![](media/image1.jpeg){width="10.75in" height="7.625in"}**TEXAS
LEADERSHIP DECISION MATRIX R = Responsible A = Authority C =
Consult/Consulted I = Informed**

**Decision Matrix Footnotes:**

1.  The Regional Director of the Department of State Health Services
    (Department) acts as a local health authority where none has been
    appointed locally. (Health and Safety Code §121.007(c), or may serve
    as the designee of the Commissioner or the Department.

2.  Health and Safety Code §81.003(7) requires a declaration of disaster
    by the governor [and]{.underline} a finding of a specific serious
    communicable disease threat by the Commissioner.

3.  Public health control measures may be initiated by the local health
    authority or the Department \[of State Health Services\].

4.  Health and Safety Code, Chapter 81, Subchapter G.

5.  Law Enforcement Officer

6.  Control measures on persons, places, and common carriers are imposed
    by the health authority. Non compliance with these orders is
    judicially enforced.

7.  Most types of control measures may be imposed by the "Department,"
    but an area quarantine specifies the "Commissioner."

8.  Area quarantine may be imposed by the local health authority or the
    Commissioner. If imposed by the local health authority, he must
    consult with the department and each county and municipality in the
    affected area (§ 81.085).

9.  The presiding officer of the governing body of a political
    subdivision may declare a local state of disaster (Government Code
    (§ 418.108(a)). The county judge or the mayor of a municipality may
    control ingress to and egress from a disaster area under the
    jurisdiction and authority of the county judge or mayor and control
    the movement of persons and the occupancy of premises in that area
    (Government Code (§ 418.108(g)).

10. The Governor has implied authority under the Disaster Act
    (Government Code Chapter 418) and explicit authority under the
    Emergency Act (Gov't Code Chapter 433)

11. The Commissioner may impose additional control measures within an
    area affected by area quarantine.

12. Ordinance authority; Local Government Code Chapter 54.

13. Municipalities have ordinance authority to preserve public health
    under Loc. Government Code Chapter 54 and Health and Safety Code
    Chapters 121 and 122.

14. Most of the curfew statutes mentioned here have criminal penalties
    that would be enforced by Law Enforcement Officers.

15. Health Authority may impose other restrictions with an area covered
    by an Area Quarantine (§ 81.085(c)).

16. Title 25 Texas Administrative Code (§97.6(g)).

17. The Texas Education Code gives full authority to local school
    boards, but authority for day-to-day decisions is, in practice,
    delegated to the school superintendent.

18. See footnote 9 above. The authority to control "occupancy of
    premises" could be used to cancel public events.

**TEXAS LEADERSHIP DECISION MATRIX FOR NON-PHARMACEUTICAL INTERVENTION
STRATEGIES**

Taking into account the complex issues associated with implementing
various [non-pharmaceutical
interventions](#NonpharmaceuticalIntervention), DSHS has created a
Leadership [Social Distancing Decision Matrix](#SocialDistancing) (Table
2) to help clarify issues and guide decision-makers. This matrix
outlines critical non-pharmaceutical intervention strategies that could
be implemented, provides the person (or persons) who has the authority
and the responsibility to implement the given strategy, and suggests the
level at which the strategy might be implemented according to the World
Health Organization Pandemic Phase, Federal Government Response Stage,
or Centers for Disease Control (CDC) Intervals. ([Appendix
A](#AppendixA)). For example, the purple/black highlight indicates a
Category 4 or 5 pandemic. At a WHO Phase 6 Federal Stage 3, the governor
and health commissioner should be on standby to make the decision to
declare a public health disaster. If the stage evolves to stage 4, they
might want to consider declaring a public health emergency. At Stage 5,
it is recommended that they make a declaration.

When WHO declares Pandemic Period (Phase 6) and the U.S. Government
identifies Stage 3, 4, or 5, the CDC's Director shall designate the
category of the emerging pandemic based on the Pandemic Severity Index
and consideration of other available information. Pending this
announcement, communities facing the imminent arrival of pandemic
disease will be able to define which pandemic interventions are most
indicated for implementation based on the level of pandemic severity. 

Other epidemiologic features that are relevant in overall analysis of
prevention, mitigation, and containment plans include total [illness
rate](#illnessrate), age-specific illness and [mortality
rates](#MortalityRate), the [reproductive number](#R0), [intergeneration
time](#generationtime), and [incubation
period](#IncubationPeriod). [Case fatality ratio](#casefatalityratio)
and excess mortality rates may be used as a measure of the potential
severity of a pandemic.

All of these suggest the appropriate non-pharmaceutical tools; however,
alone, they are not suitable trigger points for action. **The primary
activation trigger for initiating interventions will be the arrival and
transmission of pandemic virus**. This trigger is best defined by a
laboratory-confirmed cluster of infections with a novel influenza virus
and evidence of community transmission (i.e., epidemiologically linked
cases from more than one household).

Other factors that will guide decision-making by public health officials
include the average number of new infections that a typical infectious
person will produce during the course of his/her infection ([R0](#R0))
and the illness rate. In [*Interim Pre-pandemic Planning Guidance:
Community Strategy for Pandemic Influenza Mitigation in the United
States*](http://www.pandemicflu.gov/plan/community/community_mitigation.pdf),
trigger points for action assume an R0 of 1.5--2.0 and an illness rate
of 20 percent for adults and 40 percent for children. In this context,
in all categories of pandemic severity, it is recommended that State
health authorities activate appropriate interventions when a
laboratory-confirmed human pandemic influenza case cluster is reported
in each State or region (as appropriate) and there is evidence of
community transmission.