Each evening when San Antonio Mayor Ron Nirenberg appears at a media briefing to report the latest number of new coronavirus cases, he also recites the number of patients who have recovered from the virus. It’s a number that has grown steadily, surpassing 50 percent of all confirmed cases, as San Antonio shows signs of putting the worst of the pandemic behind it.
How the San Antonio Metropolitan Health District determines whether a patient diagnosed with the coronavirus has recovered involves a daily follow-up phone call with each person to document any improvement or worsening of COVID-19 symptoms to determine when it is safe for them to end self-isolation. As of Tuesday, Metro Health has listed 1,028 people as having recovered from among 1,942 confirmed cases.
A 50-person team that includes community volunteers, San Antonio Fire Department personnel, and Metro Health epidemiologists contact people diagnosed with the coronavirus each day for 14 consecutive days, asking patients about improvement or worsening of symptoms, said Anita Kurian, assistant director of communicable diseases at Metro Health.
“There must be documented improvement for all symptoms of COVID-19, and after 14 days the person has to be fever-free for at least three days without taking any medication,” she said.
In any three-week timespan during the pandemic, recovery case managers have made over 11,000 phone calls, said Jennifer Herriott, assistant director of Metro Health.
While COVID-19 patients who remained at home during their illness are tracked daily, people who were hospitalized are contacted less frequently – on a weekly basis – because they aren’t released from the hospital until they are medically stable and en route to full recovery.
“We do a follow up with every hospitalized patient once they are released, and make sure to call them back on a weekly basis” as they continue to recover, Kurian said.
Laura Solis, director of infection control for University Health System, said the hospital system keeps in touch with COVID-19 patients once they are released to ensure they continue to improve.
“We have a team of physicians, advanced practice practitioners and nursing staff dedicated to following up with our patients to ensure they are doing well during their recovery and provide assistance as needed,” she said. “We also communicate regularly with Metro Health regarding the patient’s disposition.”
The recovery guidelines Metro Health uses are suggested by the Centers for Disease Control and Prevention.
In addition to questions about patient symptoms, patients are also asked about recent travel history, whether they have remained isolated at home, and if they recently were in contact with other people who tested positive for COVID-19.
Questions not related to symptom improvement or worsening aim to uncover any community contact during the time the person is symptomatic and better understand what might be contributing to or detracting from their recovery.
While the tracking system employed is relatively straightforward, determining whether a person has recovered can often be delayed depending on when the tracking team is able to reach the person by phone, and whether COVID-19 patients have the information and tools needed to properly track their symptoms, Kurian said.
To ensure consistency with follow-up and disease tracking progress for anyone who tests positive for COVID-19 in Bexar County, patients are assigned a specific member of the tracking team responsible for updating their recovery file, Herriott said.
In addition to tracking recovery rates to report to the Texas Department of State Health Services, information gathered by the recovery team is used to determine whether a patient might need to be connected with an EMT for a home visit or additional phone call to review symptoms more thoroughly.
So far, only nine COVID-19 patients recovering at home have needed to be connected to an EMT for followup, Herriot said.
Recovery case managers might also help the patient obtain transportation to a hospital or health care appointment, food delivery to their home in order to remain self-quarantined, or assistance picking up medication, Kurian said.
Metro Health employees also ask about and track other health-related signs that might indicate illness, including diarrhea and fatigue, even if they do not seem related to COVID-19.
The CDC recently expanded its list of possible symptoms of the coronavirus to more accurately reflect the unpredictability and broad variation in the way the illness can affect individual patients. The updated symptoms include chills, repeated shaking with chills, muscle pain, headache, sore throat, and loss of taste or smell. The CDC previously listed fever, cough, and shortness of breath as symptoms.
“Since this is a novel virus and we are still learning in many respects, [Metro Health] is making sure we track improvement in any symptom of illness disclosed to make sure there is improvement following a COVID-19 diagnosis,” Kurian said.
Other health departments across the state are going beyond CDC requirements for tracking patients.
Dr. Anil Mangla, a former Metro Health epidemiologist who recently retired as director of public health at the University of the Incarnate Word School of Osteopathic Medicine, is spearheading the COVID-19 tracing and monitoring teams in Public Health Region 1, which covers the Texas Panhandle. That region includes Potter County, where an outbreak at meat packing plants have led to an infection rate about four times higher than that of Dallas and Harris counties.
Patients are divided into three risk groups to ensure those with more severe symptoms “don’t fall through the cracks,” Mangla said.
Herriott said in addition to tracking symptoms of COVID-19 patients, the recovery tracking team is working to inform people about the South Texas Blood and Tissue Center’s efforts to collect plasma from people who have recovered from the novel coronavirus. The hope is that such plasma can be used to treat other coronavirus patients.
“We want to let people know that while this is a hard time, there is something they can do to help their fellow community members who have also tested positive for COVID-19,” Herriott said.