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Public Health in the Time of COVID-19

Posted on Tuesday, Aug 04, 2020

John Hellerstedt, MD
Commissioner, Texas Department of State Health Services

In 2018, I was invited to attend the Scowcroft Institute’s Fourth Annual Pandemic Policy Summit. I gave a keynote presentation on the 1918 Spanish Flu pandemic and how it impacted Texas 100 years ago. The summit really spurred my awareness and interest in the potential hazards posed by pandemics. I started investigating the topic further when I was asked to write the chapter Resilience is Key for the book Preparing for Pandemics in the Modern World (available for free download:

So last December, when I began to hear the first rumblings of a strange outbreak of a pneumonia-like illness in China, it immediately grabbed my attention. Although the menace seemed far away, it was clearly a threat nonetheless. 

I remember sitting in a meeting on January 21, 2020, the day after the Martin Luther King Jr. holiday. That morning the Centers for Disease Control and Prevention had confirmed the first case of the novel coronavirus in the United States. I commented to my coworkers “this will be the headline news everywhere by the end of this week.” Ten days later, on January 31, we officially activated the Texas Department of State Health Services (DSHS) State Medical Operations Center to prepare for the coming crisis. 

Setting up the DSHS coronavirus webpage,, was a top priority. We also prepared to launch a media campaign to communicate and engage with the public and earn their trust. Keeping the public informed as this disaster unfolded was, and still is, central to our mission. 

At DSHS, we knew it was only a matter of time before the wave would come to our state. DSHS activated the Regional Medical Operations Centers on February 17. On March 4, we made an inevitable announcement: the first positive test result for COVID-19 in Texas. Our state’s patient zero had recently returned from travel abroad and was quickly put under isolation.

Texas Governor Greg Abbott held a press conference on March 13 to declare a State of Disaster for all 254 Texas counties to support efforts to “implement preventative strategies that build on our state’s existing public health capabilities.”  

On March 17, DSHS confirmed the first fatality of a Texas resident who had tested positive for COVID-19. Two days later, on March 19, I declared a public health disaster for Texas because it had become apparent that COVID-19 was an immediate threat, posing a high risk of death to Texans through community spread.

Texas’s government agencies officially joined forces to respond to the crisis on March 26 when the State Operations Center integrated DSHS into its unified command structure. From there the response to the crisis has become ever more layered and complex. Our response staff generally work seven days a week, rarely taking a day off. Across the agency, we’ve pulled personnel away from their normal jobs addressing critical public issues to deal with this never-ending COVID-19 emergency. 

One of the most striking aspects of this crisis is the way it has come over us in waves. Pandemic planning and response have gone through multiple iterations and are still changing constantly. The scientific community keeps making discoveries and advances in what we know about the virus, how to prevent it, and how to treat it. Unfortunately, this can also sometimes lend an appearance of contradictory information or a lack of reliability, which strains public trust. The pandemic has dragged everyone out of their usual routines and they keep being asked to implement new practices. It’s not surprising that we’re encountering resistance instead of flexibility.

Working together as a state, we initially managed to flatten the curve. Our collective actions prevented COVID-19 from overwhelming the Texas healthcare system capacity earlier in the year. However, hard economic realities and strong desires for life to return to normal began to outweigh the abstract threat of the invisible pandemic. Too many people stopped believing that the public health actions they had been taking to prevent virus transmission were necessary, even though those public health actions had worked so well. People stopped taking precautions and increased unnecessary intermingling with others – leading to a surge in cases, and ultimately more fatalities.  

Wild theories and rumors have proliferated along with the virus, spreading through our population and causing collateral damage. But this is not the end of our work as public health servants or as Texans. We can still regain our unity by choosing to work together and protecting each other.  

I for one, am not giving up hope and I believe that we can rally to fight this virus together. For now, and for the foreseeable future, we must practice infection control in our everyday lives and continue the struggle to maintain our public health best practices until we have a vaccine and effective medications to prevent and cure COVID-19.