Black curtains create a makeshift corridor through the middle of the concessions area of the Alamodome, which is now the home base for the more than 100 contact investigators working to collect information from people who have tested positive for coronavirus in Bexar County.
The goal of the pop-up site is to aid in stopping the chain of transmission by gathering information about those who tested positive, along with people they were in close contact with. The Alamodome site unites what used to be seven different offices working to conduct contact tracing and investigation interviews.
The unified workspace attempts to ease the burden on staff by improving efficiency and cutting down supervisory and administrative staff, said Colleen Bridger, assistant city manager and interim director of the San Antonio Metropolitan Health District.
Metro Health does the initial case investigation, and the names of those who they were in close contact with are passed on to mobile health technology company Emocha, whose employees warn the contacts of potential exposure and urge them to self-quarantine, Bridger said.
The City has used federal coronavirus relief funding to boost its contact tracing and investigating efforts that were previously lacking, to build electronic databases to replace pen-and-paper documentation, and to pay for tracing assistance from Emocha.
The more organized approach was developed over time as the health department took a try-and-see approach to addressing the novel virus and its impact locally. New data and information became available every day, Bridger said, as the case count continued to increase rapidly.
Just like a 100-year flood, COVID-19 is a 100-year pandemic, Bridger said. “We don’t deal with 100-year floods very often. So when they happen, they’re catastrophic. And things can go just really wrong.”
What went wrong in the beginning stages of the contact tracing and investigation effort included underestimating the number of cases Bexar County would see. The City’s Health Transition Team had put forth a plan that called for a maximum of 175 case investigators, which turned out to be significantly less than what is necessary to address the continued increases, said Metro Health Assistant Director Anita Kurian, head of communicable diseases.
The plan was developed during the first wave of cases and was based on guidance from health care experts calling for 15 health workers per 100,000 people as a baseline number, Kurian said. When Bexar County first started its contact investigating and tracing, Metro Health was using 25 volunteers to reach out to the fewer than 100 people per day who were testing positive.
But using volunteers proved to be unreliable due to time constraints and increased need for tracing and investigation, Bridger said, so the City began shifting Metro Health staff from other departments to perform the work and began hiring temporary workers to aid in the effort, and shifted the contact tracing effort entirely to Emocha, with whom the City had developed a relationship in March for a pilot program.
In mid-June, the health department quadrupled the number of contact tracers and investigators, bringing the total to 100. At the time, the average number of new cases each day was less than 200 but was rapidly rising.
Former contact investigating volunteer Mario Bravo said that during his time working with Metro Health, in early June, the contact tracing effort seemed disorganized and in need of basic supplies and equipment to easily track those who tested positive and who they were in contact with.
Bravo said that while he understands that City staff was likely overwhelmed by the magnitude of work involved in responding to a pandemic, officials could have asked for more staff, equipment, and funding necessary to coordinate an effective contact tracing effort, which is lauded by public health experts as one of the most necessary interventions to quelling the spread of the coronavirus.
“Contact tracing is the most essential pillar,” and staff could have gone to City Council to ask for more funding and support to help the effort take off, Bravo said.
But City officials maintain that they worked to handle the increasing numbers as best they could with funding and staff available until the health department was able to use coronavirus relief fund money to upgrade its efforts.
Councilwoman Ana Sandoval (D7), an early critic of the City’s response to the coronavirus pandemic, calling it “not robust enough,” said while there have been fumbles along the way at the national, state, and local level, the evolution of contact tracing and investigating efforts “is a strong response” and a sign things are going in the right direction.
“It was probably hard to imagine that this was the scale that we were going to see,” Sandoval said, and while the Alamodome isn’t a permanent setup, “it’s super exciting to see the city go all in on its efforts.”
Currently, 116 contact investigators are working to connect with those who test positive, and another 50 are wrapping up training and will start next week. A contract with UT Health San Antonio is helping Metro Health hire up to 400, Bridger said, a number that will increase if needed.
The Alamodome pop-up office that opened this month provides space for the 15-fold increase in the scale of the contact tracing and investigating response, Bridger said. Each socially distanced folding desk has a desktop computer that case investigators use to organize case files and input information received electronically and via fax machine into its database.
At least 3,000 faxes a day come in from area medical providers detailing patient information used in the initial contact phase, Kurian said. With no universal online medical records system used in the health care industry, some offices are still maintaining paper files.
“It’s a lot of paper and a lot of information coming in, but it’s not so much that it is overwhelming for the number of staff available to complete the initial investigation,” Kurian said.
Over 14 days Metro Health follows up with anyone who tests positive and will monitor over time the symptoms of those they come into contact with, while Emocha staff connect with anyone who may have been exposed.
Those who test positive and those who are in close contact with someone who tests positive are contacted at least three times over the 14-day time frame per guidelines from the Centers for Disease Control and Prevention, Bridger said. If a person doesn’t answer a call from Metro Health, but they are not reported as being hospitalized or dead, they are counted as recovered at the end of 14 days.
“We’re doing something we’ve never done before, and we did the best we could [in the beginning] and we’re also doing the best we can now,” Bridger said. “Every day we do it a little bit better.”