Sitting in an empty meeting room at the Galveston County Health District’s offices, Dr. Philip Keiser acknowledged he had made some dire predictions about how hard coronavirus would hit here.
On March 27, two weeks after the first local case was identified and a day after the county had issued stay-at-home orders, Keiser, the county’s local health authority, warned the virus was about to “explode.”
At the time, Keiser was looking at the numbers and considering the state of things on the ground, he said.
Hospitals were setting up tents and triage procedures and desperately searching for supplies of protective equipment. The world was still coming to grips with measures it could take to slow the virus.
There were only 40 cases of COVID-19 in the county, and no one was yet hospitalized. Some questioned whether the warning was premature and, in hindsight, the accuracy of his prediction might be debatable.
Within a week of his warning, the number of cases of COVID-19 in Galveston County quadrupled — mostly because of outbreaks in nursing homes. But the outbreak didn’t overwhelm medical providers, as some had feared it might.
Now, more than two months after that warning, Keiser said he stands by it and said a series of steps taken about the same time helped guide the county more or less safely through a dangerous period of the pandemic.
“I feel good about that,” Keiser said. “I don’t mind being the prophet of doom.”
A PART-TIME, FULL-TIME JOB
When Keiser became the local health authority in 2016, the local board of health, which governs the county health district, assured him it would be a part-time gig, he said. Something like 15 hours a week.
He wasn’t hurting for work.
Keiser is a practicing physician and a professor at the University of Texas Medical Branch in Galveston, where he has worked since 2008. He runs the medical branch’s HIV-AIDS clinic and helps lead regional and international HIV education and training programs, He also oversees an initiative to help track and regulate antibiotics use in medical branch facilities.
Before Galveston, Keiser ran an HIV-AIDs program at Parkland Hospital in Dallas.
Dr. Ben Raimer, interim medical branch president, recommended Keiser for the health authority position.
“I told him it would be a real easy job and he would enjoy it,” Raimer said. “He is a remarkable physician and public health official, and I think he’s enjoyed the job. He brings incredible experience and credential for this job.”
As the local health authority, Keiser’s job is normally about making sure outbreaks of diseases, including HIV and tuberculosis, are tracked and counted and that local leaders are properly advised about how to handle public health threats.
He has led efforts to warn people about lung disease from vaping devices and directed response to a scare about an outbreak of HIV and Hepatitis-C connected to the health district’s dental clinics.
None of that compared to what Keiser, the health district and other agencies had to do in response to COVID-19, he said, adding that local preparations for the outbreak began as early as Jan. 20. In the time since, he has taken maybe “two or three real days off,” he said.
“The first couple months were just frantically planning,” Keiser said. “It hit me very early on that this was going to be bad.”
A SERIES OF UNFORTUNATE EVENTS
Galveston’s crisis hasn’t been medically overwhelming, but it has required Keiser to meet different kinds of crises and potential crises very quickly.
Early on, the health district was warned that the University of Texas Medical Branch had only an 11-day-supply of personal protective equipment, he said.
Then came news about an outbreak at The Resort at Texas City long-term care facility, which prompted Keiser to issue orders to prohibit visits at similar facilities across the county and bar people from working at multiple facilities.
That move was among a few times during the pandemic that Keiser has used his power to quarantine people, to legally force them to isolate.
“I’m convinced we did absolutely the right thing,” he said. “It contained the outbreak among the nursing homes, and it didn’t spread to other places.”
Then there was a series of outbreaks among local first responders, during which Keiser found himself consoling people who feared their jobs could harm their families.
Looming threats also mounted. The district had to work with the Port of Galveston, cruise lines and federal agencies to discuss a potential outbreak among crew members on ships berthing in Galveston. A surge in patients being treated at the Texas Department of Criminal Justice’s hospital at the medical branch also required Keiser’s input.
During all that, the health district worked with the medical branch to establish one of the earliest mass testing programs in Texas and the nation, which has led to Galveston County still accounting for an outsized share of COVID-19 tests per capita.
The work of leading the county health response has involved “lots of constituencies,” he said — many with different motives.
“For somebody who is a doctor, who doesn’t live in the political realm, I’ve learned an awful lot about how politics work,” Keiser said.
There have been political pressures in guiding local responses to COVID-19, Keiser said. In the early days, as the first local cases emerged, there were sharp disagreements among local elected leaders about how far shutdowns should go and how vocal officials should be about the outbreak.
Differing opinions from politicians don’t affect the kind of public advice he issues, however, Keiser said.
“It is challenging to learn how to navigate a lot of people’s issues and concerns,” Keiser said. “But what I’ve found is, at pretty much every level, if I had a chance to express what we were doing and why we were doing it and express our concerns, we were listened to.”
There were some frustrations about the district’s communication and information sharing early on, Galveston Mayor Jim Yarbrough said, particularly with getting information about local cases.
But Yarbrough lauded adjustments Keiser made in response to those complaints, including agreeing to daily briefings with the city on top of the other work he was doing.
“I was frustrated in the early stages with some of the information we were getting and not getting,” Yarbrough said. “But I’ve certainly changed my opinion. I think he’s done a heck of a job. I like his approach. It’s steady, methodical and not panicked.”
COVID-19 has not gone away in Galveston County. Just the opposite.
In recent weeks, after a period of gradual decline in known active cases, infections have started to rise again.
Some of the rise can be attributed to more testing in nursing homes, but half of the 157 new cases identified in the past two weeks have been people under the age of 40, Keiser said, adding that those cases can be attributed to community spread caused by businesses and public areas reopening.
This rise in cases isn’t prompting Keiser to warn of another explosion, however. He said he and his wife, Unsil, are going out to restaurants but making sure to only patronize places that are taking proper social distancing measures.
“We see some that are doing absolutely great jobs,” Keiser said. “We’ve seen some restaurants that we walk in and walk out immediately.”
Keiser keeps going by finding moments to relax and refocus, he said. He wakes up at his home in Tiki Island at 5 a.m. daily, exercises and sometimes plays guitar before getting to work.
For a prophet of doom, his personal playlist tends toward positive vibes: The Beatles’ “Here Comes the Sun,” Bob Marley’s “Three Little Birds” and Cat Stevens’ “The Wind.”
“I play a little bit and get my head on,” he said. “And then I check some numbers.”