On the day in April that he announced his state would emerge from lockdown the Texas governor, Greg Abbott, said: “A core part of opening up safely is having an effective testing and tracing process – a process that can quickly identify any flare-ups in Covid-19.”
As Texas flung open its doors before much of the country, it needed to lean on “doctors and data to provide the safest strategies”, Abbott went on.
That has not worked out. Only four months later, Texas is nearing the grim milestone of 12,000 deaths from Covid-19, after being walloped by the virus for much of the summer.
“It was never a situation we were gonna contact trace our way out of,” said Chris Van Deusen, director of media relations at the Texas department of state healthservices (DSHS). “We were seeing so many cases throughout July that doing that alone wasn’t going to stop the outbreak from spreading.”
Now, discrepancies between state and county data abound in Texas. Local contact tracers are bombarded by exponentially more confirmed cases than they are equipped to handle, and Texans are still struggling with the deceptively simple distinction of which test actually confirms whether they’re infectious. Some students are already heading back to campus, including the state’s gargantuan public universities, despite pushback from co-eds and employees.
Testing has dropped off in recent weeks, possibly because people are letting their guard down. And, despite mitigation efforts, a continual, alarmingly high rate of positive test results indicates that Texas won’t be able to control the virus as successfully as in other places, warned Ashish K Jha, a professor of global health at the Harvard TH Chan School of Public Health.
Contact tracers in Houston, Texas, on 22 July. Photograph: Adrees Latif/Reuters
“What we’re gonna see is schools have large outbreaks, and probably have to shut down. And that’s likely what is coming in many, many schools across Texas,” Jha said.
Meanwhile, quantitative measures used to understand the virus’ impact continually reveal dramatic inconsistencies on the state and county level, painting an even more nebulous portrait of the coronavirus pandemic in Texas.
By Wednesday evening, Hidalgo county, a hard-hit border community, had suffered 1,130 Covid-19 deaths, according to its local dashboard. But only 1,027 fatalities appeared on the state’s county-by-county list.
“Our numbers are usually higher than the state’s, and they’re more accurate,” said Ivan Melendez, Hidalgo county’s health authority.
It was never a situation we were gonna contact trace our way out of
Chris Van Deusen
Harris county and Houston, on the other hand, reported losing 1,252 residents – 854 fewer than were included in the state’s official tally for the county.
Van Deusen defended DSHS’ methodology, which relies on the cause of death written on someone’s death certificate. He said it gives “a more consistent view” of fatalities across Texas, but that the health department isn’t leaning on any single data point.
“In order to have [an] effective response, you’ve gotta have a consistent set of data that everybody agrees on,” Jha countered. “I mean, part of an evidence-based response is to have – is to use – evidence. And evidence is about data.”
The contradicting statistics also lend themselves to credibility issues and skepticism among Texans, some of whom have already fallen prey to a widespread misconception that the coronavirus is a hoax or overblown.
“I do believe that data has both been our friend and our enemy,” said Nueces county judge Barbara Canales, who presides over the tourist beach town of Corpus Christi. “Until you are personally affected, sometimes the data’s all you’ve got, and so if the data looks inaccurate or not current, it causes a lack of integrity.”
As Canales grapples with a devastating local death toll and the loss of dozens of people she personally knew she’s simultaneously fielding conspiracy theories about why those counts are so high.
“I had one woman ask me if we make more money if, you know, we basically logged in more deaths,” Canales said. “I almost just fell over, and just lost it.”
Data has both been our friend and our enemy
Beyond numerical variations, DSHS has been releasing massive data dumps from a backlog of tests, distorting Texas’ positivity rate. Counties have been receiving positive results from weeks if not months ago, even though those results are rendered “essentially useless” if they’re delayed beyond 72 hours, Jha said.
The backlog didn’t keep patients from learning if their tests came back positive, but “it did prevent those from getting into the public health system”, Van Deusen said.
“You can’t do contact tracing on ’em. It’s too late,” said Philip Huang, the health and human services director in Dallas county. The government there reported more than 5,000 new cases from the state’s backlog earlier this month, including some dating as far back as March.
Generally, testing has declined in recent weeks, potentially because Abbott’s policies such as a mask mandate and bar closures are working, Huang suggested. But Melendez offered another hypothesis: “I think people are getting a false sense of security,” he said.
He warned that patients have been given an “inadequate education” about what tests mean, a dangerous trend that volunteers in Hidalgo county are trying to rectify. Certain tests on the market, such as antibody and antigen tests, are “pretty worthless” because they don’t answer whether someone should sequester, he said. But in his community, where 30% of residents live in poverty, the gold-standard PCR test can cost exponentially more than other, less telling alternatives, unless people know to go to a free testing site, he said.
Even with the current decrease in known daily infections, some counties’ contact-tracing operations are still overwhelmed. Dallas county, for example, is staffed to handle 192 cases a day, but a recent report placed the seven-day average daily new confirmed and probable cases at earlier this month. Likewise, Hidalgo county gets assistance from the state and has hired about 20 contact tracers, Melendez estimated, but it would need closer to 100 staff to deal with all the infections it has right now.
Across Texas, just under 4,000 contact tracers are currently employed, about half of them by local health departments, Van Deusen said. The statewide effort makes contact with most new cases within a day of getting their information, he said, and it’s been able to pick up some of the slack from counties.
In Nueces county, the phones aren’t ringing off the hook anymore, and contact-tracing is up and running again with help from the state, Canales said. She still isn’t getting too comfortable.
“It is a lull, and only time will tell if the storm will hit us, or will it skirt on by?” she said. “But we don’t take chances around here. We put our hurricane shutters down.”
Originally published: 2020-08-28 05:30:35