Texas stumbles on tracing
Confusion, snags impair effort to monitor virus
AUSTIN — Just as coronavirus infections began rising a few weeks ago in Texas, contract workers hired by the state to track down exposed Texans were spending hours doing little or no work, received confusing or erroneous instructions and often could not give people the advice they expected, interviews and records indicate.
Health authorities around Texas also say they are running into technical snags with new contact tracing software the state has deployed, known as Texas Health Trace, saying it isn’t ready for widespread use in their counties.
The chaotic beginning and technical glitches — combined with exploding case counts and widespread testing delays — have undermined the goals of boosting COVID-19 monitoring statewide and the state’s massive
deal for a privatized contact tracing workforce.
“I know that a lot of local health departments are still trying to figure out how to utilize that contract and some have decided to do the work on their own,” said David Lakey, chief medical officer at the University of Texas System and former commissioner of the Department of State Health Services. “There is concern with local health department individuals I’ve talked to related to how they are going to benefit related to this large investment from the state.”
DSHS said problems identified by the Houston Chronicle have since been fixed and that “every week” more counties are using its software.
Gov. Greg Abbott’s office said months ago that robust contact tracing capacity would help Texas “box in” the coronavirus. But after the state reopened its economy, infections, hospitalizations and deaths skyrocketed, making it impossible for many health departments to keep up with contact tracing.
“When you kind of jump the gun a little bit and open too soon, and you skip the processes that need to be in place, this kind of thing happens,” Harris County Judge Lina Hidalgo said. “You might have the most successfully designed contact tracing program or you may not, but honestly it’s not gonna make a difference because you’re setting yourself up to fail.”
At the state level, Texas moved to ramp up and modernize contact tracing in May, when the Texas Health and Human Services Commission quietly awarded a $295 million contact tracing deal to little-known MTX Group, a tech startup that has a headquarters in North Texas. Abbott’s office has staunchly defended the emergency expenditure, but it’s been controversial from the get-go.
The bid for the work, which was never publicly posted, was awarded to MTX without input from top state leaders, and more than a dozen legislators subsequently called for the state to cancel the contract.
More recently, four people who performed contact tracing work for MTX or one of its partners raised questions about the tech company’s performance. They spoke to the Chronicle on condition of anonymity because they weren’t authorized to speak on the record about their employment. Three said they fielded only a handful of phone calls during several weeks in May and June.
Wrong training materials
The Chronicle also obtained audio recordings from meetings about technical glitches, training flaws and problems with scripts used during phone calls with Texans exposed to the virus.
MTX said it writes no scripts and blamed technical problems on the state’s Texas Health Trace software.
One early glitch that ate up time: The state said MTX “mistakenly uploaded” training materials that were designed for state employees, who have more latitude to communicate with sick or exposed Texans. MTX contractors are using their own computers and email addresses — which lack security and encryption features
— so managers had to warn the contact tracers not to rely on those training materials.
During a June 2 virtual meeting, one of the managers hired by MTX to help bring on new workers warned workers not to “email anything out to anybody” even if requested to during a contact tracing interview.
“We’re trying to raise that with the powers that be to understand what are we supposed to do in this situation,” the manager said. “Because the training, it said one thing. But it was built for the state employees, not for us, and we can’t do what it says. So what are we supposed to do?”
In written responses to a few of the questions from the Chronicle, MTX said it could not address the “messages from early June” but a spokesperson for the company said: “We can assure you that today, our call center workers are working non-stop on the cases they’re being assigned.”
The company also said it got all its training materials from the state and referred questions about scripts to DSHS.
Chris Van Deusen, a spokesman for DSHS, said script problems and other technical glitches uncovered by the Chronicle have been resolved.
“The specific concerns you raise are old and outdated,” Van Deusen said. “They date back to early June, just after MTX started bringing on its contact tracing workforce. Call scripts, job aids and Texas Health Trace, itself, have been updated multiple times since then.”
In early June, though, managers and workers hired to do case investigations and tracing repeatedly discussed technical glitches and limits on their ability to perform the work normally done by government employees.
In one instance, during the meeting on June 2, one of the managers said the telephone scripts provided to the contact tracers working for MTX provided erroneous information about what to do when people inquire about social services they might need while in quarantine.
“We don’t have access to those things. We don’t have the ability to tell people, ‘I’ll get you some help or an email or child care or you know, food or whatever the issues are,’” one manager said. “So in the script, when it’s saying to tell them that I will send you an email with information on so and so, you can’t say that out loud because it’s not true.”
“Right, so we don’t offer social support at all?” one of the workers asked.
A manager replied that they should not.
Ultimately, it was decided to tell people in need of social services to dial 211 — a resource hotline operated by the state.
In another script malfunction, which an epidemiologist said was reported via email as “Urgent huge glitch,” a script inside the computer program erroneously said a caller had a lab-confirmed test showing he had tested positive for COVID-19. That wasn’t true.
“This puts the CT in a position where they’re like, ‘I don’t want to lie to this person,’” one of the workers said in a June 6 meeting.
“It’s not just happening to you,” an epidemiologist responded. “This has to be addressed right now. I don’t have any update on it, unfortunately.”
During a subsequent virtual meeting on June 9, a supervisor can be heard telling workers to direct their contacts to search for testing sites on the internet rather than give them specific information.
“I mean, you can literally search on Google, “free COVID test sites near me.”
Van Deusen, the DSHS spokesman, said the “huge glitch” discussed at the June 6 meeting, confined to self-reported cases, was “quickly corrected.” He also said contact tracers can forward requests for social services to local and regional health authorities and that the workers will be able to send out secure emails from the Texas Health Trace app in a future software upgrade.
‘I never got a call’
While they were sorting out technical problems and training difficulties, three workers who performed case investigations or contact tracing under the MTX contract said they did almost no work for weeks — just as the virus was taking off again in Texas in late May and early June.
A lead epidemiologist — or “epi lead” — spent five weeks and only completed one call, and later oversaw an 11-member team that had zero calls for days.
“When I was on the little system, like logged in, it rang once, ever,” the epidemiologist said. “I would get cases assigned to me but I never got a call. I never made a call, I never got a call beyond that one. Then for several days, my team … didn’t have any calls either.”
Another epi lead who only got five cases over four-and-a-half weeks told the Chronicle “we would sit in front of our computers and refresh … to see if any cases would pop up.”
“But nothing ever did,” the second epidemiologist said. “So in the meantime, I either just worked on schoolwork or I would take my computer to each room with me and I would just clean … they just didn’t have any cases and nothing was populating in there.”
MTX said in a written statement that the Chronicle is “relying on 7week old anecdotes” and overlooking “the big picture.”
“MTX stood up a call center in a matter of days, collaborated with the state to quickly make improvements and troubleshoot transition issues, and has hit all contract milestones in terms of hiring and call volume handling,” the company said.
MTX’s own figures, however, show its call center handled just 1,719 inbound and outbound calls from June 1 through June 7, or about 245 per day; by mid-July its figures show the volume had increased to about 4,000 a day.
Keeping it local
Abbott made robust contact tracing a pillar of his “Open Texas” report released in late April.
But three months later, the state has authorized MTX to hire only about 600 of the 1,500 contact tracers DSHS has set as its maximum hiring target, though the MTX call center has another 660 contact tracing personnel from universities and other partners, officials said. The call center in mid-July was handling “only a portion” — about 20 percent — of the cases reported to Texas Health Trace, MTX said.
DSHS also said COVID-19 would be even “more difficult to contain” without MTX.
Local health departments were given the option to keep their own contact tracing systems or let the state do all or part of it. Most, including the largest ones in the state, have decided to keep it local.
The Texas Health Trace app is supposed to help both the state and local governments track confirmed COVID-19 cases and their contacts in the new state database. But most locals are using their own apps and some say the effort to get their data integrated into the statewide program has hit technical snags or gotten off to a slow start.
Public health agencies in Dallas, Harris, Travis and Nueces counties, for example, all said they were using their own software and contact tracers as of mid-July.
At Harris County Public Health, which has its own contact tracing workforce of about 300 people, Dr. Umair Shah, the director, said Texas Health Trace has “been slow and uneven in trying to work with the urban communities.”
That’s happening in some smaller agencies, too.
“There are still some bugs in the system,” said George Roberts, CEO of the Northeast Texas Public Health District in Tyler. “We’re looking forward to using it. But at this point we have not.” He said he’s working with the state to fully implement the system.
As for contact tracers, using contracted workers was a nonstarter for Roberts and others. While contractors reported facing heavy restrictions in what they can say and share with infected and exposed Texans, those acting under the authority of local health departments can recommend specific testing sites, talk through medical symptoms and even help them get social services.
“An Eeast Texan is going to understand how to communicate with a fellow East Texan,” Roberts said. “And so that’s that’s the way we want to handle it.”
While the “vast majority of contact tracing” is being done at the local level, Van Deusen said 25 local and regional health entities, including all eight run by DSHS, were using Texas Health Trace, and some are getting state help with case investigations or contact tracing.
The San Antonio Metropolitan Health District is moving to Texas Health Trace and will turn its contact tracing duties over to the MTX-run call center, Van Deusen said.
The most notable exception to the keep-it-local formula: Collin County’s public health agency, where MTX has headquarters, is the only local health department that has turned over both the investigations of infected people and the tracing of their contacts to the Texas Department of State Health Services. Candy Blair, the public health director, said there has been “no negative feedback” so far.
County Commissioner Susan Fletcher, a Republican, described the decision — which she estimated would save the county $6 million and help keep taxes down in the future — as a no-brainer. They’ve redirected some of the money to help local citizens pay their rent, utilities and mortgages.
“It’s a big deal to hire the department, to get everybody a computer and a place to operate and all the things that it costs,” Fletcher said. “If somebody paid for something, why would I pay for it again? I just cannot get past that.” Zach Despart contributed to this
report.