The following is a timeline of the COVID-19 pandemic in Texas.

Background and evacuee cases

A pandemic involving the spread of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began in 2019 with the outbreak first identified in Wuhan, China, in December 2019.^[1][2][3] The World Health Organization (WHO) declared the outbreak a Public Health Emergency of International Concern on January 30 and evaluated it as a pandemic on March 11, 2020.^[4][5] The first case in the United States was reported in Snohomish County, Washington, on January 20,^[6] and the Trump administration declared a public health emergency on January 31, 2020.^[7]

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]

Evacuee quarantines and cases

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]

Timeline