Clearing Up Released vs Recovered COVID-19 Patients

Health Department Director Sandra Villareal tried to explain to San Angelo Live the difference between recovered and released COVID-19 patients. Finding her explanation confusing I researched the difference.

Most communities are not classifying cases as recovered. Arizona will report recovered patients but the method for calculating the measure is unclear.  AZ Central reported:

Jessica Rigler, the Arizona Department of Health Services assistant director, elaborated on the complexity of defining “recovered,” saying there is no standard definition. The state initially took repeated tests of infected individuals to find out exactly when they tested negative, she said, but as case numbers increased and testing supplies fell short, that was no longer viable. 

The state considered an algorithm for identifying recovered cases by going back 30 days and comparing total cases with death certificates. By knowing the number of people who died in the past month, the state can estimate the number of people who have recovered, Rigler said.  

Minnick, the spokesman, did not answer a question about the final process the state used to determine who counts as recovered.  Only a handful of other states report on recovered cases.

Recovered patients should meet clinical criteria that is consistently applied.  COVID-19 is a tricky virus that can harm the body in multiple ways.  Clinicians do not know the long term implications of the disease so using the word recovered could be premature.

The City's website states the following on released patients:

The removal of positive cases from quarantine/isolation is based on guidance from the Texas Department of State Health Services (DSHS) and Center for Disease Control (CDC); therefore, the health department will report the number of positive cases that have been removed from isolation in adherence to these guidelines. Because removal from isolation is on a case-by-case basis, a cumulative count will be reported on a weekly basis every Friday. 

As a local health department, we are under the umbrella of DSHS. When it comes to case management, DSHS does not report on the medical management, recovery or follow-up of patients on any infectious disease. We follow suit.

DSHS and the local health department are focused on identification of infectious disease (in this case COVID-19) and the notification of contacts of said case(s), as well as providing and adhering to guidance issued by DSHS or CDC. The health department would also report any deaths associated with the disease. Medical management, follow-up and recovery information of patients are between the individual and their medical provider or physician. 

The CDC utilizes three different strategies to release patients from isolation.  They are:

1.  Symptoms based strategy
2.  Time based strategy
3.  Test based strategy -- A test-based strategy is contingent on the availability of ample testing supplies and laboratory capacity as well as convenient access to testing.

Sandra mentioned the first two strategies.  When asked Villareal said "they can retest" but framed it as a means to become a plasma donor.  I thought the test for antibodies after having the disease was different from the test indicating the presence of active COVID-19 virus.

San Angelo's Local Health Authority recently ordered citizens to wear masks in stores.  His order revealed the "length of time it takes to get a COVID-19 test result back has increased to seven days."  That may explain why the City is not using a test based strategy to release patients from isolation.   It simply takes too long.

Update 7-7-20:  The City of San Angelo informed the public of its testing strategy and its non-testing method for releasing positive patients.  Public information officials called it a clarification but it is the first communication the city had for citizens on its testing practices.  Today's City Council meeting revealed the city is not performing any tests.  Those are being done by area hospitals.

City and Goodfellow AFB Restrict Lake Nasworthy Access to July 4th Fireworks

Goodfellow Airforce Base was the first to restrict access to its Recreation Camp at Lake Nasworthy for the July 4th fireworks show.  The base website stated on June 26th "The Goodfellow Recreation Camp will not be a viewing area for the fireworks display at Lake Nasworthy."

Today the City of San Angelo announced all Lake Nasworthy parks will close Friday July 3rd at midnight and remain closed until July 13th.  It's not clear at this time if the fireworks show will go on.

Update 6-30-20:  The fireworks show is a go. The Lake Nasworthy Homeowner's Association encourages residents to come out, legally park and treat the fireworks show like a drive in theater.  As normal viewing will be closed this sounds a recipe for a traffic nightmare.  The trash debacle is normally seen the next morning.  Hopefully viewers will do as requested and take their refuse with them when they leave.

Twin Buttes Reservoir will be open over the July 4th weekend.  For decades the July 4th weekend was an annual trashing event.  The property remains without restroom facilities despite promises from the City, the Bureau of Reclamation and Parks and Wildlife to make improvements.

Update 7-1-20:  The Lake Nasworthy Homeowners Association announced Tuesday, June 30, that it would be moving forward with the annual fireworks show July 4. In light of this announcement, the City of San Angelo will open certain parks to allow citizens to view the fireworks. These parks will be open from 3 p.m. to 11 p.m.  Lake Nasworthy parks that will be open from 3 p.m. to 11 p.m. July 4:

• Mary E Lee Beach, 2160 Mary E. Lee Road
• South Concho Park, 1608 South Concho Drive
• Pecan Creek Park, 8400 Country Club Road
• Knickerbocker Park, 6402 Knickerbocker Road
• Hillside Drive, 6600 block of Knickerbocker Road
• Fish Hatchery Road Park, 3500 block of Country Club Road.

Update 7-3-20:  The Homeowner's Association postponed the fireworks show.  Lake Nasworthy parks are once again closed until July 13th.

Texas Reopening Pauses: Current Case Explosion

Pandemic diseases spread at a rate determined by actions of their hosts, actual and potential.  Texans mixing more resulted in an increase in positive cases in June.  I noticed the change in late May when shopping.  Few people wore a face mask as stores became increasingly crowded.

The City of San Angelo reported 31 new cases today, bringing the total to 342.  It was 95 before Memorial Day weekend.  Lots of events loom.  How many will be super spreader events?

Update 6-29-20:  Texas Gov. Greg Abbott says the coronavirus "has taken a very swift and very dangerous turn in Texas over just the past few weeks."

Update 6-30-20:  Texas had 6,975 positive cases today, a new record high. The exponential growth theory remains in play.

Update 7-17-20:  Texas new cases have been over 10,000 five times in the last week

City Acts to Reign in Coronavirus

San Angelo officials undertook a flurry of activity to address weeks of growth in coronavirus cases.  Yesterday afternoon the city published:

The City of San Angelo has issued an order that prohibits any outdoor public events over 100 people and all public events with more than 100 people in any City facility. This is effective immediately. This also applies to outdoor events in the county unless approved by the county judge.

In addition, it requires masks to be worn in all auditoriums/theaters and performance halls by employees, volunteers and audience members.

The City gave an exception to events approved by City Council's Special Events process.

It's not clear which upcoming events fit that exception.

Wake the Desert canceled this year's event due to the coronavirus.

The flurry came after cases rose from 95 before Memorial Day weekend to 282 this afternoon. Mayor Brenda Gunter shared her concerns with citizens on March 16th.  City Council as a whole and Tom Green County Commissioners Court failed to address the growth in cases in their recent meetings.  Public health officials made no presentation and elected leaders asked no questions of those officials.

Commissioner's Court did approve spending over $1 million in coronavirus aid.

County Judge Steven Floyd did not think citizens were up for everyone wearing a mask, a component of a gold standard pandemic approach.

Another element is rigorous contact tracing.  Two days ago the city said it would classify all cases as community spread from this point forward.  The City Attorney informed Council several meetings ago that she was doing contract tracing, but that was before our local numbers soared.

This afternoon Local Health Authority Dr. Vretis ordered shoppers to wear masks to prevent further disease spread.

Effective 12:00 a.m. on June 27, 2020 all retail stores that have a posted occupancy load of 100 persons or more within Tom Green County, Texas shall require all customers 10 years or older and all employees to wear a mask or cloth that covers the mouth and nose while they are within the store or within 6 feet of a person from another household when they are outside the store and on store property.

His order revealed the "length of time it takes to get a COVID-19 test result back has increased to seven days."  A week's delay in diagnosis makes contact tracing very difficult.

That means San Angelo is behind the curve on three elements of a gold standard pandemic response, everyone wear a mask, rigorous contact tracing and aggressive testing.

Texas had a record 5,996 new cases today.  The U.S. hit a record 36,975 cases yesterday.  A gold standard pandemic response is sorely needed but elected officials don't have an appetite for it.

Update 6-26-20:  San Angelo reported 29 positive cases today (311 total), while Texas had 5,707.  The United States reached another record with more than 44,000 new cases.  Dr. Anthony Fauci said contract tracing was not going well.

Update 6-27-20:  San Angelo had 31 new cases today bringing the total to 342.   Texas passed Illinois today to become the state with the 4th largest number of cases.  Not long ago Texas was over 20,000 cases behind Illinois. 

City Council Special Meeting is Not on Coronavirus

The City of San Angelo experienced a sharp rise in COVID-19 cases since Memorial Day weekend.  Positive cases are up 170%, from 95 on May 31st  to 256 today.

City Council will hold a special meeting June 24th at 5:00 pm but the topic is not our deteriorating public health situation.  Instead, city leaders will consider spending up to $6.5 million for improvements for Goodfellow Airforce Base.

I hope base leaders inform City Council of their efforts to contain COVID-19.  Everyone on base must wear a mask.  Goodfellow has had two positive cases to date.

Mayor Gunter and Dr. James Vretis attribute the rise to people ignoring steps needed to contain the disease. 

"Each time an individual is in close contact with another, they increase their chance of exposure to coronavirus," Vretis said. "Over Memorial Day, we saw many gatherings of greater than 10 people who obviously were not from the same household."

Vretis said they have seen the percentage of shoppers wearing masks continuously decrease.

Oddly, Vretis and Mayor Gunter approved a gathering of up to 1,000 people at Lake Nasworthy in the midst of the recent rise of cases.   The Beers, Bands and BBQ Bazaar event will be held July 24-25, 2020.  In between is July 4th holiday, when families gather to celebrate the founding of our nation.

The way to get our community to a vaccine is through following public health measures.  Texas hit 5,489 new cases today.  Before Memorial Day weekend new cases ranged from 500 to 1,500 per day.   Exponential spread of the disease would be disastrous for Texas citizens.

A second person died of the disease in San Angelo and eleven people are currently hospitalized.  To survive in West Texas required fortitude and the help of neighbors.  Citizens can show both characteristics by wearing masks and social distancing.  That's mighty neighborly.

Update 6-24-20:  Texas Governor Greg Abbott said yesterday: “I did authorize local officials to have the authority to establish regulations in gatherings of 100 or more people,” he said. “This was intended to allow local authorities in particular to regulate gatherings for Fourth of July celebrations. We did not specify what restrictions or regulations they could impose. It’s possible they could require masks in such an environment. It’s going to be up to local officials in that regard.”

The City announced 16 new COVID-19 cases today bringing the total to 272.  Texas daily case count reached a record 5,551.  Council approved the $6.5 million funding for Goodfellow improvements needed for the grant application.  A Goodfellow leader spoke but on the project was silent as to coaching Council on coronavirus control.

Update 6-25-20:  Mayor Gunter and County Judge Steve Floyd issued an order that prohibits any outdoor public events over 100 people and all public events with more than 100 people in any City facility.  It also equires masks to be worn in all auditoriums/theaters and performance halls by employees, volunteers and audience members. The order does not apply to events approved through City Council's Special Events process.

Coronavirus Accelerating in San Angelo

New COVID-19 cases the last four days were 15, 10, 20 and 20.  The highest daily count prior to Memorial Day weekend was seven.  Cases more than doubled since the last Friday in May.  Case, case, case, cluster, cluster, boom.  We appear to be entering the boom phase.  Everyone wear a mask.

Update 6-20-20:  The city announced nine new cases for each of the last two days.  Total is now 232 positive cases.  The state of Texas reported 4,430 new cases today, a record number.

Update 6-22-20:  Cases total 250 today.  That's a 163% increase from 5-29-20. City Council will hold a special meeting on 6-24 but it is not on the coronavirus explosion.  Council will entertain spending up to $6.5 million in improvements for Goodfellow Airforce Base.

Coronavirus Spreading in San Angelo

The number of positive COVID-19 cases soared over the last two weeks for San Angelo and Tom Green County.  City statistics revealed 53 new cases since the start of Memorial Day weekend.

City Council will deal with a possible super spreader event in their upcoming meeting.

It's not Mardi Gras but is a sizeable gathering where people are highly unlikely to wear masks and social distance.

This is the only one of two COVID-19 related agenda item Council will consider, according to the posted agenda.  The other item involves the issuance of health permits.

Should COVID-19 cases continue to rise it may be wise to postpone the Beer, Bands and BBQ event.

Update 6-15-20:  The City announced 15 new positive cases today with total positive cases reaching 164.  City officials revealed an error from April 26 when a positive case was not added to the count. That is why the total went up 16 today, 15 new plus the April error.

Update 6-16-20:  Ten new coronavirus cases today brings the total to 174.  Several council members asked about a plan to reduce the risk of attendees getting COVID-19.  Event sponsors submitted a risk minimization plan to the city prior to our recent increase of cases.  That plan was not included in council's background packet. Participants are to wear a mask and social distance.  I'm not sure why that would happen at Beer, Bands and BBQ Bazaar when it isn't happening in the grocery store.  Anyway, Council approved the event by a vote of 6 for and 0 against.  This came after Mayor Brenda Gunter encouraged citizens to self isolate to reduce disease spread at the beginning of the meeting.

Update 6-17-20:  The City announced 20 new COVID-19 cases today.  That's 45 new cases in three days.   Add the missed case from April and the total testing positive is now 194.

Update 6-18-20:  NYT highlighted our community as a COVID-19 hotspot due to our soaring number of new cases. Cases have more than doubled since Memorial Day weekend began going from 95 to 194.  Case, case, case, cluster, cluster, boom!  Add another 20 postive cases today.  Total 214.