If you were a surfer, you’d be looking for big waves to ride. When you’re fighting a pandemic, you would prefer a flat glassy surface. But then it probably wouldn’t be a pandemic, so the most you can hope for are small, calm waves with no riptide. Right now, we’re in the midst of some choppy waters when it comes to COVID in Bexar County.

Cocoa Beach, FL, following the launch of Solar Orbiter

All these data can be found on the COSA Website, though some data points are taken from the Mayor’s nightly briefings. The data shared here isn’t different. I’m just going to try to explain it. Prepare for a lot of graphs.

First, we’ve seen a substantial increase in cases over the last four days. Those are not included in this first graph. That’s because these data indicate the date of onset, rather than the date of report. This gives us an estimate of when people were infected. To use the date one developed symptoms can be useful but also problematic. We don’t always remember when we first started feeling sick, especially if the symptoms were mild.

Until recently, lab results were often delayed. So a large batch of positive results on one day wouldn’t necessarily mean 130 new cases appeared that day. Those infections have already been out there over the previous two weeks. So this graph shows date of onset until a week ago, 6/5/20, with a 7-day rolling average (the red line). That’s the epi curve.

This is more like choppy waters than waves.

If we look at these by date of test report, i.e. when SAMHD received the lab reports. This includes the four days of > 100 positives this week. There’s no doubt COVID-19 is gaining steam in San Antonio.

Dr. Vince Fonseca said, “We’ve not really had a first wave recede. What we’ve done is take the lid off simmering, long, controlled stretch of the first wave and make it less controlled. We need to get it under control or we will get a spike like other cities have had.”

Roaring 20s

This next graph shows the number of cases per age group from May 1 until June 12. Most of the new cases in the past week have been in 20–29 year olds.

While much has been said about the many asymptomatic cases in the jail, 86% of the cases outside the jail have had symptoms. Being 20 doesn’t allow one to escape COVID-19 symptoms.

We have also had 20 cases in the 90–99 age group and 3 in the 100+ group.

In fact, since May 1, the greatest increase in cases has been in the 20–29 year old group.

When looking at demographics, we always have to ask, “Do we see more cases in one group because we have more people in that group?” Our census data are grouped differently .

We expect the 30–59 age group to have the most cases, because that’s the biggest proportion of the population. And they do. The 20–29 year olds are gaining ground, though.

While we see this surge of cases in the younger population, we’ve lost more of our older patients. Bexar County has now had 84 deaths, most still in people older than 60. But we’ve lost two people in their 30s, four in their 40s, and 16 in their 50s. All age groups can be affected, severely.

More COVID patients are being hospitalized, and more are in the ICU. We’ve seen an increase in hospitalizations, ICU admissions and ventilator use (data not shown). After a drop, we’re back to where we were a month ago. Our local hospital systems are not over-taxed, yet. This is why it’s essential to pay attention to these indicators. If we continue to see a rise in hospitalizations, ICU admissions and ventilator use, then we need to respond with stronger control measures. We’re still in choppy, but manageable, waters.

We’ve talked a lot about race and racism in COVID mortality. The Black/African American population makes up 9% of cases as of today, but 20% of the deaths. Of the 994 new cases since June 5 for whom we have race information, 8% have been in the black community. (Data on race by age are not available at the moment.) Hispanic people in Bexar County continue to get infected more (69%), but are more likely to survive.

I’m asked a lot about the Black Lives Matter protests and whether these have had an impact on the increasing numbers. While it’s possible some of the 994 cases since June 5 may have participated in the protests, which began on May 30, it’s not likely that many of these can be attributed to that. The city’s Disease Investigation Specialists will ask the questions to determine potential sources, but most people will have had multiple points of exposure.

Even if we see a continued rise, it will be difficult to link the new cases directly to the protests. The state has been “open” for the past month. And while many businesses have taken strict precautions, people have gotten relaxed. Many people are no longer wearing masks. They’re gathering in groups. Meanwhile, at the protests, mask wearing is usually ubiquitous.

While it seems counter intuitive to have mass gatherings when we worked so hard to minimize exposures just a month ago, we recognize that racism IS a public health issue. The Population Health Advisory Committee (PHAC) released a statement last week:

Institutional racism has led to the disproportionate burden of COVID-19 on Black and African-American communities and perpetuates police violence. We support protests against systemic racism, as these demonstrations are vital to the national public health and specifically to the health of Black and African-American people. We support the application of public health best practices during demonstrations without detracting from peoples’ ability to gather and demand change.

Photo: William Luther, San Antonio Express-News

That wave of COVID cases is building. But we can stay in front of it. And we can fight for human rights. #MaskUp.

Some extra data points:
Of those tested, 4.71% have been positive, and we have currently, 205 cases per 100,000 people or 0.2% infected. In Bexar County, 4.3% of the ppoulation has been tested.

Dr. Rohr-Allegrini is an epidemiologist and tropical disease scientist currently working to prevent diseases through immunizations.