The Convergence of COVID‐19 and Systemic Racism: An Evaluation of Current Evidence, Health System Changes, and Solutions Grounded in Reproductive Justice

ImportanceThe COVID-19 pandemic has claimed nearly 6 million lives globally as of February 2022. While pandemic control efforts, including contact tracing, have traditionally been the purview of state and local health departments, the COVID-19 pandemic outpaced health department capacity, necessitating actions by private health systems to investigate and control outbreaks, mitigate transmission, and support patients and communities.ObjectiveTo investigate the process of designing and implementing a volunteer-staffed contact tracing program at a large academic health system from April 2020 to May 2021, including program structure, lessons learned through implementation, results of case investigation and contact tracing efforts, and reflections on how constrained resources may be best allocated in the current pandemic or future public health emergencies.Design, Setting, and ParticipantsThis case series study was conducted among patients at the University of Pennsylvania Health System and in partnership with the Philadelphia Department of Public Health. Patients who tested positive for COVID-19 were contacted to counsel them regarding safe isolation practices, identify and support quarantine of their close contacts, and provide resources, such as food and medicine, needed during isolation or quarantine.ResultsOf 5470 individuals who tested positive for COVID-19 and received calls from a volunteer, 2982 individuals (54.5%; median [range] age, 42 [18-97] years; 1628 [59.4%] women among 2741 cases with sex data) were interviewed; among 2683 cases with race data, there were 110 Asian individuals (3.9%), 1476 Black individuals (52.7%), and 817 White individuals (29.2%), and among 2667 cases with ethnicity data, there were 366 Hispanic individuals (13.1%) and 2301 individuals who were not Hispanic (82.6%). Most individuals lived in a household with 2 to 5 people (2125 of 2904 individuals with household data [71.6%]). Of 3222 unique contacts, 1780 close contacts (55.2%; median [range] age, 40 [18-97] years; 866 [55.3%] women among 1565 contacts with sex data) were interviewed; among 1523 contacts with race data, there were 69 Asian individuals (4.2%), 705 Black individuals (43.2%), and 573 White individuals (35.1%), and among 1514 contacts with ethnicity data, there were 202 Hispanic individuals (12.8%) and 1312 individuals (83.4%) who were not Hispanic. Most contacts lived in a household with 2 to 5 people (1123 of 1418 individuals with household data [79.2%]). Of 3324 cases and contacts who completed a questionnaire on unmet social needs, 907 (27.3%) experienced material hardships that would make it difficult for them to isolate or quarantine safely. Such hardship was significantly less common among White compared with Black participants (odds ratio, 0.20; 95% CI, 0.16-0.25).Conclusions and RelevanceThese findings demonstrate the feasibility and challenges of implementing a case investigation and contact tracing program at an academic health system. In addition to successfully engaging most assigned COVID-19 cases and close contacts, contact tracers shared health information and material resources to support isolation and quarantine, thus filling local public health system gaps and supporting local pandemic control.

show abstract

“…Systemic racism has created these inequities, which can be exacerbated by disinvestment in prevention strategies like CI and CT. [35][36][37]…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, more than half of our participants were Black, and Black participants were more likely than White participants to report unmet social needs that interfered with isolation or quarantine. Systemic racism has created these inequities, which can be exacerbated by disinvestment in prevention strategies like CI and CT …”

Section: Discussionmentioning

confidence: 99%

Design, Implementation, and Outcomes of a Volunteer-Staffed Case Investigation and Contact Tracing Initiative at an Urban Academic Medical Center

et al. 2022

View full text Add to dashboard Cite

show abstract

“…[3][4][5] As such, Black populations are more likely to report concerns of trauma, distrust, and hesitancy when it comes to participating in research initiatives. 3,5 Coupled with the twin pandemics of racism and health disparities exacerbated by COVID-19, 6,7 Black populations are facing a unique set of circumstances in the present healthcare climate. The complexity of this experience must be carefully considered before an onslaught of studies and initiatives are developed and haphazardly thrust upon the community.…”

mentioning

confidence: 99%

Refocusing the Conduct of Maternal Mortality Research in Black Pregnant Populations

Amore¹

2022

Journal of Perinatal &Amp; Neonatal Nursing

Self Cite

View full text Add to dashboard Cite

Introduction:Maternal morbidity and mortality rates are on the rise in the United States, particularly among Black populations. Recently, there has been an uptick in research funding to identify and address root causes, particularly among at-risk groups. However, given the historical trauma experienced by Black populations in research settings, novel approaches built firmly on ethical principles and grounded in a framework of reproductive justice are necessary to minimize harm and center the research process on maintaining the dignity and respect of research participants. Methods: Ethical principles as outlined by the American Nurses Association, Black Mamas Matter Alliance, and federal research guidelines are reviewed within the context

show abstract

Doula Support Challenges and Coping Strategies during the COVID-19 Pandemic: Implications for Maternal Health Inequities

Nguyen

Donovan

Wright

2021

Health Communication

View full text Add to dashboard Cite

The Convergence of COVID‐19 and Systemic Racism: An Evaluation of Current Evidence, Health System Changes, and Solutions Grounded in Reproductive Justice

Cited by 4 publications

References 38 publications

Design, Implementation, and Outcomes of a Volunteer-Staffed Case Investigation and Contact Tracing Initiative at an Urban Academic Medical Center

Design, Implementation, and Outcomes of a Volunteer-Staffed Case Investigation and Contact Tracing Initiative at an Urban Academic Medical Center

Refocusing the Conduct of Maternal Mortality Research in Black Pregnant Populations

Doula Support Challenges and Coping Strategies during the COVID-19 Pandemic: Implications for Maternal Health Inequities

Contact Info

Product

Resources

About