Trends in COVID-19 Infections during Four Surges in Bexar County, Texas

Research Article

Austin J Infect Dis. 2023; 10(3): 1088.

Trends in COVID-19 Infections during Four Surges in Bexar County, Texas

Sarkar S; Alonzo C; Cunningham J; Martinez P; Kurian A*

Department of Communicable Diseases, San Antonio Metropolitan Health District, San Antonio, Texas 78205, USA

*Corresponding author: Kurian A Deputy Director, San Antonio Metropolitan Health District, 100 W Houston St. 14th Floor, San Antonio, Texas, 78205, USA. Tel: 210-207-8805; Fax: 210-207-8999 Email: Anita.Kurian@sanantonio.gov

Received: July 12, 2023 Accepted: August 11, 2023 Published: August 18, 2023

Abstract

Background: Bexar County, Texas has experienced four COVID-19 surges during the pandemic. This study investigates trends in COVID-19 infections over the course of pandemic. The objective is to describe the association of COVID-19 infection cases with changes in testing availability, masking, distancing policies, and occurrence of public holidays during the surges.

Methods: Cases occurring since May 26th, 2020, until March 31st, 2022, comprise this analysis. Case data were obtained from the Texas NEDSS database. Aggregate hospitalization data were obtained from STRAC (Southwest Texas Regional Advisory Council) for Bexar County hospitals. Analyses were conducted using R-Studio and Excel. Demographic statistics, percentages, case fatality rates were computed.

Results: Average age (34 years), female gender (52%), Hispanic ethnicity (69%), residing in the Southern zip codes of Bexar County, and negative vaccination status were associated with the four COVID-19 surges. During all surges, test positivity, hospitalization and mortality rates all increased. Surges coincided with the major public holidays.

Conclusion: These findings highlight the association COVID-19 infections with implementing and loosening restrictive policies, along with sociocultural events and public holidays in Bexar County, Texas. Preventative efforts promoted safer behavior and decreased the COVID-19 infection on majority of days during the pandemic except closer to public holidays when a high infection rate was observed in the form of surges.

Public Health Significance: Preventative efforts at the local governmental level along with voluntary compliance with restrictive COVID-19 policies by Bexar County Residents are necessary for decreasing community infection and widespread disease.

Keywords: COVID-19; Surge; Trends; Holidays; Bexar-county; Policy-decision

Abbreviations: COVID-19: Coronavirus; SARS-COV-2: Severe Acute Respiratory Syndrome Coronavirus 2; JBSA: Joint Base San Antonio; NEDSS: National Electronic Disease Surveillance System; STRAC: Southwest Texas Regional Advisory Council; WHO: World Health Organization

Introduction

Coronavirus (COVID-19) infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2), originated in Wuhan, China in December 2019 and spread to the United States in January 2020 [1]. On February 2020, confirmed cases of Coronavirus were identified among a group of Diamond Princess cruise ship passengers who were quarantined at the Federal facility at JBSA (Joint Base San Antonio) Lackland [2]. The initial origin of community spread in Texas remains unclear as testing capacities across the state were limited and not much was known about the novel coronavirus infection. The Texas Department of State Health Services reported the first non-cruise ship positive COVID-19 case on March 4, 2020, in Fort Bend County [3]. Since then, Texas has been severely impacted by COVID-19 pandemic.

The World Health Organization declared COVID-19 a global pandemic on March 11, 2020 [4]. During the pandemic, rates of infection, hospitalization, and case mortality all increased in Texas and individual counties implemented and evaluated their own responses. This paper examines trends in COVID-19 infections in Bexar County, Texas, during the four surges and highlights associations with public holidays, testing availability, masking, social distancing policies, and vaccination.

Methods

Cases occurring from May 26, 2020, through March 31, 2022, comprise this analysis. Case data were obtained from the Texas NEDSS (National Electronic Disease Surveillance System) database. Aggregate hospitalization data were obtained from STRAC (Southwest Texas Regional Advisory Council). STRAC maintains the regional trauma system. COVID-19 tests included public, commercial, and military lab results reported to the San Antonio Metropolitan Health District and recorded in NEDSS. Analyses were conducted using R and Excel. Descriptive statistics including percentages and Case Fatality Rates (CFRs) were computed.

Results

Bexar County, Texas, has experienced four COVID-19 surges during the pandemic. Surges coincided with major public holidays. During all surges, case numbers, weekly positivity rates, hospitalization and mortality rates increased. In aggregate, 552,192 cases and 5,689 deaths (CFR, 1.0%) were reported during the surges. Demographic characteristics indicated an average age of 34 years, 52% female gender, and 69% Hispanic ethnicity among cases with available ethnicity data. Cases tended to concentrate in the Southern zip codes of Bexar County. Negative vaccination status was associated with COVID-19 surges. Timeline Events (Appendix 1) and specific reports for the individual surges are detailed below:

First Surge

This surge started on May 26, 2020 (one day after Memorial Day), peaked on June 29, 2020, (close to July 4, 2020, Independence Day holiday) and ended on September 8, 2020 (one day after the September 7, 2020, Labor Day holiday).

Timeline Events

Due to increases in COVID-19 cases, on June 27, 2020, “Stay Home” alerts were issued [5]. On June 29, 2020, restaurant dining capacity was reduced to 50% occupancy [5]. On July 2, 2020, mandatory mask and face covering orders were executed across Texas as cases surged and public gatherings of more than 10 people without government approval were prohibited and fines were implemented for non-compliance with the executive order [5,6].