Hays County’s health department has been doing contact tracing since it found its first coronavirus-infected patient, and this method has helped the department hold down the spread of COVID-19 in several instances.
“It has helped us to identify a couple of clusters that were linked back to people who tested positive and were asymptomatic,” said Dr. Eric Schneider, epidemiologist at the Hays County Local Health Department. “These people are the ones that typically expose the majority of our cases because they do not know they are infected, or that they are contagious. We have had several home healthcare nurses that were identified through this method that were potential carriers because they were the only common link between residents in certain cities.”
So what is contact tracing and how is Hays County implementing it?
The method used by Hays County is an internal style, which means that epidemiologists contact lab-confirmed cases, gather information from those individuals for names and numbers of people they think may have been exposed. Once the department has gathered this information, the epidemiologists follow up with them. Due to HIPAA compliance, contact tracers cannot say who is infected or who may have infected the patient.
Utilizing contact tracing to slow down the spread of the coronavirus is proving itself to be an essential tool to fighting the invisible illness. Yet contact tracing is conducted by individual counties and they each have their own methods. The coronavirus knows no county lines, though, especially when people are commuting to work, to visit families and more. The state cannot legally force each county to perform contact tracing and, even if they did, they cannot force individuals to participate.
Since contact tracing is an expensive and time-consuming method, Texas has put in place several aids for its counties to use. The state is adding contact tracer positions which will disperse 4,000 employees to cities that need them. They have also created an online Texas Health Trace system which connects cities and counties together and with the state.
Hays County has decided that for the time being, it will not use the state-employed health tracers, said Dr. Ian Harris, also a Hays County epidemiologist. The state can appoint four contact tracers in the county, but Hays already has four contact tracers and an additional two that will be pulled if needed.
Adding more contact tracers might not be a farfetched solution; Hays County has been seeing a rapid increase in new cases.
“It does seem we are seeing more cases day by day,” Harris told the Hays Free Press, “and as the lockdown becomes more relaxed, I think it’s important for the community to remember COVID-19 is around. We’re seeing more cases than we did a month ago.”
Two weeks ago, the county saw an additional 15-18 new cases a day, and a week prior to that, they were seeing six to 14 cases, and prior to that, the average was between two and five cases a day.
Harris saw a glimmer of hope in one place – several weeks ago, counties were asked to test all nursing home residents, staff and caregivers. Of the 1,300 people tested, none came back positive. This was not expected, but Harris said it was a pleasant surprise.
Even though the six nursing homes in Hays County have been marked as clear for now, there is still much work to be done in terms of state effort for contact tracing and ensuring resident health. Additionally, there are an undetermined number of assisted living facilities, which were not part of the testing ordered by Gov. Greg Abbott.
Hays, Travis and Williamson counties have all been working closely and sharing information about contact tracing due to their close proximity. There may be a lag of a day or two in information sharing, but because so many people commute between these counties, they must work together, Harris said.
Setting up Texas Health Trace is also supposed to encourage cities to participate in contact tracing, he added.
One of the major pros is that counties and localities that do not wish to perform this function can turn the responsibility to the Texas Department of State Health Services, where Texas Health Trace can take over, said a former DSHS staff. Part of the process involves the recruitment of university students who study public health. The potential downside is that in certain environments, these deeds may be more challenging and require more experience.
Once cities and counties have decided to participate in contact tracing, patient compliance plays a major role. A lot of the time people are willing to comply and provide information on who they have been in contact with, but sometimes people do not divulge that information.
Dr. Jason Terk, pediatrician and chair of Texas Public Health Coalition, said there are ways to put people’s minds at ease if they are concerned about giving contact information. The most important thing is understanding why they might not want to give out this information.
In his opinion, the most important thing contact tracers can ask is why a person does not want to say who they have been in contact with and communicate with them. But generally, the reason is people are protecting their privacy. If this is the concern, the tracer must make it clear that the information shared is a response to a disease outbreak and that it is to limit and protect others from suffering. No other agenda lies here except for the prevention of disease spread, he said.
After all, this information is protected by HIPAA, therefore they cannot cross the privacy line.
Ultimately, the state cannot force people to give up information and this has long been a part of the battle between public health and personal liberty. Contact tracing is a widely-used method that has existed long before the coronavirus, this is not the first time this conflict has been seen. Terk said in his view and experience, society frowns upon legally enforcing certain public health measures because it can be viewed as an infringement on civil liberties.
“The one thing I want people to know,” Terk said, “is that people doing contact tracing are public health advocates want to keep people from getting sick and dying. These are measures we have taken for decades and they are extremely effective when effectively used.”
