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Metro Health official explains how positive COVID-19 cases are investigated in Bexar County with new system

SAN ANTONIO – This week, the city migrated to a new statewide system called Texas Health Trace to track its positive COVID-19 cases. The web-based case management system will allow the state to help the Metropolitan Health District with its case investigations if the new cases are too high to manage.

Metro Health is also counting on additional help to help track the case investigations. It dug itself out of a backlog caused by the sudden surge of COVID-19 positive cases that it needed to investigate.

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Metro Health says it has 165 case investigators. It’s contracted UT Health Houston to hire up to 200 case investigators in the future, 79 of whom will start working on cases on Aug. 10.

The city also has a contract with Emocha Health to help with contact tracing. Emocha says it has anywhere between seven and 15 case tracers working on cases seven days a week for San Antonio. That contract with the city will end on Aug. 15.

Dr. Anita Kurian, assistant director of Metro Health, during the contract tracing process, positive COVID-19 test results from labs are sent to the Texas Department of State Health Services and Metro Health.

“We try to de-duplicate the cases and determine if the person has already been reported to us. Because what we are also finding is that a number of people do get tested more than once on a weekly basis,” she said.

Faxes are sorted by city staff and organized to begin an investigation. Then a caseworker will start by making contact with the person who tested positive.

“We reconfirm the demographic information that’s been told to us. We collect additional exposure information, clinical information and lab information,” Kurian said.

The next phase is contact tracing, which means reaching the people the positive person might have infected.

“We reach out to each of those contacts to determine two things: if they are asymptomatic or symptomatic and if they should quarantine or take additional precautions,” Kurian explained.

Because of the surge in cases, Metro Health contracted Emocha Health to help handle this part of the process.

Sebastian Seiguer, CEO of Emocha Health, says about 30% to 40% of the cases they need to contact are hard to reach.

“Our role is to contact those persons, provide information about COVID-19 to them and give them instructions regarding isolation and those protocols,” Seiguer said. “And then we enroll them on Emocha to monitor their symptoms for the next 14 days.”

The information is then given back to Metro Health to close up the case. The cases are faxed to the state and then entered into the system. At one point, there were so many cases that the documents had to be physically driven to the state, Kurian said.

A completed case is needed by the state to make sure those positive cases are counted at the state level.

Kurian says with more staff and an updated system, Metro Health has a better handle and turnaround on case investigations. At one point, the system involved paper, pen and fax machines.

“We are addressing the new cases. The first cases that are less than 10 days old are being addressed promptly,” she said. “Faxes are being deduplicated promptly within the same day.”

Regarding the backlog of some 2,600-plus cases at one point this summer, she says about 60% of those have been cleared.

“That small proportion of those cases that we are waiting for are primarily for callbacks from the patients or the cases to call us back,” Kurian said.

Kurian said the use of out of date systems was not unique to Metro Health. But she said the new state system should help them stay up to date once the staff gets over the learning curve that comes with any new system.

Kurian said that getting the numbers quickly to the state is vital in helping get a handle on the pandemic.

“Reporting all this information in a timely manner to the state and having a standardized way of reporting certainly addresses the state’s need for disease management at all levels and certainly provides a unified approach to addressing this pandemic,” she said.


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