In a moment of strength in Connecticut’s fight against COVID-19, with the number of cases and deaths at an all-time low, health officials across the state are addressing one of the weaknesses in their pandemic response plan — contact tracing in communities of color.
According to health equity advocates and community leaders across the state, there are complex, deeply rooted barriers to engaging people of color in contact tracing efforts, which attempt to find and notify anyone a COVID-positive person has interacted with to stave off community spread.
It’s an effort that’s especially vital in Black and Hispanic communities, which have been disproportionately sickened by COVID-19, rendering ongoing racial health disparities painfully clear in the midst of the national reckoning on racial injustice sparked by the murder of George Floyd.
“Everyone sees that there’s a need to reach pockets of individuals who may not have the same access to information that others do,” said Liany Arroyo, Hartford’s Health and Human Services director.
After the initial challenges of adapting to state contact tracing software while dealing with countless cases, which felt like “flying plane while building it,” she said, the current lull has allowed her to “take a deep breath, and focus on ramping up” efforts to do this outreach, focused on communities of color.
Arroyo has met weekly with community leaders, including faith leaders, hearing about their needs and answering their questions about how to implement social distancing in different settings, what to do if a worker is infected, and anything else on their minds.
Her department recently announced that it would fund five community organizations to help them “put boots on the ground” for outreach and information sharing around COVID.
When strange people call you and start asking you questions, these folks in neighborhoods like mine are very suspicious.”
She’s also working to hire community health workers from communities of color, initially bringing on five in the next several weeks and eventually, if funding permits, as many as 20, she said. The community health workers will be a bridge between communities and contact tracers, conducting presentations to inform and build trust.
“Community health workers can go out into the community and provide information about COVID and contact tracing, so when they do get that phone call, they’re aware of what to expect,” Arroyo said.
Similarly, Kara Prunty, the health director in Danbury, plans on hiring about six community health workers in the next few weeks from communities of color, she said. Their recruitment efforts have started with houses of worship, which are “some of our strongest community leaders,” she said.
Steve Harris, a former city councilman and retired firefighter in Hartford’s North End, said that in his tight-knit Black neighborhood, this awareness is vital for contact tracing to work. People are highly skeptical of sharing personal information with strangers, he said.
“When strange people call you and start asking you questions, these folks in neighborhoods like mine are very suspicious,” he said.
There’s a host of reasons why, he said. Oftentimes, residents’ “experiences with law enforcement and with systems have not been the best,” he said. Others see COVID-19 ravaging their communities – according to state surveys, Black and Latinx people are more than three times as likely as white people to contract the virus, and up to 2.5 times as likely to die from it — and they “believe that may be by design,” Harris said, making them less likely to participate in government contact tracing efforts even as their own are hit hardest.
Harris said, too, that many older Black people also remember the Tuskegee Experiment. Starting in 1932, the U.S. Public Health Service recruited 600 Black men, 399 of whom had syphilis, administered fake treatment and even withheld penicillin after it became the known cure in 1947, so researchers could study the full progression of the disease until it disabled and killed the men.
“The health system has a really painful and at times ugly history over how it has treated and experimented on people of color,” said Pat Baker, president and CEO of health equity group CT Health Foundation. “Those have played and shaped into people’s consciousness.”
Baker said that particularly in communities of color, this has resulted in a “fundamental distrust” and a “real reluctance to participate” in government health initiatives, especially contact tracing efforts that require them to divulge private information.
Emanuela Palmares, editor of Latinx community newspaper Tribuna and vice president of Latinx advocacy group The New American Dream Foundation in Danbury, said that in Danbury’s undocumented immigrant community, suspicions about officials asking for personal information during contact tracing are heightened by their “constant fear of losing everything.” Danbury’s mayor has cooperated with ICE and taken hard stances against immigration in the past.
“It’s very, very shaky ground to want to start a deep relationship that tells me, ‘You’re a human being, and your health matters to me,’” she said. “It’s really hard to make people believe that, and be vulnerable with their information.”
In a pandemic, we may not be all citizens of this country, but we’re all residents of this state.”
But policy debates about immigration are moot in a pandemic, when every person in a community is vulnerable to the virus and shares responsibility to help prevent its spread, she pointed out.
“In a pandemic, we may not be all citizens of this country, but we’re all residents of this state,” she said.
Building trust
The state already has an encouraging track record of getting residents to come around to the value of contact tracing. Initially, everyone distrusted the process, according to four health directors from across the state.
But Jeff Catlett, director of Manchester Health Department, said that in his area, which is 65% white, trust was quickly built through social media campaigns, posting on community message boards, and putting up informative flyers in libraries and community centers.
Things quickly get more complicated for residents whose first language isn’t English. Since the state first rolled out its digital contact tracing platform, ContaCT, in May, automated texts and emails to people who test positive have been available in English only, leaving contact tracers to spend some of their finite resources following up by phone.
In Manchester, that left staffers initially scrambling to learn Google Translate, Catlett said. They have since created translated versions of documents and become more adept at using both translation services and helpful relatives. But the state system remains English-only, leaving the burden of language accessibility to individual cities and districts. In Hartford, for instance, there’s on Spanish-speaking contact tracer in a city that’s 44% Latinx, and one who speaks Haitian Creole.
“There needs to be a concentrated effort to address and adapt to all the multiple languages spoken in different communities,” Baker said.
Prunty said that language is an important part of the Danbury team’s approach to building trust. At Danbury’s coronavirus testing sites, she said, testers ask people their preferred language and enter it into the system. Then, when it’s time to make initial contact with them later, they assign a contact tracer who speaks that language to the case, so that from the very first moment of the phone call, they hear a familiar tongue.
“That helps because you can just build relationship right there, and there’s trust formed,” Prunty said.
She said that while they don’t have data on which demographics have been more or less likely to respond to contact tracers in Danbury, because many are hesitant to disclose their race when their case profile is created at a COVID testing location, efforts to raise awareness and spread information about contact tracing have resulted in more people overall answering their calls.
“The more outreach we did, the more education we did, the more people were talking about it, the better it got,” she said.
She said this was particularly important for communities of color, including immigrant communities. At testing sites, she said, people are informed about contact tracing and told what to expect, and told that “they’re not going to be using that information in any sort of way against you.”
“We’ve been trying to do as much as we can proactively, so the first time they receive a phone call, they’re not shocked or scared that someone’s calling them on the phone asking them for personal information,” she said.
Rev. Robyn Anderson, pastor of Blackwell AME Zion Church in North Hartford and co-founder of faith-based health advocacy group Ministerial Health Fellowship, said that ideally, the local health officials hire contact tracers from the neighborhoods they serve.
“[The contact tracer] could actually say, ‘I’m Robyn Anderson, I’m from Covenant Baptist Church,’ ‘I’m from Calvary Baptist Church’, so that they can say, ‘I identify with you as a person, or identify you with an entity in my community,’” she said.
Harris agreed.
“When that phone rings and they pick up, it’d better be somebody they know and have some kind of relationship with,” he said.
In lieu of that — contact tracing forces are often small; Danbury employs 12 for a population of over 80,000, for instance — it’s equally important, Baker said, to have community health workers working as those “trusted messengers” in their communities. They can spread comprehensive coronavirus information, including “how to prevent it, how to get services, the importance of testing, why tracing is important, how people who have the disease get the support they need.”
“It’s that holistic approach that would benefit populations of color, and increase access and participation across the state,” she said.
Oftentimes, community health workers are funded by grants from groups like hers, and “when the grants run out, they get laid off,” she said. Rather, she said, the state should prioritize supporting community health workers, seeing them as “part of either a clinical team or prevention efforts” and funding them as such. City and regional health departments are already stretched thin, working under the strain of years of funding cuts. Baker said that local health officials need resources to be able to support community health workers in a sustainable way.
“You can’t rely on philanthropy completely,” she said.
Community outreach by community groups
As local health officials seek to partner with community groups to ramp up outreach, those organizations are already hard at work.
Earlier in the pandemic, CT Health Foundation awarded “messaging grants” of around $10,000 to nine community groups to support them in spreading information.
Hartford faith-based health advocacy group Ministerial Health Fellowship, led by Rev. Anderson, was one of them. She said they’ve been using the funds to buy thermometers, masks, sanitizers and other COVID supplies, and to make educational materials about COVID-19 and contact tracing. Church volunteers have been assembling the supplies into wellness kits to distribute door-to-door in Black communities, she said.
Another group that received a grant was Khmer Health Advocates, a group that advocates for Connecticut’s Cambodian community. Founder and director Theanvy Kuoch is a survivor of the Khmer Rouge’s genocide that killed nearly 2 million people from 1975 to 1979 and that, she said, continues to shape the consciousness of the Cambodian community in Connecticut.
Since the start of the pandemic, Kuoch has spent much of her time calling people in the community, listening to them and comforting them.
“They trust us, and tell us that they’re very frightened and nervous, and don’t know what to do,” she said. “I tell them, ‘You are very strong. You survived through the genocide. You have to think positive. Make sure that you have gloves, and you wash your hands, and have masks.’”
Khmer Health Advocates employs two Cambodian community health workers who answer questions and connect people with resources — attention that used to be spent educating about diabetes is now directed toward COVID-19. With the new grant money, they hired several outreach workers to check in constantly with people throughout the community, answer basic questions, and connect them with Khmer Health Advocates’ community health workers if needed.
She emphasized that government contact tracers who aren’t from the community must be sensitive when conducting their calls.
“If you ask in a way that feels like interrogation, that takes them right back to the Khmer Rouge,” she said.
The story has been updated to note that Manchester is about 65% white, as opposed to “mostly” white.