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2020 MEDICAL YEAR
IN REVIEW
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ously, determining which COVID
tests could be used based on the con-
dition of the patient also added com-
plexity to the case counting. Finally,
due to the testing surge, some large
laboratories and hospitals were re-
porting cases in batches, often weeks-
to-months delayed.
Then, there was the challenge in
death reporting. Sadly, many people
in San Antonio have died with
COVID ever since the pandemic
began. The complexity of “cause of
death” reporting was not different
during a pandemic, but the public
rightfully wanted the information
faster than the normal death records
process would allow. This led to ac-
must adapt to the environment around us to meet the needs of the cepting unofficial reports from facilities or the coroner to show sever-
person in their entirety, not just the physical; learn what drives their ity of illness to our community but had to await official confirmation
belief system and accommodate where they are in accepting the world weeks-to-months later, after a death certificate was available to review.
as it has changed. And finally, recognize that the system used for rigor The reconciliation process added fuel to the conspiracy theories saying
in science is the counterweight to the art of medicine. numbers were inflated to increase payments from the government or
to sabotage a political candidate.
3. Counting in a Pandemic is Tough The reality was simply this: counting cases during a pandemic is not
Being transparent is essential during a crisis. The pandemic was no clean due to the complex health care and public health systems we have
exception. Many governments turned to data as a presumed unmiti- in Texas that existed prior to the pandemic. There is a lag time between
gated source of truth and a community impact index. Yet, during the when people get care and how that information is shared. It is not like
COVID Pandemic in San Antonio, the situation was like Americans going to the ATM and pulling out cash where your bank account is up-
watching football games; the community looked to daily number up- dated instantaneously. I wish it was! But sadly, think of it like the days
dates of cases, deaths and outbreaks on television, radio and other when you wrote a check for a purchase and never knew when it would
media channels. Government agencies were quick to share what they be cashed; your account could be flush with money and then suddenly
knew of the case counts and overall impact in multiple formats from overdrawn. Ideally, our community would see the statistics as a gauge
social media, local news and even the Mayor’s “Daily Briefing” on tel- more than a definitive marker for COVID in the community.
evision (and other broadcast modalities). The desire to be transparent
is the culture of the San Antonio government to make sure citizens 4. Contacting Contacts Has Always Been Difficult
make informed decisions. The role of public health has always been to confidentiality notify
Yet with the commitment to transparency, the challenge public contacts of reportable communicable diseases. There are different tac-
health officials faced to account for cases became the focus, instead of tics that have been employed by public health experts over the years
the message of safety. For instance, though COVID-19 was a re- based on the disease, the environment, and the next steps the “contact”
portable condition, recognizing laboratories were overwhelmed in the must take. For instance, a person who has been diagnosed with tu-
early days of the pandemic, meaning sometimes a result was available berculosis would identify the places where they spent more than 8
10-12 days after collection. This delay in confirmatory diagnosis hours with others while indoors. For measles, which is more easily
added to a delay in reporting to public health. As lab capacity im- transmitted, a sick person would describe every environment they
proved, the official definition of a COVID case continued to evolve were in over 2 days prior to symptom onset. For a sexually transmitted
in public health, so some persons were able to be included in official infection, a person would share the information they knew of intimate
counts, while others were pending further investigation. Simultane- partners they had in the last 2 months. But when it came to COVID-

14 SAN ANTONIO MEDICINE • December 2020