This story was originally published in The Texas Tribune.
As Texas moves forward with a new phase of Gov. Greg Abbott’s plan for reopening businesses, the state has fallen more than 25% short of its goal for a workforce of disease detectives that experts say are crucial for tracking the spread of the new coronavirus.
One of Abbott’s reopening metrics for June 1 called for up to 4,000 Texas contact tracers, who work to identify people with possible exposure to the coronavirus and call them to get tested and self-quarantine.
But Texas officials said Thursday there were roughly 2,900 contact tracers working around the state. Of those, some 1,140 are working for the Texas Department of State Health Services, 1,170 are working for local health departments or their nonprofit and university partners, and about 600 are working for a company recently hired by the state.
State officials downplayed the importance of meeting the initial goal despite the public health agency’s statements last month assuring that health departments were in a “phase of hiring that will get us up to 4,000 in the coming weeks.”
The 4,000-person figure was an estimate taken from a national association of public health officials that was determined by the state’s population, Texas Department of State Health Services spokesman Chris Van Deusen said.
“Texas has had significantly fewer cases per capita than the national average, and we want to match the number of contact tracers to the actual workload,” Van Deusen said in an email, adding that the state has enough personnel to contact all new cases in its jurisdiction.
But other groups have suggested that Texas needs a far higher number of contact tracers. One model from George Washington University put the number at more than 8,000.
Abbott announced his third phase of reopening Wednesday, allowing most businesses to operate at 50% capacity effective immediately. Restaurants will be allowed to operate at 75% capacity beginning June 12 under the governor’s order.
As more people venture out and come into contact with others, public health experts say there will be a greater need for contact tracing to identify people who have been exposed to the virus. And after tens of thousands of Texans gathered to protest against police violence over the past week, epidemiologists expect the daily count of new coronavirus cases in Texas to grow at a faster clip in the coming weeks.
After someone tests positive for the coronavirus, a contact tracer calls them at the telephone number they gave to the testing agency. The tracer’s goal is to obtain a list of people and places where the patient might have spread the virus, call those contacts and encourage them to self-quarantine and get tested for the virus before they potentially infect a new group of people.
Over the past week, the average daily number of new coronavirus cases has grown in Texas, with new data reflecting outbreaks in prisons and meatpacking plants. Thursday’s figures: 1,649 new cases, 33 new deaths and about 5% of tests coming back positive.
The cumulative U.S. death toll from the virus has surpassed 100,000. Without adequate testing and contact tracing efforts, that number will continue to rise, said Georges Benjamin, executive director of the American Public Health Association.
“For all practical purposes, the vast majority of Americans have not yet really felt this, but we will,” Benjamin said. “It is still a lethal disease, and I think that the solution to us getting back to as close to normal as we can is adequate testing and contact tracing.”
But epidemiologists say they are encountering more resistance to their contact tracing efforts — including hang-ups and people providing false phone numbers — as the pandemic drags on.
“In the beginning, when this was new and everyone was scared, everyone was willing to take our calls. They were so grateful that someone was reaching out to them,” said Elya Franciscus, lead epidemiologist for Harris County Public Health, which has about 350 contact tracers. “Now, as a community, I think we’re experiencing COVID fatigue.”
That resistance also has manifested in the world of politics. From anti-vaccine activists to the Texas attorney general and Republican state lawmakers, some Texans have become more vocal in their opposition to contact tracing efforts.
In a letter to Abbott this week, state Rep. Valoree Swanson, R-Spring, criticized the decision to bring on thousands of contact tracers, calling it a “tracking program of Orwellian proportions.”
“My constituents and I believe it to be a threat to our privacy and individual liberties,” she wrote.
Benjamin said “terrible risk communication” from the U.S. government was partly to blame for growing suspicion of contact tracing efforts, which public health experts broadly regard as essential to containing the virus’s spread.
“People don’t know what to believe, and when they don’t know what to believe, they don’t know what to do,” he said.
Anger also has been directed at a $295 million, federally funded contract authorized by Texas health officials last month. The contract, awarded to Frisco-based company MTX Group, pays the firm to create a call center and hire up to 1,000 contact tracers. Lt. Gov. Dan Patrick and a bevy of state lawmakers have criticized state health officials for signing the deal speedily and without their knowledge, leaving them unable to vet whether the company was qualified for the work.
Since early spring, local health departments around the state have ramped up the number of disease detectives in their ranks, including reassigning workers from other responsibilities and hiring temporary staff. Most say they expect at least some of the work to be reimbursed with emergency federal funds authorized for coronavirus response.
The Texas Department of State Health Services performs contact tracing in parts of the state where local health departments cannot. Health departments in the state’s biggest cities run their own shows, and the size of their workforces varies greatly. (The 2,900 statewide contact tracing figure provided by Texas officials did not specify where tracers are located.)
In some of the hardest-hit regions of the state, public health officials have declined to offer any details about their contact tracing efforts. Amarillo spokesperson Dave Henry declined to say if the local health department had anyone performing contact tracing despite a high rate of infection in the region linked to outbreaks in meatpacking plants.
Houston and its surrounding Harris County have a contact tracing workforce of nearly 500, local public health officials said last week. Many of them are volunteers, including medical and public health students and nonprofit workers. The county health department is not hiring, spokesperson Martha Marquez said in an email, while the city is aiming to fill about 300 temporary positions related to COVID-19, including contact tracers.
Dallas County has about 180 contact tracers, including paid and volunteer workers, whereas San Antonio’s Metropolitan Health District has about 100 workers and has no immediate plans to hire more.
“At this time we are doing well with the staff we have,” spokesperson Michelle Vigil said in an email.
Rita Espinoza, the department’s chief of epidemiology, said she has not experienced significantly greater resistance to contact tracing efforts for the coronavirus than with other diseases. But a key difference with the coronavirus, she said, is the large variety of testing sites, from pop-up locations to doctors’ offices, which have inconsistent standards for collecting patients’ contact information.
As a result, tracers are sometimes unable to get working phone numbers for Texans who test positive, hampering efforts to identify whom they may have exposed.
“Like all diseases, it would be unrealistic to think that we get 100% of individuals,” Espinoza said. “We try our hardest and we try through various different mechanisms, but sometimes you just might not be able to or maybe they don’t want to share that information with you.”
And although there are record numbers of unemployed Texans looking for work, some are finding it difficult to find temporary employment as contact tracers even as the state is some 1,100 people short of its original goal.
Zainab Diwan, 24, took a free course through the University of Houston to be trained in how contact tracing works and the privacy rules associated with handling sensitive information. A master’s student in biochemistry who aspires to work in a medical field, Diwan felt like a qualified candidate.
“It was very much an opportunity to put together what we’re learning in our textbooks and apply it in real life, and I jumped at that opportunity,” she said.
After being laid off from her part-time job as a secretary, she’s applied for unemployment and is “living off of ramen” while hoping an opportunity comes up.
For now, she’s still waiting.
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