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Bruce Blog Contact-Tracing

Fear and language barriers hinder COVID-19 contact-tracing

In the current pandemic, experts opine that contact-tracing is one of the most important tools for containing viral infections and identifying people who may test positive for the coronavirus.

According to the Centers for Disease Control and Prevention (CDC), contact tracing:

“is key to slowing the spread of COVID-19 and helps protect you, your family, and your community. Contact tracing slows the spread of COVID-19, Contact tracing helps protect you, your family, and your community by:
  • Letting people know they may have been exposed to COVID-19 and should monitor their health for signs and symptoms of COVID-19.
  • Helping people who may have been exposed to COVID-19 get tested.
  • Asking people to self-isolate if they have COVID-19 or self-quarantine if they are a close contact.”

The very nature of contact tracing involves contact – local health departments contact people in the community and ask them questions about their health and recent contacts with potentially infected individuals. However, what if there is a language barrier? What if people because of their immigration status are reluctant to talk to government offices? Such scenarios are playing out today, with implications for contact tracing’s ultimate goal – slowing the spread of the coronavirus.

According to a Fox29 Philadelphia report:

“Only a handful of contact tracers working to slow COVID-19 in 125 communities near Chicago speak Spanish, despite significant Hispanic populations. Churches and advocacy groups in the Houston area are trying to convince immigrants to cooperate when health officials call. And in California, immigrants are being trained as contact tracers to ease mistrust.

The crucial job of reaching people who test positive for the coronavirus and those they’ve come in contact with is proving especially difficult in immigrant communities because of language barriers, confusion and fear of the government.

The failure of health departments across the U.S. to adequately investigate coronavirus outbreaks among non-English speakers is all the more fraught given the soaring and disproportionate case counts among Latinos in many states. Four of the hardest-hit states — Florida, Texas, Arizona and California — have major 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 contact tracers speak Spanish.

And the language barriers go beyond Spanish: Minneapolis needs tracers who also speak Somali, Oromo and Hmong, Chicago needs Polish speakers and Houston’s Harris County is grappling with a population that includes Vietnamese, Chinese and Hindi speakers.

But even when health officials overcome language barriers, they still must dispel the deep suspicions raised among immigrants when someone with the government calls to ask about their movements in an era of hardline immigration enforcement under President Donald Trump.”

Contact tracers are trained to explain that they will not ask people for identifying, personal information, such as Social Security number, Bank account information, Salary information, and Credit card numbers. Contact tracers will also not ask their contacts for money since contact tracing is a paid government service. But in immigrant and limited English proficient communities, there is much wariness and uncertainty about speaking with government health officials, especially if the conversation is not enabled with effective language assistance.

As Fox 29 reports:

“…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 nation also is averaging more than 60,000 new cases a day, which has overwhelmed many laboratories. All that can significantly affect tracers’ ability 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’s especially difficult to meet that threshold in immigrant communities. Contact tracers take pains to reassure patients that nothing will be passed along to immigration officials and that their contacts won’t know who shared their names and phone numbers.

Still, “there are a lot of rumors and myths,” said Hevert Rosio-Benitez, who oversees contact tracing for Harris County Public Health. “We do try to train our staff to be convincing enough to establish trust and tell them what the contact-tracing process is about, but we can only do so much with that.”

…Rosio-Benitez said his tracers’ success rate currently is 40 to 50 percent because of a lack of cooperation overall — especially in immigrant communities. Some of the patients “are very forthcoming,” but others may identify people they’ve come in contacts but won’t provide a phone number, he said.

Rosio-Benitez said about one-third of Harris County’s 300 contact tracers speak Spanish, but that more are needed because the area’s Hispanic population has been disproportionately affected by COVID-19.

In Maryland, state health officials have created public service announcements for both English and Spanish-language TV stations imploring people to pick up the phone when contact tracers call. “The personal information we’re asking for is totally protected,” Dr. Michelle LaRue assures viewers in Spanish. LaRue is a manager at CASA de Maryland, an immigration advocacy group that has partnered with health officials… to make the calls to Spanish speakers. She said earning trust begins with hiring contact tracers who not only speak Spanish but also intimately understand immigrant communities.

Ruth Rivera, who is from Puerto Rico, fits that mold. “I feel the connection right away,” said Rivera, a bilingual contact tracer with a company called HealthCare Dynamics International. “I know their fears.”

Scientists and medical experts expect a second wave of coronavirus infections this fall, as more people congregate indoors with the advent of cooler weather, which also heralds the start of the annual cold and flu seasons. This fall, there may be significant need for robust contact tracing and linguistically equipped tracers. Now, with knowledge of the need to reach out to all people, in languages they can understand, state and local health departments should respond accordingly with fulsome language services to protect the public health of communities across the country.

According to Dr. Kiran Joshi, senior medical officer at the Cook County Department of Public Health, “… his department has few Spanish-speakers among its 25 tracers but plans to hire more, as well as people who speak Polish, Arabic and other languages. “If the caller … speaks one’s own language, they’re more likely to answer honestly and feel comfortable.”

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© Bruce L. Adelson 2020. All Rights Reserved The material herein is educational and informational only.  No legal advice is intended or conveyed.

Bruce L. Adelson, Esq., is nationally recognized for his compliance expertise.  Mr. Adelson is a former U.S Department of Justice Civil Rights Division Senior Trial Attorney.  Mr. Adelson is a Department of Family Medicine faculty member at Georgetown University School of Medicine where he teaches organizational culture, implicit bias, cultural and civil rights awareness.

Mr. Adelson’s blogs are a Bromberg exclusive

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