From March 4, when the first COVID-19 case was reported in Texas, through much of May, state data shows Texans did an effective job at controlling the spread of the virus.

The effort came at a great cost, as state unemployment numbers swelled into the double digits. But while other states in the U.S. were hit harder and faster by the outbreak of the virus, Texas hospital beds remained open, and staff remained able to treat coronavirus patients. Between April 5 and May 31, the Texas Department of State Health Services reported between 1,100 and 1,700 hospitalizations each day.

"We proved we can control the virus and flatten the curve. We did that by simply changing our behavior. For a couple months there was amazing cooperation among all of us to accomplish that goal," said Dr. John Abikhaled, the president of the Travis County Medical Society, about Central Texas residents. "But then we got tired; we got a little stir crazy, and we lowered our guard. As a result, the virus has surged."

Every day for nearly two weeks, from June 12-24, Texas reported a record number of daily hospitalizations. On June 23, the testing positivity rate exceeded 10%, up from a range of 4%-6% in April and May.

In Houston, the Southeast Texas Regional Advisory Council has reported over 90% of intensive care unit beds are in use, and Texas Children's Hospital has begun taking on adult patients as fewer beds become available. In Dallas, UT Southwestern Medical Center researchers are projecting a 20% increase in COVID-19 hospitalizations by early July.

"In Texas as a whole, what we’re seeing right now is we are in the highest-risk phase of the pandemic we’ve ever been in," said Dr. Spencer Fox, the associate director of The University of Texas COVID-19 modeling consortium.

Fox is part of a team at UT led by Dr. Lauren Ancel Meyers that has worked closely with Travis County officials throughout the pandemic and presented projections to the city of Houston on June 15. According to their modeling, Central Texas could exceed its hospital capacity of 1,500 beds by July.

Based on the models and other data, Harris County Judge Lina Hidalgo has recommended that residents in the area minimize all contact.

"Right now, there is significant uncontrolled spread of the virus. We're not any safer today than we were back in March, so it is urgent that residents, businesses and everyone do their part," a spokesperson for Hidalgo's office wrote in an email.

Upcoming holiday a cause for concern

In a June 22 press conference, Dr. Mujeeb Basit, assistant professor of internal medicine and cardiology at UT Southwestern, said the Dallas-Forth Worth area is about four to six weeks away from straining hospital capacity on its current trajectory, but a major upcoming holiday weekend could affect that curve.

"The big unknown is July 4th. We’ve been on a pretty stable trajectory until we had major holidays. The major holidays affected the curve quite significantly," Basit said.

Dr. Darlene Bhavani, an infectious disease epidemiologist at the Dell Medical School at The University of Texas, said a number of factors could have led to the Austin area's recent increase in cases aside from just Memorial Day weekend—from the opening of businesses to increased testing to simple quarantine fatigue and warmer weather.

But Bhavani said with the virus becoming more prevalent in Central Texas, there is no doubt the only way to completely avoid risk during the upcoming holiday weekend is to avoid going out at all.

"When in doubt stay home. The risk is much lower if you stay home. I understand, practically speaking, people are going to go out. If you’re going to go out, do it as safely as possible and understand the risks," she said.

Fox described those risks as two-fold. First, he said, there is a risk associated with gathering in large groups. According to the Centers for Disease Control and Prevention, the potential risk for spreading COVID-19 becomes higher when an individual interacts with more people and for a longer amount of time.

Second, Fox said, is the increased risk of spreading the virus to high-risk populations. In a June 16 press conference, Gov. Greg Abbott said Texans under the age of 30 are testing positive at a higher rate in many parts of Texas, including Hays County.

"It's hard to tell exactly where those people contracted COVID. It could be Memorial Day celebrations; it could be a bar setting; it could be some other type of gathering," Abbott said.

Fox said those trends show large gatherings are not the only cause for concern. Even a small family gathering presents a risk because an asymptomatic younger person could unknowingly spread the virus to an older family member.

"It may not be the young people getting [the virus] who bear the brunt of it. It may be their parents or aunts or uncles or friends. We have to understand we are responsible for each other," said Dr. Mark Escott, the interim Austin-Travis County health authority.

On June 23, Abbott gave local governments leeway to create their own rules and restrictions for gatherings of more than 100 people. Many Texas cities have altered their plans for Fourth of July fireworks: Houston will be holding a virtual show; Plano raised the altitude of its display to make it more visible to residents in their homes, vehicles or neighborhoods; and for just the second time in more than 40 years, the organizers of Austin's fireworks show and concert canceled the event altogether.

If residents do host Fourth of July gatherings, Bhalwani said there are steps they can take to stay safe. Visual cues are good reminders for guests to keep distance—whether that means spacing out furniture or marking X's 6 feet apart. She also recommended limiting the sharing of plates and cups, staying outdoors if possible and limiting the size of the gathering.

According to Escott, the risk of the virus spreading is so great in Central Texas that residents should stay home unless necessary and should not be gathering in groups of more than 10 people.

"I know it’s Independence Day. We want to celebrate our country. We want to celebrate with our family. We are putting people in danger when we do that," he said.