Days before the state recorded its first death linked to the coronavirus pandemic, Dr. Marshall Baca Jr., Artesia General Hospital’s emergency department director, issued a warning to residents of the small town in southeast New Mexico.
“Artesia has a population of approximately 13,000 people. As soon as ONE person tests positive for COVID-19, we can estimate that potentially 1,300 members of our community will also be infected in a short amount of time assuming an infective rate of 10% (infective rates vary significantly),” Baca wrote in an open letter published in the Artesia Daily Press on March 20.
Three days later, a 78-year-old Artesia man died at Baca’s hospital from a COVID-19 infection after presenting himself at the hospital’s emergency room the night before. Baca, at a news conference, said the man had previously refused to be tested for the coronavirus.
How the man acquired the virus in a city at least 40 miles from the nearest big population center and who else he might have unintentionally exposed are questions under investigation by a state Department of Health team that is in a daily race to find the public health answers to this case and hundreds of others.
The effort, called contact tracing, serves as an early notice to those who might get sick and need to self-isolate or quarantine. At the same time, the state is relying on contract tracing as a preventative tool to try to contain the spread of the highly contagious disease within New Mexico.
“We take every single case. We consider all of them important. We, of course, have the unfortunate situation of having a death here and so we do tread lightly with the family understanding that they’re in the grieving process,” deputy state epidemiologist Dr. Chad Smelser said in an interview. “But we also understand it’s important for them to get answers and for us to do … a rigorous investigation.”
On Friday, a DOH spokeswoman told the Journal the Artesia man “had no known exposure. At this time, we don’t know where he got it from and this is still under investigation. DOH contact tracing yielded only a few contacts.” Some of those people were tested.
The 78-year-old’s death was in the words of one Artesia native “a wake-up call” to a rural New Mexico county that hadn’t recorded a positive test result for the virus to that point.
Since then, three people have tested positive for the virus in Artesia, one reported at the hospital just days after the man died.
Artesia Mayor Raye Miller told the Journal last week that the three people may have been related to the victim. In total, Eddy County, which also includes Carlsbad, had recorded four cases as of Saturday.
Even before the death, Miller said, his community was taking the virus seriously.
“It certainly heightened our awareness, but I think most everyone had already adopted all the measures folks were recommending,” he said.
Miller described the victim and his family as “excellent folks.”
“There’s some speculation that he may have received it from another person and that person’s not even in our community,” he added.
Hunt for a source
Smelser said about 60 DOH staff are performing the trace work and more may be added if needed.
“We generally conduct the investigation by phone and we can get most of it done in the first couple of hours after we get a positive test result,” he added.
“In this case, since unfortunately this is a decedent, we ask their closest contacts. So family members, where was this person? What were they doing and we track down their activities before.”
The tracing team, led by a DOH epidemiologist, then notifies people who came into contact with the person and urges them to self-quarantine or isolate themselves if they are at risk or have had close contact.
People have the right to refuse COVID-19 testing under the New Mexico’s Public Health Emergency Response Act, but the Secretary of the state DOH does have the ability to isolate and quarantine someone who refuses testing, said Jodi McGinnis-Porter of the state Human Services Department.
“To be clear,” she stated in an email, “the DOH is not all that interested in taking involuntary actions against people.”
With an increase in testing capacity announced last week, the state permits testing of asymptomatic people who are close contacts or household members of New Mexico residents who have already tested positive for the coronavirus.
People who don’t show symptoms of the virus, such as fever or shortness of breath, could still have COVID-19 and become carriers who infect others.
Dr. Baca’s plea on March 20 told Artesia newspaper readers, “Please understand that it is your societal and moral responsibility to protect the community and those who are most vulnerable, including infants, the elderly, and those who are immuno-compromised. These individuals could be any one of your family members or friends and have the highest risk of dying from COVID-19. It is estimated that four out of five people who tested positive for COVID-19 contracted the virus from someone who did not know they had it. Even if you do not have any symptoms, you could still be infected, and you can still pass the virus on to others who may be at risk of serious illness or even death.”
Among New Mexico’s early coronavirus cases, state officials say some contracted the infection while traveling in Egypt or on a trip to New York City.
When DOH workers, through their investigations, cannot find a “known explanation” for the infected person’s illness, that becomes more troubling.
That usually falls into the category of “community spread” and which McGuinnes-Porter said is defined as having at least two patients with the virus in one county where the source of the infection is unknown.
The goal of contact tracing is containment of the virus, said Dr. Tracie Collins, University of New Mexico Health Sciences Dean of the College of Population Health.
Community spread can increase rapidly.
So in order to contain, she added, “Time is of the essence.”
To date, community spread had been detected in five of the state’s 33 counties: Bernalillo, Santa Fe, San Juan, Sandoval and Doña Ana. The majority of the 30-plus cases were in Bernalillo County.
A week after Gov. Michelle Lujan Grisham added San Juan County in northwest New Mexico to the list, top state officials warned that a surge of cases would begin to hit the northwest part of the state “soon, very soon.”
In San Juan and McKinley counties, the total number of reported COVID-19 cases late last month soared from five to 48 in a span of 10 days.
Contact tracing may become more challenging as the number of cases spikes.
“Once we are at a point where we understand this disease a bit more and are flattening the curve (of new virus cases), then we would scale back on the contact tracing, but right now we’re not anywhere near that so it has a lot of value,” Dr. Collins said.
Large gatherings troublesome
South Korea, which some countries view as a model for slowing virus spread, used contact tracing to learn early on that a church congregation was the primary source of the outbreak in that country, according to the New York Times. In Westport, Connecticut, health officials traced a rash of cases to a birthday party.
The Los Angeles Times reported on a Skagit County, Washington, choir group that decided to go ahead with a rehearsal, and three weeks later 45 of the 60 who attended had been diagnosed with the coronavirus and that two had died.
McGinnis-Porter said investigators haven’t linked any New Mexico cases to large gatherings. But they have found “multiple health care workers who have tested positive for COVID-19.”
“The investigation into health care workers includes tracking contact with patients and other health care workers to assure patient safety and to exclude exposed health care workers from patient care for 14 days,” said McGinnis Porter.
For those who test positive, Smelser told the Journal that DOH investigators speak with the infected person’s close contacts as well as their health care providers “and anybody else, if we unearth or identify anybody else that needs further questioning and investigation.”
Those who are deemed to have been exposed are contacted, interviewed, home quarantined and monitored for symptoms for 14 days from the last exposure.
“We do follow-up calls to make sure we’re not missing anything,”Smelser added.
He said the “vast majority of people (contacted) have been incredibly cooperative” in heeding the DOH recommendations.
“They do understand the gravity.”
As for the Artesia man’s death, health department officials have said very little. McGinnis-Porter, who is on loan to the DOH as top officials release information about the crisis, said the federal Health Insurance Portability and Accountability Act (commonly known as HIPAA) “prevents us from providing any identifying information on patients.” His name hasn’t been released.
However, in contact tracing, DOH “obviously in their investigations will communicate with family members and provide guidance.”
Dr. Baca declined to be interviewed by the Journal last week.
As reported by the Artesia Daily Press, he gave this preliminary timeline on the man’s case during a conference call with the news media on March 25.
• On March 12, the patient is believed to have visited an outpatient clinic in Roswell, where he was seen by a nurse practitioner. Baca said health investigators were looking at that clinic as a possible source of the infection. And one Roswell clinic, while not addressing the death, told the Journal last week that a clinician there tested positive for the coronavirus and remains on home quarantine.
Because of federal HIPAA constraints, it wasn’t divulged whether the Artesia man had been treated at that clinic or by that medical provider.
• On March 18, the patient was seen at Memorial Family Practice in Artesia for a cough and respiratory symptoms. Baca said the patient was identified as a possible candidate for screening upon check-in. He was offered testing for flu and strep as well as COVID-19 at that time, particularly due to his age and underlying conditions. The patient refused.
Baca stressed that the patient was still instructed to engage in home quarantine, as were family members. Baca said he didn’t know whether those recommendations were followed.
• On March 22, the man arrived at the emergency room of the 49-bed Artesia hospital complaining of weakness. He denied having experienced any fever, cough or shortness of breath in the last 14 days. As a result, staff at registration as well as members of the nursing team who made first contact with the man initially were wearing only the simple masks the hospital has required of all staff since preparations for the pandemic first began.
After nursing staff quickly realized the patient was in respiratory distress, Baca said protocols, including the donning of more stringent personal protective equipment (PPE), were initiated to protect staff, and a mask was placed on the patient.
• On March 23, the man died at the hospital.
• By March 25, his test for COVID-19 after he was hospitalized came back positive, triggering the DOH contact tracing.
Meanwhile, Miller said his community is practicing social distancing and quarantine measures if warranted.
“Fortunately, most of our folks do well.”
He said the governor’s office has been “very kind to call and alert us if our county has new cases.”
But he added, “We dread each day to get a call.”
Journal staff writer Jessica Dyer contributed to this report.