a couple of sources if you want to dig deeper into the issue.
I am going to focus on broader questions: Is it time to reopen bars in Harris County? (No); What role should personal responsibility play in community control of the virus? (A critical one); How are we doing in our efforts to have a civil, respectful public debate? (C+, but I tend to be an easy grader).
First, a couple of references for background reading. There is an article in this morning’s Houston Chronicle that does an excellent job summarizing the issues around bar reopenings. I would recommend reading this if you were under the mistaken impression bars were already open.
If you are interested in this topic, I would also encourage you to read Gov. Greg Abbott’s actual executive order (GA-32). It is a detailed document, which makes attempts at a degree of nuance. For example, when drinking in a bar you must remain seated. That is, unless it is a wine tasting, in which case you may stand “if in a group of six people or fewer and there is at least six feet of social distancing or engineering controls, such as partitions, between groups.”
At a very high level (please read it for yourself) the Governor’s order a) permits bars to open at 50% of total listed capacity, b) but only in counties that do not have an excessive burden of COVID-19 in hospitals and c) in a major digression from prior executive orders, requires the county judge to opt-in to the reopening decision.
So should we reopen bars? First of all, let us acknowledge at this point in the debate, most of us are either viral bulls or bears. The primary concern of the bulls is economic. Government mandated limitations on businesses create hardship and long-term damage to the social, economic, emotional and medical well-being of people. Others are viral bears. Failure to adequately mitigate the virus in communities via public health measures, including limitations on businesses, will result in preventable death and a repetitive cycle of shut downs, reopenings and surges. There is validity to both positions. I work for an organization whose explicit mission is to improve healthcare. I acknowledge my bias – I am a bear, and suspect most, but by no means all of my colleagues, are similarly inclined.
Why is now not time to open our bars? Our numbers are stable to improving. Our R(t) has been less than one (indicating the virus is receding) for more than two weeks. Community cases (which we want below 200 per day) seem to have stabilized between 300-500. As I have previously reviewed, I have some apprehension this number is under-reported due to Texas DSHS data reporting challenges. New daily hospitalizations (probably a more reliable, but indirect estimate of disease prevalence in the community) are 20-25% of what they were during our July surge, but seem to be trending slowly upward over the past week. At best, our monitoring metrics are at a tenuous equilibrium. At worst, we are in the early phases of exponential growth. The unfortunate reality is we will only know which condition is true – best case or worst case – looking in the rear-view mirror.
Our numbers look relatively good, but the experience around the world should drive us to act cautiously. If we are too exuberant in our path back to normalcy, we will surge again. And shut down again. Critically, we are getting ready to stress our system further. School systems and parents still need to make decisions regarding a return to face-to-face instruction. Cooler weather will drive people indoors and will probably promote viral spread. Our equilibrium can only withstand so much perturbation – let us focus on getting children back in schools before we reopen bars.
A word in support of bar owners. Many are tax-paying small business owners, with personal investment in their enterprise. They employ Houstonians. They have families to feed. They are no longer receiving any government assistance to help mitigate the impact of government-ordered restrictions on their businesses. Their expenses continue, even though their revenue has evaporated. The rent still comes due. Those of us who had the good fortune to remain employed through this crisis should be careful not to vilify those who face a choice we have not had to make – close up shop, or find a way to do business in the challenging pandemic environment.
Gov. Abbott’s executive order creates some clarity, but in Harris County is likely to stoke political debate as to next steps. Should Judge Lina Hidalgo – clearly a “bear” – opt-in or opt-out? Most of us will have an opinion heavily influenced by our bullish or bearish inclinations. There will be passionate declarations made from both extremes. What can we all do to help drive a good outcome for our community? A few thoughts:
Proprietors of bars and restaurants:
- Demonstrate to those of us who are justifiably worried about the resurgence of this disease that you are taking it seriously. Most of the business community has, and we thank you. Some clearly have not.
- Look at your space. Create visual cues like floor markings and furniture placement to encourage distancing. Require masking upon entry. Creatively use outdoor spaces. Regularly walk the floor of your business, and critically assess if your patrons are effectively distanced. Do more than meet the technical requirements imposed by restrictions; meet their intent.
- Use the opportunity to innovate. Build your take-out business. Develop home mixed drink kits. Hold virtual on-line wine tastings, pre-selling the wine. I do not pretend to understand your business, or what is required to remain profitable, but I believe it is a risky strategy – from a business and public health perspective – to tie your economic recovery to packing people into a confined space.
Patrons and the general public:
- Reward those businesses – bars included – that are doing this well, and making a sincere effort to keep the community safe. Patronize them if they appear safe. Order take out. Tip generously. Tell your friends and colleagues when you have an enjoyable COVID-responsible experience.
- Remember, no matter how carefully crafted an executive order or local mandate might be, regulation will never be enough to ensure your safety. To repeat an analogy I used a couple of weeks ago: The government tells me how fast I am allowed to drive. I make a conscious decision to slow down when visibility is poor, because I have good situational awareness, and I am concerned about the safety of those around me. The same goes for viral safety. Stay alert and aware. If you walk into any environment and people are crowded and unmasked, turn around and walk out.
- In what has become an increasingly divisive environment, let us all work to take the temperature down a notch or two. I freely acknowledge as a professional working in health care, I lean towards the “keep people safe and healthy, prevent the spread of the virus” side of the debate. I am a viral bear. I hope I have empathy for those who have experienced severe economic impact from the pandemic, who are justified in their desire to see things reopen as rapidly as possible. I hope I have respect for the informed opinions of bulls. There is a tension between these worldviews. In a democracy, that tension is a good thing – it helps drive better decision-making. It helps, that is, if we are actually listening to each other. Both sides – let us concentrate on listening more, and shouting less.
James T McDeavitt, M.D.
Senior Vice President and Dean of Clinical Affairs
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