Texas officials are scrambling to remain prepared for a major outbreak of a pneumonia-like disease whose global spread one expert says is now moving into “the next phase.”

From the governor’s office to hospitals to state agencies, Texas officials are intensifying efforts to plan for scenarios that could unfold now that the coronavirus is no longer relatively contained to China and surrounding countries and the number of cases is soaring in countries in Europe and the Middle East.

“I think we need to call an audible,” said Peter Hotez, an infectious disease specialist at Baylor College of Medicine and Texas Children’s Hospital. “We need to refresh the algorithms about who’s at risk and when we should suspect someone has the virus. We’re not calling it an epidemic yet, but we should start operating as if it were.”

Hotez said the disease’s spread — the number of cases in Italy and Iran, now about 900, more than doubled in two days, for instance — has made basing screening on the individual’s travel history less relevant. He also noted some recent cases have been characterized by gastrointestinal symptoms rather than respiratory symptoms.

The virus, which originated in Wuhan, China, in early January but has now spread to 48 countries, has been diagnosed in 82,000 people and caused nearly 3,000 deaths, most involving elderly people or those with underlying serious conditions. Most people experience mild symptoms and make full recoveries.

Texas Gov. Greg Abbott sought to reassure the public Thursday, noting that state agencies have been working on the matter for a month “using historical knowledge gained from responses to other infectious disease emergencies.” But he also announced a number of new preparedness steps — such as for the Texas Division of Emergency Management to begin holding biweekly meetings with state agencies starting next week and for the division to convene working groups with experts to inform response plans.

He also said the Texas Department of State Health Services is preparing state laboratories to administer tests for the virus, known as COVID-19. The Centers for Disease Control and Prevention in Atlanta, which has the only test for the virus, is expected to mail kits soon to local and state health agencies to conduct their own testing, after previous ones it sent out early this month proved faulty.

Abbott added that the health department has made room at the Texas Center for Infectious Disease in San Antonio to reduce pressure on local hospitals. The facility, which features 22 negative pressure rooms sealed off the from the rest of the facility, is being used to care for patients being tested for COVID-19 and those who are positive with mild symptoms or are recovering.

There are 10 patients with the coronavirus in Texas, including six confirmed by the CDC and four who tested positively in Japan but whose results have not yet been confirmed by the U.S. agency. Of the 10, two came from Wuhan on a State Department-chartered flight and eight came from the Diamond Princess cruise.

There are 15 cases in the U.S. — none in Texas — that weren’t imported.

But CDC officials warned this week that it’s a matter of “when, not if” the virus arrives in the U.S. in larger numbers. The officials said people should start preparing for significant disruptions to daily life.

Noting the alarm that caused in some people who rushed out to buy water or face masks, Dr. Umair Shah, executive director of the Harris County Public Health Authority, said the remarks glossed over the timeline at which the U.S. cases are likely to significantly ramp up. He said that likely won’t be soon.

“The containment strategy in China was effective for giving everyone more time to prepare for the virus,” said Shah, noting the realistic hope was always to delay the virus’ spread, not stop it. “Governments were able to get information out and alert people to be on guard, just as they should be for the everyday flu.”

Shah said all Texas hospitals seem well prepared for the immediate stage, during which suspected COVID-19 cases are sporadic and staff are instructed to isolate patients whose travel history and symptoms suggest they may have contracted the virus. But he said not all Harris County and Texas hospitals are as well prepared for longer-term preparedness, when cases may be plentiful.

“We’re asking hospitals to really lean forward in surge planning,” said Shah. “This is the time for hospitals to really start planning what to do if they get an influx of coronavirus patients. The reality might be sooner rather than later.”

Carrie Williams, spokesperson for the Texas Hospital Association, said Thursday that hospitals are “well aware they are on the front lines and need to be ready for a possible COVID-19 patient to walk through the door at any moment.” She said the THA Wednesday convened Texas hospitals around the state on a call with the health department about the state of the disease, infection control protocols, preparedness measures, personal protective equipment and other issues.

It’s not just health care settings that are responding to the threat. Officials at six of Houston’s more populous school districts — Houston, Alief, Aldine, Katy, Cypress-Fairbanks and Klein — said this week they are monitoring updates on the spread of the coronavirus and following CDC protocols.

“We’re telling everybody to keep doing the same thing they’ve been doing to protect themselves from the flu, but I know in our district, we’re going to have a back up plan,” said Sheleah Reed, a spokeswoman for Aldine ISD in north Houston. “We’ll hammer out a plan just like we do with any other emergency or weather issue we meet about.”

Reed said hundreds of school district communications officials at an annual public relations meeting in Austin this week ended the day brainstorming about how to track and prepare for the potential of confirmed cases in their areas.

At Houston ISD, interim Superintendent Grentia Lathan wrote a letter to parents, detailing the district’s plans, which include training staff to regularly monitor educators and students who show symptoms, such as fevers, coughing, shortness of breath. Those who report feeling ill will go through assessment and monitoring, she wrote.

Texas universities previously clamped down on student and faculty travel to China, but a number of them — Texas A&M, the University of Texas-Austin, Baylor College of Medicine and Baylor University — this week extended their restrictions on college-funded travel to include South Korea. The country reported more than 250 cases last Friday, bringing its total to 2,022, the largest outbreak outside of China.

Shelby Webb and Brittany Britto contributed to this report.

todd.ackerman@chron.com

taylor.goldenstein@chron.com