San Antonio Express-News (Sunday)
In pressure cooker and tested by fire
Metro Health boss started her job after pandemic began
Arriving in San Antonio this year as the new director of the Metropolitan Health District, Dawn Emerick was only about a week ahead of the novel coronavirus.
Emerick hadn’t unpacked all of her boxes in early February when dozens of evacuees from Wuhan, China, landed in a chartered plane at Joint Base San Antonio-Lackland to be quarantined. Four days later, officials confirmed one of the evacuees was infected with the virus: the state’s first case.
By the time the highly contagious virus had engulfed the United States, turning face-toface interactions anywhere into a life-threatening activity, Emerick hadn’t even met most of her 500 employees.
“As soon as she arrived, she had to be field general,” Mayor Ron Nirenberg said. “So there wasn’t a whole lot of time for the niceties normally when somebody’s new to staff.”
Emerick, 52, put it more bluntly.
“I don’t know what San Antonio was like before this,” she said. “I don’t have a contrast. All I know is who I work with and who I answer to and how the community is set right now, all based on COVID-19 response. I don’t know what it was like prior to that. I don’t know what people are like.”
The city recruited Emerick from her position as the top health official in Benton County, Ore. Divorced over the summer, she sold most of her belongings, fit everything else into the back of a Suburban and drove more than 2,000 miles to her new home in South Texas.
The virus showed up before she could settle in.
“Everybody is in this response
mode,” she said. “Everything is critical. No room for mistakes. Lots of pressure. So I don’t know what normal is.”
For the field general of a never-ending war against a new disease, here’s what “normal” is.
Every morning, seven days a week, Emerick wakes up about 4:30 a.m., before her alarm goes off.
She flips open a laptop to pull the latest data on infections and deaths, knowing 12 hours later, at 4:30 p.m., she will meet with the region’s top leaders — Nirenberg, Bexar County Judge Nelson Wolff and City Manager Erik Walsh, among others — and attempt to explain what the daily numbers mean for the community’s health and safety.
“It’s the translation of the data,” Emerick said. “I’ve got really smart people, but that’s what they do. They’re the scientists. Sometimes the scientists don’t know how to tell the story. They’re brilliant minds. They know the numbers, they know the EPI curve. They know that. But boy, when I need to translate that to the mayor and to the judge. …”
Last week, the story was unfolding in ways that Emerick knew could be misleading.
Laptop open, she sat with other responders in the vast central command space of the Emergency Operations Center at Brooks. Overhead, a massive screen displayed the latest COVID-19 data for the county and the state.
Emerick wore a mask decorated with flower-laden skeletons, a recent birthday gift that she would slip often from her nose and mouth out of sheer discomfort.
Sleep-deprived, overwhelmed by a cascade of conflicts, Emerick nonetheless was poised, at times even buoyant and quick to laugh, as she cycled through meetings with other officials.
“I’m a freakin’ robot,” she said, adding later: “I’m a little bit of a hot mess.”
Daily infections were ticking up, sometimes by large numbers. But the vast majority of new cases were from “congregate settings” such as nursing homes, where Emerick had instituted universal testing for the virus weeks before Gov. Greg Abbott ordered it.
Confirmed new cases of community spread actually were dwindling, even as Metro Health has opened free testing to anyone regardless of their symptoms. Some of Emerick’s own staff interpreted the decline as a gradual return to normal. But even this was misleading.
As the state continues to reopen, Emerick knows an uptick in community spread is inevitable.
“The virus is still here,” she said. “It’s here. It’s probably in this room somewhere. It’s community spread. It’s here.”
She added, “I literally had to tell my team the other day, the language that you’re using about ‘we want to go back to normal.’ … There is no normal. What you did, how we functioned pre-COVID, is no longer.”
‘Big-vision girl’
Emerick’s childhood was not normal by any stretch.
Her mother was 19 when she gave birth to Dawn in California and handed her off to her own parents, who raised the girl in poverty in the small town of Edmonston, Md.
“I probably should have been a statistic myself,” she said.
Emerick’s grandfather was a plumber. She never knew her own father or her five siblings — or her mother, for that matter.
“Only when I was little,” she said. “I seem to remember her being at my ninth or 10th birthday, but that’s it. So I really did not have a relationship with her. She’s still alive.”
Raised in a large Catholic family, Emerick came to call her aunts and uncles her “sisters and brothers.”
After she put herself through college with the help of a Pell grant and a work-study program — she was first in her family to go — those same “sisters and brothers” were not impressed, she said.
“I remember that poverty mindset of family turning against you. ‘You’re uppity. Who do you think you are? Oh, you’re college educated. Oh, you’re too good for us?’ There was a lot of that from my own family,” Emerick said.
She had wanted to be a nurse.
But after an education in chronic disease and a job at a health department in Jacksonville, Fla., Emerick shifted her focus.
“I was too entrepreneurial,” she said. “I was like big-vision girl. I wanted to shake (expletive) up. That wasn’t really happening in the public sector in the South.”
So Emerick earned a doctorate in educational leadership, landing a job as CEO of the Health Planning Council of Northeast Florida on the same day she walked the stage. She would make mistakes in that job, she said, but it molded her.
“I clearly learned then that I was a leader,” Emerick said. “I loved organizational development. I loved culture. I loved morale. I loved organizational change. Communication. All that stuff that comes with leaders, that’s what I knew I did well and what I wanted to be. I didn’t need to be a subject matter expert.”
Eventually, Emerick ended up as a public health director in Clackamas County, Ore., where her boss, Richard Swift, took note of her ability to lead.
“I think she’s courageous,” said Swift, director of health, housing and human services there. “She’ll step into hard spaces and do the work. She’s innovative. I think she’s charismatic. She’s charming. That helps a lot. And she’s quite effective at getting staff to buy into her vision.”
That vision was shaped by her youth and its difficult circumstances.
“I think that makes me appreciate being in public health so much,” Emerick said. “I was a recipient of that. I was on Medicaid with my grandparents. That safety net saved me. And then as a single mom — I married my high school sweetheart, we ended up divorcing, we had two children together — I was a single mom and wasn’t getting any support from him. And so I had WIC, they had Medicaid, and I had child care subsidy because I wanted to work.”
Nirenberg was not aware of the economic challenges Emerick has faced. Even so, the mayor has noticed her focus on the city’s low-income residents as she responds to the epidemic.
“Before any of the country was talking about race equity teams and going out and targeting neighborhoods that didn’t have health care access, she had already deployed health intervention teams to really understand what was happening in some of our more impoverished communities,” Nirenberg said.
“That was the underpinning of the health transition team’s focus on where to place testing sites,” the mayor continued. “So she intuitively or otherwise knew about that dynamic before we even got the health transition recommendations.”
Emerick has faced criticism from the City Council over barriers to testing for the virus.
“Why are you not in brown and black communities?” Emerick said she was asked. “That’s why we eliminated all the barriers. We were like, screw it, eliminate barriers. Eliminate symptomatic whatever, eliminate ID, eliminate addresses, just get the tests in the community.”
“Let’s pop a tent,” she said. “Get a tent and we will just swab people.”
‘The push, the pulls’
At the Emergency Operations Center, Fire Chief Charles Hood motioned for Emerick to step out of a meeting of the testing task force and into the central command space.
There was a problem with a walk-up testing site selected by Metro Health.
“We talked to (Councilwoman) Jada (Andrews-Sullivan),” Hood said, “and went to Claude Black (Community Center) instead, instead of. …”
“The Barbara Jordan? OK,” Emerick said, referring to another center. “I think there was a heat issue?”
“The heat, and it needs to be cleaned,” Hood said. “Just so you know. I talked to Jada this morning. I talked to Erik. So we’re going with Claude Black instead of Barbara Jordan.”
Back at the meeting, Emerick lauded Metro Health for getting ahead of the governor’s order to test all residents of the state’s 12,000 nursing homes. Metro Health already had conducted universal testing at 15 of the city’s 65 nursing homes.
“So it’s wonderful to know that we have set the pace for the state and have just been doing some pretty innovative things already,” Emerick told the task force. “The one thing that I think is primed to actually help us lean in even more, to help us be even more super bad-ass, is to look at our existing testing task force and really elevate that up into a more formal but flexible structure.”
About an hour later, Emerick had just settled into a data visualization meeting on her laptop — she was getting a first look at an online tool for teams she had deployed across the city to monitor virus hot spots — when a flurry of texts came over her cell phone.
“My phone is blowing up and I just need to see if it’s an emergency,” she told her colleagues. “Hold on just a second? OK, thanks.”
Relative to the ongoing public health catastrophe, it was not an emergency, but rather one more conflict arising from that catastrophe. The Barbara Jordan Community Center was not pleased with the decision to move the testing site to a different location.
“They’re very upset with us,” Emerick explained later. “People that are there are not happy that we’re changing it.”
In the time of COVID-19, conflicts of this sort were constant.
“Oh, every day,” Emerick said. “Every day. I’m serious. All the time. It’s just all the time.”
Sometimes, this can cause the new director of Metro Health to feel overwhelmed. Her outlet usually is photography, but there’s no time for that now.
“I do partake in some wine,” she said. “Probably more often than I should. It’s not probably a good thing.”
A couple of weeks ago, before a staff meeting, she sketched something out to show how she feels.
“I was at that point where if I tell people that I’m overwhelmed, I can’t explain it, so the best way I could do it is to draw it,” Emerick said. “It was a moment where I took how I felt and put it down on paper. This is pretty much how I feel every day — the push, the pulls.”
In the center of a whiteboard, Emerick had drawn a circle around the words “me” and “us” and filled it with squiggly lines — “the pressure,” she said. Around the circle, multiple entities were bearing down.
“This is me,” Emerick said. “This is the city manager’s office, they’re pushing. I’ve got the state pushing. I’ve got this equity task force pushing. I’ve got budgets, transition back to normal. … City Council. Commissioners Court. Pressure. Expectations. Directives.”
Despite the sprawling network of influences bearing down on the local pandemic response, Emerick knows that Metro Health is the face of it.
“At the end of all of this, I’m the one that gets in front of City Council,” she said, unexpectedly choking up. “It’s Metro Health that’s in front of City Council. It’s tough. You’re going to make me cry. It’s tough sometimes.”
She added, “When things go really well, there’s a lot of people that take credit. And when things are sideways, it’s Metro Health.”
More than anything else, even more than catching the killer virus, Emerick worries about “burnout,” she said.
“I do worry about that,” she said. “I’m worried about my workforce. If we go down and I don’t have a bench, who’s going to do this?”
‘Cool under pressure’
The numbers, at first blush, were not good.
Another death. Sixty-five new cases.
As usual, translation was required.
It was 4:30 p.m. Thursday, and Emerick was in a spacious gallery at Plaza de Armas flanked by the mayor and the county judge. Walsh, the city manager, sat directly across from her.
“So 65 is a big jump from what we’ve had in the last few days,” said Nirenberg, who would have to report the daily numbers in a televised news briefing in less than two hours. “Do you attribute that to the congregate setting testing?”
“100 percent,” Emerick said. “Yes, absolutely.”
“And then I saw on the website we’re now at a 5-point-something percent positive rate? That’s great,” the mayor said.
“Also, we have a lot of negatives,” Emerick said. “So when you’re testing big volumes like we’re doing, you’re getting a ton of negatives. So the more you test, then that positivity rate will go down.”
Wolff asked about the nursing homes, where Metro Health was testing all residents and staff.
“I think the real key message is that you’re going to see positives,” Emerick said. “You’re going to see them. But you also have to keep in mind that this is a good thing. You’re going to see a sprinkle of one, twos, threes, but if we didn’t get them now early on, then you’re going to see 13, right?”
After the meeting, Nirenberg sat in the studio where he soon would deliver news of the day’s toll.
“I’m looking forward to getting to know Dawn,” the mayor said. “She is very cool under pressure. She’s been through a lot. She hasn’t unpacked her boxes yet. She’s been working 24/7 since she got here. And she doesn’t let people see her sweat.”