San Antonio Express-News (Sunday)
When social distancing takes a vacation
As folks seek summer fun, rules go by wayside
The heat already was oppressive well before noon when David Burshe arrived at Rockin’ R River Rides in New Braunfels with other revelers to float the cool, green Guadalupe River.
An emergency and critical care radiologist at Methodist Healthcare System, Burshe had seen his share of “really sick” COVID-19 patients in recent weeks, he said. But he’d had his fill of staying home to slow the spread of the virus — at least for now.
“I was behind the initial lockdown for the purposes of not getting our ICUs overwhelmed,” Burshe, 40, said Wednesday. “I was there at the peak. And they were coming in every day. But we never even got close to being overwhelmed. My worry is that if and when a true wave comes, a wave that is overwhelming the systems, we will have exhausted our patience for social distancing.”
With the novel coronavirus still spreading, relaxing social distancing now could prove catastrophic, experts say. Gov. Greg Abbott has pushed ahead anyway with a phased reopening of the hobbled economy that will allow for some familiar summer pleasures, even as it exposes more Texans to the deadly virus.
Abbott’s most recent order
keeps amusement parks and water parks closed, but it has opened beaches, rivers and lakes.
Swimming pools and bars now may operate at 25 percent capacity, along with other public spaces, including zoos, museums and bowling alleys. And restaurants now are open at 50 percent capacity.
The governor’s order also allows overnight youth camps to begin operating next week.
“Our goal is to find ways to coexist with COVID-19 as safely as possible,” Abbott said last week. “That includes continuing the safe practices that you’ve already adopted: maintaining safe distances, wearing a mask, sanitizing your hands.”
This amounts to a Texas-sized paradox, experts say.
Given the infectiousness of the virus, keeping a “safe distance” at many summer haunts is exceedingly difficult, even with health protocols in place.
“I think that the key thing, and I’m not sure how anybody is going to do this, is to restrict your interaction, your personal interaction between different groups,” said Dr. Vince Fonseca, a former Texas state chief epidemiologist.
Fonseca was skeptical this could be achieved floating on a river, let alone in bars or museums.
“I think that it would be almost impossible to keep the nonmixing,” he said. “On a river, you can’t even control it — even if I wanted to maintain my distance from you, I can’t. You always end up in those logjams, and there’s nothing anybody can do about it. So it’s probably not a good idea.”
Still, experts say outdoor activities are much safer than anything inside, provided you keep your distance from others.
Recent studies have shown that warmer temperatures and increased humidity may reduce transmission of the highly contagious virus, although changes in weather alone aren’t enough to fully contain COVID-19.
With a vaccine still months or years away, social distancing can buy time. Even with a possible lull in infections this summer, experts say it’s critical to prepare for an expected spike in the fall by building a public health system robust enough to test, trace and isolate anyone infected with the virus.
“Seasonality is in our favor,” Fonseca said, “but if we don’t work extremely hard right now, we won’t be able to deal with the seasonal change.”
As carloads of other tubers arrived in the scorching lot at the bank of the river, Burshe said he wasn’t concerned about exposure to the virus. He had come to float with his sister, Amelia Burshe, and her boyfriend, Frederick Schlick, both freelance opera singers who had fled New York in March.
When the virus hit, Schlick, 28, and Amelia, 25, holed up in their small apartment just outside Manhattan.
“Everything exploded all at once,” Schlick said. “We were getting hundreds and hundreds of new cases every day. And so I got a call from my mom in Pennsylvania, and she said, ‘Get the hell out.’ And I was like, ‘OK, fine, we’ll get the hell out.’ ”
Compared to the “dense cesspool” of New York, he said, Texas is a different universe.
“People are going about their lives,” Schlick said. “And the biggest thing, in Pennsylvania, New York, New Jersey, every single person has a mask on. You don’t have masks. We went to Buccee’s — no one had a mask on. In Texas, it’s just kind of like, ‘Live free, do your own thing.’”
‘Like going 56 in a 55’
As general manager of Rockin R’ River Rides, Shane Wolf has adopted every health protocol required for river outfitters by the governor’s “strike force” to open Texas — disinfecting his shuttle buses between every ride, for instance.
And as board president of the Water Oriented Recreation District of Comal County, which is charged with maintaining health and safety on the river, Wolf has made sure the dozens of other outfitters stretching from the outskirts of New Braunfels to Canyon Lake know the rules, too.
Whether all are abiding by them is a different story.
“Who’s going to enforce anything?” Wolf said. “It’s all recommendations.”
Abbott’s team also released rules for people who visit parks, beaches or other bodies of water, stipulating that any group “may not exceed” the greater of a person’s household or up to five people who arrive together.
Good luck enforcing that, too, Wolf said.
Law enforcement officers “are out here, they’re looking at it, but it’s kind of like going 56 in a 55,” he said. “I have them working on the weekends here, just so when people drive up they see that. And that has always helped in a variety of ways, whether it’s alcohol or rowdy behavior — or now COVID-19.”
Abbott’s team also has released detailed rules for overnight youth camps that would seem to alter the communal experience of summer camp in fundamental ways.
For instance, the governor recommends that camps “separate campers and staff into groups or cohorts that remain consistent over the camp session” and “discourage mixing between groups or cohorts.”
Fonseca, the epidemiologist, wondered how feasible that would be.
“I would have to talk to camp owners to see what they think they’re going to do,” Fonseca said,
“because the whole idea is to have fun together with strangers.”
Many camp directors had no interest in sharing their plans with a reporter, even though their gates are opening soon.
“We have had over the past few days many, many opportunities to be interviewed regarding the summer,” said John Robertson, general manager of Camp Longhorn in Burnet County. “We have always and still do prefer not to go public with this. We would prefer to communicate directly with our camp families.”
Administrators at T Bar M, in New Braunfels, and Burnet County’s Camp Champions also declined to comment.
Dr. Jimmy Perkins, former dean of the UT School of Public Health, wasn’t surprised.
“They’re going to be super nervous,” Perkins said. “The kids in the cabin is the bottom line. The kids in the chow hall. All the indoor places they gather. It’s just problematic. And those cabins are notorious for being old buildings, poor ventilation. It’s not a situation I’d put my kids in, frankly.”
Children are not immune from serious complications from COVID-19 — some have been hospitalized, and some have been diagnosed with a new inflammatory syndrome associated with the virus. But experts say the risk of children becoming severely compromised by the disease is low.
Person-to-person
If summer encourages people to spend more time outdoors during the pandemic, that’s certainly preferable to the alternative, experts say.
That’s because shared airspace — where people talk, sneeze or cough, producing respiratory droplets that can drift into others’ noses, mouths and lungs — is likely the primary environment in which the virus spreads.
Last week, the CDC updated its summary of COVID-19 transmission to clarify that “the virus is thought to spread mainly from person-to-person … through respiratory droplets.”
“Outside is the best place we can be by far,” Perkins said. “It’s far superior to indoors. When you’re outside, even on a calm day, there’s even more air movement than there is in a building. Even if you’re within 3 feet of someone outside, you’re better off than when you’re within 6 feet of someone inside.”
Perkins added, “I’m wary of going into buildings for any period of time that’s lengthy. For example, sitting for an hour or an hour-anda-half in a restaurant, I’m not going to do that. Even if you’re not within 6 feet of someone sitting next you, it doesn’t really matter because it’s a (duration of ) time aspect.”
Another reason to get outside: Evidence is emerging that changes in weather can inhibit transmission of the virus.
A new working paper and database released by Harvard University suggests the reproductive number of the coronavirus — the average number of people who could be infected by someone with the virus — is diminished as temperature and humidity increase.
“Our projections suggest warmer times of the year, and locations, may offer a modest reduction in reproductive number, helping with efforts to contain the pandemic and build response capacity,” the researchers said.
Humidity can help in at least two ways: It makes respiratory particles heavier so they fall to the ground, and it improves our ability to move things out of our respiratory system, Perkins said.
But weather is only one factor in how the virus can spread.
“It’s absolutely not enough,” Perkins said. “The two wild cards for the future are behavior and weather. And if we behave like poor people who have to live in crowded spaces, like in Guayaquil, Ecuador, or Brazil, it’s not going to be very effective. Because there are raging epidemics in those countries, and those are very hot, humid countries.”
That prospect wasn’t enough for Burshe, the radiologist, to stay away from others who had come out to enjoy the gently flowing river — in part because he believes a strong wave of infections is inevitable, even in far-flung Texas.
“I almost feel like there’s a wave of zombies coming, right? And we have some ammo,” Burshe said. “And the ammo is our social distancing. And you can’t maintain it for long, right? So you’ve got six magazines. And the first zombie through the door, we emptied all of our ammo on that first zombie. And the horde still hasn’t come.”
He added, “I think we need to slow the transmission so we don’t overwhelm. We need to protect the weak. It’s a fallacy to think we’re going to stop it.”