Classrooms inside Eloise Japhet Elementary have protective measures in place such as restricted desks that allow students to be socially distant. Credit: Bonnie Arbittier / San Antonio Report

Health experts are bracing for another spike in coronavirus cases in San Antonio as children return to the classroom and residents tire of social distancing practices.

The seven-day average of new case in Bexar County is now at its lowest since mid-June, down from a recent spike in mid-July that saw a seven-day average of more than 1,500 new cases per day. However, the county saw surges of new infections following the Memorial Day and July Fourth holidays, so Labor Day has officials urging residents to continue to wear masks and avoid large gatherings.

Juan Gutierrez, a mathematician who studies infectious disease and chair of the University of Texas at San Antonio’s math department, cautioned that residents should view the recent decline in numbers with “a bit of skepticism.”

“We’re not done with this,” Gutierrez said. “We’re just starting. We have been in this situation for six months; this could last for another year and a half.”

Since March, Gutierrez has studied Bexar County’s coronavirus data closely, using it to create a model that predicted how the case rate might change in response to shutdowns and other methods to slow the spread. His model projected hundreds of thousands of total cases if residents completely dropped all social distancing measures.

But Gutierrez said his modeling work stopped in mid-July, around the time that Metro Health announced it was adding a backlog of 5,000 cases to the numbers in a single day as a result of complications of data changing hands among private labs, the Texas Department of State Health Services, and Metro Health. Issues with collecting and entering the data made it too imprecise to use for modeling, Gutierrez said.

Still, in an Aug. 27 interview, Gutierrez pointed to multiple signs that San Antonio’s infection rate has indeed slowed. Hospitalization data from the South Texas Regional Advisory Council is more reliable than case count data, and that’s showed a decline in the number of people hospitalized, in intensive care, and on ventilators, he said.

But that trend could reverse as students return to classrooms, he said. UTSA began holding 5 percent of its classes in-person on Aug. 24, and many local pre-K-12 public schools are planning to resume in-person instruction after Labor Day, though at reduced capacity.

The gathering of children and teachers in classrooms comes as scientists warn that children can easily spread the coronavirus, even when showing few or no symptoms. An Aug. 20 study involving 192 children published in the Journal of Pediatrics showed that the amount of virus present in children in the first two days of symptoms was “significantly higher than hospitalized adults with severe disease.”

Metro Health’s school reopening risk level is in the moderate, or yellow, range. That indicates that Metro Health officials believe in-person instruction can resume in small groups – no more than six in a pod – and among at-risk student populations such as special-needs students and those without home internet connections.

Another factor that might lead to a spike in cases is that people are getting tested less frequently than in recent months, Gutierrez said. It could be fatigue, but he also pointed to recent federal health guidelines that he called “absurd.”

In late August, the U.S. Centers for Disease Control and Prevention softened its recommendations on testing for people who don’t show symptoms, even if they have been exposed to the virus.

“That has absolutely no scientific basis,” Gutierrez said. “It is an evident partisan move from those who are managing the federal government to keep the numbers down because they believe that if they test less, then there are fewer cases and it’s better for the economy.”

San Antonio officials are noting a decline in the number of residents seeking tests, at least from the four free testing sites available in Bexar County, Assistant City Manager Colleen Bridger told council members on Aug. 28. For example, on Aug. 27, 637 people received testing at all four sites combined, a number Bridger called “quite low.”

However, Bridger also pointed to the three-week trend increase in the number of hospital beds, intensive care beds, and ventilators available for patients. She reminded listeners that the point of social distancing has always been to reduce the stress on the medical system.

“The reason behind flattening the curve was to keep people out of the hospital, to keep
them from overwhelming the hospital system,” Bridger said. “We were close during the peak of July’s spike of overwhelming our hospital system.”

If San Antonio does see another spike in cases, local officials will be more prepared than they were in July, Bridger said. The agency has more than tripled the number of case investigators available to contact infected residents and urge them to self-quarantine.

During mid-July when case counts soared, Metro Health had access to only 58 case investigators, Bridger said. As of Aug. 27, they had 189 “people who are trained and ready to do case investigations, should they be needed.” That includes Metro Health employees, furloughed City workers, San Antonio Fire Department staff, and others hired by UT Health San Antonio. By the end of September, 214 case investigators will be available.

“That is more case investigators than we would have needed during the spike that we experienced in July,” Bridger said.

Metro Health has also added more physicians to its team, Bridger said, including Dr. Sandra Guerra, a former Metro Health official and preventative care expert hired to assist Dr. Junda Woo on suppressing the virus’s spread in congregate settings, such as nursing homes or schools.

Metro Health has also contracted with Dr. Barbara Taylor, an infectious disease expert with UT Health San Antonio and former chair of the local COVID-19 Health Transition Team, as well as Dr. Jan Patterson, another specialist in infectious diseases with UT Health San Antonio.

At the Alamodome, the hub of San Antonio’s coronavirus response, the City has put retired Marine Maj. Gen. Juan Ayala, director of military and veteran affairs, in charge. His military experience “is coming very in handy with our Alamodome day-to-day operations,” Bridger said. An average of 250 employees per week are working at that site.

Overall, Bridger said that “what we are doing is working,” a sign of hope for residents struggling through six months of mask-wearing and minimizing contact with people outside their household.

“We need to keep that up, especially through Labor Day, especially with schools reopening, so that we don’t see another spike,” Bridger said. “If there is another spike, we are prepared, and staffed, and ready to respond.”

Brendan Gibbons

Brendan Gibbons

Brendan Gibbons is the San Antonio Report's environment and energy reporter.