In late March, Dionny Lopez, 26, began feeling sick after her family’s trip to Monterrey for a funeral. Doctors couldn’t diagnose her cough and trouble breathing, until her mom tested positive for the virus, becoming the fourth COVID-19 case in Hidalgo County.
Within a few days, a contact tracer went through her mom’s contacts, urged Lopez to take a test, and later instructed them not to go out. A sheriff’s deputy even had the Lopezes sign a document committing themselves to quarantine.
Months later, after a full recovery, Lopez’s friend tested positive.
“She didn’t get contacted by the state, at all.” I asked, “Are you sure? Nobody called you?”
In the months since it started in Texas, contact tracing has evolved to include more staff, enhanced structures, and more data. While Valley residents move further away from the summer COVID-19 peak and grow more comfortable gathering in crowds, health officials warn not to expect a call informing them of possible exposure in every case.
Tracing is spearheaded by local health departments and the Texas Department of State Health Services, or DSHS.
Every case — probable cases reported by rapid antigen tests, and all confirmed cases from PCR tests — belonging to Hidalgo or Cameron County should be reported to their respective health departments.
Cases are either handled by the county’s tracers — about 50 people hired in Hidalgo County and about 10 employees in Cameron County — or they can enter the case into DSHS’s Texas Health Trace program where there’s currently 1,100 people hired throughout the state to initiate the exhaustive process.
Eddie Olivarez, Hidalgo County Health & Human Services’ chief administrative officer, said a majority of their cases get submitted to the state. “Just due to the sheer volume that we have to look at,” he said.
“It’s a judgment call,” Cameron County Health Administrator Esmeralda Guajardo said. They prioritize taking on cases where greater risk is involved like in schools or nursing homes.
The number of people hired for tracing by the state is far from Gov. Greg Abbott’s goal in May to have 4,000 people employed. They came close.
“We were right around that point through much of the summer, in that 3,900 range, pretty much for all of the month for August,” Chris Van Deusen, director of media relations for Texas Department of State Health Services, said.
The number was scaled back when cases decreased, but they plan to ramp up the numbers soon as cases increase, Van Deusen said.
About 200 of those 1,100 currently employed by the state are working at UTRGV. Dr. Michael Dobbs, vice dean of clinical affairs and chief medical officer oversees the tracing program at the university.
In August, they had fewer employees, about 130. They had case investigators, contact tracers and epidemiologists.
As time passed, Dobbs said they began pruning their structure to include more case investigators and fewer tracers and increased the load of tracers assigned to epidemiologists.
“What we were finding was that there was more of a need for the investigators with the number of positive cases than the tracers,” Dobbs said.
Case investigators will be the first person to reach out to the sick person and will then pass the case to the tracers. Investigators need a more “enhanced knowledge base,” because they’re going to be calling people who have the disease and will have to answer questions around it and about it, Dobbs said.
Data is collected along the way. Some suggest positive results.
Dobbs said he recently heard statistics from the state’s Texas Health Trace program that demonstrate the importance of the massive task.
He said they’ve “established contact with more than 215,000 positive cases and they’re finding about, on average, 2.5 exposed contacts per case. And, it turns out, that about 12% of those end up testing positive later.”
Dobbs credits his staff working seven days a week for some of that hard work.
In the last week, UTRGV logged 550 hours and completed about 6,200 calls.
But 991 other calls made in that same period went unanswered.
“They get hung up on quite a bit,” Dobbs said. “They’ll start the script, ‘Hi, this is Texas Health Trace, you’ve been identified — click.’”
Voicemails will be left in English and Spanish saying, “Hi, I’m calling from the Texas Department of State Health Services. I would like to ask you some questions. Please call us back at [833-753-0909].”
One out of every seven calls went without getting picked that week, according to Dobbs’ figures.
CHALLENGES AT EVERY TURN
“If the person who is positive, if they don’t answer,” Dobbs said, “then that derails the whole contact tracing process.”
Contact tracing works like a relay race.
The effort requires multiple people exchanging a baton — or information, in this case — until it reaches the end. Health officials in the Rio Grande Valley say many times that race is lost at the sound of the starting pistol.
All health officials suspect some calls fall victim to the public’s reluctance to answer an unknown number, or out of concern to safeguard their immigration status.
Legitimate calls coming from them won’t include requests for money or an interrogation about their status in the country.
But even before a number is dialed, the attempt can be predestined to fail.
“So many people touch the data,” Olivarez said.
It starts at the doctor’s office, hospital, or testing site where the patient is asked for their personal information. That gets shared with the local health department and state.
Two last names, hyphenations, spelling variations, double spaces, wrong numbers — all of these are some culprits in faulty data entry that can thwart tracing efforts.
Guajardo and her team in Cameron County decided to collect the information in Excel, a program whose files can be interpreted by any computer.
“I think we have a system that’s been working for us, but it didn’t come without screaming, yelling and becoming frustrated,” Guajardo said jokingly, adding, “I hate Excel.”
Positive cases will be reported to her office by those conducting tests, but some labs will send the names to the state, too. The state will enter the names into the Texas Health Trace program. Sometimes, that leads to duplicates when they arrive in Cameron County’s Health Department.
Weeding out duplicates “sounds so simple, but it has been the most daunting task of all,” Guajardo said.
That’s if the cases arrive at the health department at all.
Testing specimens sat in labs during the summer peak for over a week, at times.
One of the overwhelmed labs in July, Quest Diagnostics, reported turnaround times of up to seven days or more, well into the required 10-day isolation period.
Even now, while cases are slow, the turnaround time for results can vary.
On Saturday, Cameron County reported 97 new cases. Of those, about 85% of them were of people tested within the last five days, according to Guajardo.
“They’re supposed to let us know as soon as possible. … But, let me tell you, I will take it because it’s a massive improvement from before.”
COVID-19 fatigue is expected to play a role in this year’s Thanksgiving celebration, winter visitors’ annual migration to the Valley, returns to school, and Christmas posadas.
Even planning for the celebrations includes convening at grocery stores, shopping centers or restaurants.
Olivarez said he’s witnessed dismissive attitudes about the risks, because of the soon-to-be-released vaccine. That could prove a fatal misunderstanding of its intended use.
“The vaccine is not a cure. It’s a preventative,” Olivarez said, like the flu vaccine.
As the health official in the Texas county with the highest death rate per capita, Olivarez expressed feeling dismayed with the expectations placed upon contact tracing.
“If the only way for me to stop this illness is a phone call to you not to go out,” Olivarez said, “That’s kind of hard to stop a pandemic.”
Guajardo in Cameron County said it’s impossible to contact everyone exposed to such a wide-reaching virus.
“We’re at that point where you hope that’s what they’re doing. They talk among themselves, ‘Hey, I’m positive. You may want to go get tested.’”
Contact tracing, a method used in traditional scenarios of fast-moving viruses, was outpaced by the global phenomenon.
Olivarez, urging personal responsibility, said, “Why are you waiting for me to call you?”