November 12, 2020

Judge Clay Jenkins

Dallas County Judge
Via email to clay.jenkins@dallascounty.org

Dear Judge Jenkins,

As you are aware, COVID-19 cases and hospitalizations in Dallas County have increased
dramatically. The increase in cases and hospitalizations has led to significant morbidity and
more deaths for our community. Despite the community’s efforts to follow the recommended
non-pharmacologic mitigation strategies that reduced cases in August and September, COVID-
19 “fatigue” is occurring in our community. This “fatigue” has led many people to forgo the
important personal protective measures necessary to reduce COVID-19 transmission. We have
lost the gains we made in the late summer. We know from our experience this spring that it
takes much longer to flatten the curve.

The number of hospitalized COVID-19 patients in Dallas County hospitals has increased by 140
percent since mid-September. As of September 17th our COVID hospitalized patients
constituted 6 percent of all hospitalizations in Dallas County, 14 percent of all ICU patients, and
11 percent of ventilated patients. As of November 10th those numbers have nearly doubled
with COVID-19 patients constituting 12 percent of all hospital inpatients, 31 percent of all ICU
patients, and 18 percent of all ventilated patients, respectively.

Furthermore, this increase in cases and hospitalizations, presents at a time that nurses,
physicians, and other front line providers and healthcare workers have not had respite from
their extraordinary efforts in the healthcare settings caring for COVID-19 patients. Since March,
these efforts have continued, resulting in a stressed and fatigued healthcare workforce.

The trajectory with which new COVID-19 cases are climbing in Dallas County is far worse than
we even imagined several weeks ago. On October 14th, Dallas County’s COVID Risk Level
returned to “RED” the highest risk level in our metrics. Despite this clear signal to the
community that our County was experiencing the COVID-19 growth that merited doubling
down and increasing mitigation measures such as physical distancing, wearing of masks and
hand hygiene, we have not seen any meaningful decrease in cases, hospitalizations, percent
positivity among laboratory tests and other metrics.

The Public Health Committee believes that immediate and dramatic steps are necessary to
reduce case growth, save lives, and relieve pressure on our healthcare system where today
almost 15 percent of hospital inpatients are COVID-19 patients. In order to regain control of
the COVID-19 infection rate in Dallas County, the Public Health Committee unanimously
recommends the introduction of the following measures immediately:

Request local control authority for closure orders enabling enactment of recommendations
from the local public health experts and professionals in response to the local epidemiology and
the realities on the ground. These would include:
1. Implementing a stronger and more expansive public mask order for Dallas County.
2. Maintaining current bar closures and close any venues functionally serving as bars, and
closing any loopholes permitting bar operations that may have been created by TABC.
 3. Closing all indoor dining at restaurants and similar facilities and permitting only take-
out, drive through, curbside pick-up options, and only permit outside dining where 6
feet separation can be maintained between parties.
4. Limiting ALL indoor gatherings – both public and private -- to less than or equal to 10
people. Removing exemptions for sporting events, entertainment, and other similar
large gatherings such as weddings and funerals, etc.
5. Limiting ALL outdoor gatherings – both public and private to less than or equal to 10
people where masking and physical distancing of at least 6 feet cannot be enforced.
Removing exemptions for sporting events, entertainment, and other similar large
gatherings such as weddings and funerals, etc.
6. Re-enforcing strict infection control practices and enhance visitation restrictions for
long-term care and healthcare facilities.
7. Restricting all gyms and fitness centers to virtual classes only.
8. Restricting all retail businesses (grocery stores, hair salons, box stores, movie theaters,
etc.) to 25 percent of customers capacity.
9. Reducing capacity for non-essential businesses to 50 percent and encourage virtual
work strategies/drive through and other modalities to limit people congregating
together.
10. Allowing public schools flexibility working with the TEA to utilize virtual learning
following Thanksgiving if ongoing community SARS-CoV-2 prevalence persists in order to
protect the health of children, teachers, staff and families of all these groups.

Time is of the essence and if these targeted interventions do not measurably reduce case
growth, additional measures will have to be considered in order to control COVID-19 case
growth. In addition to these interventions, it goes without saying that the public needs to
continue to adhere to strict masking, physical distancing, and refraining from social gatherings.

We are nearing a point where our health care facilities and their ability to appropriately admit
and care for COVID-19 patients will break. This would impact all patients who suffer from any
other medical condition. If we do not act now to regain control over COVID-19 infections, we
will find ourselves in a situation similar to what happened in March in New York City where
caring for all who needed it was not possible. That does not reflect the spirit of North Texas.

Thank you for your leadership in all the efforts to arrest the spread and the harm associated
with this virus.

Respectfully,

Dallas County Public Health Committee

Trish M. Perl, MD, MSc.

Ruby Blum, MHA Robert H. Haley, MD
Debbie Branson, JD Philip Huang, MD, MPH
Mark Casanova, MD W. Stephen Love
Fred Cerise, MD, MPH Peter Urbanowicz, JD
Cristie Columbus, MD