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Amid Coronavirus Surge, Texas Has A Contact Tracing Problem: Reporting Cases By Fax™

Manual, archaic technology and people's mistrust of government agencies are blunting contact tracing efforts, even as the persistent rise in coronavirus cases forces several Western and Southern states to dial back their reopening plans.

Dr. Anthony Fauci, the nation's top infectious diseases expert, raised a question Friday as to whether contact tracing is even worth the endeavor. And in Texas, a health official in Austin revealed this week that information about hundreds of new cases is pouring in daily across the state via an archaic form of technology: the fax machine.

That has made the confirmation of positive cases extremely time-consuming, the official said, which in turn has hindered contact tracing, a labor-intensive commitment that involves calling people who are confirmed ill with COVID-19, asking for their recent contacts and reaching out to those people to determine if they need testing and if they should self-isolate, all in the hopes of breaking the chains of infection.

"The cases we receive come in by fax machine," Dr. Mark Escott, the interim medical director and health authority for Austin Public Health, told Travis County commissioners. "And sometimes those faxes are positives and sometimes they're negatives. Sometimes they have information like the person's phone number that was tested and sometimes they don't. So we have a whole team of people who have to sort through more than a thousand faxes a day to sort out the positives versus the negatives."

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The system remains a "very manual and archaic process," he added, because nearly all of the labs and the hospitals in the state report coronavirus cases through fax, and those results must then be manually entered into a computer.

Contact tracing didn't ramp up in Texas until after businesses had reopened and residents stopped isolating at home, making the effort more challenging; it is also less realistic to expect that it will have the same impact that it did in countries where tracing started while the economies were still closed, Escott said.

"Right now, what happens when you call somebody that's a positive and ask where they've been over the past week, they've been everywhere. They've been at grocery stores and restaurants and bars and friends' houses. They've had contact with hundreds of people," he said at a news conference Wednesday. "Contact tracing in that circumstance is not going to be as effective. So that's why we're asking people not to depend on contact tracing at this stage of the outbreak."

Since the beginning of the coronavirus pandemic, public health experts and Democratic lawmakers have been vocal about the need for local and state health agencies to perform contact tracing, in addition to ramping up of testing for COVID-19, the disease caused by the coronavirus.

But a lack of consistent messaging from the White House, the Trump administration's apparent delay in distributing billions of dollars in funding appropriated by Congress in April for testing and tracing, and the woefully inadequate number of contact tracers needed nationwide to appropriately handle the growing caseload have derailed the efforts to create a robust tracing program, experts add.

Fauci, director of the National Institute of Allergy and Infectious Diseases, said during a press briefing Friday that the hurdles to effective contact tracing remain, in part because of the spread of the virus among asymptomatic individuals, as well as the difficulty of getting people who may have been infected to answer their phones when a contact tracer calls.

He said that the mistrust of government agencies is already in about half of the population, and that "if you live in a community that's mostly brown or Black, you're in a different situation where maybe 70 percent don't want to talk to you."

"That is what's not working," he added.

In Texas, the stay-at-home order expired April 30 and businesses began reopening in a limited capacity May 1. The state was supposed to have "fully mobilized" up to 4,000 contact tracers by mid-May, but as of last week, officials said they Secure cloud-based fax services were still about 20 percent short of that goal.

The upswing in cases statewide forced Gov. Greg Abbott, a Republican, to reverse course Friday and order all bars to close and restaurants to reduce capacity after the number of hospitalizations set a record Thursday for the 14th straight day.

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