KTEP - El Paso, Texas

The border creates additional challenges for COVID-19 contact tracing

May 29, 2020

People walk across the Paso del Norte Bridge from Ciudad Juarez to El Paso. The U.S. border is closed to all but essential travel to contain the novel coronavirus, but U.S. citizens, and legal residents are still crossing, creating possibilities for binational spread of the disease.
Credit Angela Kocherga / KTEP

As testing increases in El Paso, contact tracing is the next critical step to prevent the spread of COVID-19. On the border, those close contacts can include relatives, friends and coworkers in two countries.  

“This morning I contacted the health authorities in Juarez to refer them individuals that were exposed to cases that are in El Paso,” said Fernando Gonzalez, lead epidemiologist for the El Paso Department of Public Health. 

The United States. and Mexico recently extended a joint shutdown of the border to all but essential travel and trade. Even so, a significant number of U.S. citizens and legal residents still cross back and forth to visit relatives and do essential jobs in both countries.

“We have cases in El Paso, some have been hospitalized, but some have had contact before getting sick with relatives or friends in Juarez,” Gonzalez said.

El Paso increased the number of contact tracers from eight to 150 to handle COVID-19 cases. Bilingual skills are critical.

The contact tracing process

Luis Jauregui, a contact tracer with the health department, demonstrated what happens when someone who tests positive for COVID-19 gets a call from the health department.

“I’d like to ask you some questions to see how you’re doing and to identify family or other loved ones around you that we should be keeping an eye on,” Jaurgui asks.  

Questions involve checking on the person who tested positive but also getting critical information including identifying all members of the household, coworkers and other close contacts who may have been exposed to the virus and need to self-isolate to keep from spreading COVID-19 to more people.  

In El Paso at least half of all COVID-19 cases are the result of close contact with relatives, friends and coworkers, according to health department data. When those ties extend across the border, health authorities in El Paso reach out to their counterparts in Ciudad Juarez so they can  follow up on cases in Mexico.

“We provide information to our colleagues in Juarez not only for active or infectious cases, but also with contacts,” Gonzalez said.  

Binational health challenges

The health departments in the sister cities have long collaborated to prevent and contain a range of infectious diseases on the border.  The pandemic though is creating new pressures in both El Paso and Ciudad Juarez.

“I understand that historically we’ve had great relations with the public health department there, but in the trying times of a pandemic, it tests the strength of those relationships very quickly,” said Dr. Ogechika Alozie, an infectious disease expert and chief medical officer at Del Sol Medical Center in El Paso. 

 Each border city has to contend with layers of local, state and federal governments and different schedules for restarting economic activities. As Texas reopens more businesses, drive-through testing is now ramping up in El Paso.  

Mexico tests at a much lower rate and in Ciudad Juarez, the bulk of testing has been done at hospitals and health clinics. A few private clinics have also been authorized to do testing. 

The lag time between identifying a positive case and contact tracing can have serious consequences. 

“That’s probably a positive that was infected two weeks ago. When we see people showing up in our emergency room, that’s probably four weeks ago. And when we unfortunately do have deaths, that was probably six to eight weeks ago. So, we’re always behind the eight ball in terms of the data we have and how we respond,” Alozie said. 

Contact tracing in Juarez

In Ciudad Juarez, global health expert Dr. Alejandro Diaz Villalobos shares that concern. He refers to contact tracing as a basic “steppingstone” for containing COVID-19.

“The more information and reliable information we have the better the outcome so that’s basically the challenge: information. We need to know who, where and how, everything,” Diaz said. 

Workers at the Lear Río Bravo Plant in Ciudad Juárez wait in the shade after attending training sessions on May 26. Lear lost at least 18 employees to COVID-19 and is training employees in safety and hygiene practices before reopening on Monday. (Corrie Boudreaux/El Paso Matters)

He is especially worried about having adequate protocols in place as maquiladoras or multinational manufacturing plants reopen in Ciudad Juarez.  A few of those factories have been involved in clusters of cases that resulted in deaths

The official opening for maquiladoras is Monday, but this week some maquiladora workers returned for training on procedures and factory floors that have been adapted to promote social distancing.

Juarez has reported 238 COVID-19 deaths as of Thursday. Testing has remained steady and slow, with 1,013 cases reported, according to the Chihuahua State Health Department. 

With testing so low, contact tracers also follow up on “suspected” COVID-19 cases in Ciudad Juarez, according to health officials. 

Growing workload

El Paso has reported 2,569 COVID-19 cases and 72 deaths as of Thursday. 

With cases spiking, contract tracers are also seeing their workload grow.  An individual who tested positive recently in El Paso also had multiple contacts in Ciudad Juarez.

“One of the binationals was 10 contacts,” Gonzalez said. 

Contact tracers had to warn those people they were all at risk of having been infected with COVID-19 and could be spreading the coronavirus to others on both sides of the border.

This article first appeared on El Paso Matters