colleges and universities throughout the state extended 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. school districts also announced temporary suspensions of classes statewide. empty shelves from panic buying at the sams club in lufkin on march 13, 2020 on march 17, dshs reported 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. the texas national guard was activated, making texas the 21st u.s. state to activate its national guard; the security force was not yet deployed. abbott granted waivers to hospitals to bolster unused bed capacity without applying or paying added fees. abbott also asked the small business administration to declare an economic injury disaster declaration for the state, with eligibility granted three days later. on march 19, the cumulative number of confirmed cases in texas reported by the dshs surpassed 100. the dshs declared a public health disaster, marking the first such declaration since 1901. dshs director hellerstedt issued 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." abbott issued 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. the texas national guard was deployed on march 27 to aid mobile covid-19 testing on march 26, the cumulative number of confirmed cases in texas exceeded 1,000, and abbott mandated visitors flying from connecticut, new jersey, new york, and new orleans, louisiana, to self-quarantine for 14 days. a team of researchers at the university of texas at austin projected that the healthcare capacity of greater austin would be exceeded if "extensive social distancing measures" were not implemented. their findings indicate that a 90 percent compliance scenario would maintain hospitalizations within capacity through august 17. mass distribution sites for food were established in texas, including one at the alamodome on april 17, abbott announces the start of his plan to reopen the texas economy, citing a "semi-flattened curve" of covid-19 cases in the state. the reopening was outlined in three executive orders allowing for state parks to open under social distancing regulations on april 20, limiting nonessential surgeries at hospitals beginning after april 21, and product pickup at retail stores beginning april 24. the reopening process also established the strike force to open texas, an advisory panel to abbott for reopening economy. the panel was led by james huffines with mike toomey as chief operating officer; its consulting members are all members of the republican party. the panel also consisted of a medical team and a special advisory council. abbott also called for public schools to remain closed for the rest of the 2019–2020 academic year. ten days later, pursuant to the executive order establishing the strike force to open texas, abbott released the texas governor's report to open texas, putting forth a phased approach to reopen the state's economy. on may 5, abbott modified his earlier reopening timetable, allowing barbershops, hairdressers, and nail salons to begin reopening on may 8 while maintaining social distancing. gyms and exercise facilities were allowed to reopen beginning may 18 while operating at quarter occupancy. on may 18, texas entered phase 2 of the governor's reopening plan. on june 3, texas enters phase 3 of abbott's reopening plan. on june 23, the state reported more than 5,000 new cases of covid-19 in a single day for the first time, documenting 5,489. hospitalizations related to covid-19 also reached a record high with 4,092. abbott gives approval for mayors and county judges to enact restrictions on outdoor gatherings with more than 100 people, reducing the size limit from 500. abbott also indicated that respirator enforcement is within the purview of local officials. abbott ordered the hhsc to reinstate covid-19 health and safety standards at child care centers, reversing the agency's lifting of those requirements on june 12. two days later, a record-high number of new covid-19 cases, 5,996, was set for the third consecutive day in texas; the three days contribute over 17,000 cases to the cumulative case count. abbott paused the reopening of the businesses in the state as hospitalizations deaths and new covid-19 cases begin to quickly rise, though prior relaxations of covid-19 restrictions remain in place. on june 26, abbott began rolling back some of the lifted restrictions from his earlier state reopening plan, issuing an executive order that promptly closed bars except for takeout and curbside pickup and closed rafting and tubing businesses in addition to restricting indoor dining at restaurants to 50 percent capacity. the order also required most outdoor gatherings with at least 100 people to seek approval by local governments. harris county judge lina hidalgo evaluated the county as having reached the highest threat level, indicating a "severe and uncontrolled level of covid-19", and called for the reinstatement of a stay-at-home order for the county in addition to prohibiting outdoor gatherings with more than 100 people in unincorporated parts of the county. on july 2, abbott mandated the wearing of face coverings in public spaces, with fines for non-first time offenders. counties with 20 or fewer active cases, children under 10, and persons with interfering medical conditions were allowed to opt-out of the order, as well as people attending church, voting at polling places, or exercising outdoors. austin mayor adler issued an executive order restricting gatherings with more than 10 people outside of child-care services, religious gatherings, and recreational sports. on august 11, 2020, texas became the third state in the u.s. after california and florida to exceed 500,000 in total number of reported cases. on a per capita basis texas ranks 12th among us states, with louisiana, florida, arizona, mississippi and georgia leading the list. by october 29, 2020, larger hospitals in amarillo, lubbock, and el paso did not have space available to accept transfers of seriously ill covid patients from rural areas. during the fifth wave of infections in august 2021, demand for icu beds in at least 50 texas hospitals reached or exceeded 100% of icu capacity. a surge in hospitalizations among children caused houston and dallas to run out of pediatric icu beds, with houston resorting to an air lift evacuation in one case. dallas county judge clay jenkins told parents that "if your child is in a car wreck, if your child has a congenital heart defect or something and needs an icu bed or more likely if they covid and need an icu bed...your child will wait for another child to die. your child will just not get on a ventilator." on august 17, 2021, it was announced that governor abbott had tested positive for covid-19. he had been fully vaccinated against covid-19 and began taking regeneron's monoclonal antibodies. epidemiology the first positive test result for covid-19 in texas, outside of the evacuees quarantined at jbsa–lackland from china and the diamond princess cruise ship, was reported by the dshs on march 4 and involved a resident of fort bend county. the patient was a man in his 70s and had traveled on the nile river cruise ship ms a'sara in egypt. a total of 12 positive test results were reported in fort bend and harris counties from travelers aboard the same ship. the first case of possible community spread—where the source of infection is unknown—was reported by public health officials on march 11, involving a man in his 40s in montgomery county; he had recently attended a barbecue at the houston livestock show and rodeo on february 28. the first death in texas identified in connection with covid-19 occurred on march 14 from a man in his 90s at the matagorda regional medical center; matagorda county officials reported the death on march 15 and the dshs confirmed it the following day. according to the dshs, the state exceeded 100 total cases of covid-19 by march 19 and 1,000 cases by march 26. by the end of march 2020, there were 3,266 known cases of covid-19 and 41 fatalities in texas, with nearly half of the state's counties reporting at least one case. an analysis of the first month of covid-19's spread in texas, published in the journal of community health, found that while the total case counts were highest in the state's metropolitan areas, the highest incidence rates of the disease per capita occurred in donley county, with 353.5 cases per 100,000 people. the case fatality rate (cfr) was 10.3 percent in comal county; high cfr counties had "a higher proportion of non-hispanic black residents, adults aged 65 and older, and adults smoking, but lower number of icu beds per 100,000 population, and number of primary care physicians per 1000 population." the cumulative number of covid-19 cases confirmed by the dshs reached 10,000 on april 9 and 100,000 on june 19. the number of confirmed fatalities eclipsed 100 on april 4 and 1,000 on may 9. counties that adopted shelter-in-place orders early showed a 19–26 percent decrease in covid-19 case growth 2.5 weeks following the enactment of those orders according to an analysis published in the national bureau of economic research. the same analysis found that such orders in urbanized counties accounted for 90 percent of attenuated case growth in the state by may. a surge in new covid-19 cases began in june with large increases in the state's major cities and within a younger population compared to the beginning of the pandemic. responses