Contact tracing initiatives will help contain the spread of Covid-19 only if they’re fully integrated into the communities hit hardest by Covid-19, health equity advocates say.
Contact tracing, which is designed to identify and inform people who have been exposed to the virus, is seen as crucial to slowing the pandemic and getting people back to work. But efforts to track peoples’ whereabouts require a level of trust that communities might be better served building from the ground up.
That could be difficult to earn from Black, Hispanic, and other people who are at higher risk of getting Covid-19 yet are often wary of engaging with a health-care system that has underserved them in the past, advocates say.
“A lot of communities of color, for a variety of reasons and rightfully so, don’t trust the government and don’t trust that government has their best interests at heart,” said Tekisha Dwan Everette, executive director of Health Equity Solutions, a Connecticut health-equity policy group.
“When we talk about the important role of contact tracing in controlling the spread of Covid-19, it’s really important to make sure that we’re including trusted voices who know how to reach and communicate with hard-to-reach communities,” she said.
That means state and local officials in charge of contact tracing should bring trusted community leaders on board to help get the message out, Everette said.
They also should use channels of communication that will reach the community, ensure that members of the community are represented in messaging campaigns and among the contract tracers themselves, and be prepared to offer assistance with quarantining.
Black people are five times more likely to contract Covid-19 than White people, and over four times more likely to be hospitalized, according to the Centers for Disease Control. Hispanics are four times more likely to contract Covid-19, and four times more likely to be hospitalized than non-Hispanic Whites, the CDC says.
Yet Black people are less likely than White people to trust doctors and medical research scientists, according to a recent study by Pew Research Center.
The study found that 61% of Black Americans have a positive view of doctors, compared with 75% of Whites. About half, 53%, of Black people have a positive view of medical research scientists, compared with 68% of White people.
Contact tracing can involve hundreds of people interviewing those who have been exposed to the virus and piecing together information on where they’ve been and who they’ve come in contact with.
To succeed, contact tracing must be deployed effectively in the communities most heavily impacted by the virus, said LaShawn Glasgow, director of community and workplace health at RTI International, a public policy research group in Atlanta.
Doing so requires an understanding that people in Black and other minority communities have reasons rooted in history and their personal experiences to mistrust government and the health care system, Glasgow said.
“Things have gotten better over time, but we still have a long way to go,” she said.
People in those communities, like most Americans, have little or no experience with contact tracing, and may have concerns about how the information they share will be used, she said.
That concern could be prominent in Latinx communities where fears of information being shared with immigration authorities could make people unwilling to talk with contact tracers, according to Vickie M. Mays, a UCLA professor who focuses on minority health disparities.
“I know that we’re in an epidemic, and we need answers and we need to do this as quickly as possible. But we also need to realize that data is a commodity that can be collected by one entity, re-purposed, and used by another,” she said.
To ease those concerns, public health officials should partner with community leaders and organizations to get the word out about what contact tracing is and why it’s important, Glasgow said.
“There are a lot of organizations in our communities that have been providing community health services already, and are well suited to this task,” she said. “And that also includes faith leaders and coalitions that have been active in the community.”
Public messaging campaigns also should be carried out through channels that will reach different communities, Glasgow added. “You can’t just use the most popular radio station in your city for your messages,” she said. “Not everyone may listen to that station.”
And getting the message across can depend on who is delivering the message. “The perception that comes over the radio that this is a Black person talking to Black people, that helps show that the message is coming from a trusted source,” she said.
“If you’re calling people who haven’t received messages from trusted community leaders about what this is even about, and why it’s important, they may not even answer the phone,” Glasgow said.
Shaping the Message
It also helps to have contact tracers who come from the community itself, according to Amanda Brzozowski, an epidemiology specialist with the St. Louis County Health Department.
Her department decided early on to hire only people from St. Louis County, a large and diverse part of the St. Louis, Mo., metropolitan area with many predominantly Black neighborhoods.
“This is a remote job that can be done over the phone, and we got over 1,100 responses to our initial job posting, many from all over the country,” Brzozowski said. “But we know we wanted people who knew our community and can talk to people about what’s going on here.”
Contact tracers and community groups helping to deliver the message about the importance of tracking people can help shape that message in a way that would be most effective for a particular locality’s residents, Glasgow said.
Being able to explain what contact tracing is in laymen’s terms and in a culturally relevant way can make all the difference, she said.
“The ‘scripts’ that are used to talk to people should be developed and tested by people who know the community,” Glasgow said. It’s even important to consider details like the name that comes up on caller ID, according to Brzozowski.
“People who know the community may have a reaction to certain language, even to how people introduce themselves, that can help improve the language and make it more welcoming,” Glasgow said.
—With assistance from Jeannie Baumann