Cases climb in tri-county as contact tracing overwhelms state and officials warn of spread

The above graphic shows Region 9/10 of the Texas Department of State Health Services, which covers 36 counties, including the tri-county area. Five investigators, with help from six surge team members, handle contact tracing for the households of people that test positive for coronavirus. Illustration by Claire Lindsay-McGinn.

TRI-COUNTY — Coronavirus is gaining a foothold in the tri-county region, with officials in both Presidio and Brewster counties warning of community spread as local case-counts reach nine active and one recovered in Presidio County and 21 active and one recovered in Brewster County. At press time, Jeff Davis County is still at zero cases.

Coronavirus has been in the region since April, when Brewster County reported its first confirmed case. But for the first time, officials are seeing cases with no clear origin and are assuming community spread — meaning residents could pick up the disease not just with trips to El Paso and beyond, but with outings in the local community. And with the growing case-counts, it has fallen to the regional state health department to track the spread in West Texas.

“Five investigators in our region are working full time to do the contact tracing,” Presidio County Judge Cinderela Guevara said Wednesday. “The investigators are medical personnel, and they are bogged down and have the whole region to take care of.”

“Our region includes areas that have nursing homes, and quite frankly their priority is going to be the nursing homes because of how vulnerable those people are,” said Guevara.

A map of Region 9/10 of the Department of State Health Services shows the tri-county is grouped into a region with 36 counties, that cover El Paso, Midland-Odessa and other rural areas in West Texas like Crane, where a recent outbreak in a nursing home is driving case increases.

The five core investigators are currently assisted by six surge team members to contact households of people who test positive in Region 9/10. All others potentially exposed to those who tested positive are now put through the state’s new online program, where tracers from across the state are assigned to contact people.

In a report from April laying out Texas’ “reopening” plans, state officials said they planned to coordinate with local health officials and “fully mobilize contact tracing of up to 4,000” tracers. For contrast, Illinois also plans to hire 4,000 contact tracers despite having less than half of Texas’s population. And as The Texas Tribune reported this month, Texas has even fallen short of that goal.

By June 4, the state had hired fewer than 3,000 such tracers, including 600 people at a company that received a $295 million contract from the state. As reported by The Dallas Morning News, that company, MTX Group Inc., won’t “reveal the subcontractors involved in the project” or “say how much the tracers are being paid.”

When Governor Greg Abbott first allowed reopening, small counties like Presidio and Brewster with fewer than five cases could apply to open at an even higher capacity if they could meet a few requirements, including a contact tracing plan.

When Presidio and Brewster judges reached out to the DSHS about making their own contact tracing plans, they were told the state would instead take care of it for them. Following that assurance, they applied and opened at a higher capacity, depending on DSHS for local tracing needs.

In an interview Tuesday, Presidio County Health Authority Dr. John Paul Schwartz said he hadn’t heard from DSHS officials since they last confirmed a case on Friday, June 5 — eleven days earlier. “I’m just not getting the support that I need,” Schwartz said. “I’m not getting the feedback.”

After multiple attempts by The Big Bend Sentinel to contact the Texas Department of State Health Services in Austin, at press time, the agency had not responded to requests for comment about contact tracing or the escalating situation in Far West Texas.

Throughout the coronavirus pandemic, Texas DSHS has only responded to one press request from The Big Bend Sentinel — and even then, they did not fully answer our questions. The Big Bend Sentinel last week filed a records request with the agency, asking for detailed information on its local contact-tracing efforts and is awaiting a response to the request.

“Local officials are frustrated at the meager response of the health department to the area,” Dr. Schwartz said. “Contact tracing is not generally discussed once the single case has been described,” he said. “There doesn’t seem to be lots of follow-up of what happens later. That’s been my experience.”

On June 5, Presidio County officials said they’d found a confirmed case of coronavirus in Marfa: a man in his 40s who is believed to have contracted the disease from traveling.

Luis “Junior” Nuñez, a Marfa resident, confirmed in a phone interview with The Big Bend Sentinel that he was that patient. And with four family members living at his home, health officials are treating those four as “probables,” which are not counted in official tallies.

One of the family member’s employers had expected to hear from the state about tracing, repeatedly checking their email and phones for any messages, but the employer confirmed that twelve days after the case was announced, they had still not been contacted.

On Tuesday night, another local business, barbeque eatery Convenience West, said on social media that it was temporarily closing after being “in contact with someone who has tested positive for coronavirus.” They found out not from state health officials, but from the concerned COVID-positive person.

Mark Scott, chef and one of the owners of the restaurant, said a resident who had stopped by to pick up food later contacted them to disclose they’d tested positive for coronavirus at a mobile testing site in Marfa on Friday, one of the newly announced cases here. At press time on Wednesday, the restaurant had not yet heard from the state.

“Zero contact at the moment,” Scott said in a follow-up call Wednesday morning.

In a phone call on Wednesday, Greg Davis, a Border Patrol spokesperson, confirmed that an employee at Big Bend Sector Headquarters in Marfa had tested positive for coronavirus. The employee is believed to have contracted the disease through travel and is now quarantining at home, Davis said. Local Border Patrol officials have not yet heard from the Department of State Health Services regarding the case.

“In a small community like ours, word travels faster than they can do their investigation,” Judge Guevara said about the state’s attempts to trace new cases as they emerge.

On Wednesday, Presidio County officially announced eight new cases in Marfa, all results from the most recent drive-through testing in Marfa. “Based on contact tracing case investigations, all patients have residences in Marfa, Texas. All are community transmission. The majority of the cases range from no symptoms to mild symptoms,” according to Judge Guevara. Patients range in age from their teens to their 60s.

Alpine has not proven immune to rising case-counts, either. After finding a coronavirus case in South County in April, Brewster County’s case-count sat for weeks at just one. That patient recovered. Then, on Saturday, Brewster County announced six new confirmed cases. On Monday, it announced four more. In a news release this week, the Texas Department of State Health Services warned that in Alpine, “all transmissions are assumed to be community-spread.”

On Wednesday evening, Brewster County Judge Eleazar Cano announced the case total in Brewster had climbed to 22 total, saying “most were due to community transmission.”

As the local crisis grew, Stephanie Elmore, the emergency management coordinator for Brewster County, made a State of Texas Assistance Request for around 300 more coronavirus tests, which would be for the hospital to use, she said. At least some of the tests are earmarked for employees at an Alpine restaurant, which Elmore said had become a “hotspot” for coronavirus. Employees there were quarantining, Elmore said, and the restaurant was closing for 14 days to clean.

When Brewster County got its first coronavirus case in April, DSHS contacted that patient, Elmore said. Otherwise, though, she’s heard little about state contact-tracing efforts in the region. “I know they’re supposed to,” she added of state efforts, but she hadn’t “gotten the facts” on aspects of the state’s approach.

In its own statement on Saturday, Alpine Independent School District announced that one of its staff members had coronavirus. They began a 14-day closure “immediately,” cancelled all summer school for kids aged pre-K through 8th grade and said buildings would be “deeply sanitized.” Texas is directing people to disinfection guidelines from the Centers for Disease Control and Prevention, which recommend waiting 24 hours or “as long as practical” to clean, opening windows and doors and turning on fans to “increase air circulation in the area” and disinfecting using EPA-registered disinfectants on all areas “used by the ill persons, focusing especially on frequently touched surfaces.”

Alpine public schools also cancelled their summer workouts and conditioning for athletes and the school summer meal program. Becky McCutchen, the superintendent for Alpine ISD, did not respond to requests for comment by press time.

Separately, Basecamp Terlingua, a short-term rentals company in Terlingua, said in a social media post that a group of four guests had all tested positive for coronavirus and that one had started feeling symptoms during their stay.

Basecamp also said the guests “did not heed our suggestion to stay out of local establishments.” In response, Basecamp said it was conducting its own contact tracing, which included contacting a server at an area restaurant who may have been exposed.

That’s precisely the job that state health officials said they would do for the tri-county. But as Texas plows ahead with its “reopening” strategy and contact tracing lags behind, that task is increasingly falling to tri-county officials instead. Local residents and businesses are also joining in the effort, for better or worse.

In the case of Basecamp Terlingua, those positives will be counted in the guests’ home county and managed by their regional DSHS department. At press time, Basecamp had not confirmed if they were contacted by any state tracing officials.

When DSHS began tracing Marfa’s first case, Nuñez told health officials on June 5 that his family had stayed in place and left it at that. Local officials urged DSHS to look further into it, to which DSHS agreed.

Even under quarantine, Nuñez travels out of the region three times a week for dialysis, a regular emergency procedure required by some diabetics and people with other kidney issues to keep the organs in balance. Such trips are essential and considered a valid reason for travel, and Nuñez speculated that might have been where he contracted the disease.

But law enforcement authorities say that after being confirmed positive, Nuñez was also making visits around town, violating quarantine rules. Last week, county officials warned that Nuñez and his family had “not been respecting control measures.” For that reason, the Presidio County Sheriff’s Office warned on social media, “the probability exists of possible spread.”

In an interview with The Big Bend Sentinel, Nuñez insisted that he and his family had been following quarantine rules. But Steve Marquez, chief of the Marfa Police Department, said he’s received numerous calls from concerned citizens.

One person said they saw one of Nuñez’s children at a local store. Two said they saw Nuñez ordering from a restaurant. Another person at a store in Alpine put up a sign, urging employees not to serve the family. Chief Marquez said he followed up on the Marfa complaints with a warning for Nuñez that he could face charges if he was violating quarantine orders.

But the reports kept coming in. One person said they saw Nuñez’s wife at a park. One person said they saw Nuñez’s son at the post office.

On Friday, two people called to report that Nuñez was walking around town. Marquez called Nuñez. He denied that he was in Marfa, according to Marquez. “He advised me he was actually in El Paso” for dialysis, Marquez said. “He said he just spoke to his wife and that they [the family] were all home.”

Nuñez said he wasn’t sure why people were reporting seeing him around town. “It just kind of upsets you,” he said of the situation. “You don’t really know what’s going on, and then all of a sudden everybody sees you everywhere.”

Some residents on social media were furious with Nuñez over the alleged sightings. Others felt he was being unfairly turned into a pariah and rallied to his defense. An online “meal train” was set up for the family, so that residents could donate and deliver food.

Four days after the case was confirmed, Judge Cinderela Guevara released a statement that a regional DSHS department had taken action “to ensure the prevention of the introduction, transmission and spread of the disease in this community.” Namely, they issued an order that remains in effect until the person is notified by DSHS in writing when the incubation period has passed and they are no longer suspected of having the communicable disease. Should the patient with COVID-19 not comply, they would be subject to criminal prosecution, the statement read.

Nuñez, who said on Friday that he was feeling “fine,” was cheered by the outpouring of support. “It makes me feel a little welcomed,” he said. “Everybody is telling me to keep our heads up and get well soon.”

At press time, Guevara said Nuñez and his family have not yet been released from their quarantine order by DSHS.

Guevara wrote in her release that she was providing that information to the public in response to “the many phone calls or texts with concerns of suspected person (or persons) not complying with control measures,” adding, “The only recourse for us in authority was to reach out to the Department of State Health Services Regional Medical Director.”

Nuñez, the first Marfa patient, said state officials have been regularly calling him. “They’ve been contacting us every day,” he said, “just to tell us to stay at home and stay in place until our quarantine days are over.”

For the county judge, contact with DSHS is less regular. “The only details they’ll give me are to do with if someone is positive, and then they’ll give me the generalized information that we have received,” Guevara said, including information like the anonymous person’s gender and a rough suggestion of their age. She added that because she is not a doctor, the state would give more information to the local health authority.

But Dr. Schwartz, the local health authority, isn’t hearing much, either. “The last time I talked to them, I had to pursue them, talk to them and pin them down, and I think that’s indicative of how poorly they’re handling this,” said the doctor.

Schwartz said he would like the state to provide better instructions and guidelines for those who test positive and to supply a caseworker that checks on them and helps them access services or get meals while they are mandated to stay home.

He also called for more comprehensive testing than the “sporadic,” one-day events in the Big Bend region and for more communication between the state and the county.

As for tracing, Schwartz said he wanted a report from the state after tracing had been completed for a case, informing the county of how many people came into contact with the positive case and making sure those folks are able to get tested quickly. “That’s what we need. That’s when we can design what to do on this end,” he said.

Chief Marquez has been unimpressed by the state response to the first confirmed coronavirus case in Marfa. “I would like to see where this contact tracing is,” he said. “We have a lot of vulnerable people here.”

Despite receiving no resources to conduct contact tracing, Marquez felt the task was falling to him. “It’s becoming ridiculous,” he added. “We want to help the situation, but we don’t know who to contact.” But he said local police were happy to help in the efforts “if the state wants to give us those resources.”

Teresa Todd, city attorney for the City of Marfa, said that from the start, Texas should have put local leaders in charge of contact tracing.

“I think it would have been a better system for money to have been given to local governments to hire contact tracers and handle that locally,” she said. “I think when you’re in a community and you know people, you just do a better job.”

Local contact tracers would have a better sense of patients’ movements and possible contacts, Todd argued. And besides, “we’ve got people out of work here,” she said. “I’d like for them to be hired as contact tracers.”

Marfa and Presidio County, she said, were doing a fine job of protecting locals from coronavirus. “And then suddenly, the governor swooped in,” enacting state rules that overturned local safety measures, even those requiring face coverings.

“I think lives were saved here,” she added. “When it was on city council and the mayor’s watch, we didn’t have any confirmed cases. Now, we do. And that’s after the governor stepped in.”