Frustrated by state efforts, Marfa wants its own contact tracing

MARFA — Michael Roch wondered if he had coronavirus. He knew people who tested at the same Marfa testing site in June, and they all got results within three days — but he was still waiting.

But when a worker with the Texas Department of State Health Services called Roch the next day with his positive results, it was still a shock. “I was a little discombobulated,” he said. His mind raced to anyone he might have interacted with while contagious. “Who have I seen?” he asked himself. “What have I done?”

Thankfully, Roch had been mostly staying put. So when state officials asked him about recent possible contacts, he didn’t have many to list.

He told the state health worker that he’d worked at the Marfa Volunteer Fire Department and that he’d responded to an incident a couple days earlier. “In firefighting, social distancing is something we cannot do,” Roch said in an interview Monday. “It doesn’t work with one person. We’re often in close quarters.”

He gave the official contact information for his boss: Jenny Moore at the Chinati Foundation, where Roch is the director of education and curricula. He might have also mentioned that he visited a local restaurant, but he isn’t sure.

Then the call was over. Roch worried whether he forgot to mention any contacts.

“I think it could have been done maybe a little bit slower, or spelled out a little bit better,” Roch said. But he knew the official was busy: “They have to go through all these phone calls.”

As coronavirus case counts climb across Texas, it has overwhelmed state efforts to contain and trace the virus. The Big Bend Sentinel reported on these issues last month, noting the regional contact tracers tasked with the tri-county also covered 33 other counties, including big cities and nursing homes with outbreaks.

Testing, distributing results and now contact tracing have overwhelmed the state. “They’re inundated,” Presidio County Judge Cinderela Guevara said at a county meeting last Wednesday, addressing delays in testing results and other issues.

In Roch’s case, contact tracing went more or less how it should. Roch told the interviewer about his contacts at the Marfa Volunteer Fire Department.

State officials called Fire Chief Gary Mitschke a day later, telling him staff could have had contacts. Mitschke went into quarantine and told around five other firefighters to do the same.

But like so much of the state’s response to coronavirus, the experience hasn’t been consistent for everybody. With testing, some people get results in days, while others wait for weeks.

Likewise, while Roch described his DSHS interviewer as “competent” and “thorough,” not everyone has his experience. Doctors and officials across the region have heard reports of people who weren’t adequately traced — or worse, were never contacted at all.

On social media, residents have complained about never hearing results, positive or negative, from state health officials. And in at least one case, one person later found out they were positive.

After enlisting the help of a local doctor to get her results, Lari Quigg, an Alpine resident, learned she had coronavirus.

“By the time the doctor actually made the call to me,” Quigg said, “I was experiencing symptoms.” She was “so exhausted,” with nausea and headaches.

Another tri-county resident, who wished to remain anonymous about his positive coronavirus status, was somewhere in between those two extremes. State officials at first did “a lot” of contact tracing, a family member said, reaching out to everyone that patient remembered interacting with.

But when that patient thought of some more contacts, the experience was different. State officials “did not contact those people,” according to his relative.

Even in Roch’s case, details were overlooked. Jenny Moore, executive director at the Chinati Foundation, said in an email that she’d never been contacted by state health workers. Roch said he’d been with Moore during his infection window, though they were standing apart and wearing masks. “Maybe that’s why they didn’t [contact her],” he said. “I have no idea.”

Mark Scott, co-owner at Convenience West where Roch had picked up a meal during his potential infection window last month, also said he didn’t think the restaurant ever heard from contact investigators. And it was Roch — not health workers — who told Convenience West about the contact, prompting the restaurant to close for two weeks as a precaution.

These mixed experiences have been troubling for people like Don Culbertson, a physician assistant at the Marfa Clinic. Decades ago, he worked as a contact tracer in King County in Washington State, where he focused on sexually transmitted diseases.

“It was like being an investigator-cop,” he said of those days. “We drove around, looking for leads.” He would go to bars and ask workers if they’d seen someone matching a particular description.

Culbertson would like to see similar efforts here. “I think COVID is particularly amenable to contact tracing,” he said. Unlike diseases like HIV/AIDS, coronavirus has an incubation period of days, not months.

But from talking to patients and officials, Culbertson doesn’t see much gumshoe work like this happening in the tri-county.  He puts the blame on “anemic” funding of health resources in Texas.

“If it doesn’t have to do with oil or pipelines, we’re not funded very well,” he said. But “now we have a pandemic.”

Faced with reports like this, officials in Marfa have started to wonder if they could do better. After months of considering the idea — and with case counts continuing to climb in the state and region — city leaders this week hoped to discuss setting up local contact tracing efforts at a city council meeting on Tuesday.

But with no sign-off from the state — and with state officials telling county officials that local efforts like this wouldn’t be legal — the item didn’t make it onto the agenda. In the meantime, some officials are starting to lose patience.

The City of Marfa isn’t the only tri-county government wondering if it could set up its own contact tracing efforts. At a meeting about coronavirus last week, Alpine city leaders said they would “definitely segment off resources to help with contact tracing,” according to City Manager Erik Zimmer, who was present at the meeting. They asked Dr. Escovar to look into it.

But in an interview on Monday, Zimmer said that — last he’d heard — there was still no answer from the state. Dr. Escovar did not respond to a request for comment.

Would it be legal for Marfa to set up its own contact tracing efforts? Asked about these issues, a DSHS spokesperson did not respond directly about Marfa’s situation or the legal ins-and-outs.

Instead, she noted that cities with health departments — which typically include big metro areas like Midland and Houston, and not small towns like Marfa — were largely handling their own contact tracing. Cities without their own health departments could use regional investigators, she said. And in both cases, information from local or regional tracing efforts was uploaded into the statewide Texas Health Trace system, which also has a call center to pick up additional loads.

“Most local health departments chose to continue doing their own case investigations and contact tracing,” the spokesperson added. “The call center is set up to accommodate additional case investigations.”

Meanwhile, the City of Marfa and Presidio County have themselves at odds over this issue. The county says Marfa can’t set up its own contact tracing.

Gary Mitschke, the emergency management coordinator for Presidio County, cited the legal and logistical issues of getting confidential state health data to city or county workers, as well as the ethical problems of having Marfans contact tracing friends and neighbors.

Presidio County Judge Cinderela Guevara, who has spent days researching the issue with state health officials, agrees that local efforts wouldn’t be legal. Instead, she said, any locals who wanted to help with local contact tracing would instead need to work under the “daily oversight” of DSHS.

But it would be DSHS’s decision on whether or not to scale up those efforts — and even if the state did hire some Marfans, they would likely be working not just locally, but making tracing calls all across the state.

“I applaud the efforts of those in our community eager to volunteer to help stop the spread of COVID-19 by becoming contact tracers for our area,” Judge Guevara wrote in an email, citing conversations with state officials. However, “the state does not currently allow for this.”

When locals have tried to become contact tracers, though, they haven’t had much luck. At a Presidio County Commissioners Court meeting last week, one resident complained that she’d been trying — unsuccessfully — to become a contact tracer.

But after applying to around eight jobs — mostly in Texas, but also elsewhere — she kept “hitting these weird roadblocks,” she said later. Among them was a job that required her to have a PC (she didn’t) and another that required her to be a furloughed employee in the state of Virginia (she wasn’t). She’d started looking outside Texas after running into dead ends in the state.

City leaders aren’t so sure they can’t do contact tracing. Because while Judge Guevara is hearing one thing from the state, some local leaders say they’re hearing otherwise.

Take Buck Johnston, a Marfa city council member who has spearheaded efforts to bring contact tracing down to the local level. Her goal, she says, is to create one or two new contact-investigator positions in the city, with Culbertson likely taking one of them. But with conversations on the topic lagging since March, she’s growing frustrated with what she called “bureaucratic” slowness.

“I just feel like it’s worth a try,” Johnston said of those efforts. “It’d be a real game changer for us.”

There are a few reasons why Johnston thinks Marfa could set up its own contact tracers. For one thing, the Texas Department of Emergency Management says cities can use CARES (Coronavirus Aid, Relief and Economic Security) Act funding to establish such a program. A New York Times article last week noted that Corpus Christi has “dozens of contact tracers.” Unfortunately, the situation isn’t exactly parallel with Marfa’s: Nueces County, where Corpus Christi is, has its own health department, whereas the tri-county relies on Region 9/10 of DSHS due to the absence of local health departments.

Another piece of evidence Marfa could have its own tracing, Johnston says, is that a member of Governor Abbott’s task force told her as much.

In a lengthy email, which Johnston shared with The Big Bend Sentinel, Dr. John Carlo, a Dallas-based doctor and member of the task force, told her he could find no legal basis for barring Marfa from establishing such a program.

“I don’t see how they could not allow the City of Marfa to conduct the same activity as Dallas, Houston, San Antonio which are all doing their own contract tracing investigations,” he said. “The issue would be whether or not your local jurisdiction has a sworn health authority.”

Presidio County does in fact have a sworn health authority: Dr. John Paul Schwartz. And like Johnston, he’s losing patience with the red tape.

“Out here in West Texas, we’re way behind in terms of contact tracing,” he said in an interview Monday. “I haven’t seen any agents on the ground out here. I see [contact tracing] all being done over the phone — which is the least effective way you can do it.”

“There’s no leadership from the country, and there’s no leadership from the state government,” he added. “It’s total incompetence from the top to the bottom.”

Another issue, Dr. Schwartz says, is that while the tri-county is effectively one big community, formal distinctions between the counties prevent health officials from sharing data with each other in a timely manner. “We’re a triple county region,” he said. “It works all as one unit, and [the state] should be turning this into a single health zone and treating it like that.”

Roch, the Marfa patient, has had positive experiences with DSHS. “The person I had really cared,” he said of his contact investigator — noting that they called him every few days to check in. They sometimes even chatted about a shared interest: Marfa. Instead, Roch thinks DSHS isn’t getting the resources it needs from the state.

“For being under-budgeted,” he added, “they do a lot.”

Still, Roch said, contact tracing “seemed to be the missing link.” And when his experiences were over, he wrote a letter to his caseworker, thanking DSHS for their “patience” with him and encouraging some changes to make the contact tracing experience more user-friendly.

Among his suggestions: Give people “simple prompts” and encourage them to make a two-week calendar of any possible contacts. “I doubt I’m the only person with an ‘Oh yeah, I forgot’ moment,” he wrote. He also suggested that patients be given the option to share protected information with local officials.