San Antonio has a serious COVID-19 testing deficit and a problem with the way Mayor Ron Nirenberg and Bexar County Judge Nelson Wolff are addressing the media and citizens without the participation of public health professionals or scientists alongside them.

Timely, significant change on both fronts is essential for the city to look ahead to the recovery of public life and the economy, even as the number of people testing positive for the virus and the number of people dying continue to rise.

In short, we do not know what we need to know.

The number of people tested for the coronavirus more than doubled over the past 10 days from 3,000 to nearly 7,000, counting the inexact totals representing public and private tests conducted in the city. Testing totals maintained by the state put Bexar County’s number at 4,379 as of April 8, its latest date. By comparison, Travis County’s test total is 6,221, nearly 50% higher. No Texas city is testing widely. Harris County has administered 12,000-plus tests, Dallas County 9,000-plus.

The City’s numbers represent a rough total for the previous month, an insignificant statistical representation of the population. A relaxation of the testing requirements has led to a rise in the number of individuals testing positive for the virus. The numbers, however, are insufficient to construct a model predicting the peak of the viral outbreak.

The number of people being tested, in general and in at-risk populations, is too small for medical professionals and scientists to gauge the degree of the outbreak locally or to know when the city might establish herd immunity, when enough people in a community become immune to an infectious disease that the spread of the disease is halted.

We can’t flatten the curve, or the spread of the disease, if we can’t measure the curve itself.

The unavailability of tests is not the fault of local officials, but establishing more ambitious testing protocols and targets does fall on their shoulders. Public health officials should tell citizens how much more testing needs to be done to establish actionable data.

The presence of the single public testing site at Freeman Coliseum points to a glaring shortcoming: In a city with hundreds of thousands of people living in poverty and dependent on public transportation, it’s no surprise there are entire inner city zip codes where few persons have been tested. Officials must establish testing centers in all parts of the city. Popup testing sites will not prove adequate.

“In an ideal world you would test 30% of the 2 million people living in the county, and you would want to focus on particular segments of the community such as the elderly and those living in nursing homes,” one San Antonio scientist who asked not to be quoted by name told me last week. “Looking ahead to social and economic recovery can only begin when we understand the full dimension of the outbreak.”

Nirenberg and Wolff have both served as strong, calming leaders during the outbreak, and neither has shied away from making unpopular decisions to protect the community. But they cannot serve alone as the face of leadership in a crisis.

The two men conduct seven-days-a-week media briefings that are livestreamed but remarkable for the notable absence of public health professionals, clinicians, and research scientists who can offer fact-based assessments and help persuade the public of the necessary measures needed to control the virus.

Mayor Ron Nirenberg (left) and Bexar County Judge Nelson Wolff. Credit: Bonnie Arbittier / San Antonio Report

“President Trump may not listen closely enough to the professionals on his team, but at least they are out there with him,” one local medical leader told me, adding that he would participate periodically as needed in such community briefings if called upon. “I don’t see anyone wearing a lab coat standing alongside our mayor and country judge addressing questions that right now are being left to political leaders who have no expertise to draw on.”

I spoke to a range of local medical and research experts and found universal agreement on the testing deficit and communications issue, even as most people declined to speak on-the-record.

Last year, the Rivard Report made a concerted effort through this column and a major forum to raise the profile of what we termed the evolving “$1 billion research and development collaborative” in San Antonio forged by UT Health San Antonio, UTSA, Southwest Research Institute, and Texas Biomedical Research Institute, all of whom are engaged in work related to the COVID-19 pandemic.

We sensed a high level of unawareness in the community of the world-class talent here that is engaged in critically important research. Yet none of the leaders of those four institutions has been called on by Nirenberg or Wolff to visibly lend authority to the daily briefings.

The Rivard Report on April 3, livestreamed an interview with Assistant City Manager and former Metro Health Director Colleen Bridger conducted by Health Reporter Roseanna Garza. Testing was a major subject of conversation. Bridger, however, is not appearing at the briefings.

One leader in the biosciences sector who did offer brief comment when I called was Dr. Larry Schlesinger, president and CEO of Texas Biomedical Research Institute and an infectious disease specialist.

Texas Biomed is doing direct research on the COVID-19 virus in the broader global effort to develop an effective vaccine. Most San Antonians might be unaware of the research institute here, but it ranks among the world’s top research facilities for its Level IV laboratory research into deadly viruses that have led to previous pandemics.

“We need to know how many people here are antibody-positive, the people who have resolved the virus, which is done via a simple blood test,” Schlesinger said. “Assessing this concept of seroprevalence will be a critical step forward for us developing strategies for allowing immune individuals to return to the workforce. We can’t continue to exist with social distancing as the primary modality as our sole defense.”

Anxious San Antonians uncertain about the future trajectory of the virus should be hearing directly from Schlesinger and his colleagues. Their expertise shared publicly can guide elected leaders through uncertainty in the weeks and months ahead.

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Robert Rivard

Robert Rivard is co-founder and columnist at the San Antonio Report.