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

ABSTRACT Marshallese Pacific Islanders bear a disproportionate burden of COVID-19 infection, hospitalization, anddeath, with rates 4 to 25 times higher than those of other US racial and ethnic groups in the Continental US.2,3For example, in Northwest Arkansas Marshallese people represent less than 3% of the total population, butthey account for 1 out of 5 COVID-19 cases in this area.2 Similarly, Marshallese represent just 1% of thepopulation in Spokane County, Washington, but were nearly 30% of COVID-19 cases between March andMay, 2020.4 Social determinants of health have powerful influences on community and individual risks forCOVID-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 socialevents, all of which increase vulnerability to the COVID-19 pandemic.19,20Marshallese are important recipientsof 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 onone's place in the highly clustered Marshallese community. For Specific Aim 1, bilingual MarshalleseCommunity Health Workers will recruit and train a longitudinal cohort of 800 Marshallese adults, ages 18 andolder, in participatory disease surveillance methods that include using a wireless thermometer to continuouslytrack body temperature; social media and text messaging in which participants (aka citizen scientists) canreport symptoms; and a CHW helpline to report symptoms and request COVID-19 information. Participatorydisease surveillance complements traditional surveillance systems by engaging communities in reportingCOVID-19 symptoms and events. Its strengths lie in the speed at which data can be made available, the abilityto scale the technology to obtain data at low cost, and the ability to cover populations that might not otherwisebe tracked. For Specific Aim 2 participants will complete an ego-centric contact survey to characterize thesocial contact networks of members in the disease surveillance cohort from Aim 1. The networks will allowidentification of people at highest risk of COVID-19 infection and elucidate targets for high-impact preventiveintervention. For Specific Aim 3 we will integrate findings from Aims 1 and 2 into the existing test-baseddisease surveillance currently being performed at the state and local levels. This Aim will augment existingsurveillance systems that have proved insufficient to stem the pandemic in Marshallese people. The proposedstudy will be generalizable to other high risk, clustered underserved populations.