About 1,500 new coronavirus cases were reported in Bexar County on Wednesday, the highest increase since July 28 and the fifth-highest of the pandemic. The increase brought the seven-day average up from 736 on Tuesday to 802 on Wednesday.

And with nine deaths reported on Wednesday, the death toll is now up to 1,371. The deceased ranged in age from 50 to 99 and included four white men, two Hispanic women, one Hispanic man, one white woman, and one Black man.

Thirteen fewer COVID-19 patients were in local hospitals on Wednesday than there were on Tuesday. Of the 580 patients in San Antonio hospitals on Wednesday, 192 were in intensive care and 103 were on ventilators. Seventy-five patients are from El Paso.

But a lesser effect on local hospitals amid this latest surge might be moot if hospital capacity continues to be overwhelmed in South Texas’s smaller communities. Where the first wave in the summer hit urban areas the hardest, now hospitalizations in rural areas and smaller cities threaten to bring those locales to the brink. As it has with patients from El Paso, San Antonio would play a significant part in providing care to patients from places with overwhelmed health care infrastructure.

“Unfortunately, [rural communities in South Texas] don’t have a whole lot of medical capacity,” Mayor Ron Nirenberg said on Wednesday. “So if things go bad in the rural areas of the state, it’s going to be on the urban hospital systems to take that on, so we’re watching that carefully.”

Earlier on Wednesday, Gov. Greg Abbott announced Texas would begin distributing COVID-19 vaccines to immunize more than 1.4 million health care workers on the front lines of the pandemic and the state’s most vulnerable residents, such as patients at long-term care facilities.

The vaccine, still pending emergency U.S. Food and Drug Administration approval, is coming at a critical juncture. Centers for Disease Control and Prevention Director Robert Redfield said Wednesday that this winter threatens to be “the most difficult time in the public health history of this nation,” with cases already surging in many parts of the country and outbreaks likely to get worse after holiday gatherings.

Texas residents ages 40 and younger should get tested if they gathered with people they don’t live with over the Thanksgiving break, the White House’s coronavirus task force recommended. A Nov. 22 report from the task force includes a list of metropolitan areas and counties in the red zone for coronavirus risk. The San Antonio–New Braunfels metro area and Bexar County are among the highest-risk areas in the state, according to the report.

JJ Velasquez was a columnist, former editor and reporter at the San Antonio Report.