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2020 MEDICAL YEAR
IN REVIEW

As a backdrop, the San Antonio Metropolitan Health Department 7 days a week, long hours, and in alternative work sites for most of the
was thrust into a response for which no agency in the United States year. The agencies each responded in their areas of expertise and
could have adequately prepared. What the city had going for it were greatly expanded their impact. For instance, San Antonio Fire De-
a few valuable gems that are rarely discussed, which ultimately saved partment used their Mobile Integrated Health program to provide
lives. First, at the health department, the primarily female and diverse COVID testing at Skilled Nursing Facilities to control outbreaks.
leadership team was highly experienced, educated, dedicated and This Emergency Response System had previously been used in re-
widely respected. Under the leadership of the Assistant City Manager, sponding to natural disasters, such as people evacuated from hurri-
Dr. Colleen Bridger, the team was crafted over years of smart hiring canes to San Antonio. That experience, plus tabletop exercises in
and trusted leadership during challenging times. Secondly, the city preparation for a pandemic, led to established roles and responsibilities
leadership chose to respect the health department’s guidance and reg- of the same organizations in 2020. But beyond the textbook plans
ulations. Under Mayor Ron Nierenberg and Judge Nelson Wolff, the and ability to execute the plan, responding to a crisis required trusted
department was provided verbal, financial and political support. relationships between organizations which took years to build during
Third, the most impactful professionals in our community during the smaller events and even being partners during a non-event. The inter-
pandemic were two doctors whose names are now recognized by the agency relationships that public health depended on required the care
entire city. that any relationship needs…communication, trust, dedication and
The Local Health Authority, Dr. Junda Woo, came to the role 5 mutual celebration for good work.
years ago as an OB/Gyn and former writer for the New York Times.
She was thrust into the spotlight, skillfully translating the science into 2. Public Trust in Science is Fragile
practical terms that could be used by elected leaders, epidemiologists, Earning the public’s trust in science, medicine and evidence-based
school boards, business owners and the public. Through her legal au- healthcare had been taken for granted by most for many years. What
thority under state law, Dr. Woo was able to help curtail outbreaks in we learned this year is that when people’s health is threatened, they
long term care facilities and other environments. Another doctor, Dr. look for alternative plausible solutions and explanations. This is
Anita Kurian, a former family physician in India and executive public human nature and as physicians, we are accustomed to second opin-
health leader in Texas, was the ultimate leader of the response. Nor- ions and internet searches when we give a challenging diagnosis. For
mally responsible for communicable disease programs, and as the pan- many scientists, it was alarming to see the same reaction on a popula-
demic exploded, Dr. Kurian quickly assumed the task of shepherding tion basis; some blamed politics, others blamed the novel-ness of the
a public health workforce of over 520 people working all aspects of virus, others blamed system failures or even competing views of scien-
the COVID response. Physician leadership was a significant contrib- tists, but in the end, the result has been the same. The public’s trust in
utor in the race to beat the pandemic. I was honored to join this team science is fragile.
of science leaders in July, almost 5 months into the pandemic. The les- Science is not immune to challenges and is built on testing assump-
sons learned below are from the combined experiences of the amazing tions. Yet that rigorous scientific process that we were trained on has
leaders of the San Antonio Metropolitan Health District. come under scrutiny to respond in the speed needed when the threat
is ubiquitous. The rigor was viewed as bureaucratic. The statistics were
HERE ARE THE TOP 10 LESSONS perceived to be gaming a system or advancing a political view. The
LEARNED IN THE PANDEMIC recommendations on safety were seen as overbearing or not truly pro-

tective. The actions by the government officials to impose quarantines
1. Responding in a Public Health Crisis Requires a or close places of congregation were challenged as overreach and sti-
Multi-agency Emergency Response fling civil liberties. Theories around public health hiding information
For San Antonio, the public health crisis of the pandemic required were as abundant as the theories around hidden motives in inflating
a Unified Command and multiagency response. San Antonio Met- numbers or providing guidance. The work of public health was met
ropolitan Health District, San Antonio Fire Department, South Texas with legal, social and intellectual push-back.
Regional Advisory Council, City Manager’s Office, Mayor’s Office, So, what does this fragility of trust in science mean going forward?
Bexar County, University Health System, UT School of Public It means as scientists, we must recommit to having meaningful, honest
Health, the Bexar County Medical Society and many other crucial conversations with patients, peers and the community on a regular
agencies became instrumental in ensuring the response was compre- basis, not simply in times of crisis. We must respect the decisions of
hensive, timely and robust. Most of the agencies dedicated a substan- people without condemnation or fault. We must educate to the best
tial portion of staff and resources to responding to the Pandemic, often of our knowledge and give options when they are available. And we
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