How San Antonio Metro Health Is Measuring School Reopening Readiness
San Antonio Metro Health’s new directive issued Friday lays out a roadmap to help Bexar County school systems decide when and how to safely reopen for in-person learning.
The directive uses a color-coded reopening indicator to recommend districts hold off on face-to-face instruction or cautiously open their doors, depending on the risk of spreading COVID-19.
The reopening indicator is based on three key public health metrics:
1.) The percent of coronavirus test results coming back positive, known as the positivity rate.
2.) How long it takes for the number of cases to double, known as the doubling time.
3.) If the number of cases has been on a continuous decline for two weeks
Bexar County is currently in the high-risk red zone, with a positivity rate around 13% and case numbers that continue to rise and fall daily like a yo-yo.
The positivity rate has gone down significantly over the last month from a high of 24%, and San Antonio has edged past its goal of taking at least 18 days to double the total number of cases. But the slight improvements haven’t been enough to move the region into the indicator’s yellow zone, which indicates moderate risk.
At a virtual town hall two days before she issued the new directive, Bexar County Health Authority Dr. Junda Woo said it was safe in both the red and yellow zones to bring in an “extremely limited” number of children for face-to-face instruction, if safety measures were strictly followed and there were no more than six students per class.
“I would not ask anybody to go into a situation that I would not myself go into,” Woo said during the town hall. “I think there are ways to lower the risk. It’s not going to be zero risk, but I think there’s a way to lower the risk to where it’s similar to the risk that you would experience going shopping.”
But by the time the health directive was issued, Woo had changed her mind and said districts should keep learning 100% remote as long as the indicator stays in the red.
The only in-person student interactions recommended by the directive during the red zone are one-on-one “ancillary services” that won’t require contact closer than 6 feet for more than 15 minutes. If a district decides to offer those services, all employees should wear both face masks and eye protection.
The directive moved the recommendation for limited in-person learning with no more than six students per class to the yellow zone, about halfway between the current high-risk level and the low-risk green zone.
Woo said special education students should get first priority for face-to-face instruction during the yellow zone because their disabilities make virtual learning difficult — and sometimes impossible.
“It's a right just on its own and then behind it, it's a right that's backed by the law,” Wood said. “There's a legal requirement that there's equal access to education for students with special needs.”
Although teachers would be in the classroom for a lot longer than the hour or so it takes to go to the store, and even though students with disabilities often need a lot of hands-on support that requires staff to be a lot closer than 6 feet, Woo said it’s still possible for districts to keep their employees as safe as they would be shopping.
“The standard that we use in hospital settings is if the other person is not wearing a mask, but you have a mask and eye protection, then you are protected,” Woo said. “We've got this down. We do not see our health care workers very commonly getting infected.”
Woo said good ventilation also decreases the risk, and should be a factor in a district’s decision to reopen. She said schools should follow the recommendations of an industry organization called ASHRAE to modify their air cycling practices if possible.
Metro Health doesn’t fully recommend in-person instruction until the low-risk green zone. Even then, the directive says older children and adults should stay 6 feet apart and wear masks.
In order to reach the green zone, Bexar County needs a positivity rate of no more than 5% and two weeks of continuous decline in the number of cases. It also needs to maintain the doubling rate of at least 18 days.
According to the World Health Organization, communities should maintain a 5% positivity rate for two weeks before reopening.
What Happens Next
At the coronavirus briefing the night the new health directive was released, San Antonio Mayor Ron Nirenberg confirmed that it replaces Woo’s original order, which closed all Bexar County schools to in-person learning through Labor Day.
“Let me be clear. The local public health authority can’t order a school to be closed. But we are working with our school districts to make sure that they are operating in a safe way,” Nirenberg said.
The new directive was issued following a week of confusing back-and-forth messages from state officials that left districts wondering if they could lose funding if local health authorities ordered blanket, county-wide school closures.
Most recently, Gov. Greg Abbott said schools can get a waiver to stay virtual longer than the eight weeks allowed under the latest rules from the Texas Education Agency.
So far, most school systems based in Bexar County seem to be committed to following both Metro Health’s original order and its new recommendations.
If they do, Woo said that gives her more time to learn from other districts and cities that are being less cautious.
“We already see other communities jumping in to be the guinea pigs,” Woo said. “All we have to do is stay on the sidelines and watch, and we're going to know a lot in one month, two months, and then we can stop speculating and hopefully (stop) being mean to each other because of our speculations.”
But when San Antonio schools do open, Metro Health is expecting coronavirus cases to follow.
During Friday’s coronavirus briefing, Metro Health’s assistant medical director, Dr. Sandra Guerra, said cases would likely show up in schools the first month they reopen.
“This is so prevalent in San Antonio at the moment it is likely to end up in a school as well,” Guerra said.
The new directive requires districts to report the number of infections and absences to Metro Health weekly, and post them online.
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