When Jennifer Shuford, MD, first heard about COVID-19 in mid-December 2019, the news seemed interesting but not something to worry about.
“I’m personally not an alarmist,” she told Texas Medicine. “So, when I hear rumors about cases, I take it with a grain of salt and wait for more data. I was hearing about these cases in China, and I thought it was all just going to blow over and nothing was going to come of it.”
Dr. Shuford, then the state infectious disease medical officer for the Texas Department of State Health Services (DSHS), certainly did not realize this obscure cluster of pneumonia cases halfway across the world was caused by a virus that would plunge Texas medicine into chaos and consume most of her time for the next two and a half years.
But it didn’t take long for COVID to spread rapidly and catch the attention of Dr. Shuford and other public health officials in Texas.
“By the time we hit the end of December 2019 … then I really started to take note. And our leadership team over that Christmas and New Year’s break started having phone calls about it because we knew this was growing and we were going to be impacted,” Dr. Shuford said.
One thing became obvious quickly: Texas’ public health infrastructure – like that of the entire country – needed a serious upgrade to cope with the demands of a global pandemic.
Suddenly, Dr. Shuford and her DSHS colleagues were expected to brief state officials on the emerging situation; collect information on the disease from medical journals and the media; consult with hospitals and physician practices about the best ways to handle patients; advise private companies and public school systems about how to stay open safely; and provide reliable data about a brand new disease to let people know how the virus was moving around Texas.
DSHS built the teams needed to carry out those tasks while responding hourly to developments in the pandemic, Dr. Shuford says. That took a personal toll. She suddenly saw a lot less of her husband, Clark, as well as her two children – Soren, 15, and Calliope, 13.
“It was absolutely exhausting. Yet every day, you knew you had no choice,” she said. “We needed to get this information out to Texans, so we just used all 24 hours a day.”
Texas physicians were impressed by Dr. Shuford’s ability to juggle her many duties and remain a “consistent voice related to the science of COVID,” said David Lakey, MD, a member of the Texas Medical Association’s COVID-19 Task Force and a former DSHS commissioner.
“I don’t think people who haven’t been in that situation understand how all-consuming that can become quickly – in the midst of all the other stuff you have to do” to fight infectious diseases statewide, said Dr. Lakey, now vice chancellor for health affairs and chief medical officer at The University of Texas System.
Dr. Shuford’s “exceptional analytical and communications skills” during the pandemic helped pave the way for her to be promoted to chief state epidemiologist in December 2020, said DSHS Deputy Commissioner Kirk Cole.
Responding to a crisis like COVID was one of the reasons she had gotten into medicine and specialized in infectious diseases. Caring for people ran in the family.
“My mom was a nurse, and my dad was a pharmaceutical representative, and so [health care is] what we talked about at the table,” Dr. Shuford said.
Dr. Shuford graduated from UT Southwestern Medical School in Dallas and earned a master of public health degree from Harvard University. She moved into infectious disease private practice in Austin before joining DSHS in 2017. Like most physicians, one of her goals was to be helpful in a crisis.
“When the influenza pandemic occurred in 2009, I was so sad that I wasn’t already in public health and couldn’t help with that response at that point,” she said. “I didn’t want to miss another pandemic. When [COVID] started, I was so glad that I was in the position that I was, so that I could do a statewide response. I couldn’t imagine a better place to be.”
COVID exposed many of the weaknesses of the public health system in both Texas and the U.S., she says. Namely, it showed that public health officials must improve their communication efforts, starting with the data they present to the public.
In the past, most infectious disease data weren’t displayed publicly until they had been collected, “cleaned” of duplicate case reports or other problems, and finalized – a process that can take months or years. Clearly, that would not work in trying to inform an anxious public about the progress of COVID, and Dr. Shuford helped oversee DSHS’ efforts to speed up and liven up the way data about the disease were presented.
“It’s hard to have actionable data when it’s a year and a half old,” Dr. Shuford said. DSHS’ experience with COVID data “is showing us that we can start to collect and display provisional (preliminary) data so that people can start to make decisions about it before it’s been totally finalized.”
But the pandemic also did other damage. It left physicians and health care professionals – as well as public health workers – more burned out than ever, she says. Constant controversies on topics like masking and vaccines have made at least some people more wary than ever of public health efforts. That widespread exhaustion over COVID is troubling because other diseases and emergencies are bound to come up.
On the other hand, “we are better prepared than we were back in 2019,” she said. “The coordination within our state, within our nation, and with international laboratories and scientists has improved over time. Sharing data has improved, and the lab techniques have also improved. The databases to store that information have improved. All of these things have moved forward.”
Physicians are perfectly positioned to help address one of the biggest concerns to emerge from the pandemic, Dr. Shuford adds.
“People have become more skeptical and hesitant about vaccines. But people still trust their doctor. So just having physicians who are aware of the importance about vaccines and are willing to communicate that to their patients can take us a long way toward recovering the ground that we’ve lost – and taking Texas further than we’ve been before.” (See “Getting Another Shot,” July 2022 Texas Medicine, pages 45-47, www.texmed.org/GettingAnotherShot.)
Recent data show that more than 95% of Texans have at least some antibodies against COVID-19 – either through vaccines or catching the illness or both – and that may help prevent more serious illness from the disease in the future, Dr. Shuford says. But COVID-19 is not going anywhere, and Texans must now cope with fighting it while addressing other infectious diseases that have been neglected during the pandemic.
For instance, tuberculosis is unusually high compared with other states, and Texas has the highest number of congenital syphilis cases in the country. (See “Making a Comeback – Not the Good Kind,” July 2022 Texas Medicine, pages 38-41, www.texmed.org/CongenitalSyphilis2022.)
“We’re going to have to maintain a focus on COVID-19 while we also maintain a focus on these other public health threats,” she said. “It’s going to make those things that have always been challenging even more challenging.”
Tex Med. 2022;118(7):38-40
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