Chicago is warily eyeing a host of issues that could set the city back in its fight against COVID-19, just as cooped up residents started to return to some sense of normalcy.

Mayor Lori Lightfoot inched open the city’s economy on June 3 after more than two months of a stay-at-home order to slow the spread of the new coronavirus.

That coincided with days of packed shoulder-to-shoulder protests for George Floyd, a black man who was killed by Minneapolis police when a white officer knelt on his neck.

Businesses destroyed by looters have been cleaning up. Add to the mix more people venturing outdoors as the weather warms up.

Suddenly, there are a lot more people who could be catching and spreading COVID-19.

“I think these next two weeks will be telling,” said Dr. Janet Lin, an emergency department physician at the University of Illinois health system on the Near West Side.

That’s because it typically takes up to 14 days for COVID-19 symptoms like a cough and shortness of breath to surface.

Hospitals are bracing for a potential spike in cases, while Chicago public health leaders are keeping a close eye on a host of metrics that could push the city back into so-called Phase 2 — a phase with restrictions Lightfoot just lifted. The city is currently in Phase 3 of its reopening plan.

Hospitals across Chicago and Dr. Allison Arwady, the city’s public health commissioner, offered WBEZ a glimpse into what they’re looking out for.

What could set Chicago back

Chicago’s public health department analyzes a variety of data that falls into seven buckets to determine how well the city is fighting COVID-19 and whether the city can lift restrictions, or needs to put them back in place.

For example, health officials want to see cases of COVID-19 decline consistently, for hospitals to be able to manage patient caseloads, for fewer than 15% of people in communities to test positive for the coronavirus, and less than 30% testing positive in congregate settings like nursing homes and homeless shelters.

Arwady said what could set Chicago back isn’t one metric among any one of those buckets. It’s about patterns.

“At the end of the day, the biggest concern out of all of this is the threat of overwhelming the health system,” Arwady said.

She said city leaders knew that as the economy reopened and more people started leaving their communities for a bite to eat or a haircut, there would be more cases.

But Chicago hospitals can only handle so much COVID-19. They currently have the combined capacity to manage up to 600 intensive care beds for the sickest patients, up to 1,800 other beds for patients who aren’t as sick but still need to be hospitalized, and put up to 450 patients on ventilators.

Chicago’s COVID-19 patient caseload is below these caps now. But, “if we were starting to see a significant increase that started to move us up toward those numbers, that would be a pause, perhaps a little bit more restriction,” Arwady said. “And if we got up to those numbers, we would absolutely just need to go back into shelter in place.”

There are less drastic alternatives, Arwady said. For instance, if cases in Chicago start to pick up, but not to the point that hospitals would get overwhelmed, city leaders wouldn’t necessarily take a step backward into Phase 2. But they might not reopen aspects of the city they had planned to in the current Phase 3, like the popular lakefront.

“My biggest goal is to not have to take that big step backwards,” Arwady said. “The way we don’t have to take a big step backwards is I think by taking, especially right now in this first month or so, very gradual small steps forward, continuing to keep a close eye on things and then move forward from there.”

She said she’s concerned about what the next few weeks could bring.

“COVID[-19] was just not top of mind through this whole time, through the protests, through the violence,” Arwady said. “And I would not expect it to be. But during that time, not just the protesters but I think a lot of us here in Chicago were getting together in ways that we just had not done in months, whether it’s people getting together for comfort or security or neighbors gathering.”

Weary hospitals gear up for the next wave

Doctors and leaders at hospitals around Chicago say they were already waiting to see if COVID-19 cases would start to climb on the heels of summer as people tired of staying at home started to venture out. Now doctors are factoring in people huddled close together at protests, wearing masks or not.

“We’re optimistic with the trends we’ve seen,” said Dr. Paul Casey, chief medical officer at Rush University Medical Center just west of downtown. “But I think it’s safe to say hospitals throughout the city and throughout the country are kind of holding a collective deep breath.”

Still, hospitals say they’re more prepared and experienced for any surge than they were in March, when the pandemic grew here. Hospitals have already set up essentially separate emergency departments and hospital units for suspected and positive COVID-19 patients. They can test people much faster, waiting in some cases less than an hour for results instead of more than a week.

They’ve gotten creative with protective gear amid a global shortage, buying more durable and reusable items, like plastic goggles or respirator masks that can be cleaned and their filters changed every two weeks instead of using them just once. And they can treat patients better with lessons learned, such as putting patients who are having a hard time breathing flat on their stomachs to preserve life-saving ventilators.

And public health officials now know that African American and Latino residents are dying of COVID-19 at higher rates than other racial groups, helping officials steer resources to communities impacted the most.

At the University of Chicago’s medical campus in Hyde Park on the South Side, the number of hospitalized patients with confirmed COVID-19 rapidly declined from a height of around 140 in mid to late April, to just over 40 on June 5. Emily Chase, senior vice president of patient care services, said U of C was planning for an uptick in cases in the fall if kids headed back to school and the weather cooled with flu season approaching. They thought about winding down their COVID-19 operations over the summer and relaunching them in September or October as cases picked up.

Then large gatherings swelled after Memorial Day.

“We really talked a lot about what would it look like if in two to three weeks we saw that increase and we’d have to quickly turn around and pivot back into caring for more COVID positive patients,” Chase said.

So instead of putting around 40 beds reserved for coronavirus patients that are now empty back in the mix for non-coronavirus patients, U of C is going to keep them vacant for now.

Sinai Health System on the Southwest Side created a tool to predict when COVID-19 could get worse. So far, there’s no sign of it. Doctors admitted about 30 patients a day when cases peaked in late April to early May. Now it’s fewer than 10.

Still, Sinai’s chief operating officer Airica Steed said, “We have not let our guard down whatsoever.”

Just down the street from Sinai’s flagship hospital, bordering Lawndale and Little Village in the heart of some of the highest rates of confirmed COVID-19 in Chicago, Saint Anthony Hospital’s Dr. Alfredo Mena Lora echoes Steed’s sentiment.

“Everything is slightly better than many weeks ago, but we’re still in full kind of battle mode,” said Mena Lora, an infectious disease specialist who is leading Saint Anthony’s COVID-19 plans.

About 45% of patients there in late May tested positive for the coronavirus compared to around 50% in mid-April.

How to manage the next outbreak

Mena Lora said going forward, as Chicago continues to open, the outbreaks could be managed using what he refers to as a hammer, and a dance.

“What we’re going to see is little waves hopefully,” Mena Lora said. “The hammer is if you see a wave rising, then you have to use the hammer, which is aggressive infection prevention measures and social distancing measures, hopefully not as aggressive as we’ve had to do. And it was necessary. The dance is what we’re doing now.”

The dance is doing regular activities, but in a protected way, such as wearing masks and staying six feet apart while grocery shopping, or going out to eat in small groups with bookcases or large plants in between tables.

Mena Lora plans to partake. His wedding anniversary is June 8. “I’m trying to find a place where I can safely social distance and take my wife to a nice lunch or something,” he said.

Mena Lora said he has the same concern about protesters spreading the virus as he did with people who crowded bars to celebrate St. Patrick’s Day before Gov. JB Pritzker’s stay-at-home order began. Still, at least many protesters wore masks, Mena Lora points out, compared to at the bars back in March.

And he said he understands why people are gathering and marching for George Floyd. He said he tried to explain it recently to his 5-year-old daughter. People protested across the street from where Mena Lora and his family live in the South Loop.

“All of this is all connected,” Mena Lora said. “The disparities that we see in health and frankly, what the protests were all about. It’s about dignity.”

Kristen Schorsch covers public health on WBEZ’s government and politics team. Follow her @kschorsch.