What Physicians and Health Care Workers Need to Know about Stay-at-Home Orders
By Sean Price

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Texas' largest counties and cities have issued stay-at-home orders designed to keep residents at home and away from each other as much as possible. Most of the orders exempt health care activities, but the specific language in each varies.

Most of them are set to expire at the end of April, though they could be revised or renewed. 

Texas also is under a statewide order issued by Gov. Greg Abbott on March 31 that effectively tells people to stay at home as much as possible throughout April. That superseded a previous, less-stringent order forbidding social gatherings of more than 10 people. Both orders forced restaurants to close dining rooms – though they can still deliver food and provide takeout service – and closed establishments like bars, theaters, and gyms.

Before Governor Abbott's March 31 order, 79 counties had issued stay-at-home orders of their own, according to Mark P. Jones, PhD, professor of political science at Rice University in Houston. Since then, cities and counties appear to have stopped issuing new orders and relied on the statewide order to keep people at home.

The 79 counties issuing local orders include the six largest – BexarDallasEl PasoHarrisTarrant, and Travis. In many cases, large cities within these counties – including Fort Worth and San Antonio – issued joint orders along with their county governments. Also, 13 smaller cities in counties without stay-at-home orders issued orders of their own. They included Lubbock and Odessa.

The local orders have shut down all businesses except those exempted as "essential," such as health care facilities, grocery stores, gas stations, and news media outlets. Orders typically followed guidelines on "critical infrastructure" established by the U.S. Department of Homeland Security's Cybersecurity and Infrastructure Security Agency, which include health care.

Below is a list of the largest counties with stay-at-home orders, their duration, and the language in the order that pertains to health care activities and health care operations. Links to the full orders are included. The Texas Medical Association will stay abreast of these orders and others to update this list when necessary.

In addition, the TMA COVID-19 Task Force has published a draft letter you can customize and print out for essential staff to use while traveling to your facility under stay-at-home orders.

 Bexar County

Took effect April 7 and ends April 30

  • Exempted activities include:
    • "Health and Safety Activities. For example, to engage in activities or perform tasks essential to their health and safety, or to the health and safety of their family or household members (for example, obtaining food, medical supplies or medication, visiting a health care professional, or obtaining supplies needed to work from home) or to care for a family member or pet in another household."
  • "For purposes of this executive order, exempted businesses are defined as follows:
    • Health Care Services. For example, health care operations, including hospitals, clinics, dentists, pharmacies, pharmaceutical and biotechnology companies, other health care facilities, healthcare suppliers, mental health providers, substance abuse service providers, blood banks, medical research, laboratory services, or any related and/or ancillary healthcare services. Home-based and residential-based care for seniors, adults, or children are also considered health care operations. Health care operations also includes veterinary care and all health care services provided to animals. This exemption shall be viewed broadly to avoid any impacts to the delivery of health care. Health care operations do not include fitness and exercise gyms and similar facilities. Health care operations do not include elective medical, surgical, and dental procedures."
  • "That no person shall sell any of the following goods or services for more than the price the person charged for the goods or services on 11:59 pm on Thursday, March 19, 2020 and continuing during the pendency of this Executive Order:
    • Groceries, beverages, toilet articles, ice;
    • Restaurant, cafeteria, and boarding-house meals; and
    • Medicine, pharmaceutical, and medical equipment and supplies."  
  • That in order to reduce the risk of transmission of COVID 19 among vulnerable populations in long-term care facilities: a. Any individual providing in-person services, or who is otherwise employed or staffs a long-term care facility (e.g. nursing home, or assisted living facility), and has direct patient contact shall be prohibited from working in, or visiting, more than (1) long-term care facility for any purpose as a result of the increased risk for transmission of COVID-19 to an at-risk population. This prohibition is based on the Centers for Disease Control and Prevention (CDC) identifying that staff members working in multiple long-term care facilities can contribute to intra- and interfacility spread of COVID-19. The prohibition shall extend to any agency or organization who employs individuals for purposes of staffing or on a temporary basis. Notwithstanding, this prohibition does not, and is not intended to, impact or restrict the ability of an individual, organization or entity to operate as an exempted business under the Order/Declaration of either the Texas Governor or the County Judge for Bexar County, but shall only restrict the ingress/egress and movement of persons into or out of more than one nursing home facility. Additionally, long-term care facilities should follow all additional CDC guidance to take proactive steps to protect the health of residents and preserve the health care workforce by identifying and excluding potentially infected staff members, restricting visitation consistent with the Governor's Executive Order, the Mayor's Fifth Declaration, and the County Judge's Executive Order, ensuring early recognition of potentially infected patients, and implementing appropriate infection control measures; and b. In accordance with executive order GA 08 of Governor Greg Abbott, people shall not visit nursing homes, retirement homes, or long-term care facilities unless to provide critical services. 

 Dallas County

Took effect March 23 and ends April 30

  • "All elective medical, surgical, and dental procedures are prohibited anywhere in Dallas County. Hospitals, ambulatory surgery centers, dental offices, and other medical facilities are directed to identify procedures that are deemed ’elective’ by assessing which procedures can be postponed or cancelled based on patient risk considering the emergency need for redirection of resources to COVID-19 response."
  • Essential activities include:
    • "To engage in activities or perform tasks essential to their health and safety, or to the health and safety of their family or household members (for example, obtaining medical supplies or medication, visiting a health care professional, or obtaining supplies need to work from home)."
  • "Essential Health Care Operations:
    • Health care operations, including hospitals, clinics, dentists, pharmacies, pharmaceutical and biotechnology companies, other health care facilities, health care suppliers, mental health providers, substance abuse service providers, blood banks, medical research, laboratory services, or any related and/or ancillary health care services. Home-based and residential-based care for seniors, adults, or children are also considered health care operations. Health care operations also includes veterinary care and all health and welfare services provided to animals. This exemption shall be viewed broadly to avoid any impacts to the delivery of health care. Health care operations do not include fitness and exercise gyms and similar facilities. Health care operations do not include elective medical, surgical, and dental procedures as established in accordance with Subsection 1(g) of this Order." 

 El Paso County

Took effect March 24 and has no definite end date

  • "Essential Activities. For purposes of this Order, individuals may leave their residence only to perform any of the following ‘Essential Activities’. People at high risk of severe illness from COVID-19 and people who are sick are urged to stay in their residence to the extent possible except as necessary to seek medical care. [The list includes:]
  • For Health and Safety. To engage in activities or perform tasks essential to their health and safety, or to the health and safety of their family or household members (for example, obtaining medical supplies or medication, visiting a health care professional, or obtaining supplies need to work from home)."
  • "Essential Business. For purposes of this Order, Essential Business shall be defined as the following:
    • Health Care Operations. Health care operations, including hospitals, clinics, dentists, pharmacies, pharmaceutical and biotechnology companies, other health care facilities, health care suppliers, mental health providers, substance abuse service providers, blood banks, medical research, laboratory services, or any related and/or ancillary health care services. Home-based and residential-based care for seniors, adults, or children are also considered healthcare operations. Health care operations also includes veterinary care and all health and welfare services provided to animals. This exemption shall be viewed broadly to avoid any impacts to the delivery of health care. This includes all ancillary workers necessary for the delivery of health care services. Health care operations do not include fitness and exercise gyms and similar facilities. In accordance with the Governor Abbott’s orders issued on Sunday, March 22, 2020 health care operations do not include elective medical, surgical, and dental procedures." 

 Harris County 

Took effect March 24 and ends April 30

  • Essential activities include:
    • "To engage in activities or perform tasks essential to their health and safety, or to the health and safety of their family or household members (for example, obtaining medical supplies or medication, visiting a health care professional, or obtaining supplies needed to work from home)."
  • "For purposes of this Order, ‘Essential Businesses’ include:
    • Essential Health Care Operations. Health care operations, including hospitals, clinics, dentists, pharmacies, pharmaceutical and biotechnology companies, other health care facilities, health care suppliers, mental health providers, substance abuse service providers, blood banks, medical research, laboratory services, or any related and/or ancillary health care services. Home-based and residential-based care for seniors, adults, or children are also considered health care operations. Health care operations also include veterinary care and all health and welfare services provided to animals. This exemption shall be viewed broadly to avoid any impacts to the delivery of health care." 

 Tarrant County

Took effect April 4 and ends April 30

  • "That this Executive Order authorizes the County to take any actions necessary to promote health and suppress disease, including quarantine, evacuation, regulating ingress and egress from a disaster area and controlling the movement of persons and the occupancy of premises, pursuant to § 418.108(f), (g) of the Texas Government Code."
  • "All elective medical, surgical, and dental procedures are prohibited anywhere in Tarrant County. Hospitals, ambulatory surgery centers, dental offices, and other medical facilities are directed to identify procedures that are deemed ’elective’ by assessing which procedures can be postponed or cancelled based on patient risk considering the emergency need for redirection of resources to COVID-19 response."
  • "That no person shall sell any of the following goods or services for more than the price the person charged for the goods or services on March 16, 2020, and continuing during the pendency of this Executive Order:
    • Groceries, beverages, toilet articles, ice;
    • Restaurant, cafeteria, and boarding-house meals; and
    • Medicine, pharmaceutical, and medical equipment and supplies."
  • Essential activities include:
    • "To engage in activities or perform tasks essential to their health and safety, or to the health and safety of their family or household members (for example, obtaining medical supplies or medication, visiting a health care professional, or obtaining supplies need to work from home)."
  • "Essential Businesses means:
    • Essential Health Care Services. Health care operations, including hospitals, clinics, doctors, dentists, pharmacies, pharmaceutical and biotechnology companies, other health care facilities, health care suppliers, home health care services providers, mental health providers, substance abuse providers, blood banks, medical research, or any related and/or ancillary health care services, veterinary care provided to animals. Home-based care for seniors, adults, or children. Residential facilities and shelters for seniors, adults, and children. Health care operations do not include fitness and exercise gyms and similar facilities. Health care operations do not include elective medical, surgical, and dental procedures as established in accordance with this Executive Order."   

 Travis County

Took effect March 24 and ends April 13 (but the county court plans to extend it)

  • Essential activities include:
    • "For Health and Safety. To engage in activities or perform tasks essential to their health and safety, or to the health and safety of their family or household members (including, but not limited to, pets), such as, by way of example only and without limitation, seeking emergency services, obtaining medical supplies or medication, or visiting a health care professional."
  • "Essential Businesses. For the purposes of this Order, "Essential Businesses" means:
    • Health Care Operations. Health Care Operations includes but is not limited to hospitals, clinics, dentists, pharmacies, pharmaceutical and biotechnology companies, other health care facilities, health care suppliers, mental health providers, substance abuse service providers, blood banks, medical research, laboratory services, or any related and/or ancillary health care services. Home­based and residential-based care for seniors, adults, or children are also considered health care operations. Health care operations also includes veterinary care and all health and welfare services provided to animals. This exemption shall be viewed broadly to avoid any impacts to the delivery of health care. Health care operations do not include fitness and exercise gyms and similar facilities. Health care operations do not include elective medical, surgical, and dental. Health care operations do not include retail outlets selling electronic cigarette products and cannabidiol products;"
  • "Critical Infrastructure is defined as all public and private facilities and assets, including both physical and cyber systems, and other functions and sectors vital to the security, governance, public health, safety, and economic continuity of Travis County."
  • "Critical Infrastructure, includes but is not limited to the following: …
    • Emergency services;
    • Public health and medical services; …”
    • "Future requirements for temperatures screening of critical infrastructure employees. When there are sufficient supplies and a need is determined by the Health Authority, it may be ordered that employers screen the temperature of all employees entering facilities. Notice of this requirement will be posted on Austin/Travis County Public Health Authority and the Travis County websites. Whenever possible, the Health Authority will attempt to provide written notice by email to impacted entities."   

Last Updated On

April 07, 2020

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Sean Price

Reporter

(512) 370-1392

Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

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