Contact tracing is the next step Texas needs
Peddling the narrative that the economy invariably suffers with strict directives to stay at home and socially distance, the governor of Texas announced last week a phased plan for resuming economic activities. A broad consensus of physicians, scientists and public health officials agree that we should not enable gatherings without much greater testing and contact tracing capacity. As we race for a vaccine or cure, these are the only tools at our disposal to mitigate and contain COVID-19.
As we have not reached the level of testing or contact tracing needed to resume all economic activities safely, we should be reconsidering whether it is in fact true that we must choose between reducing economic insecurity and reducing harm at the hands of a poorly controlled pandemic.
The leveling off of new cases and fatalities in Houston over the last two weeks has reduced the burden of this disease on our health care infrastructure. Still concerning is the fact that Texas hit an all-time high of 1,003 new cases and 50 deaths in the 24-hour period prior to the execution of the first phase of the governor’s plan to lift restrictions in Texas.
That same day we finally outpaced South Korea, a country hailed for its exquisitely effective strategy to contain this disease, on testing per capita. The important difference in Texas is that testing remains at worst untargeted, despite well-described disparities in infections and deaths by race and poverty, and at best non-randomized, for accurate prevalence data to inform future risk. Inequity in access to testing remains a major challenge. The Congressional Budget Office estimates that federally funded vehicles will support less than 10 percent of tests for the uninsured. Lack of access to testing and barriers to COVID-19-related care for the large un- and underinsured population in Texas compound historic disinvestment in Medicaid and distrust of the health care system by communities of color.
Furthermore, testing must be paired with contact tracing to rapidly identify and quarantine exposures to positive cases for containment. The medical community at large called for the expansion of the health care workforce months ago to this end.
The former acting administrator for the Centers for Medicare and Medicaid
Services and former head of the U.S. Centers for Disease Control and Prevention have now called for an “army” of 180,000300,000 contact tracers. If distributed per capita, that is 14,400-24,000 for the state of Texas. Abbott for his part has finally heeded the advice of public health officials and has proposed to increase contact tracing in Texas to a mere 4,000 of those by May 11. It is unclear who will create and lead these teams, how data collection will be coordinated between state and local authorities and public and private labs and how data will be securely stored and communicated to ensure the protection of those who are most vulnerable.
Trainees in the health sciences who are currently unable to participate in patient care can be taught to contact trace. Similarly, community and political organizers who would have been engaged in work around Census 2020 and electoral races this spring can pivot their efforts for the next two to three months to launch a COVID-19 contact tracing effort. There is a profound need to train health educators, as the misinformation around this disease has proven to be just as dangerous in many ways as the disease itself. Grassroots efforts by engineers furloughed by major oil and gas companies and even enterprising high school students are presently manufacturing personal protective equipment for health care workers. As that supply chain finally begins to exceed demand, the groups on these projects can be redirected toward design and operations for systems to track, report and visualize the dissemination of this disease.
We can leverage a huge medical and scientific braintrust in Houston and put thousands of people to task on protecting us from COVID-19 and inaugurating a public health economy. The critical piece is to support a diverse and inclusive multidisciplinary workforce to invest in the new mission of securing equitable health outcomes. Historical responses to prior American economic disasters including FDR’s New Deal and the 2009 American Recovery Act provide road maps for bold projects and reforms which have led to transformative recovery in our communities.