Dawn Emerick had been on the job as director of the San Antonio Metropolitan Health District for less than two weeks when evacuees from the coronavirus-stricken region of Wuhan, China, arrived at Joint Base San Antonio-Lackland.

Since then, her days have been a whirlwind of crisis meetings, press briefings, and logistics plans as her department worked to slow the spread of the disease, an experience she likens to having to “juggle chainsaws and watermelons while walking on a tightrope.”

Emerick, 52, has more than 20 years of experience in the public health and human services sector, including serving as public health director in Oregon’s Clackamas County for three years, and in that state’s Benton County for just nine months before she was tapped to take over Metro Health, which had been without a permanent director since Colleen Bridger was promoted to assistant city manager in March 2019.

Emerick’s first day at Metro Health was Jan. 27, and the first evacuees, some of whom were later diagnosed with COVID-19, arrived Feb. 7.

In an interview with the Rivard Report, Emerick discussed what it’s been like to be thrust into an unprecedented public health crisis while trying to get acclimated to a new job. The interview has been edited for length and clarity.

Rivard Report: You describe the experience of developing a local response to combat COVID-19 as juggling “chainsaws and watermelons while walking on a tightrope.” Break that metaphor down, and discuss the struggles the health department faces in developing new protocols for testing and protecting the community.

Dawn Emerick: This is a whole new world for public health workers as well as emergency response folks, including police and fire. I have never seen anything like it. It’s called a novel virus for a reason, and because we don’t know a whole lot about it, we have had to pull information from as many resources as we can, including experiences other countries are having, and figure out how to do the most effective thing in a moment where there is little wiggle room for mistakes. To some extent, as much as you plan there is still a lot of airplane-building you’re doing while already flying.

To break down the metaphor, we are dealing with the sensitivity of health data, we are dealing with fear in the communities and among first responders, and we are dealing with the inability to sometimes get information out in a quick manner. Not to mention the landscape of the virus and its impact changes every 15 minutes. Right when you release some information, within 15 minutes it all changes again, whether that be testing protocols or business closures. How do you ensure quality assurance and build trust in the community when the information changes so much? It’s really tough.

Health systems across the country take great pride in making sure we have the trust of our community. We are the thought leaders, the experts, and when it becomes difficult to quell concerns or always have an answer – or its difficult to get an answer – that concerns me just as much as it does anyone else.

RR: Has there been a time in your public health career when you have had to deal with an outbreak like this?

DE: In public health, we are used to isolated outbreaks, like foodborne illnesses, and things that you can put your epidemiologist on and they do their magic and are able to zero in on who the culprit is to contain it quickly. In some instances, it may take longer than others to find the cause, but we are able to contain it very quickly once we know. We can’t do that now, not with this novel virus.

The problem we and other health departments across the globe are having that we do not normally have is a lack of data. The data comes from testing, and we use that to do forecasting and find trends and make decisions based on data. The shortages and backlogs of testing, not just in San Antonio but across the country, makes it very difficult to forecast what is happening or determine the absolute best way to contain it.

We are all learning and are watching what is happening across the U.S., and I am contacting my public health peers in larger cities to see how we are facing these challenges and are learning together how to deal with it.

When the evacuees arrived from Wuhan, we had no idea that folks who were going to be on Joint Base San Antonio-Lackland were not going to be able to stay on base if they were infected. We had no clue. Within 24 hours of the first evacuee being diagnosed with COVID-19 we set up a health care system to manage it when there were no real protocols and so little information.

RR: You came here from Oregon and before that you worked in Jacksonville, Florida, two very different public health landscapes. How will those experiences help guide your work here, in a state with the highest uninsured rate in the nation and in a county with 2 million residents?

DE: I lived in Florida and was there for 25 years working in public health, and it was a struggle to get care to residents. The state didn’t expand Medicaid and rejected pretty much all of the funding associated with the Affordable Care Act when it became available. I was living in Jacksonville and looking for ways to improve our system, so I started reading up on Oregon and everything it was doing and I said, ‘I want to be part of that. I want to be a trailblazer and be a part of progressive policy that is impacting the state.’

I started using what I was learning from Oregon to push for initiatives to increase access to care for uninsured people who didn’t qualify for Medicaid and increase funding for community-level programs to get people the healthcare they needed. When a position became available in Clackamas County, I went for it hoping the outcome would be that I learned a tremendous amount of information concerning what it takes to overhaul public health systems and do it effectively so it impacts all residents.

Every health department is different, but after working in Florida, then in Oregon, I feel more empowered to say definitively what is possible when investments in public health infrastructure are made.

I know that in Texas, like in Florida, I can’t change what is going on at the state legislation level, but I think we can take some of those principles of modernizing the system. We have a team of officials – including Mayor Ron Nirenberg, Assistant City Manager Colleen Bridger, and City Manager Eric Walsh – who all believe in public health.

RR: You have been going nonstop on COVID-19-related work since you arrived in San Antonio. What do you want to focus on once the pandemic slows down?

DE: The first thing I want to do is meet my team, get to know who they are. We have had 100 percent of our Metro Health staff redeployed so that everyone is focusing on this pandemic in some aspect, and I want to meet these people who have been working so hard and get to know them, learn their children’s names, and what motivates them.

After that, I want to understand what we do and do not do well. I want us to continue to be a national model in policy and in adverse childhood experiences and trauma-informed care at the community level. What might help that would be to create relationships with local universities so we can function more as an academic health department, so we can share local research and work together to really map out progressive health policies that we can back up with numbers.

I am a big vision girl, and I am ready to do some really big things for San Antonio. Once I hone in and see what our strengths and weaknesses are, I want to bring people to the table and create synergistic relationships that will help the department have success and allow it to be more innovative.  

Roseanna Garza

Roseanna Garza reports on health and bioscience for the San Antonio Report.