Commentary: This Is Not a Drill
By John Hellerstedt Texas Medicine February 2021

The Scowcroft Institute of International Affairs at Texas A&M University invited me to attend its 2018 Fourth Annual Pandemic Policy Summit and give a keynote presentation on the 1918 Spanish Flu pandemic in Texas. The summit spurred my awareness and interest in the potential hazards posed by pandemics. I started investigating the topic further when the Scowcroft Institute asked me to write a chapter for the book Preparing for Pandemics in the Modern World (tamupress.com/pandemics-ebook).

As that chapter, “Resilience is Key,” was undergoing the final editing phase, reports of an outbreak of a pneumonia-like illness in China started surfacing. Although the menace seemed far away, it grabbed my attention as a serious potential threat.

On Jan. 21, 2020, the Centers for Disease Control and Prevention confirmed the first case of novel coronavirus, later named “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2), in the U.S. At the Department of State Health Services (DSHS) we realized it was only a matter of time before the virus arrived in Texas. By Jan. 31, we activated the DSHS State Medical Operations Center to prepare for the coming crisis.

Setting up the DSHS coronavirus webpage, dshs.texas.gov/coronavirus, was a top priority. We also prepared to launch media campaigns to communicate and engage with the public and establish ourselves as a reliable source of information. Keeping the public informed as this public health disaster unfolded has always been central to our mission.

Nearly a year ago on March 4, 2020, DSHS announced the first positive test result for SARS-CoV-2 in Texas. Gov. Greg Abbott held a press conference on March 13 to declare a State of Disaster. On March 17, DSHS confirmed the first fatality of a Texas resident who had tested positive for the disease caused by SARS-CoV-2, COVID-19. I declared a public health disaster on March 19 because it had become clear that COVID-19 was an immediate threat, posing a high risk of death to Texans through community spread.

This was the beginning of public health and public policy challenges that are epic and unprecedented in living memory. One of the first was the difficulty in finding personal protective equipment (PPE). As demand soared, the supply dried up. This pattern repeated itself with many of the resources needed to combat COVID-19, from nasal swabs, gowns, and viral transport media, to gloves, data systems, medical-grade masks, and laboratory capacity.

During that initial wave of the pandemic, our health care delivery systems went into overdrive and met with success. Physicians, nurses, and hospitals managed to find whole or partial solutions to problems. At DSHS, we worked 24/7 for days on end to meet the public health needs of the state. It was a baptism by fire.

I am proud of the way DSHS staff have risen to the challenge of COVID-19. Since early spring of 2020, the range of our response efforts during the pandemic have covered:

• Coordination of local and state public health efforts.
• Statewide management and provision of lab testing and capacity.
• Data collection, analysis, and reporting.
• Health care system support and deployment of medical staffing to hospitals and nursing facilities.
• Statewide public awareness, including social media campaigns under #StayAtHomeTexas, #MaskUpTexas, #HealthyTexas, and other messages.
• Science-based public health guidance for individuals and businesses and consultation with local elected leaders.
• Sourcing and consulting on medical supplies and personal protective equipment.
• Developing the infrastructure to safely and appropriately disseminate vaccines.

The scale and scope of the COVID-19 pandemic necessitated a massive statewide public health response encompassing all parts of DSHS. Staff were redeployed throughout the agency as we prioritized our activities while still performing the other ongoing important public health work Texans expect of us: vaccinations, newborn screening, chronic disease prevention, vital statistics, food safety, and consumer protection activities.

DSHS has been working with Texas communities, the health care system, state and local leaders, and many other partners to steer the trajectory of the pandemic in our state.

I’d like to thank the Texas Medical Association and its members for being key partners through it all. I greatly appreciate the support for DSHS and the assistance getting vital information out to professionals and the people of Texas.

The pandemic has affected the medical community in many ways. Some practices saw decreases in visits while other physicians were in the thick of it on the frontlines in an emergency department or intensive care unit. Some of our colleagues acquired the infection themselves, and some lost their lives. When we are able to start the recovery phase of the pandemic, mourning the untimely loss of these heroes will be a part of it.

One of the most striking aspects of this crisis is how it has come in waves. Pandemic planning and response have gone through multiple iterations. The scientific community has continually made discoveries and advances in understanding the virus, how to prevent it, and how to treat it. Unfortunately, this can also lend an appearance of contradictory information or a lack of reliability, which strains public trust.

As physicians, we know how important trust is. Our patients won’t listen to us and take the actions they need to live and thrive unless they believe what we tell them. One of my biggest challenges, interwoven with everything DSHS has done, is maintaining the public trust. That’s especially challenging when our advice is the opposite of what people want to hear.

Sometimes we have to give our patients tough news and don’t know how they’re going to take it. The pandemic has forced people to suspend their usual routines and disrupted their lives. We keep asking them to take new infection control measures that for some are unfamiliar and inconvenient. It’s not surprising that we’ve encountered resistance along the way instead of the flexibility we’d like to see. The resistance has been exacerbated as pandemic fatigue set in.

As of this writing, the timing, technical specification, and quantities of vaccines and therapeutics remain unknown. We’ll need to be flexible as the time to produce the hundreds of millions of doses to achieve herd immunity will add to the complexity of the vaccination process. Demand is going to exceed supply, so even among health care workers, we must manage the supply carefully. That is why I have appointed a vaccine allocation panel to make recommendations following science and data.

DSHS is still enrolling COVID-19 vaccine providers and relies on TMA members to help educate their communities on the safety, efficacy, and benefits of the vaccines. Physicians and the health care community will be the ones who ultimately bring this pandemic under control with your vital role in vaccinating our fellow Texans. (See “Vaccine Rollout,” page 32.)

Please remember to visit dshs.texas.gov/coronavirus for up-to-date guidance and factual information on the pandemic and virus.

Thank you for helping create a healthier Texas.