Dallas County Thrust into Global Spotlight

County Judge Clay Jenkins Coordinates America’s Ebola Response 

        In its Oct. 6 online article, TIME Magazine named Dallas County Judge Clay Jenkins as “the first local elected official in the world to oversee the emergency response to a case of Ebola.” http://time.com/3474650/ebola-dallas-judge-jenkins/. First in the world…

The Texas Constitution names the County Judge as the emergency management director, and the Lone Star State is no stranger to emergencies; Texas has faced its share of fires, floods, droughts, hurricanes, tornados, accidents, and even catastrophic explosions. For example, many of us remember that fateful February morning in 2003 when the Space Shuttle Columbia broke up during re-entry over East Texas. Then-Nacogdoches County Judge Sue Kennedy was later praised for her leadership as she coordinated the large-scale response while navigating a barrage of national and international media requests.

Regardless of the scale of the crisis, our County Judges rise to the occasion, using their leadership skills and implementing carefully developed emergency management plans. It is rare, thankfully so, that Texas emergencies are severe enough to garner the collective attention of the state, nation or world. Yet, it does happen. And if one were to guess, it is a once-in-a-lifetime experience.

Two-plus years ago, Jenkins and Dallas County were in the midst of a public health emergency when Dallas County was labeled the epicenter of the country’s West Nile outbreak, attracting state and local attention as the county managed the crisis. As reported by County Progress in September 2012, Dallas County led the West Nile case count with 353 cases confirmed and 15 deaths. Perhaps this would be Jenkins’ one-and-only large-scale emergency. As we now know, more was to come.

From the moment the first U.S. case of the deadly Ebola virus was confirmed at Texas Health Presbyterian Hospital in Dallas on Sept. 30, the eyes of the state, nation and world turned to Texas as Jenkins, the county, and their local, state and federal partners fought to not only contain the disease, but calm the panic and fear associated with Ebola.

More than 4,500 people have died in the Ebola outbreak in West Africa. Thomas Eric Duncan, the first person diagnosed with Ebola on U.S. soil, died in a Dallas hospital on Oct. 8. Two nurses who helped care for Duncan at the hospital were later diagnosed; as of press time both nurses had been declared Ebola free.

Dallas County marked the end of the Ebola crisis on Nov. 7 when the last of the 177 people being monitored for symptoms of the deadly virus were cleared at midnight.

Within a day of speaking to County Progress about his experience, Jenkins had conversations with President Barack Obama, who called to thank him for his efforts, and Texas Sen. John Cornyn. Both the Cornyn and Jenkins agreed that this wasn’t just Dallas County’s response to Ebola, but America’s response.

County Progress would like to thank Judge Jenkins for taking the time to answer our questions.

Q: How were you first informed of the diagnosis?

Dallas County Health and Human Services Director Zach Thompson told us in Commissioners Court that morning, Sept. 30^th, that “we think we might have” a case of Ebola. Later in the afternoon, someone from the White House called my office to let me know there would be confirmation from the Centers for Disease Control (CDC). Later that day the CDC called, and I talked to some friends from the CDC with whom I had worked during the West Nile emergency. Several from the CDC flew down that first day.

Q: What was your first response?

At first, I did not know I would be asked to take Incident Command. At that point, I thought that the CDC would be giving directions to our health department. It was only after meeting with Gov. Perry and others the next day that I was I asked to establish Incident Command, name an Incident Commander from my staff, and take over the response. This likely had a little to do with the success we had with the West Nile Virus, and with the scope and size of that situation.

That evening, I asked Dr. David Lakey, commissioner of the Texas Department of State Health Services, to stay with me and help me. We “white boarded” what President Obama would later call “a national model for Ebola response.” We literally wrote out our policy by hand on a white board in my office. We had our Emergency Operations Center (EOC) set up by 9:30 p.m. that night and had it manned with workers by 8:30 a.m. that next morning. The County Judge oversees emergency management, and here we call it the Office of Homeland Security & Emergency Management.  I wanted to do it in a unified way. We brought in representatives from the city, school, state, and federal agencies. We all “custom-discussed” the situation and came up with the best way to carry out the policy.

Q: Why did the county choose not to declare an emergency?

When you make those declarations, what that does for you funding and resource-wise, is allow the governor’s staff to handle resource requests. When you say “emergency” and “natural disaster,” it helps the public realize, “This is really serious.” For example, an emergency sends a message like, “Don’t go near those downed power lines.” In this case, we had one person who brought over Ebola without realizing he had done so. We had already done the “disease detective work,” and we were monitoring the people with whom he had been in contact. Then we had the nurse situation, and we had good tracking on that. We immediately knew when they were sick. What we needed was to calm the irrational, panicky public fears that were counter-productive to getting our job done, not to accelerate those fears. Because the governor and I had already done several disasters together, we have a good working relationship. He was already offering resources. The governor and I discussed it, and we decided not to declare a disaster. If we had thought it would keep “you” a little safer, we would have done that. But it wouldn’t have. It would have sent a mixed message. If you hadn’t come in contact with anyone with Ebola, if you had not been exposed to that patient’s bodily fluids, then you didn’t have Ebola. Declaring a disaster wouldn’t have gotten us any more money or any more resources.  Instead, it would have sent the message, “Maybe I do need to keep my children home from school,” etc.

Q: What was the strategy to preventing a potential outbreak?

Our EOC was in downtown Dallas. The night that the first nurse, Nina Pham, tested positive, I was in my home. I received word about 11:15 p.m., and by 11:58 p.m. we were in the hospital setting up a mini-conference room. I have to say, it was humbling working around these kinds of healthcare heroes. It could have happened anywhere in America, but it happened here. We ended up with 75 hospital workers being monitored. They dealt with it with grace.

With regard to containment, I directed all ambulances that picked up someone with recent West Africa travel history or any symptoms related to Ebola to bring those people to Presbyterian. We’ve got five flagship hospitals and several smaller hospitals. There was no way we were going to set up an Ebola unit at another flagship hospital.

We have 2.5 million people in our county, and one in four lack insurance, meaning our emergency rooms fill up. People were avoiding Presbyterian hospital, and the wait time was going up at the other hospitals. When you have a large, uninsured population, that means you’ve got people with diseases like diabetes, congestive heart failure and severe asthma, and they are going to the emergency rooms. You’re going to have deaths from heart failure, diabetes, strokes and other emergencies because of the increased wait time. We wanted to try and localize the Ebola response to Presbyterian. If ambulances took patients with Ebola symptoms to other hospitals, people would avoid those hospitals as well and not seek treatment, or go to only one or two hospitals with drastically increased wait time.

The night that the second nurse, Amber Vinson, became sick, we talked about several things that needed to happen at Presbyterian. As far as practicing medicine or how the hospital cared for patients, that wasn’t under our Incident Command.

I have to tell you, I’m 50 years old, and these nurses that came and volunteered during this period, they could have easily been my sons or daughters. We had both Nina and Amber sick at the same time, and they were flown to other facilities. I’m looking in the eyes of all of these young people, some as young as 22 years old, and it’s just awesome to see that kind of heroism.

Q: What was your strategy in calming fears and preventing a panic?

When a person gets Ebola and becomes symptomatic, only then are they contagious. The only way the disease spreads is by contact with bodily fluids of a symptomatic patient. If you weren’t around Eric Duncan when he was in that phase, then you did not have Ebola. We told people that they did not need to stop going to work or school. You’re safe to go to the hospital and have your sonogram or your annual physical. You can’t get Ebola from walking through a lobby of a hospital where an Ebola patient is being treated. We tried to continually get that message out.

Q: Please tell us about your experience driving Eric Duncan’s loved ones to their new home.

When we wrote out the incident command on the white board, we asked what we wanted to do about Eric Duncan’s fiancée, Louise, and her three children. I said that I wanted to get her out of that house and into another home, and we wanted to remove the hazardous material from the original home. It was more difficult to accomplish than we thought, as many of the cleaning groups did not want to touch Ebola. At the same time we were trying to find a house for Louise. No one would rent to her, and no one would let her stay. Finally, I called the bishop of the Catholic diocese for Dallas, who is a friend of mine. I said, “There’s literally no room at the inn. I need your help.” He replied, “Surely someone will help.” I told him there was no one. The bishop was able to find a place, and we began discussing how to get them there. Some suggested putting Louise and her three children in yellow hazmat suits and then putting those who were helping in different-colored hazmat suits. I asked the doctors and scientists what was necessary. I was told that hazmat suits were not needed. Rather, we needed to stay away from the room in the original home that had any hazardous waste.

Those having the conversation were kind and heroic hard workers. However, as the conversation about the move and hazmat suits continued, I could tell they were genuinely concerned. I decided I wasn’t going to ask any responder to do anything I wasn’t willing to do myself. I know in my heart that if I had asked them to work the move without hazmat suits, they would have. But I decided, out of respect to them and their families, I would go and assist with the move. Louise and her family had already suffered a great deal, and I thought dressing them in hazmat suits might dehumanize them. Since the scientists said there was no need, that is how we proceeded. As far as the press and the move, we did not plan a press conference and decided to ground the helicopters; however, they stayed up long enough to take some photos. I guess in the end it helped reassure the public that the government was telling them what we believed to be true; they could see that the head of the government would not expose his own family to Ebola. Others may have thought I was wrong, but at least they would know I wasn’t lying. After that happened, a lot more people went back to school and went back to work, didn’t shun health care workers, and didn’t shun people from other countries.

Q: As you look back on the response thus far, do you have any “lessons learned” that could help other counties face emergencies?

Trust the science. Follow the science. Don’t do anything “out of an abundance of caution” if you have a panic situation. Don’t do anything more or less than what science dictates. If you do less, you have danger. If you do more, you have irrational fear. Remember to treat everybody, and I mean everybody, how you would want your family to be treated. We focused on those who were afraid; we never demonized them, but tried to treat them with respect. I think that helped a lot. There are enough people who will jump on either side of an issue. We wanted to respect everyone.

Q: What is the estimated cost of the Ebola crisis to Dallas County, and will the county have to absorb any of this cost?

Sen. Cornyn came to see me, and we agreed we were fighting “America’s Ebola,” and not Dallas County’s Ebola. This may sound like a large amount to smaller counties, but as of now we are only out just over $350,000; we’ve been out more than that on an ice storm. I think we’ll likely get most of it back from the state and federal government.

Q: Finally, we understand you had a personal experience years ago when you were involved in an automobile accident. You’ve mentioned this experience has influenced how you respond to crises. Can you please elaborate?

I was fortunate in that I was able to attend college; I was the first in my family to graduate from college. I went on to law school. I was young and single and making what I thought was a decent amount of money, and I was “living the life.” At some point I remember being in the shower and telling God, “I know we’re not close and I know why and I want you to know I’m sorry.” I was later in a car wreck, and my injuries included a broken neck, collapsed lung, heart contusion, and a broken pelvis. I was pretty banged up, and I survived. Logistically, I shouldn’t have. I had one of those experiences people have when they survive something like that. When you are able to walk after being told you might not, it is very humbling. It makes you sympathetic to other people because it makes you learn how to do things all over again, like feed yourself. You also feel embarrassed in a strange way, that you are faring better than you should have. And it makes you grateful. I think that made me more in tune with people than I was before. It wasn’t that I was disrespectful before, but this experience, grace being given to me, changed me. I gave a talk at a synagogue last night, and the basic tenant of all religions and human kind is that we treat others the way we want to be treated. This is how we tried to operate during the Ebola crisis, treat others as we would want to be treated, or as we would want our families to be treated.