San Antonio’s Public Health Transition Team met in late April to prepare a plan for re-opening. Phase I was the most severe, the Red Zone: Stay Home, Work Safe. Every thing would be closed. Well, almost.

In Phase II, some businesses could re-open with restrictions on capacity. Daycare facilities would open, some summer day camps, but no overnight camps and no schools, yet. Phase III would be when schools were opened, businesses could open to capacity, but still restrictions. Phase IV would be when we were “back to normal” and could focus on preparing for the next pandemic.

At each stage, the city would look at the following indicators:

  • A decrease in the number of days it takes for the number of COVID-19 cases in our community to double (doubling time)
  • An increase in the percentage of COVID-19 tests suggestive of active infection that are positive for COVID-19
  • An increase in indicators of health system stress, such as reductions in personal protective equipment, hospital bed, or ventilator capacity, and increases in emergency medical system calls

It didn’t quite work out that way. We moved into Phase II before being out of Phase I. But really, in retrospect, we were probably already in Phase II this spring based on our caseload.

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Today, we’re very much in the Red Zone, Phase I.

The bars in this graph shows the average number of new cases each week since April. We wanted to flatten the curve. We were supposed to use that time to make sure we were ready to deal with the inevitable spike. Our case load was consistently low enough, that being in Phase II seemed acceptable.

But see how fast that changes. The orange line is the positivity rate. At the beginning, we were testing mostly people who were very likely positive, and not very many. Today, we’re testing many more per day.

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The orange bars are the average number of tests performed per day for each week. We’re performing far more tests now, with many more positives.

As for hospitals, they’re in the danger zone.

So if we go by our indicators, we’re in Phase I. We closed schools preemptively when we were effectively in Phase II. Opening them now that we’re in a situation of severe stress seems counter to public health practice.

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

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