A couple of weeks ago, I wrote about the Spurs and victory being snatched from us at the last moments.

Here’s an update: we’re holding steady, but still above the threshold recommended by Dr. Tom Frieden, former CDC director (back when we could trust the CDC) and lead of Resolve to Save Lives. His team suggests less than 40 NEW cases per 1 Million people per day on average is needed to shift from Level 4 High Alert to Level 3 Moderate. Here is San Antonio compared to the (simplified) global alert system:

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San Antonio Data from COSA. See note below re staffed bed.

The black line is the 40 per 1M threshold. We’ve dropped substantially from our high in July. For daily cases, we’re still above that threshold and still higher than we were in May and early June. Remember what happened then?

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We’re a week out from Labor Day. Hopefully we won’t see the post-Holiday spike that we saw after Memorial Day. Schools have opened to very small groups in carefully controlled settings. This week and next will be critical.

Our weekly average has been plateauing. To shift, we need it to continue to drop.

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Critically, we must continue to ramp up our capacity for testing, tracing, and tracking. In a commentary in the Express-News this week, Councilwomen Ana Sandoval (D7) and Rebecca Viagran (D3) emphasized the importance of hiring local workers . In addition to building capacity for COVID-19 response, training local workers provides an educated workforce available for future work in the healthcare industry. We follow epidemic Best Practices by utilizing a culturally competent local population. Furthermore, we stimulate our local economy by paying a living wage with benefits to local people. It’s a win for all.

Those “blips” in the graphic below could very well be huge waves if we fail to bolster our public health systems.

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We can’t slow down, we can’t stop, just because we’re in a better position than where we were at our worst.

And just because I have your attention, I’ll remind y’all of who is being hit the hardest. Districts 1, 2, 3, 4, and 5. That’s the South, East, West sides of Bexar County. Highest proportion of Latinos and Black/African-Americans. Highest rates of poverty. Lowest life expectancy in the best of times.

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A note on the “Staffed beds” metric. As of 9/13, Bexar County hospitals have 246 total hospitalized. This is down from a high of more than 1200 in July. Of those hospitalized, 108 are in ICU. That’s 44% of hospitalized cases are in ICU. That means they’re pretty sick.

There are currently 706 of 4442 staffed beds available, 16%. This metric isn’t meant to imply that the 84% of occupied beds are for COVID-patients. With 246 used for COVID, that means 3490 are being used for other patients. Even if there were no COVID patients in hospital, there would still only be 22% of beds available. This metric alone isn’t used to determine overall stress. What it says is that on any given day, our hospitals are working hard, busy, and near full. That means that there is very little wiggle room to manage a crush of severely ill patients all at once. In flu season, our hospitals experience similar stress to what we saw in July with COVID. Now imagine flu + COVID. Flattening the curve means keeping new, severe cases low enough so that the hospitals can handle the regular things — like heart attacks, car crashes, strokes and more.

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

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