AUSTIN — Gov. Greg Abbott’s four medical advisers were not all on board with his move to end the state’s coronavirus restrictions — or even included in the decision.
“I don’t think this is the right time,” said advisor Mark McClellan, former commissioner of the U.S. Food and Drug Administration, adding he was not consulted before the decision.
“Texas has been making some real progress but it’s too soon for full reopening and to stop masking around others,” McClellan said in an email.
From the start of the pandemic, Abbott said he would rely on data and doctors to guide state policy. But conflicting opinions from his medical advisers about one of the biggest shifts in state pandemic policy raise questions about how the choice — which has been widely panned by public health experts — was made.
State health commissioner Dr. John Hellerstedt on Wednesday didn’t explicitly answer whether he endorsed the plan ahead of time to end the mask mandate and let businesses fully reopen on March 10. Pressed by state lawmakers, Hellerstedt said he “did not have a personal conversation” with Abbott before the decision, but that his agency is in regular contact with the governor’s staff.
A third advisor, Dr. Parker Hudson of Dell Medical School in Austin, has said he was “not involved in this decision.”
And a fourth said he agreed with the decision, explaining it was initiated by Abbott and rested on the governor’s general comfort level with the pace of vaccinations, other medical improvements, and the notion that Texans know to wear masks and will continue to even without a mandate — an idea refuted by public health research.
“He brought it to us, he talked to us about it, he talked through it,” said Dr. John Zerwas, a vice chancellor with the University of Texas System. “And he said, ‘okay, this is when I feel like it’d be a good time to do it’.”
The nation’s top infectious disease experts and President Joe Biden criticized Abbott’s decision to end restrictions next Wednesday, saying it’s premature and warning the move could lead to a new surge in the outbreak that has already killed more than 43,000 Texans.
Former U.S. Centers for Disease Control and Prevention director Tom Frieden said the reversal of the mask mandate was particularly dangerous and could lead to a decline in their use.
“A mask mandate is about you not inadvertently killing someone,” said Frieden, who served during the Obama administration. “There is no argument for not having a mask mandate.”
When asked Wednesday about defying some medical advisers, Abbott said he spoke with Zerwas and Hellerstedt.
“They both agree that because of all the metrics and numbers… now is a very safe time to open,” Abbott said Wednesday during a television interview on KFDX-TV in Wichita Falls. “Texans know how to keep themselves safe and they don’t need government mandates to tell them anymore.”
In making his announcement Tuesday, Abbott offered no one specific reason for the timing of the roll backs; rather he focused in general on increased access to vaccinations, and a recent decline in the number of people hospitalized with COVID-19.
Abbott intended to unveil his plan even earlier, on Feb. 22, but was forced to postpone when the winter storm delayed vaccine shipments to Texas, he told a radio host Tuesday.
“All of our decision-making processes hinged to the distribution of those vaccines,” Abbott, a Republican in his second term as governor, said in the interview on KYFO.
Texas is one of several states to lift mask requirements within the last few weeks.
Discussions about the rollback had been ongoing over the last week and a half, said Zerwas, who is a former Republican state representative and an anesthesiologist.
Masks came up as a point of discussion.
Abbott “pushed on it and said ‘Do you really think that a state mandate for masking is the thing that is really driving people to comply’,” Zerwas recalled. “And I said personally, ‘No, I don’t and the people that I’m around on a regular basis don’t even mention that.’”
Zerwas said that Abbott’s statewide order for face coverings last year helped get the message across, and now, citizens of Texas are doing it because they are familiar with the benefits.
Abbott concluded, Zerwas said, that “the heavy hand of the state doesn’t need to be doing this.”
Asked what evidence Abbott’s administration had for that, Zerwas didn’t cite any specific examples.
“I can only speak for myself,” Zerwas said. “I think I’m your regular person out there that is as much tuned into this pandemic as anybody else.”
Freiden, however, said the data shows the opposite. Mask mandates are effective, as are mandates for other safety measures. For example, states have not repealed seatbelt laws because people know the benefits of wearing one, he said.
“Every piece of data we have from public health strongly indicates that ending a mask mandate prematurely will decrease mask use,” Frieden said. “I think that’s a political decision that will result in the loss of lives.”
Enforcement left to businesses
Abbott’s new order leaves it up to businesses to make the public health decision on whether their employees and customers must wear masks.
Some businesses are now only “urging” customers to do so. Others are maintaining a mandate, although without a statewide policy, enforcing it may be more difficult.
“The advantage of a consistent expectation from the state was that it set that expectation for everyone,” said Dr. James McDeavitt, senior vice president and dean of clinical affairs at Baylor College of Medicine. “We will certainly see people peel off that now.”
As for the timing of the decision, Zerwas said there was no medical threshold or trigger the state had been working toward.
“It’s always been a conversation in progress,” he said. “And where could all of us, when we talk about this, get comfortable with where we were going, what we were accomplishing.”
Late Wednesday, Abbott told KXAS-TV (NBC5) in Dallas that the timing of the rollback was tied to vaccination rates among Texas seniors. People aged 65 and older make up a majority of COVID-19 deaths in Texas and in the nation.
“We wanted to achieve this 50% mark in vaccinations for seniors,” Abbott said. “Once we got the extra doses this past week, and once we saw the vaccination rates among seniors increase, we knew that we would be able to have more than half of seniors vaccinated by the time we opened back up.”
Frieden said many public health experts advocate rolling back restrictions when new daily cases drop to about 1 per 100,000 population. Texas is currently above 25, he said.
Just this week, federal public health experts cautioned states to keep their guard up against the virus. While the pace of vaccinations is expected to pick up over the coming weeks, only about 2.2 million Texans are fully vaccinated against COVID-19 in a state of 29 million. Others are likely to have some natural immunity if they’ve been infected, but many Texans still have none.
Zerwas said he didn’t specifically recall whether Abbott discussed waiting a few weeks, or months, longer to make the change. But Zerwas recalled mulling over the issue himself.
He remembers asking himself “what are you going to get if you wait, what are you going to get in 30 days?”
I just announced Texas is OPEN 100%.
I also ended the statewide mask mandate.
— Greg Abbott (@GregAbbott_TX) March 2, 2021
“I said ‘yeah, you’re going to put a million more vaccines into people’s arms in a week’,” he said. “That’s a good thing. And in two more weeks after that, you’ll put a couple million more in there.’”
In the end, Zerwas said, the decision was Abbott’s.
“You could make an argument to do it later,” Zerwas said. “But I don’t know that it’s a good argument.”
Hellerstedt, who leads the Texas Department of State Health Services that oversees that state’s pandemic response and vaccination efforts, did not appear alongside Abbott at the Tuesday announcement, which was held at a crowded restaurant in Lubbock.
On Wednesday, Hellerstedt stressed the importance of still wearing masks, and said Abbott also believes wearing masks is valuable. Asked by The Dallas Morning News whether Hellerstedt supported Abbott’s decision to repeal the restrictions at this time, a spokesman for the department did not answer directly.
“Dr. Hellerstedt agrees with what the governor said yesterday that COVID-19 is still with us, and people should continue to take public health precautions to slow its spread as more and more people are vaccinated,” Chris Van Deusen said in a statement.
Zerwas said he told Abbott that if he was going to rescind the mask mandate, he needed to emphasize that it was still a good idea.
Although Abbott’s executive order urges Texans to wear masks, the governor didn’t stress it when he announced the changes Tuesday. And Abbott’s social media posts Tuesday emphasized the rolling back of the mandate, not the need to keep wearing them.