Commentary: This Is Not a Drill.

On Jan. 21, 2020, the Centers for Disease Control and Prevention confirmed the first case of novel coronavirus, later named "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2), in the U.S. At the Department of State Health Services (DSHS) we realized it was only a matter of time before the virus arrived in Texas. By Jan. 31, we activated the DSHS State Medical Operations Center to prepare for the coming crisis.

Identifying Maternal Deaths in Texas Using an Enhanced Method, 2012.

OBJECTIVE: To more accurately estimate the 2012 maternal mortality ratio for Texas using an enhanced method for identifying maternal deaths. METHODS: This population-based descriptive study used both data matching and record review to verify pregnancy or delivery within 42 days for 147 deaths with obstetric cause-of-death codes, and used data matching alone to identify additional maternal deaths within the same timeframe. Crude maternal mortality ratios were calculated for confirmed maternal deaths overall, by race and ethnicity, and by age. These maternal mortality ratios were compared with maternal mortality ratios computed using obstetric cause-of-death codes alone (standard method). RESULTS: Fifty-six maternal deaths were confirmed to have occurred during pregnancy or within 42 days postpartum. Using our enhanced method, the 2012 maternal mortality ratio for Texas was 14.6 maternal deaths per 100,000 live births, less than half that obtained using the standard method (n=147). Approximately half (50.3%) of obstetric-coded deaths showed no evidence of pregnancy within 42 days, and a large majority of these incorrectly indicated pregnancy at the time of death. Insufficient information was available to determine pregnancy for 15 obstetric-coded deaths, which were excluded from the 2012 maternal mortality ratio estimate; however, had these deaths been included, the resulting maternal mortality ratio would still be significantly lower than that reported using the standard method. CONCLUSION: Relying solely on obstetric codes for identifying maternal deaths appears to be insufficient and can lead to inaccurate maternal mortality ratios. A method enhanced with data matching and record review yields more accurate ratios. Results likely have national implications, because miscoding of obstetric deaths with the standard method may affect the accuracy of other states' maternal mortality ratios.

The State of Health in Texas.

At the beginning of the 20th century, the major health threats to individual and community health in the United States were infectious diseases, injuries due to unsafe workplaces, diseases due to poor nutrition, and poor maternal and infant health. During the next 100-plus years, tremendous advances were made in longevity and health status. As the impact of certain historically significant diseases decreased, however, the pattern of public/population disease burden became dominated by chronic diseases such as cardiovascular disease, diabetes, asthma, and cancer. In Texas in 2015, chronic diseases made up the top four causes of death. Public health professionals are largely focused on identifying the risk factors for these chronic diseases via enhanced morbidity and mortality surveillance. In addition to health care providers and the health care sector, a cross-section of other stakeholders, including businesses, communities, and social services, must work collaboratively, creatively, and effectively to reduce the chronic disease burden.

Typhoid Fever on the Half Shell.

Protecting the public from communicable infectious disease outbreaks is one of the most important, and most challenging, functions of public health. Foodborne outbreaks are not uncommon, and they can be especially difficult. This true story of the epidemiologic investigation into a typhoid fever outbreak illustrates the critical importance of timely reporting by front-line clinicians, extensive interprofessional teamwork, and statewide coordination.

Maternal Mortality in Texas.

A commentary on maternal mortality in Texas is provided in response to a 2016 article in Obstetrics & Gynecology by MacDorman et al. While the Texas Department of State Health Services and the Texas Maternal Mortality and Morbidity Task Force agree that maternal mortality increased sharply from 2010 to 2011, the percentage change or the magnitude of the increase in the maternal mortality rate in Texas differs depending on the statistical methods used to compute and display it. Methodologic challenges in identifying maternal death are also discussed, as well as risk factors and causes of maternal death in Texas. Finally, several state efforts currently underway to address maternal mortality in Texas are described.