The Texas Medical Association COVID-19 Task Force on Tuesday told state lawmakers and fellow physicians to prepare to combat the disease, which so far has affected only a handful of people in Texas.
As of Wednesday morning, the state has 21 COVID-19 cases, but that number is sure to rise in the coming weeks, says Charles Lerner, MD, a San Antonio epidemiologist and infectious disease specialist, who spoke on TMA's behalf before the Texas House of Representatives Committee on Public Health.
"There is an urgent need to prepare now, and with the full force of our medical community and the support of the Texas legislature," Dr. Lerner told the committee.
Later Tuesday, the task force held a virtual town hall meeting on COVID-19, giving Texas physicians a chance to speak with officials at the Texas Department of State Health Services (DSHS) and TMA’s own experts about the rapid changes COVID-19 is forcing on health care.
“I personally think this is going to be the greatest public health challenge in living memory,” DSHS Commissioner John Hellerstedt, MD, (pictured right) told about 1,800 physicians who participated in the town hall. “And we want to do as much as we can to slow the progression of this disease in our population so that we do not overwhelm our health care system.”
A poll taken during the town hall showed only about 10% of Texas physicians said they are very prepared to handle COVID-19 patients, and another 30% said they are somewhat prepared. Meanwhile, 60% said they are either somewhat unprepared, not at all prepared, or unsure.
So far, all of Texas' known cases of COVID-19 have been imported from elsewhere, says Jennifer Shuford, MD, infectious disease medical officer at DSHS (pictured left). But like Dr. Lerner, she says that is about to change – especially among groups identified as high-risk, such as people over 60 and those with pre-existing conditions.
"We're at the tipping point right now where we don't have community transmission that we've identified, but we think we might be there because other states are there," she said. "And for now we're just telling people who are in the higher-risk groups to really practice social distancing and not get around anybody. But even by the end of the week, we'll probably be telling everybody to stay 3 to 6 feet away from anyone else in their surroundings."
Despite the call for greater social distancing, many physicians cannot help but work in close proximity to patients, says Justina Taube, MD, a Houston ophthalmic plastic and reconstructive surgeon.
"We can smell their breath – that's how close we are [to patients]," Dr. Taube said of ophthalmologists. She asked the town hall experts for some advice.
Dr. Shuford suggested asking patients with respiratory illnesses to delay appointments until they are well. She also suggested wearing a mask when possible to improve protection.
"Even having a surgical mask on can protect against some droplet transmission," she said.
During the town hall, Michael Garrett, MD, of Austin expressed concerns about the availability of testing kits and personal protective equipment, both of which have been in short supply nationwide.
"We have to have more widespread testing – that's the first part of it – and we have no access to protective equipment," Dr. Garrett said. "I'm a family physician seeing patients every day with respiratory illness, and all of our vendors [for protective equipment] have been on backorder for at least four weeks."
Obtaining personal protective equipment will likely remain a problem for the foreseeable future, Dr. Hellerstedt says. U.S. government agencies are trying to improve availability and they are working with DSHS to conserve existing stock, he says.
TMA's testimony before the Public Health Committee called for the state to ensure continued supply of personal protective equipment. It also called for the expansion of telemedicine services; emergency funding to help physicians pay for the disruption caused by outbreaks and quarantines; and to study ways to improve the availability of beds and ventilators in intensive care units.
Testing availability should improve within the next week, Dr. Shuford says. Private labs are in the process of providing greater testing capability to augment testing done by local health departments, she said during the town hall.
"There is something of a longer turnaround time at commercial labs than for the public health labs that are in Texas," she said. "But I think that's going to be improving as well."
The town hall also heard from TMA Practice Consulting on the business aspects of preparing for COVID-19, such as making sure a practice has business interruption insurance and a line of credit for emergencies.
For more information, check out the TMA Practice Consulting website or call (800) 523-8776.
Stay up to date with the latest news, resources, and government guidance on the coronavirus outbreak by visiting TMA’s COVID-19 Resource Center regularly.