Coronavirus cases and hospitalizations across the country are surging because of the highly contagious delta variant, leading federal health officials to recommend face masks for everyone, regardless of vaccination status, and state health leaders to push for increased vaccinations.
But while health experts say stronger actions are needed again to slow the spread of the virus, Texas Gov. Greg Abbott has doubled down on his insistence that Texas will remain open for business and vaccinations and masks will remain voluntary.
In a sweeping order issued Thursday, Abbott reemphasized that state agencies and local officials are prohibited from mandating vaccinations, adding that businesses would lose state contracts or license and operating permits if they require vaccinations. He also continued to ban local governments from requiring face masks, the latest push and pull between Abbott and local officials.
And Abbott hasn't strayed from his message about COVID-19 vaccinations: "Always voluntary, never forced," he adds to the end of each tweet on vaccines.
As vaccinations rose and cases dipped through the spring and summer, Abbott regularly shared the latest numbers on social media to show that lifting restrictions worked in Texas. At news conferences, he said Texans can beat the coronavirus because of their own personal vigilance, not because of government mandates on vaccines and masks.
Abbott continued delivering those messages in recent weeks, even as the delta variant surged at alarming rates across the state and the country. Political experts say his message supporting personal choices will help his reelection bid, but health experts worry that without tightened policies, especially regarding masks, the delta variant will spread and hospitals could reach their breaking point.
"He's betting on the fact that people are going to recognize that they need to wear a mask if ICU beds are gone," said David Thomason, an associate professor of political science at St. Edward's University. "He's betting on that and saying, 'Look, politically, I'm going to get hurt if I start mandating (masks or vaccines).'"
But hospitalizations and cases have ticked up every day across the state because of the delta variant, and dwindling intensive care beds are pushing Travis County toward Stage 5, the most severe level of the county's risk-based guidelines.
Previously, health officials said vaccinated people could be indoors without a face covering, but recent research has shown that they can still carry the same amount of virus as unvaccinated people, though the vaccine decreases the chance of severe illness and hospitalization.
Now federal officials and the U.S. Centers for Disease Control and Prevention have shifted their messaging.
The Biden administration announced new steps last week to increase vaccinations in the U.S. and impose strict protocols on mask wearing and testing for federal employees who choose not to get vaccinated.
The CDC changed guidelines to recommend that Americans wear masks indoors, regardless of vaccination status. Health officials say breakthrough cases are rare but possible among vaccinated people, who face an extremely low risk for hospitalization.
"We're really at a moment of crisis in Austin and across Texas with the delta variant," said Lauren Ancel Meyers, director of the University of Texas COVID-19 modeling consortium. "Our ICUs, our hospitals are getting really worryingly full, and the numbers are continuing to climb."
Meyers said the long-term plan should be to vaccinate as many people as possible, but that won't happen fast enough to stop the current surge in its tracks. Public health messaging and policy changes altered behaviors in previous coronavirus surges, and the same strategy should be used this time, she added.
"We need to be able to at least very strongly encourage the same kind of behavioral changes that we were able to during the previous surges, but it's difficult right now because we can't mandate face masks and we can't mandate some of these other restrictions," Meyers said.
There is one glimmer of hope: Vaccinations have increased in recent weeks. Chris Van Deusen, spokesman for the Texas Department of State Health Services, said Texas' vaccination numbers have gone from a seven-day average of about 44,000 doses per day just after July 4 to about 72,000 Sunday.
"People are realizing that we're in a serious situation, and if they had been putting it off or didn't think they were at a very high risk, that it's time to stop waiting," Van Deusen said. "That is important because vaccination is the best tool we have to protect people, and getting everyone who is eligible vaccinated is the thing that will stop the spread of all the variants we're seeing, including delta."
Van Deusen added that the state health agency has seen success with vaccines widely available at doctors offices, neighborhood pharmacies and clinics run by local health departments. The agency's pop-up parking lot events at Walmarts also "seem to have made an impact," he said.
"At every one, people are going on the spot to get vaccinated and then showing our folks their vaccine cards on their way out," he said.
Abbott, who is facing reelection next year for his third term, can look to 2020 when determining how to handle the rising coronavirus cases and hospitalizations, said Mark Jones, a Rice University political science professor.
When Abbott closed businesses and tightened restrictions, his own party criticized the move. In October, then-state GOP Chair Allen West and Agriculture Commissioner Sid Miller joined a protest at the Governor's Mansion to call for the end of all COVID-19 restrictions.
Jones said Abbott is "trapped" because of the flak he took from the Republican Party last year.
"He realizes that if he were to adopt a more California- or New York state-style policy, there will be considerable blowback from the right wing of the Republican Party, which tends to turn out in large numbers in Republican primaries, such as the one that he will face this spring," Jones said.
Abbott ended the mask mandate and moved to "open Texas 100%" in March but said local officials could use "COVID mitigation strategies" if hospitalizations rose to about 15% of an area's total bed capacity for seven straight days.
He removed that option for local officials in the Thursday order.
"The only risk is if things get demonstrably worse in Texas over the next few months" and he receives calls from his own party to shut things down or impose mandates, Jones said. "In some ways, he's rolling the dice."
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