By Stephen Paulsen, The Big Bend Sentinel
Marfa city officials are moving ahead with plans for local contact tracing. At a city council meeting on Monday night, the council voted unanimously to approve such a program.
Local contact tracing efforts (coupled with state ones) are already the norm in places like Houston and Corpus Christi, where the existence of city- and county-level health departments makes it easier for health officials to coordinate at the state and local level. But Marfa’s contact tracing initiative would be a first for small-town rural Texas, leading some city leaders to dub it a pilot program.
Monday’s vote was the latest development in what’s been a long journey for advocates of local contact tracing. After hearing conflicting reports on Texas’s contact tracing efforts, Marfa city officials have spent weeks figuring out the logistics of local contact investigations.
Buck Johnston, a city council member who has taken a leading role in those efforts, said she’d first floated the idea of contact tracing in March. But the issue ended up “on the backburner” as Governor Greg Abbott “took over more control on the local level” and passed rules limiting the decision-making powers of city and county officials.
Still, the lack of local control over issues like public health and safety left Johnston and others looking for alternative ways to help the community. And as it became clear that Texas’s contact tracing efforts were floundering, they began work to get a local contact tracing program off the ground.
“I’m really excited,” Johnston said in an interview Tuesday after city council’s vote. “This is something that we can do to protect our small little town.”
For a while, a Marfa contact tracing program seemed far from guaranteed. County leaders said the program likely wouldn’t be feasible, citing conversations with state officials and ethical concerns with Marfans tracing friends and neighbors.
But city leaders were hearing otherwise — including Buck Johnston, who solicited the advice of Dr. John Carlo, a Dallas-based doctor and member of the state coronavirus task force. He said he saw no reason why Marfa couldn’t establish a contact tracing program.
City Attorney Teresa Todd heard the same from the office of State Senator José Rodríguez, and particularly his chief of staff, Sushma Smith. Smith helped coordinate a meeting between local officials and DSHS higher-ups, who ultimately gave the program the green light.
It got another boost on Monday, when city council also unanimously approved the program. Johnston, who’s researched the issue, told the council Marfa could likely pay for local contact tracing through Texas Division of Emergency Management funds.
With that city decision now reached, Todd will take that answer to state health officials, who have said they’d figure out the final logistics once Marfa leaders gave the go-ahead. Barring some sudden and unforeseen changes — and in the Texas coronavirus response, there certainly have been a fair number of those — that means Marfa will likely get a contact tracing program.
Marfa’s city council meeting also offered more details on what the local contact-tracing program will look like — and rather than just using data from the DSHS, it’ll likely work on a collaborative basis with state officials.
After all, city leaders have argued, the state has a range of resources they don’t have, including connections to emergency aid and counseling. But Marfans are better in touch with the situation on the ground — including information on where people actually live in a town where almost all mailing addresses are P.O. boxes.
The city will likely put out ads, asking people to contact them if they’ve had positive test results or symptoms. The city will set up a number not only for outgoing calls, but for incoming ones — and ideally, it’ll be a local number, staffed by contact tracers who officially work for the city.
The city wants to hire one to three people for the role — and at press time, two candidates have been publicly announced. First, as The Big Bend Sentinel previously reported, there’s Don Culbertson, a physician assistant at the Marfa Clinic who also helped jumpstart the possible Marfa contact tracing program and would likely run it. He previously worked as a contact tracer in Washington State and has received contact tracing training from Johns Hopkins University.
This week, city officials also announced that they were considering Leticia “Letty” Garcia, a medical assistant also at Marfa Clinic, for the role. Although she hasn’t yet trained in contact tracing, she’s worked with Child Protective Services, which city officials say has an overlap.
“With my prior work as a social worker, it all ties together,” Garcia said in a phone interview on Tuesday. As a caseworker, she also did wellness checks, conducted investigations and helped families find resources, she said.
Marfa’s contact tracing program could still see challenges, though. For one, Dr. J.P. Schwartz, who serves as local health authority and could help facilitate communication between Texas DSHS and Marfa contact tracers, is technically a county official.
With Marfa the size it is, he also happens to be Culbertson’s colleague at the Marfa Clinic. “We work together all the time,” Schwartz said. They already have work rapport, and Schwartz supports the idea of local contact tracing efforts.
Still, Presidio County Judge Cinderela Guevara has said that the city would need to get approval to use Schwartz, a county official, in his official capacity during any non-county coronavirus response. (Guevara was not available to comment by press time on this particular issue.) Otherwise, the city would need to find its own health authority, which appears to be another legal option, according to the Texas Health and Safety Code.
Another issue is problems with state data. Both Schwartz and Culbertson said they’d learned more about the scope of the virus in Marfa from talking to patients than from reading state reports.
In one case, Culbertson told city council, a patient received positive results, went through quarantine and was released before ever hearing from state health officials.
“I felt like a congressperson getting a redacted version of the Mueller report,” he said of state data, which is funneled from the state to county officials before being released in public news releases. There’s a backlog on that information at state level, and the information that does get released — as Culbertson put it to council — isn’t “particularly useful.” That’s why Marfa officials think they won’t just be tracing off state data, but finding their own cases and adding to the state rolls.
In an interview Tuesday, Culbertson said he was happy about the new program. “People don’t need to feel ashamed or self-conscious or judged for having COVID,” he said. “All we’re trying to do here is to prevent the spread. And it really is spread innocently and invisibly.”
After the council’s decision, Culbertson said he considered celebrating. Then, he decided he didn’t have anything to celebrate.
“We got invited to the race, but we don’t have a car yet,” he said. “That’s what we’re working on now.”