Each year, hospitals across San Antonio participate in a heavily coordinated, mock medical emergency test known as the San Antonio Mass Casualty Exercise and Evaluation. In years past, the drills, which routinely include hundreds of volunteers and more than twenty hospitals in the area, have included mass shooting scenarios and plane crashes. But the theme of last year’s exercise, which took place in early November, is now eerily prescient: a pandemic involving a novel flu virus.
The apparent scope and sophistication of the exercise underscore something about San Antonio that local officials fear their federal counterparts have failed to grasp as the highly contagious coronavirus and the disease it causes, COVID-19, threaten to take root in Texas’s second-largest city.
“San Antonio has always been the center of the universe when it comes to military medicine,” District Eight councilman Manny Pelaez said, during a discussion about his city’s preparedness for an influx of COVID-19 patients. “We have a lot of infectious disease infrastructure in place that can handle emergency situations.”
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The “situation” Pelaez was referring to is the news that a woman recently released from federal quarantine at San Antonio’s Lackland Air Force Base, where she was taken because of the city’s extensive medical resources, has since tested positive for the virus and was returned to quarantine. During her twelve hours of freedom, the evacuee from China, who has not been identified, plunged into local population centers, traveling to North Star Mall, where she reportedly did not converse with any store clerks, and the Holiday Inn Express near the airport, where she came into contact with three people, according to the San Antonio Current.
“At the time of discharge from the facility, the patient was asymptomatic and met all of CDC’s criteria for release—resolution of any symptoms and two consecutive sets of negative test results, collected more than 24 hours apart,” CDC said in a statement issued to the San Antonio Express-News. “Following the patient’s release, results of a subsequent sample were received, and determined to be weakly positive. Out of an abundance of caution, CDC decided to bring the individual back into isolation at a local medical facility.”
The revelation prompted local officials, including San Antonio mayor Ron Nirenberg, and county judge Nelson Wolff—a former San Antonio councilman and mayor whose initiatives include public health campaigns—to release an extraordinary statement lashing out at the Centers for Disease Control. The statement accuses the federal agency of failing to “accept the guidance” of the city’s medical community after evacuees from Wuhan, China, and the Diamond Princess cruise ship, where more than seven hundred people were infected by the virus, were relocated to the river city. Both the city and the county have since declared public health emergencies in order to keep more than 120 coronavirus evacuees in quarantine at Joint Base San Antonio–Lackland.
“Time and again,” Wolff’s statement says, “I have raised issues concerning evacuees, inappropriate accommodations, the risk of exposure during transportation, and the need for additional monitoring and extended quarantine periods.”
The local officials were joined by Governor Greg Abbott, who rebuked the CDC during a Monday morning news conference, calling the agency’s actions “unacceptable.”
“It appears to be a case of negligence with regard to how this person, who had the coronavirus, could leave TCID and go back into the general population,” Abbott said. “I think they understand the magnitude of the error they made.”
The apparent lack of coordination is all the more perplexing considering that San Antonio—a.k.a. “Military City USA ”—was chosen by the U.S. Department of Health and Human Services as the site of quarantine because of its unique combination of multiple major medical centers and access to a plethora of subject-matter experts. The city’s firefighters have communicable disease training and several dozen count themselves members of the highly trained Texas Infectious Disease Response Unit (IDRU), as longtime San Antonio columnist Rick Casey noted in a piece last week calling upon the city to embrace its role as a safe haven for victims in need. For these reasons, the city has previously sheltered thousands of evacuees from Hurricane Katrina at Kelly Air Force Base and a small number of Mexican and Central American refugees ensnared by the Trump administration’s family separation policy.
When reached by phone Monday morning, Pelaez, who said he had just spoken to Wolff a few minutes earlier, added more context to local officials’ frustration, saying much of it stemmed from the fear that the CDC’s misstep could undermine public confidence in the larger emergency response, making the local government’s job harder and less effective.
“The local agencies have been on top of this and working nonstop since we received the very first coronavirus patient,” Pelaez said. “We want more communication from the CDC and want to make sure that when they put in place certain protocols they do so with the consensus of local medical communities and virologists on the ground.”
“Our experts are willing and able to help transition folks out of quarantine and into the general population,” he added. “It’s not necessarily about resources—WE are the resource!”
But health care experts say San Antonio can offer more than just expertise, with its large infrastructure, including number of beds and isolation rooms.
The city has two major military hospitals—Brooke Army Medical Center and Wilford Hall Ambulatory Surgical Center. On BAMC’s website, the hospital says it is the Department of Defense’s “largest and most robust military healthcare organization,” with 8,500 staffers who care for more than 4,000 patients each day across multiple clinics.
In an appearance on Texas Standard last week, Paul Hancock, Methodist Healthcare’s chief medical officer, said the San Antonio facility—the first to receive a COVID-19 patient in the city—remains ready for more patients who require specialized, infectious diseases treatments.
“We have isolation rooms that are available, we have the personalized protective equipment that is necessary, and we have staff that are familiar in the use of the personalized protective equipment,” Hancock said, referring to impervious plastic gowns and specialty face masks.
The question now, city officials say, is whether any of that equipment will get put to use.