AUSTIN – Governor Greg Abbott was confident that tracing contacts would help bring Texas out of the worst of the coronavirus pandemic.
As he prepared to reopen the state in late April, the governor boasted that there were more than 1,000 trackers to track infections and advise anyone exposed to stay home. A website was up and running. Within weeks, thousands of more tracers would be deployed and the technology to manage their progress will be available statewide.
“What that process does is fit into the expansion of COVID-19,” Abbott said at a press conference on April 27.
But local health officials say defending an army of tracers and the infrastructure to support them has been much more complicated than it sounds. The key components of state and local tracking programs were not in place when Abbott expanded reopens in May and June, even as cases began to escalate and tests to detect the virus fell short of expectations.
“It was a plan,” said Rebecca Fischer, an epidemiologist who leads a team of contact locators at Texas A&M University. “I think the impression was that it was ready to be implemented.”
The rushed debut, made up of an outdated reporting system and delays in processing the tests for the virus, made it difficult for trackers to avoid the increase in cases now spreading across Texas, according to health authorities.
As its largest cities prepare for a surge that has already tripled COVID hospitalizations in a month, the state is becoming a textbook example of the dangers of opening without time-tested public health measures .
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On Thursday, the governor announced that he is delaying further reopens and postponing elective hospital surgeries in four of the state’s worst-hit counties to make room for more coronavirus patients.
“There is a massive COVID-19 outbreak across the state of Texas,” said Abbott, a Republican who was among the first governors to press for a reopening, in a television interview Wednesday.
With the multiplication of cases, some city health departments are buried in the paperwork, struggling to keep up.
“If we look at the effectiveness of contact tracing in other countries where that worked, that contact tracing occurred when places were generally closed, when people didn’t move,” said Dr. Mark Escott, interim director of health for Austin Public. Health told Travis County Commissioners on Tuesday. “That is not happening here. Things are still open, and we are trying to contact each other when we receive hundreds, perhaps more than a thousand cases a day that are reported. ”
While state health officials acknowledge the system was a work in progress, they said the key pieces were in place in late April, as Abbott said.
“We will add more functionality over time, but that core ability to track contacts was there on April 27 with Texas Health Trace,” said Chris Van Deusen, spokesman for the State Department of State Health Services, referring to online tracking. of the state. portal.
A spokesman for the governor declined to comment.
‘Still waiting’
Unlike states that were hit by the pandemic from the start, Texas had time to prepare. When the state shutdown was lifted in late April, the state had already introduced Texas Health Trace. Anyone could enter their symptoms, see if they needed testing, and potentially connect with a marker.
The most critical behind-the-scenes components were not yet in place. The state was still unable to help with tracking in counties with limited resources, and there was no way for local health departments to seamlessly enter their case data every day. Some departments that are tracking themselves, including those in Houston and Harris County, still don’t use Texas Health Trace to report their data.
“We hope this plan would have all of these new hires and that this system would work any day,” said Fischer, the Texas A&M epidemiologist. “Then, week after week, we would attend these conference calls and talk about the redirection of the staff, and every week it was like we were still on hold, still on hold.”
In late May, the state had nearly tripled its tracking fleet, but it was still well below the governor’s goal of 4,000, which itself was lower than what some national models had recommended. The state health agency said it had enough tracers and that local health entities were taking the initiative whenever possible.
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“The 4,000 was a population-based estimate,” said Van Deusen in early June. “That gave us a broad goal to start. But as we start, there are enough people right now to handle this, certainly at the state level to handle all the cases that we have. “
However, new cases had already started to climb after Memorial Day, and some tests were not processed for weeks as a limited network of health laboratories was flooded with samples. When the response time slows down, tracing is less effective because exposed contacts have time to spread the virus without realizing it.
With the state still working to update its data management system, cities and large counties that had chosen to monitor their own response launched updated tracking programs. At College Station, the county hired a team of Fischer-supervised case investigators and established its own data management system. The San Antonio Metropolitan Health District hired a contractor to track it through automated text messages.
Houston and Harris County hired hundreds of new tracers and partnered with the University of Houston School of Medicine to quickly train them.
The Houston Department of Health launched an online tracking program last week, and it is currently only available in English, a challenge for the most diverse city in the country. It was still hiring and training staff when the state announced that almost all companies could reopen in limited capacity on May 18.
Having more time “definitely would have put us in a better situation,” said Kirstin Short, the department’s chief epidemiologist. “A lot of this is logistics. Tracking contacts is not easy. Developing an online system is not an easy thing. “
The Houston tracking app, while still new, probably only has a 10-20 percent participation rate, Short said.
“On the one hand, that seems low, but when you look at 900 cases, it could be 180 people that we are reaching,” he said.
Too many tracks, too few callbacks
Health officials have always struggled to get people to pick up the phone. Anita Kurian, deputy director of San Antonio Metropolitan Health, said earlier this week that there were still some 2,500 positive cases under review. The health department received responses from 300.
“An overwhelming majority of people are not contacting us,” he said.
According to some health officials, some agencies have been luckier than others, and it can be particularly difficult to reach people in and around the undocumented community, who may be nervous about giving information about themselves or their close contacts. Some have been more successful sending text messages first, although it can still be challenging.
“Let’s be honest, I don’t care if you use an alias,” said Fischer. “You can say you’re Winnie the Pooh, as long as I can call Tigger on the phone.”
Several departments say they are falling behind as cases multiply and parts of the process remain stagnant in the paper age. In Austin, Escott told commissioners Tuesday that test results are faxed in, sometimes hundreds a day.
“I am concerned that the public is overly reliant on that piece of contact tracking because public health has sold that as a solution,” he added. “It’s a good solution; It works in some circumstances, but right now throughout the state of Texas we are receiving reports from jurisdictions that they simply cannot contact to track everyone. “
