Session
Public Health In Practice: Spread and Surveillance of COVID-19
APHA 2022 Annual Meeting and Expo
Abstract
Impact of barriers to testing on patient recovery in the early phase of the COVID-19 pandemic: narratively collected perspectives from a remote monitoring program
APHA 2022 Annual Meeting and Expo
Background:
Despite impressive mobilization of testing resources at the onset of the COVID-19 pandemic, individuals were limited in their access to tests, particularly during the initial months (March-June 2020) in New York City (NYC).
Objective:
We set out to collect and analyze patients’ COVID-19 stories in order to understand how access to testing impacted illness experience. This is integral to recognition of testing barriers and sequelae that can be prevented in future public health crises.
Methods:
18 Patients in a COVID-19 Remote Patient Monitoring Program (Precision Recovery: Mount Sinai Health System) were interviewed regarding their experience with COVID-19 during the first wave of the pandemic. Transcribed interviews were analyzed using grounded theory, dimensional analysis, and constant comparative technique to guide identification of emergent themes and codebook development through an iterative process. Data coding was performed using NVivo12. References for the domain “testing were then extracted and analyzed for themes and statistical patterns.
Results:
100% of participants (18/18) referenced COVID-19 testing in their interviews, with a total of 79 references (average: 4.4 references/interview; 2.7% interview coverage). 16/18 (89%) of participants identified barriers to testing, including (1) lack of testing resources at healthcare centers (9/18, 50%); (2) denial of testing without high severity of symptoms (6/18, 33%); and (3) geographical distance to testing site (2/18, 11%). 14/16, (88%) shared that not having a concrete status to share with family, friends and professionals affected how seriously onlookers took their symptoms and experience. Furthermore, the absence of a positive test barred some individuals from access to treatment programs and employment support. For a minority (2/16; 11%), lack of a testing result was protective in barring from anxiety and fear, especially given the high death toll in NYC at the time.
Public Health Implications:
COVID-19 testing is now widely accessible; however, those who are unable to demonstrate a positive test result but who are still presumed to have had COVID-19 in the first wave must continue to adapt to and live with the effects of this gap in knowledge and care on their recovery. Future efforts are required to ensure that patients do not face barriers to care due to lack of testing and are reassured regarding their access to healthcare. Finally, recognition of these significant obstacles to infection testing illuminates complications that might arise in future public health crises. This affords opportunity for prevention and mitigation of future barriers to access to care.
Abstract
Perspectives of Contact Tracers on Factors Influencing the Effectiveness and Efficiency of Contact Tracing for COVID-19.
APHA 2022 Annual Meeting and Expo
Background:
In response to the highly contagious spread of COVID-19 in the United States public health departments rapidly implemented contact–tracing (CT) programs. CT includes contacting those who test positive and asking them to identify exposed individuals to encourage quarantining and arrange testing for those contacts.
Objectives:
We aim to identify perceptions of barriers, facilitators, and elicit recommendations from those conducting contact tracer calls for COVID-19 in the Los Angeles region of California a racially, ethnically, and socioeconomically status (SES) diverse region which had disproportionately higher rates of COVID-19 among racial and ethnic minorities and those of lower SES.
Methods:
We conducted semi-structured interviews with 34 individuals who served as contact tracers in the LA region April 2020 and November 2021 and thematic analyses of responses to questions on their perceptions of barriers, facilitators, and recommendations to improve the effectiveness of contact tracing.
Results/Outcomes:
Contact tracers were largely female (75%) and possessed an advanced degree (58%). The largest age group was 50-59 (28%), then 40-49, 60+ (25%), 30-39 (14%), and lastly 18-29 (8%). Race and ethnicity included Asian (11%), Black/African American (25%), Hispanic/LatinX (19%), multi-racial (6%), Native American/American Indian (3%), and White (36%)
Our findings were broadly categorized into factors that were client-related and those related to the CT program. Perceived client-related barriers included lack of the public’s knowledge about contact tracing, health communication and language barriers, and client’s competing health and resource needs. CT program related barriers included caller burnout, emotional stress, and timing of calls. Client-level facilitators include clients being frontline workers, having family members with COVID-19, and younger age. CT-program related facilitators included language concordance and having good interpreters, ability to provide educational resources and information, including open-ended questions, empathy, and building rapport. Recommendations focused on three domains that included improved CT processes, training, and well-being support for contact tracers. Specific processes include bilingual contact tracers, simplifying and humanizing scripts, cultural sensitivity training and communication techniques, and standardized resources for contact tracer well-being.
Conclusions:
Contact tracers reported client-related and program-related barriers and facilitators and made specific recommendations to improve CT effectiveness. The findings were generated from a diverse group of callers serving a culturally and economically diverse region of the United States.
Public Health Implications:
This research may contribute to innovations aimed at improving the practice of contact tracing and have some unique components relevant to minority and under-resourced communities that have suffered from disparate COVID-19 outcomes.
Abstract
African-American and Latinx patient perspectives on factors that influence participation in COVID-19 contact tracing
APHA 2022 Annual Meeting and Expo
Background:
In the United States African Americans (AA) and Latinx communities have disproportionate case and death rates from COVID-19 when compared to Whites. Contact tracing (CT) is a communication process whereby individuals with positive COVID-19 test results are asked to provide information about recent contacts to public health officials for tracking and controlling spread of COVID-19. Studies indicate AA and Latinx individuals are less likely to provide personal information to public health officials, which can create barriers to care, including testing and clinical referrals, for those potentially exposed.
Objective:
We identify factors and elicit recommendations that influence participation and successful completion of CT for COVID-19 in AA and Latinx individuals in Southern California.
Methods:
We conducted semi-structured interviews in English or Spanish among AA and Latinx individuals who tested positive for COVID-19 between 2020 and 2021 and received a CT phone call from public health department. We conducted a thematic analysis of responses to questions on barriers, facilitators, and recommendations to increase CT participation.
Results/Outcomes:
Fifty-one participants were enrolled of which 30 (58.8%) were Latinx (English=20, Spanish=10), 18 (35.3%) were AA and 3 (5.9%) were multi-racial in origin. Mean age was 36 years (SD ± 11.3) and majority identified as females (70.6%). Barriers included participant-centered factors (fear, embarrassment, stigma, poor memory, lack of awareness about CT and purpose, difficulty concentrating on CT questions when symptomatic from COVID-19) and processual factors (intrusive/invasive CT questions, not expecting calls, long or rushed calls, repetitive questions, and perceived indifference of contact tracers). Facilitators included participant-centered factors (altruism, potentially exposed family member, prior knowledge of CT and COVID-19) and processual factors (maintaining anonymity as source of information, recognizable caller ID, receiving resources and guidance, educated during call, compensation, and having a positive experience with caller). Specific recommendations included shorter call duration; alternate communication strategies e.g., in-person, direct messaging, prior notification; increased education and messaging about CT and explaining the purpose and usage of data collected; and ensuring callers were culturally and linguistically competent, empathetic, confident, and well trained.
Conclusion:
We identified specific themes and recommendations from AA and Latinx persons with COVID-19 that included individual- and process-level factors that influenced their decisions to participate in CT.
Public Health Implications:
These findings can aid future CT protocol development and implementation that reflects AA and Latinx perspectives and potentially increase access to care and information for those exposed in these communities that have suffered disparately from COVID-19.
Abstract
State differences in Delta Wave COVID-19 cases: An analysis of North Carolina and Florida Nursing facilities surveillance data
APHA 2022 Annual Meeting and Expo
Introduction: Multiple waves of COVID-19 have occurred since January 2020. Differences in anti-community mitigating contagion policies implemented in various states may explain variations in states’ infection rates. At the onset of the Delta Wave, Florida State implemented rules against verification of vaccination status by businesses and promoted the freedom to choose a mask. In contrast, North Carolina State policies reintroduced and extended COVID-19 transmission mitigating policies. This study assessed the differences in COVID-19 reported cases in Nursing facilities in North Carolina and Florida states during the Delta Wave.
Methods: The Nursing Home COVID-19 Public File data was linked with the National Care Compare: Skilled Nursing Facility Quality Reporting Program (SNF QRP) data. The sample was 1128 facilities in Florida and North Carolina. Nursing Home COVID-19 Public File includes data from nursing homes reported to the CDC’s National Healthcare Safety Network (NHSN) Long Term Care Facility (LTCF) COVID-19 surveillance program. Five quarterly counts of reported COVID-19 cases were obtained from July 1st, 2020, to September 30th, 2021. The Delta Wave (DW) period was defined from July 1st and September 30th, 2021. Additional data were the highest percentage of complete vaccination, of residents that received Moderna, Pfizer, and Janssen vaccines, nurse staffing hours, and overall quality rating. Descriptive trends of the quarterly average of reported cases compared were obtained. MANOVA analyses were used to determine the within and between states differences and Poisson regression for factors associated with the Delta Wave case counts.
Results: Florida facilities represented 62% of the study sample, while North Carolina represented 38%. Average COVID-19 case counts were higher in FL than in NC between July and September 2020 and during the Delta Wave, (24.70 vs. 14.6) and (9.21 vs. 1.83), respectively. The means of COVID-19 cases, when averaged over time, is not significantly different between FL and NC (p-value, 0.086). However, adjusted regression shows that counts of COVID-19 cases during Delta Wave increased significantly by 0.3410 units in FL nursing facilities compared to NC. Inversely associated factors include the percentage of residents with complete COVID vaccination and quarterly case counts between July and December 2020.
Conclusions: In states with anti-community mitigating contagion policies, nursing homes may experience lower COVID-19 cases, and past COVID-19 case counts may indicate future infection rate