This article has been updated.

Mayor Ron Nirenberg declared a local state of disaster and public health emergency related to coronavirus Monday, preventing the release from quarantine of 122 cruise ship passengers evacuated from Japan to Joint Base San Antonio-Lackland.

Nirenberg’s move came after a woman briefly released Saturday from a federally managed hospital quarantine visited North Star Mall and a Holiday Inn near the airport later that day before health officials learned a re-test for the virus showed her “weakly positive,” said San Antonio officials Monday.

The City also filed a lawsuit Monday against the federal government. In it, the City sought changes to the Centers for Disease Control and Prevention’s quarantine protocol at Lackland, including increasing the length of the quarantine. But a federal judge declined to grant injunctive relief, concluding that while its actions raise concern, the CDC is the ultimate authority on preventing coronavirus spread.

Monday marked the end of what was supposed to be a 14-day quarantine for the 122 people evacuated to Lackland from the Diamond Princess cruise ship, where a coronavirus outbreak occurred. But the mayor’s declaration put their release on hold at least temporarily.

In his order, Nirenberg declared that “ingress into and travel through the City of San Antonio from Lackland by those persons that have been quarantined in the facility is not permitted. No previously quarantined person shall be permitted to enter the City of San Antonio until further notice.”

Bexar County Judge Nelson Wolff also declared a public health emergency to protect the unincorporated areas of Bexar County and 26 municipalities within the county from receiving any cruise ship passengers released from quarantine.

Bexar County Judge Nelson Wolff also declared a public health emergency. Credit: Bonnie Arbittier / San Antonio Report

U.S. Rep. Chip Roy (R-Austin) said in a tweet Monday that the U.S. Department of Defense should use its aircraft to return evacuees to their home states and avoid using civilian airports. “My default position here is that Texas officials & San Antonio officials need to be the ones to make the call about any releases of anyone into our communities in Texas. Period,” he said in a series of tweets.

In the case of the woman released Saturday from quarantine, San Antonio health officials said potential exposure to the community “is deemed to be low” based on the short amount of time the woman spent in close contact with mall or hotel employees.

The patient was released from the Texas Center for Infectious Disease following two negative test results for the virus, but before officials had gotten the results of her third COVID-19 test. Those later results showed her to be “weakly positive” for the virus, said Dr. Anita Kurian, assistant director of communicable diseases at Metro Health. The woman returned to quarantine about 2 a.m. Sunday morning.

The San Antonio Metropolitan Health District has identified 16 health care workers who came into contact with the woman, two of whom were deemed to be at “medium risk” of contracting the virus known as COVID-19, said Kurian. Those individuals are in isolation at their homes.

Three people potentially were exposed to the virus at the hotel, but based on the distance from the woman and the time spent near her, their risk of contracting the virus was deemed low, Kurian said.

Metro Health on Saturday contacted officials at the hotel and the mall, encouraging them to complete a “routine wipedown with disinfectants” and to notify health officials should anyone begin to develop symptoms of a respiratory infection, Kurian said.

Kurian said the woman told health officials she was at North Star Mall from about 5:30 p.m. to 7:30 p.m. on Saturday, and while there, she “did not stay in one place longer than two to three minutes,” and that she spent “most of her time at the food court eating Chinese [food].”

The woman was part of a group of Americans evacuated from Wuhan, China, the epicenter of the coronavirus outbreak, and put into quarantine at Joint Base San Antonio-Lackland in early February.

Kurian said “it is not possible” to know how many people might have been close enough to the woman – the Centers for Disease Control and Prevention and the World Health Organization have suggested maintaining a 3-foot distance from anyone with symptoms of COVID-19 – to be exposed at the mall, but that any such exposure would be considered low risk.

Nirenberg said it was “unacceptable” for the CDC to release the woman from quarantine. “We simply cannot have a screw-up like this from our federal partners,” Nirenberg said.

However, CDC officials said she had two negative test results 24 hours apart, which they considered appropriate grounds for release. 

City and County officials said they are asking CDC officials to not allow coronavirus patients to be released until they receive three negative test results in a row.

“Guidance from the medical community has been to ensure that all tests come back” before a person is released from quarantine, Nirenberg said. Local officials have been working with state and federal partners to ensure no one who contracted the virus will be released before results of a third coronavirus test are known, he said.

For every person with COVID-19 symptoms, two test specimens are taken – one from the upper respiratory tract and one from the lower respiratory tract – and both should be negative for the patient to be declared free of the virus, Kurian said. The patient released Saturday had one specimen come back negative and the other positive, so her results are considered “weakly positive,” Kurian said.

Test results for COVID-19 are typically received 48 to 72 hours from the time they were submitted to the CDC.

As of Monday, six U.S. deaths attributed to coronavirus had been reported. The official tally of confirmed coronavirus cases in Texas remains at nine — all of them quarantined at the Texas Center for Infectious Disease. The person released by the CDC on Saturday is the first case in Texas in which a person who tested positive for the virus was known to have been outside the federal quarantine area.

Meanwhile, Nirenberg said a group of University of Texas at San Antonio students returning from a study abroad trip in Italy, where the number of coronavirus cases has spiked sharply, will self-isolate and not attend classes as a precautionary measure.

In addition, H-E-B said Monday it was limiting purchases of disinfecting sprays, disinfecting wipes, hand sanitizer, and hand soap to four of each item per transaction but did not indicate any supply problems. “We are in a strong in-stock position with these products and our partners are continuously replenishing these items throughout the day,” said an H-E-B spokesman in an email to the Rivard Report.

Roseanna Garza

Roseanna Garza

Roseanna Garza reports on health and bioscience for the San Antonio Report.