It’s the closest a government planning paper might come to science fiction, except the whole thing turned out, miserably, to be true.

Five years ago, a team at the Texas Department of State Health Services, the agency now at the center of the state’s response to the coronavirus, put together an 89-page report describing how the state and local health departments should prepare for a respiratory virus pandemic.

Contemplating that novel coronaviruses could lead to illness and death, the paper, reviewed by the American-Statesman, laid out a prescient blueprint about the mechanics of a bureaucratic response and gave state officials a head start in confronting the virus as it spread across the state.

If the 2015 document, titled “Respiratory Viruses Having Pandemic Potential,” went completely unnoticed by the general public, its contents — including specific terms such as “social distancing” and “droplet spread” — will now read as strikingly familiar.

The document calls for home isolation of the sick, quarantines of those exposed to ill persons, routine hand-washing and the use of personal protective equipment by health care workers — all a part of the government and medical responses to the current crisis.

“Community-based measures,” the document forecasts, “include community activity restrictions such as restricting mass gatherings; early coordinated closures of childcare facilities, K-12 schools, and colleges and universities before ... transmission becomes widespread; and workplace social distancing measures that reduce face-to-face contact among employees and between employees and customers.”

Gov. Greg Abbott issued executive orders first limiting gatherings and shutting down restaurant dining rooms and schools and then requiring Texans to stay at home except for essential work or errands such as fetching groceries or medicine.

It remains to be seen, however, how Texas will emerge from the current crisis — its confirmed coronavirus cases and deaths lag other large states, but so does its testing — and with state officials preparing to relax social distancing rules, there is the risk of a second wave of the disease.

The document was conceived after the H1N1 influenza pandemic left at least 27 people dead in Texas in 2009 — and outbreaks of a novel coronavirus, the Middle Eastern Respiratory Syndrome emerged, according to Jeff Hoogheem, the director of the department’s Center for Health Emergency Preparedness and Response.

“I hate to be doing what we’re now doing,” Hoogheem told the Statesman, “but the document suggests we were thinking the right way.”

Such documents are not uncommon. In 2006, for example, the National Governors Association published the pamphlet “Preparing for a Pandemic Influenza: A Primer for Governors and Senior State Officials.”

That year, a team of researchers from the nonprofit Research Triangle Institute published a report in the journal Emerging Infectious Diseases that examined dozens of state plans for containing influenza pandemics.

The team found that “few states explicitly discuss implementing nonpharmaceutical community interventions.” Only about a third of state reports addressed voluntary self-isolation; school or other institutional closures; or institutional or household quarantine.

Social distancing was adopted as a federal strategy by President George W. Bush’s administration — only after the doctors initially recommending it were met by ridicule from colleagues who long had confidence in the pharmaceutical industry for producing medical solutions, according to The New York Times.

The U.S. Centers for Disease Control and Prevention even published a Business Influenza Pandemic Planning Checklist. Among the boxes to check: “Anticipate employee fear and anxiety, rumors and misinformation and plan communications accordingly.”

Confronting a pandemic

The goals of the 2015 Texas report were “to provide local and state public health agencies with a decision support system” and to “define the roles and responsibilities of local and state public health entities tasked with pandemic influenza and other respiratory virus surveillance and response activities.”

The report sought to lay out how the state would monitor and control a respiratory virus with pandemic potential.

But in its details, the document chillingly describes what has come to pass, if not in Texas, in other areas where the coronavirus has hit hardest: “During an outbreak or pandemic of a respiratory virus, healthcare systems will likely experience a surge in patients, shortages of equipment and supplies (including medications), and significant staff absenteeism,” the document says.

Five years later, the document stands as a prescient forecast about what a pandemic might look like and how the state should respond.

“The value of the plan is really the planning process,” Hoogheem said, adding that the document was the product of meetings of teams of state officials in consultation with local emergency officials and public health experts. “All the people involved talk about their responsibilities. We reference it — but the idea is everybody who participated in the planning process has it cued up in their brains when it comes to ‘What do we really have to do?’ The process is as instructive as the document itself.”

The document, Hoogheem said, is meant to act like the “first five plays of the game, or an initial reaction to the response. Look at tasks and responsibilities and gauge the pace of the pandemic unfolding.”

Still, the state’s success at managing the crisis remains an open question as the pandemic continues to unfold. Even as the planning document emphasizes communication, public health advocates say the avenues of information exchange could be clearer.

“An issue that I would not hold DSHS solely responsible for is a lack of clarity (with dealing with government agencies during the crisis),” said Anne Dunkelberg, who oversees health care policy for the liberal Center for Public Policy Priorities. “If you have important input you need to get to the state leadership about their reaction to the crisis; it can be a little challenging to do that. Even as they maybe are very correctly prioritizing big system fixes, as advocates of low-income Texans, we’re trying to point out to them gaps at the bottom of the pyramid, on the consumer-facing side.”

She also said that even as the Department of State Health Services has done a good job promoting social distancing and hand-washing, state agencies should step up messaging that coronavirus testing is available regardless of insurance coverage or immigration status.

“Because they’ve been appropriately focused on dealing with overarching and critical issues, they’ve not seemed as concerned about consumer-level messaging,” she said.

On Friday, the agency, along with Abbott’s office, launched an online COVID-19 test collection map to help Texans locate test collection sites within their communities.

Following the plan

As the coronavirus crisis emerged in the U.S. in February, officials at the state’s health department communicated with an array of people in the medical and public health communities about the disease — just as the 2015 document stipulated.

The first such daily teleconference coronavirus briefings drew more than 700 participants, many of them clinicians, local health officials, hospital officials, emergency services providers, and other medical professionals.

“Emergency plans are updated all the time when we are facing new experiences, especially with new viruses,” Andy Tate, a spokesman for the city of Austin, said. “As the state implements its plan we talk to them daily.”

As part of its coronavirus preparations, state health officials surveyed hospitals about supplies of personal protective equipment.

The 2015 pandemic plan said that the department should “store a limited amount of ... mechanical ventilators for the critically ill."

Department spokesman Chris Van Deusen said it had a stockpile of 50 ventilators heading into the coronavirus crisis.

The document is meant as a guide for the Department of State Health Services — not the governor’s office per se, and not for individual hospitals — but with department Commissioner John Hellerstedt by Abbott’s side at most press conferences, Abbott in some ways appeared to be following the pandemic plan — ordering state officials, for example, to review medical supplies on hand as the pandemic progressed.

Funding for the Department of State Health Services improved during the 2019 legislative session. This year, the agency will receive about $12.6 million in general revenue appropriations from the Legislature for infectious disease prevention, epidemiology and surveillance, as well as an additional $6.3 million from the federal government — appropriations made before the virus hit.

About 100 full-time employees work in the agency’s infectious disease prevention, epidemiology and surveillance division.

But Texas still trails most states in public health funding. A study published by SHADAC, a health policy research center affiliated with the University of Minnesota, found that Texas spends about $17 per capita on state public health funding, ranking it 40th among the 50 states and the District of Columbia.

As for blind spots in the pandemic plan, Hoogheem says no one fully anticipated how much social distancing would affect the agency’s own work.

Hoogheem described himself as “anxious and optimistic.”

“I think we’ve done a lot of things to help flatten curve, but I’m anxious and continue planning for the worse.”

CORONAVIRUS IN TEXAS: What we know, latest updates