After conflicting reports from state, Marfa likely to get contact tracers

MARFA — Marfa may be getting a contact tracing program after all.

Last week, The Big Bend Sentinel reported that local officials wanted to set up their own contact tracing program after hearing mixed reviews of state efforts. That push prompted a disagreement among local officials, which mostly broke down along city and county lines.

Some county officials said such a program wouldn’t be legally or logistically feasible. They cited conversations with officials at agencies like Texas Department of State Health Services, which oversees contact tracing. They also said there were ethical and logistical problems around sharing confidential state health data with local contact investigators, as well as asking Marfans to contact trace their own friends and neighbors.

City officials weren’t so sure, though. They pointed to other Texas cities that had set up local contact tracing efforts, like Corpus Christi and Houston. The analogy wasn’t perfect: Big cities like Houston have their own health departments, whereas the sparsely populated tri-county region relies on the regional DSHS office of Region 9/10.

Still, while county officials were getting a clear “no” from state-level officials, some in Marfa city government said they were hearing otherwise. Some of the strongest evidence came from Marfa City Councilmember Buck Johnston, who sought out an opinion from a member of Governor Greg Abbott’s coronavirus task force.

That task force member, Dallas-based Dr. John Carlo, told Johnston that he didn’t see why Marfa couldn’t hire contact tracers. Instead, he wrote in an email that Presidio County would simply need a sworn health authority — which it has in the form of Dr. John Paul “J.P.” Schwartz.

It appears Johnston and others were right after all. Last week, city officials were also in conversations with the office of State Senator José Rodríguez. And like Dr. Carlo, staff members believed there were no legal reasons to deny Marfa such a program.

Chief among them were Sushma Smith, Senator Rodríguez’s chief of staff and legislative director. “It is possible for the city to collaborate with the state on contact tracing,” she wrote in an email to The Big Bend Sentinel. “The next step,” she added, would be determining the “legal requirements and logistics needed for the city to access Texas Health Trace,” the state program into which all contact tracing efforts are aggregated.

“They’re not gonna toot their own horn about this, but Senator Rodríguez’s office — and specifically Sushma Smith — facilitated this entire thing,” Teresa Todd, the Marfa city attorney, said. “We didn’t even have contacts at the state level in [DSHS].”

Marfa’s efforts gained speed on Friday, when officials from Marfa and Presidio County attended a virtual meeting with Rodríguez’s staff and a handful of DSHS officials. Present at the meeting were Johnston and Todd, who helped spearhead the effort, as well as Don Culberston and Presidio County Health Authority Schwartz, who — as medical professionals — will help facilitate Marfa’s contact tracing.

“We’re moving forward,” an excited Todd said after the meeting — noting that the city was likely “forging new territory” as it tries to set up contact tracing not as a large metropolitan area, but as a small town.

The meeting was “very collaborative,” she added, with both DSHS and Marfa officials providing insights for how they could help. For example, while DSHS can offer critical health data, Marfa city officials can help contact tracers reach locals and sort out addresses. “At city hall, we pretty much know where everyone lives,” she said.

Johnston was happy with the outcome of the meeting too, describing it as “really positive” and “very productive.” And from the DSHS officials at the meeting, she got the impression that state officials had “no resistance to us doing our thing.”

She was also pleased that DSHS — in addition to offering data — had volunteered to help with local efforts. The state agency has resources Marfa doesn’t, she said, including for counseling and mental health services after someone tests positive.

As Johnston saw it, the confusion from the state level was a result of Marfa’s unique position: not only as a very small town, but as one with people who had taken training in contact tracing from Johns Hopkins University.

What exactly will Marfa’s contact tracing program look like? Those details will likely be ironed out at the next Marfa City Council meeting, Johnston said. The next regular meeting is Thursday, July 30, though officials have said they might also call an emergency meeting.

City leaders are planning to hire one or two contact tracers, including Culbertson. They believe they can fully finance the project using emergency funds from the Texas Division of Emergency Management. But some other big questions remain, including: Will Culbertson and any other contact investigators be employees of Marfa or Presidio County? How should contact investigators identify themselves, and what’s the best way to contact patients to ensure they answer the phone?

As a county health authority, Schwartz already has access to the confidential health information necessary to do contact tracing. Now that local officials have started ironing out logistics and legalities with DSHS, it will just be a matter of Schwartz passing that information onto the tracers. But that raises another question: Will Marfa handle contact tracing solo, or will it try to work with the whole tri-county?

Schwartz has proposed that the state treat the tri-county as a “single health zone.” Doing so, he said, would improve time-sensitive communications between officials in a region where people often live, work and shop in multiple counties.

City officials aren’t opposed to the idea — but at least for now, they’re wary of doing anything that could slow down the process.

“We just felt like opening it up more would defeat the purpose of trying to do this as quickly and efficiently as possible,” Todd said. Instead, she described Marfa’s new contact tracing efforts as something of a “pilot” program.

“Everyone came away very happy,” said Schwartz, who also attended the meeting. DSHS, he said, was thrilled to learn that Marfa had people lined up like Culbertson, who is already trained as a contact tracer.

Schwartz pointed to a patient who recently tested positive for coronavirus, but had not yet been contacted by investigators. It was case-in-point, he said, for why Marfa needed to help take a lead on these efforts.

Schwartz said he trusted Culberston to handle contact tracing and would likely take a “low-key” approach towards monitoring the local case-investigators. “I’m confident they will do their job,” he said. Still, as the public health authority — and therefore the person with access to critical health information — he did expect he would be bothering the DSHS more frequently, as the agency has sometimes struggled to provide timely information on the county level.

As Schwartz saw it, the confusion around Marfa’s contact tracing push was part of a larger trend in Texas, where local leaders have often struggled to get information they need from the state.

Officials in Marfa and Presidio County have had “utterly no guidance” from the state, he said — or at very least, “no useful guidance.” And worse, he said, state and federal leaders were turning coronavirus “into a political issue,” with Americans now divided on partisan lines about the dangers of coronavirus.