Marshallese: Alternate Surveillance for COVID-19 in a Unique Population

摘要 马绍尔群岛太平洋岛民承受着不成比例的COVID-19感染、住院和 死亡率比美国大陆其他种族和族裔群体高4至25倍。 例如，在阿肯色州西北部，马绍尔人占总人口的比例不到3%，但 他们占该地区5例COVID-19病例中的1例。2同样，马绍尔人仅占该地区1%的 华盛顿斯波坎县的人口，但在3月至 2020.4健康的社会决定因素对社区和个人的风险具有强大的影响， COVID-19.18在文化上，马绍尔社区非常紧密，自成一体，高度聚集; 他们通常生活在多代同堂的家庭中;他们传统上重视密切联系和大型社交活动。 所有这些都增加了对COVID-19大流行的脆弱性。19，20马绍尔人是重要的接收者 考虑到COVID-19对这一人群的不成比例的影响以及长期的 健康和保健方面的长期差距。 MASC-UP研究将产生新的数据，反映COVID-19感染风险的变化， 一个人在高度聚集的马绍尔社区中的地位。具体目标1：马绍尔语双语 社区卫生工作者将招募和培训800名马绍尔成年人，年龄18岁， 参与性疾病监测方法，包括使用无线温度计， 跟踪体温;社交媒体和短信，参与者（又名公民科学家）可以 报告症状;以及CHW热线，用于报告症状和请求COVID-19信息。参与性 通过让社区参与报告，疾病监测补充了传统的监测系统 COVID-19症状和事件。它的优势在于提供数据的速度， 扩大技术规模，以低成本获得数据，并能够覆盖否则可能无法覆盖的人群 被追踪。对于特定目标2，参与者将完成一项以自我为中心的接触调查，以描述 目标1疾病监测队列成员的社会联系网络。网络将允许 识别COVID-19感染最高风险人群，并阐明高效预防目标 干预对于具体目标3，我们将把目标1和2的结果纳入现有的基于测试的 目前正在州和地方一级进行疾病监测。这一目标将扩大现有的 事实证明，监测系统不足以在马绍尔群岛人民中遏制这一流行病。拟议 这项研究将推广到其他高风险、聚集在一起的得不到充分服务的人群。

ABSTRACT Marshallese Pacific Islanders bear a disproportionate burden of COVID-19 infection, hospitalization, and death, with rates 4 to 25 times higher than those of other US racial and ethnic groups in the Continental US.2,3 For example, in Northwest Arkansas Marshallese people represent less than 3% of the total population, but they account for 1 out of 5 COVID-19 cases in this area.2 Similarly, Marshallese represent just 1% of the population in Spokane County, Washington, but were nearly 30% of COVID-19 cases between March and May, 2020.4 Social determinants of health have powerful influences on community and individual risks for COVID-19.18 Culturally, the Marshallese community is extremely tight-knit, self-contained, and highly clustered; they often live in multi-generational households; and they traditionally value close contact and large social events, all of which increase vulnerability to the COVID-19 pandemic.19,20Marshallese are important recipients of effective surveillance efforts given the disproportionate impact of COVID-19 on this population and the long- standing disparities in health and health care. The MASC-UP study will generate novel data that reflect variation in risk of COVID-19 infection based on one’s place in the highly clustered Marshallese community. For Specific Aim 1, bilingual Marshallese Community Health Workers will recruit and train a longitudinal cohort of 800 Marshallese adults, ages 18 and older, in participatory disease surveillance methods that include using a wireless thermometer to continuously track body temperature; social media and text messaging in which participants (aka citizen scientists) can report symptoms; and a CHW helpline to report symptoms and request COVID-19 information. Participatory disease surveillance complements traditional surveillance systems by engaging communities in reporting COVID-19 symptoms and events. Its strengths lie in the speed at which data can be made available, the ability to scale the technology to obtain data at low cost, and the ability to cover populations that might not otherwise be tracked. For Specific Aim 2 participants will complete an ego-centric contact survey to characterize the social contact networks of members in the disease surveillance cohort from Aim 1. The networks will allow identification of people at highest risk of COVID-19 infection and elucidate targets for high-impact preventive intervention. For Specific Aim 3 we will integrate findings from Aims 1 and 2 into the existing test-based disease surveillance currently being performed at the state and local levels. This Aim will augment existing surveillance systems that have proved insufficient to stem the pandemic in Marshallese people. The proposed study will be generalizable to other high risk, clustered underserved populations.