Low turnout but strong results so far characterize Marfa’s contact tracing program

MARFA — In a public notice in The Big Bend Sentinel last month, Marfa officially announced the start of its citywide contact tracing program. Around the same time, a public service announcement also aired on Marfa Public Radio.

The announcements outlined the basics of the program (like the fact it is HIPAA-compliant, state-approved and open to all residents in Marfa city limits) and gave advice to anyone who was worried they might have been exposed to coronavirus (“it is best to quarantine at home and call us for guidance on what to do next”).

“The main thing to remember is that you aren’t alone — the Marfa Contact Tracing Team is here to help,” the notice in this paper stated. “Call us at 432-279-0279.”

And just like that, after months in the works, Marfa’s contact tracing program officially hit lift-off. Discussions of starting such a program began in earnest in July, as city officials started hearing troubling stories of residents who had tested positive for coronavirus but weren’t being contacted by the state. After discussions with the Texas Department of State Health Services, city officials ultimately got approval to start a program of their own.

Then, at a city council meeting last month, council members unanimously agreed to hire three city contact tracers at a rate of $20 per hour. Among them were Don Culberston, a physician assistant at Marfa Clinic who is supervising the program, as well as medical assistant Leticia Garcia and Norma Martinez, a former CPS caseworker. At the meeting, Marfa city officials also approved the purchase of a rapid testing machine for around $5,000, which will provide COVID-19 results within minutes, and which city officials hope will bolster testing rates in the area.

In a sense, that city council meeting marked the technical start of Marfa’s contact tracing program. But in interviews at the time, city officials said the program wouldn’t really begin until they publicized the coronavirus hotline number and started hearing from residents.

In an interview on Friday, eight days after the phone number was publicized, Culbertson, the supervisor of the program, said that so far, not a single person had called into the city hotline.

In total, Culbertson said he and the other contact tracers had performed official city contact investigations on three Marfa residents. But one of those was a patient at Marfa Clinic, Culbertson said. The other two cases came not from residents calling in, but from the Texas Department of State Health Services, which provided the city with information on local cases.

While those numbers are low, there are some important caveats. As of Friday’s interview with Culbertson, the last public testing sites in Marfa were in late August — weeks before the contact tracing program even started.

With few new confirmed cases in Marfa since then, Culbertson said they simply haven’t had much contact tracing to do. And after state officials announced a testing site that took place in Marfa on Wednesday, Culberston said he expects things will get busier over the end of this week and the start of next, as results from that site start trickling in.

“With more tests,” he said, “we’re going to get more traffic.”

Culberston did receive nine calls from patients at the end of last week alone – it’s just that those calls came into Marfa Clinic, rather than through the city hotline.

Because those people were patients at Marfa Clinic — and because not all of them live in Marfa city limits — Culbertson doesn’t view those cases as part of Marfa’s official contact tracing program, which is only open to people in city limits. Still, he stressed that he helped advise those patients and investigate possible contacts. He just did so as a private health provider — not as a public official.

Of the three cases that Marfa officials have so far traced, just one of those was already being investigated by state contact tracers.

Another patient was aware of their coronavirus status but hadn’t been otherwise contacted, while the third wasn’t even aware they were coronavirus-positive, according to Culbertson. That’s despite the fact that state health workers already knew about at least two of those three cases.

Still, there are areas where Marfa’s contact tracing program could stand to improve. For one thing, the program so far just covers Marfa proper, and not outlying neighborhoods like Sal Si Puedes. That’s because those areas are under the jurisdiction of Presidio County (not Marfa) and therefore require county sign-off.

“It’s a disservice for those who live in the surrounding areas of Marfa,” Culbertson said of the fact that people in Sal Si Puedes and elsewhere are not yet covered by the program.

City officials tried to sort out this problem before the program started, writing up a memorandum of understanding for the county. But at a county commissioners court meeting last month, Rod Ponton, the Presidio County attorney, expressed concerns the document did not adequately protect the county from legal liability.

Ponton said he wanted to make sure the county was protected, and after weeks of setting up the program, some commissioners were concerned about further slowing down the process. “I, for one, do not want to hold up this program,” Commissioner Eloy Aranda said.

In the end, though, commissioners took the advice of their attorney and asked Teresa Todd, the city attorney for Marfa, to craft a new document. She and county officials will discuss that revised document at the next regular commissioners court meeting next week — but for now at least, if a resident from just outside Marfa calls into the hotline, local contact tracers will not technically be able to help them.

And while the first two weeks offer limited evidence that Marfa’s contact tracing program can effectively serve local residents, it’s still too soon to know for sure. Culbertson, who’s running the program, agrees.

“It’s a brand new program, and people need to see what our efficacy is,” he said. And figuring that out, he said, will take real data — “not just propaganda that we’re so great.” He thought there would be better evidence of the program’s successes and/or failures by December.

Still, for city officials who have spent months making the program a reality, it’s been gratifying to watch the program go live. Buck Johnston, the council member who first came up with the idea of a local contact tracing program, said she is thrilled the program is now up-and-running. And while she acknowledged a lack of public testing could hamper the work of city contact tracers, she said that once the city also sets up its rapid-testing abilities, it would “really complete the whole picture.”

Johnston said she’d asked Culberston to give regular briefings at Marfa City Council, so officials like herself could better gauge how the program is doing. But outside of those updates, she wants to let the contact tracing program do its job rather than micro-managing it.

“I don’t want to step on any toes, because of the confidentiality stuff,” she said. “[Culbertson] is going to be reporting to city council.”