(Roschetzky Photography/Adobe)

To help make sense of all the information emerging about COVID-19 in Austin, we're answering a few big questions:

Is the COVID situation improving?

After a bumpy September, Austin is seeing a decline in new COVID-19 cases and related hospitalizations even as schools and other facilities, including restaurants and public pools, continue to reopen.

"We're relatively flat right now," Austin-Travis County Interim Health Authority Dr. Mark Escott said Wednesday. "And flat is an okay place to be, and it's okay because over the last month, two months, we've increased our risk a little bit."

The seven-day moving average of daily new confirmed COVID cases in Travis County is 76, as of Tuesday evening, which is comparable to the rate a month ago and down from 128 on Sept. 16, according to Austin Public Health Data.

The seven-day moving average of new hospital admissions is also improving. It is now 14, down from 18 on Sept. 1.

Escott described this current rate as a sweet spot, or "a place where we can live for some time where we have cases going on but we can keep them at a minimum … and we can open businesses and our schools and be safe."

But he added that the Austin metro has been unable to push past a daily average of around a dozen new COVID hospitalizations, despite reaching this threshold a few times previously.

"Twelve to 13 seems to be a roadblock for us," he said.

Despite this barrier, there are other signs of progress.

Last week, Travis County testing sites reported their lowest positivity rate—3.8%—since the pandemic began. The positivity rate among Latino residents is improving, although at 6.3%, it still remains higher than the average.

Local health officials attributed the flat curve to Austinites' continued vigilance.

Escott mentioned that many people have asked him about the prospect of another surge.

"The second wave comes when we decide it's going to come," he said, "when our community has decided it's had enough of masking and social distancing and other protective actions."

What is going on with schools?

Austin ISD reopened for in-person learning on Monday, following in the footsteps of other area districts, including Eanes ISD and Round Rock ISD.

Escott expressed support for AISD's reopening plan, which follows Austin Public Health guidelines to start capacity limits at 25%, and said there is no evidence that disease transmission is occurring in classrooms or while students are passing in hallways.

He added that the risk of transmission appears to be limited to extracurricular and social activities, where students may not be wearing masks or adhering to social distancing guidelines.

Austin Public Health is currently investigating a party attended by students of a local high school, which it has not named. So far, six party attendees have tested positive for COVID-19 and another 58 individuals are in quarantine.

Additionally, two Round Rock ISD schools have suspended their volleyball seasons due to the virus.

While students may be very likely to recover from COVID, local health officials are concerned that they will become vectors of transmission, carrying the illness home and infecting members of their household, who may be at higher risk.

For this reason, Escott recommends that students who are engaged in extracurricular activities wear masks and practice social distancing while at home.

(Rational Anarchy/Reddit)

What impact does the president's COVID diagnosis have on local containment efforts? 

President Donald Trump tweeted late Thursday evening that he and First Lady Melania Trump had tested positive for COVID-19. After being hospitalized briefly, he returned to the White House, amid criticism that he is minimizing the severity of the pandemic.

"The president has to understand that he is a leader, and, as a leader, he must set an example for others," Escott told Travis County commissioners on Tuesday. "And when he does things like take his mask off and say that we shouldn't be afraid, it's sending the wrong message."

What is the status of federal coronavirus relief funding? 

Trump announced on Tuesday an abrupt end to negotiations with Democrats over additional COVID relief funding until after the election. Hours later, he tweeted a request for Congress to send him a bill for a second round of stimulus checks.

The absence of a forthcoming stimulus bill has led to questions about whether pandemic-related services—such as public testing sites, PPE distribution events and contact tracing—will be able to continue into the new year.

Local and state governments must spend all of the federal coronavirus relief dollars they received through the CARES Act by the end of the calendar year, despite the ongoing nature of the pandemic and the absence of additional relief packages passed by Congress.

"We must continue to provide testing and contact tracing," APH Director Stephanie Hayden told Austin City Council last week. "Those efforts have really helped us as a city and a county… We have to just flag it for you all that federal funding is slated to end this December."

Texas Gov. Greg Abbott announced last month that the state will allocate $171 million of CARES Act funding to help renters avoid eviction.

The Travis County Commissioners Court discussed last week how best to meet the December deadline. As of mid-September, the county has spent less than one-fifth of the federal relief dollars it received through the CARES Act, although the remainder has been allocated.

Are bars reopening?

Texas Gov. Greg Abbott tweeted Monday that he would soon announce more business openings, with a GIF of two beer glasses clinking, leading to speculation that he will allow bars to reopen.

Local health officials have repeatedly stressed that allowing bars to reopen would be unwise given their current ways of operating.

"It's unmistakable that when people come together face-to-face without masks on for longer than 15 minutes, the risk of transmission is going to increase," Escott said Wednesday. "So there would have to be substantial changes in how bars function to make them safe."

Some Austin bars have reopened under new Texas Alcoholic Beverage Commission guidance that allows them to reclassify as restaurants if a majority of their sales comes from food, rather than alcohol. But this approach doesn't work for everyone.

Industry groups and bar owners across the state have criticized Abbott for months, saying their businesses and service industry workers' jobs are at stake.

Escott did mention a few modifications that bars in other states have made to minimize the spread of COVID. These include requiring patrons to be seated at tables, rather than milling around, and implementing safe ordering procedures that don't involve crowding at the bar itself.

"With substantial modifications, bars may be able to operate," Escott said, adding that other businesses—such as grocery stores and restaurants—have already made such adaptations.

After shutting down dine-in service in March, Abbott allowed bars to reopen in May. But when COVID cases soared statewide in late June, he closed them again.

Last month, Abbott announced that restaurants could increase capacity to 75% but that bars must remain closed because they were "nationally recognized as COVID-spreading locations."

What is a "twindemic"?

It's time to add another word to your pandemic vocabulary.

Health experts have raised concerns of a "twindemic," when the COVID pandemic inevitably overlaps with the annual flu season, which begins in October.

Last year's flu season was particularly bad, Escott said last month, and local ICUs hit capacity from flu patients alone.

"Our hospitals cannot handle surges of both," he added. "We're going to have to ration care."

Escott has encouraged Austinites to get vaccinated before the flu season intensifies this winter.

Austin Public Health announced plans Wednesday to set up flu vaccination sites in the ZIP codes most affected by COVID.

What metrics would help determine a drop to a Stage 2 level of risk?

The number of new COVID hospitalizations each day would need to fall below 10, on average, and the local positivity rate would need to drop to 3% or lower for local health officials to recommend a move to Stage 2 of their risk-based guidelines, Escott has said.

At this lower level, recommended restrictions would loosen. Social gatherings would be allowed to increase from 10 people to 25, and residents would be allowed to resume non-essential trips and return to work at reopened businesses.

Travis County is currently reporting 14 new COVID-related hospital admissions each day, on average.

The overall positivity rate was 3.8% last week, but disparities remain across demographic groups, with Latino residents returning a positivity rate of more than 6%.

(Austin Public Health)

How will COVID affect the upcoming election? Holiday season? 

Escott commended Travis County Clerk Dana DeBeauvoir for her efforts procuring PPE for poll workers and designing a safe flow for voters at poll places.

"Regardless of transmission activity in November, people will be able to cast their votes in a safe way," he said Wednesday.

Like most other activities, holiday celebrations will also be impacted by the pandemic.

The Centers for Disease Control and Prevention released guidance last month regarding safe ways to celebrate Yom Kippur, Halloween, Dia de Los Muertos, Navratri, Diwali and Thanksgiving.

"This holiday season is going to look different," Escott said, adding that the best way Austinites can show their love for their families is to maintain distance from them—at least until a vaccine is widely available.

What about testing? 

Demand for testing has declined post-surge.

Escott said last month that testing sites administered by APH are testing about 2,000 people a week despite having the capacity to test more than a thousand people a day.

It is important to note, however, that the testing numbers reported by APH do not include the positive results from rapid antigen tests because of CDC guidance that they be considered "probable" and not "confirmed."

Like the genetic, or polymerase chain reaction tests, administered at APH testing sites, rapid antigen tests detect positive infections. They also provide results in about 15 minutes, which is central to their appeal.

While they are marginally less accurate, rapid antigen tests are in fairly wide use. Some private testing sites in the Austin area report that the majority of the tests they conduct are rapid due to patient demand.

Between Aug. 6 and Sept. 24, a total of 2,174 positive rapid antigen test results were reported in Travis County, according to APH. The department would not release information pertaining to the number of positive antigen tests performed overall.

During that same time period, 6,648 COVID cases were confirmed by positive genetic test results in Travis County.

If the cases detected by rapid antigen testing were considered "confirmed" rather than "probable," the local caseload between Aug. 6 and Sept. 24 would have increased by about a third.

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