Only a handful of contact tracers working to carry COVID-19 in 125 communities near Chicago speak Spanish, despite significant Spanish populations. Churches and advocacy groups in the Houston area are trying to persuade immigrants to cooperate when health officials call. And in California, immigrants are being trained as contact persons to reduce mistrust.
The crucial task of reaching people who test positive for the coronavirus and those they come in contact with proves particularly difficult in immigrant communities because of language barriers, confusion and fear of the government.
The lack of health departments in the US to adequately investigate coronavirus outbreaks among non-English speakers is even more acute, given the hefty and disproportionate number of cases among Latinos in many states. Four of the hardest hit states – Florida, Texas, Arizona and California – have large Spanish-speaking populations.
In the zip code with the highest number of COVID-19 cases in Maryland, 56% of adults speak Spanish. But only 60 of Maryland’s 1,350 contacts speak Spanish.
And the language barriers are over Spanish: Minneapolis needs tracers who also speak Somali, Oromo and Hmong, Chicago needs Polish speakers and Houston’s County needs a population that includes Vietnamese, Chinese and Hindi speakers.
But even if health officials overcome language barriers, they still have to dispel the deep suspicions that arise among immigrants when someone calls on the government to question their movements during an era of maintaining hard immigration under President Donald Trump.
“It should come as no surprise that people may be afraid to answer the phone,” said Dr Kiran Joshi, senior medical officer at the Cook County Department of Public Health, which serves 2.4 million people in communities just outside Chicago.
The challenges still exacerbating is the delay in obtaining COVID test results around the US, with waiting longer than a week. The nation is also averaging more than 60,000 new cases per day, which has overcome many labs.
Anything that can significantly affect the ability of tracers to reach 75 percent of a patient’s contacts within 24 hours of a positive test, a threshold that experts say is necessary to control outbreaks.
Officials say it is particularly difficult to meet this threshold in immigrant communities.
Contact persons take pains to trust patients that nothing will be passed on to immigration officials, that they do not have to provide social security or insurance information, and that their contact persons do not know who shared their names and telephone numbers.
Still, “there are a lot of rumors and myths,” said Hevert Rosio-Benitez, who oversees contacts for Harris County Public Health. “We try to train our staff to be persuasive enough to build trust and tell them what the contact tracing process is about, but we can only do so much with that.”
So, every week, the Department of Health meets with clergy, legislators, and advocacy groups to get feedback and answer questions about the concerns of immigrants “and tell them we need community participation so we can be successful to fight the virus, “Rosio- Benitez said.
Many of those approached are essential workers who worry about days or weeks on the site waiting for test results, while others fear how members of their community will react to contracting the virus, said Fernando Garcia, founder and CEO of the El Paso, Texas-based Border Network for Human Rights.
“I believe there is a growing stigma that people are sick, so if you are infected you do not want to tell,” said Garcia, whose group works with farm workers.
The University of California-Irvine seeks to help counties by training people from minor minority areas to be liaisons in their own communities, said Daniel Parker, an epidemiologist for infectious disease and assistant professor of public health.
Tracers are provided with loose scripts to help with their conversations, but “they already have the intuition (about) the best way to get the information and ask for something,” he said. “They have had the same experiences and know how to better approach the community.”
In Maryland, state health officials have made public service announcements for both English and Spanish language stations asking people to pick up the phone or call contacts.
“The personal information we ask for is completely protected,” Drs. Michelle LaRue viewers in Spanish.
LaRue is a manager at CASA de Maryland, an immigration group that has a partnership with health partners in Prince George’s County just outside Washington. DC, to make the calls to Spanish speakers. She said earning trust begins with hiring contacts who not only speak Spanish but also understand intimate immigrant communities.
Ruth Rivera, who is from Puerto Rico, fits in with that mold.
“I feel the connection right away,” said Rivera, a bilingual contact with a company called HealthCare Dynamics International. “I know her fears.”
In Illinois, Joshi said Cook County plans to use a $ 3 million state grant to expand its track program in the coming months, including public communications.
The department plans to work with local organizations to make sure people in all communities know they can receive a phone call from health officials, that the caller ID clearly indicates who is calling, and that “it really is It is important for the health of the public that people pick up the phone, ”said Joshi.
Rosio-Benitez said the success rate of his tracers is currently 40 to 50 percent due to a lack of cooperation in general – especially in immigrant communities. Some of the patients “are very forthcoming”, but others may identify people they have come in contact with but will not provide a phone number, he said.
Rosio-Benitez said about one-third of Harris County’s 300 contacts speak Spanish, but that more is needed because the area’s Spanish population is disproportionately affected by COVID-19.
Joshi said his department does not have many Spanish speakers among its 25 tracers, but plans to hire more, such as people who speak Polish, Arabic and other languages.
“If the caller … speaks their own language, they are more likely to answer honestly and feel comfortable,” he said.
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Webber reported from Fenton, Michigan; Garcia Cano from Baltimore. Michelle R. Smith contributed from Providence, Rhode Island, and Brady McCombs from Salt Lake City.
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