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

摘要 马绍尔太平洋岛民承担着不成比例的新冠肺炎感染、住院和 死亡率是美国大陆其他美国种族和民族的4到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 他们占这一地区新冠肺炎病例的五分之一。2同样，马绍尔人仅占 华盛顿州斯波坎县发生口蹄疫，但在3月至9月间的新冠肺炎病例中占近30% 5月，2020.4个健康的社会决定因素对社区和个人的风险有强大的影响 在文化上，马绍尔社区非常紧密，自给自足，高度集聚； 他们往往生活在几代人的家庭中；他们传统上重视亲密接触和广泛的社会交往 事件，所有这些都增加了对新冠肺炎大爆炸的脆弱性。19，20马绍尔人是重要的接受者 鉴于新冠肺炎对这一人群的不成比例影响以及长期- 卫生和医疗保健方面的长期差距。 MASC-UP研究将产生反映新冠肺炎感染风险变化的新数据，这些数据基于 一个人在高度聚集的马绍尔社区中的位置。具体目标1，双语马绍尔语 社区卫生工作者将招募和培训800名马绍尔成年人，年龄在18岁和 更古老的参与式疾病监测方法，包括使用无线温度计连续 跟踪体温；社交媒体和短信，参与者(也称为公民科学家)可以 报告症状；以及报告症状和请求新冠肺炎信息的CHW帮助热线。参与式 疾病监测通过让社区参与报告来补充传统的监测系统 新冠肺炎症状和事件。它的优势在于提供数据的速度、能力 扩展技术以低成本获取数据，并能够覆盖原本可能无法覆盖的人群 被跟踪。对于特定的目标，2名参与者将完成一项以自我为中心的接触调查，以表征 AIM 1疾病监测队列中成员的社会联系网络。这些网络将允许 确定新冠肺炎感染的高危人群并阐明高影响力预防的目标 干预。对于特定的目标3，我们将把目标1和目标2的结果整合到现有的基于测试的 目前正在州和地方各级进行疾病监测。这一目标将扩大现有的 事实证明，监测系统不足以遏制马绍尔人的大流行。建议数 这项研究将推广到其他高危、聚集性服务不足的人群。

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.