The initial spread of COVID-19 in Texas may have begun prior to the first contemporaneously confirmed case, very likely as early as September 2019 in Houston. In January, February, and March 2020, 1,473 more Texans died compared to the January–March average for 2014–2019. While the Texas Department of State Health Services (DSHS) attributed 41 of these deaths to COVID-19, USA Today reported that doctors believed additional COVID-19 deaths may not have been accounted for due to limited testing early in the pandemic.[8] In one specific case, Bastrop County judge Paul Pape reported symptoms starting February 9.[9] The infection risk of COVID-19 in Texas was initially expected to be low in mid-January, with risks limited to travelers recently returning from China.[10]KWKT-TV in Waco reported that the virus was "no cause of concern in Central Texas" according to local doctors amid the ongoing flu season.[11] On January 23, a student at Texas A&M University was isolated and monitored by the Brazos County Health District after returning from Wuhan, China, and presenting with a respiratory illness; at the time, there was only one known case of COVID-19 in the United States.[12][13][14] They were the first person in Texas contemporaneously identified as potentially contracting SARS-CoV-2.[15] Medical supply stores in the Brazos Valley experienced medical mask shortages as demand increased in response to the first suspected case.[16] Over the next four days, Texas health officials identified another three suspected cases of COVID-19 meeting testing criteria, including a student at Baylor University; all four tested negative for the virus after samples were delivered to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, leaving no confirmed cases in Texas.[17][18][19][15]
The Tarrant County Health Department activated its operations center on January 24. Paramedics in the Metroplex increased usage of personal protective equipment (PPE) and adjusted their screening procedures for respiratory illnesses.[20][21] Hospital protocols were updated to isolate patients presenting to emergency rooms with COVID-19 symptoms and with recent travel to Wuhan.[21][22] While the CDC did not initially designate Dallas/Fort Worth International Airport to carry out "enhanced screening" of passengers for COVID-19, the airport began coordinating with local hospitals and health departments in late-January.[20] The CDC later implemented COVID-19 screenings at Dallas/Fort Worth International Airport, George Bush Intercontinental Airport in Houston, and El Paso International Airport, with screenings beginning "on a rolling basis" according to Nancy Messonnier of the CDC. These locations were designated as three of twenty CDC Quarantine Stations across the U.S. due to their frequent use as points of arrival for international travelers.[23][24] The Allied Pilots Association, a labor union representing pilots serving American Airlines, sued American Airlines on January 30 through Dallas County to end all flights to China;[25][26] the airline acquiesced on February 4.[27] On February 3, the U.S. Department of Homeland Security named Dallas/Fort Worth International Airport as one of 11 airports receiving rerouted flights from China.[28] Health workers from the CDC were dispatched to the airport to screen passengers for COVID-19 symptoms.[26] Screenings were also expanded to border crossings between the U.S. and Mexico at El Paso.[29]
Texas A&M University suspended all undergraduate travel to China on January 28 and allowed only essential travel to China for faculty, staff, and graduate students.[30] Baylor University and the University of Texas also temporarily banned university-sponsored travel to China with the exception of essential travel.[31] Two people in the Dallas area were monitored for possible contraction of COVID-19 on January 31.[32] Another patient was reported as a possible carrier in Beaumont on February 5,[33] and six were being monitored in Austin.[34] Some residents in San Antonio began 14-day self-quarantines.[35] Local health departments, hospitals, and schools in Texas continued to revise their COVID-19 protocols through February.[36][37][38][39] Stocks of N95 masks at clinics in Central Texas were low due to high demand as the pandemic escalated.[40]
Lackland Air Force Base near San Antonio served as a quarantine center for American nationals evacuated from China and the Diamond Princess cruise ship beginning on February 7.
As part of COVID-19 evacuations of American nationals in China, the Texas Health and Human Services Commission (HHS) and U.S. Department of Defense agreed on February 1 to house at least 250 evacuees for up to a month at Joint Base San Antonio–Lackland (JBSA-Lackland) near San Antonio as one of four reception centers across the country.[41][42] JBSA–Lackland was chosen due to its large housing capacity, available space, and proximity to medical facilities in San Antonio.[43] The evacuees were flown to U.S. bases on chartered flights operated out by the U.S. Air Force, with the first flight landing in San Antonio on February 5.[44][45] On February 13, the CDC confirmed one of the individuals quarantined at JBSA-Lackland contracted COVID-19, representing the 15th confirmed case in the U.S.[44] They were among 91 people on a flight arriving at JBSA–Lackland on February 7.[46] After an outbreak of COVID-19 impacted the Diamond Princess cruise ship in February, the U.S. State Department arranged for two charter flights to evacuate U.S. nationals to two U.S. locations, including JBSA–Lackland. Fourteen of the evacuees tested positive for SARS-CoV-2 after being initially asymptomatic,[47] of which seven landed in JBSA–Lackland before being transferred to the University of Nebraska Medical Center in Omaha, Nebraska.[48] On February 21, the CDC announced that another two individuals tested positive for the virus among Diamond Princess evacuees quarantined at JBSA–Lackland, bringing the San Antonio and statewide case total to three.[49][50] By February 24, the case total in Texas rose to six, all of whom were quarantined at JBSA–Lackland;[51] a total of 11 people at the base were later confirmed as infected, with 9 from the cruise ship and 2 from Wuhan.[52]
Evacuees quarantining at JBSA–Lackland were sent to the Texas Center for Infectious Disease in San Antonio, with 22 beds at the hospital reserved for suspected COVID-19 patients and those presenting with "mild symptoms." By February 19, JBSA–Lackland was supporting the quarantines of 234 people, with 144 from the Diamond Princess cruise ship and 91 from Hubei Province. Nelson Wolff, the Bexar County Judge, criticized the movement of evacuees to hospitals before definitive diagnoses in a letter sent to U.S. Representative Chip Roy. Bexar County Commissioner Tommy Calvert also criticized the decision to move patients out of JBSA–Lackland, stating that the move created "additional vectors for the virus to spread into the civilian population."[43] On February 20, the evacuees from Hubei Province at the base were released after showing no symptoms for 14 days.[53] Despite two earlier negative tests for the virus, one person had a "weakly positive" test after their release from JBSA–Lackland and were moved back to the facility for quarantine on March 1 following 12 hours out of quarantine. Texas Governor Greg Abbott, San Antonio mayor Ron Nirenberg and U.S. Representative Joaquin Castro criticized the CDC's release of the patient; Castro asked the U.S. House of Representatives to investigate CDC patient treatment protocols, with similar requests from U.S. Senators John Cornyn and Ted Cruz and U.S. Representative Lloyd Doggett.[54][55][56] The release prompted Nirenberg to declare a public health emergency for San Antonio on March 2.[57] A federal judge denied an injunction filed by the city of San Antonio against the CDC "demanding more rigorous testing" before releasing asymptomatic individuals at JBSA–Lackland.[58] The CDC modified their quarantine protocol in the aftermath of the incident to require "two sequential negative tests within 24 hours" prior to releasing quarantined individuals.[59]
The initial origin of community spread in Texas remains unclear, but numerous anecdotal accounts by those later confirmed have included onset dates as early as December 28 in Point Venture, and retrospective analyses have found unexplained statistical increases in deaths during this time.[8][60][9] Testing capacity across the state remained extremely limited until after the first recorded cases were announced.[8]
The first confirmed cases in Texas were associated with travelers on board the M.S. A'sara river cruise ship in Egypt
March 2: Research from Austin Public Health found 68 COVID-19 patients in Central Texas began reporting symptoms dating back to this time.[61] San Antonio Mayor Nirenberg issues a public health emergency after an individual positive for the virus is mistakenly released from quarantine at JBSA–Lackland.[57]
March 4: The DSHS reports a presumptive positive test result for COVID-19 from a resident of Fort Bend County in the Houston area. A man in his 70s, he is the first known positive case of the disease in Texas outside of those evacuated from Wuhan and the Diamond Princess cruise ship.[62] The patient had recently traveled to Egypt and was hospitalized.[63] DSHS commissioner John Hellerstedt calls the confirmation a "significant development" but that "the immediate risk to most Texans is low."[62]
March 5: At least eight cumulative cases, including both positive and presumptive positive cases, are identified in the Houston area. The cases involve individuals in the counties of Fort Bend and Harris counties. All individuals with confirmed cases were part of a group that traveled to Egypt in February, including the first confirmed case in Fort Bend County. The travel group rode aboard the Nile River cruise ship MS A’sara.[64][65][66] Additional individuals are also investigated as possible carriers in the Houston area in connection with the Egypt trip.[66] The state announces six public health laboratories within its Laboratory Response Network are capable of testing for COVID-19.[67]
March 6: Mayor Steve Adler of Austin declares a local disaster and cancels South by Southwest for the first time in its history.[68]
March 8: JBSA–Lackland receives around 100 evacuees from the cruise ship Grand Princess following a localized outbreak on board.[69][70]Rice University becomes the first university in the state to enact significant cancellations, suspending in-person classes and undergraduate labs during the week in response to an employee testing positive in connection with the viral cluster that traveled to Egypt.[71]
March 9: The cumulative number of confirmed cases in Texas reported by the DSHS surpasses 10.[72] A resident in his 30s of Frisco in Collin County, a suburb of Dallas, receives a presumptive positive test for the virus after recently traveling to Silicon Valley in California; he is the first case identified in the Dallas–Fort Worth metropolitan area.[73][74][75] His wife and 3-year-old child later contracted the disease, with the latter among the youngest confirmed to have the virus in the U.S.[76]
March 10: The first two presumptive positive cases of COVID-19 are reported in Dallas County, composed of a 77-year-old frequent traveler and a close contact.[77]Tarrant County also reports its first presumptive positive case, involving a recent traveler to a conference in Kentucky in late February.[78] Abbott and the Texas Department of Insurance request health insurers and health maintenance organizations (HMOs) to waive COVID-19 diagnosis and treatment costs.[79][80]
March 11: Local health officials report a positive test for COVID-19 in Montgomery County; they are identified as the first possible case of community spread—not directly related to travel or known contact with positive travelers—in Texas and in the Houston area. The patient's attendance of a barbecue at the Houston Livestock Show and Rodeo on February 28 is reported as a possible but unconfirmed source of the virus.[81] The city of Houston orders the Houston Livestock Show and Rodeo to close after announcing an emergency health declaration.[82]Lakewood Church suspends public services within the church and moves its services online.[83]Montgomery Independent School District in the Houston area and Alvarado Independent School District in the Dallas area become the first two public school districts in Texas to temporarily close classes over COVID-19, affecting approximately 12,400 students across 17 schools.[84]
March 12: After traveling to Barcelona and Paris between March 4–10, a 29-year-old-man becomes the first reported case of COVID-19 in Bell County.[85] Five people test positive for the virus in Dallas County, with one without recent travel history; the individual is the first case of community spread in North Texas, prompting a local disaster declaration for Dallas County.[86]
March 13: San Antonio reports its first positive case of COVID-19 with an individual not associated with the quarantining evacuees at JBSA–Lackland. Mayor Nirenberg declares a public health emergency and limits gatherings of more than 500 people for one week.[87] The first three cases of COVID-19 are also identified in the Austin area. University of Texas President Gregory L. Fenves announces that his wife is among the positive cases following a trip to New York City for a university function with alumni and students.[88][89] A man in his 40s with recent domestic travel is identified as the first confirmed case of COVID-19 in the El Paso area.[90] Abbott declares a state of disaster for all counties in Texas, invoking emergency powers for his administration, and orders state employees to remote work. Day cares, nursing homes, and prisons are asked to limit visitations.[91][92] The state's first mobile testing center for COVID-19 opens in San Antonio.[93] Colleges and universities throughout the state extend their spring breaks with some transitioning to online instruction, including Baylor University, the University of Houston, the University of North Texas, the University of Texas at Austin, Texas State University, and Texas Tech University.[94] School districts also announce temporary suspensions of classes statewide.[95][96][97]
March 14: Between March 14–19, some students from the University of Texas at Austin take a trip to Cabo San Lucas, Mexico, for spring break; on March 27, a student has a positive test result for SARS-CoV-2 after returning from Cabo San Lucas. A contact tracing investigation conducted by the COVID-19 Center at the University of Texas Health Austin concludes on April 5, with viral tests on 231 students. Among the sample, 60 of the 183 travelers to Cabo San Lucas test positive for the virus.[98] Abbott directs the Texas Medical Board and Texas Board of Nursing to expedite temporary licensing for out-of-state medical professionals while the state remains in a state of disaster.[99]
March 15: Texas Health and Human Services issues guidelines for nursing facilities outlining procedures for COVID-19 screening and restricting personnel and visitors at 1,222 nursing facilities in the state.[100]
March 16: A 40-year-old elementary school teacher is identified as presumptive positive for SARS-CoV-2, becoming the first case of the virus in Laredo. The patient had no history of travel to affected areas.[101] Abbott waives requirements for the State of Texas Assessments of Academic Readiness (STAAR)—standardized tests typically administered in Texas schools.[102] Parts of the Texas Open Meetings Act, which increases transparency for government meetings, are suspended to allow for telephone and video conferences.[103] The mayors of Dallas and Houston order the closure of various social establishments for at least a week; restaurants in Dallas and Harris Counties are limited to drive-through service.[104] San Antonio Mayor Nirenberg reduces the social gathering cap to 50 people.[105]
March 17: DSHS reports that a man in his 90s in Matagorda County died of COVID-19 after being hospitalized, becoming the first official COVID-19 fatality in Texas.[106] Two unrelated travelers are identified as the first two positive confirmations of COVID-19 in Lubbock; neither were hospitalized but self-quarantined at home.[107] The Brazos County Health District confirms the first case of COVID-19, a woman in her 20s, in Brazos County.[108] The Texas National Guard is activated, making Texas the 21st U.S. state to activate their National Guard; the security force is not yet deployed.[109] Abbott grants waivers to hospitals to bolster unused bed capacity without applying or paying added fees.[110] Abbott also asks the Small Business Administration to declare an Economic Injury Disaster Declaration for the state;[111] eligibility is granted three days later.[112] Texas-chartered banks restrict indoor access. Austin and El Paso close their bars, with Austin also closing its restaurants.[113]
March 18: Amarillo and Beaumont confirm their first positive COVID-19 cases, with Amarillo reporting two and Beaumont reporting one.[114][115] The Waco–McLennan County Health District announces the first six cases in McLennan County; five of the cases are identified as recent travelers.[116] The state closes all Texas Department of Public Safety Driver License Offices, excepting those seeking their first commercial driver's license, as Abbott partially suspends the Texas Transportation Code to delay expiration dates on driver's licenses.[117] Local governments are also authorized to delay elections slated for May 2 to November.[118]
March 19: The cumulative number of confirmed cases in Texas reported by the DSHS surpasses 100.[72]Cameron County reports the first positive case of COVID-19 in the Rio Grande Valley, involving a 21-year-old traveler to Ireland and Spain from mid-March.[119] The first six cases of community transmission in San Antonio are documented.[120] Austin Public Health reports evidence of community spread in Travis County as the county's cumulative case count nearly doubles in a single day.[121] An outbreak begins at the Denton State Supported Living Center in Denton, with the number of positive test results increasing to 55 residents and 67 employees of facility by May 21.[122][123] The DSHS declares a public health disaster, marking the first such declaration since 1901.[124] DSHS Director Hellerstedt issues the disaster declaration as the disease "has created an immediate threat, poses a high risk of death to a large number of people and creates a substantial risk of public exposure because of the disease’s method of transmission and evidence that there is community spread in Texas."[125] Abbott issues four executive orders to ban gatherings of more than 10 people; discourage eating and drinking at bars, food courts, restaurants, and visiting gyms (and close bars and restaurant dining rooms); proscribe visitation of nursing homes, retirement centers, and long-term care facilities with exception of providing critical care; and temporarily close all Texas schools.[126] The Texas Supreme Court halts most eviction proceedings statewide until April 19.[127]
March 21: Officials in Corpus Christi and Nueces County confirm the first case of COVID-19 in the area. The individual is believed to have contracted the virus following a one-day business trip to Houston.[131] A resident of the Southeast Nursing and Rehabilitation Center in San Antonio is hospitalized and tests positive for COVID-19.[132] An outbreak at the nursing home leads to at least 75 infections and 12 fatalities, prompting investigations by local and state offici
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