In this module, we will discuss ethical issues surrounding contact tracing in the effects of COVID-19 on vulnerable populations. By the end of this module, you will be able to review the main steps of contact tracing, describe privacy issues in contact tracing, explain HIPAA guidelines related to contact tracing, and describe the impact of COVID-19 on vulnerable populations. To review, contact tracing for COVID-19 involves four key steps. The first is reporting when a patient is identified as probable or positive for COVID-19. The second is investigation, where the contact tracer interviews the patient, and identifies who the contacts are that need to be contacted. The third step is identification. This is where the contact tracer will notify the individuals who may have been exposed to COVID-19, and explain the steps for isolation or quarantine. The fourth and final step is follow-up. Additional information about the contact tracing process can be found in the links listed here, and in the reading section of this module. Four classifications are important to use in any contact tracing effort. These will help to find the next steps needed to address the case. First, a suspect exposure defines a person who experiences a symptom of COVID-19, but does not necessarily develop acute respiratory illness, or a person who may have been exposed to COVID-19 who was formally contacted by a contact tracer. Second, a suspect case describes an individual with acute respiratory illness who has a history of travel to, or residence in a location reporting community transmission of COVID-19 disease during the 14 days prior to symptom onset. It can also describe a person with any acute respiratory illness who has been in contact with a confirmed or probable COVID-19 case in the last 14 days, prior to symptom onset. Finally, it can describe an individual with severe acute respiratory illness with an absence of an alternative diagnosis that fully explains the clinical presentation. Third, a probable case can describe two scenarios. First, a suspect case for whom testing for COVID-19 is inconclusive. And second, a suspect case for whom testing could not be performed for any reason. Last, a confirmed case describes an individual with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms. Respecting an individual's privacy and confidentiality means that the contact tracers should only ask for personal information that is relevant to contact tracing. Maintaining privacy is necessary to ensure the trust of the communities where contact tracing is being conducted. Interactions with individuals where health information is disclosed is protected under HIPAA, a federal law protecting patient health information. Public health authorities can disclose protected health information to prevent or control disease, and to conduct public health investigations to stop disease spread. Failing to protect confidentiality may harm individuals engaging in contact tracing, and may also diminish confidence in the contact tracing program. As a contact tracer, you are legally bound by HIPAA to maintain the utmost confidentiality of health related data that cases and contacts will provide. HIPAA specifically protects not only individual health information, but also protected health information like birth date, phone number, and diagnosis. Now let's discuss the effects of COVID-19 on vulnerable populations. COVID-19 continues to spread in the United States, impacting nearly every state in territory. African American, Latinx, Native American, and other minority populations are disproportionately affected by the virus, and the illnesses that it causes. As a contact tracer, you will likely conduct interviews with individuals from diverse backgrounds. As such, it is important to understand the COVID-19 related issues vulnerable populations face. It is also important to reflect on your personal views, and the ways they may impact your interactions and active listening to concerns specific to the communities with which you are engaging. Communities of color, and those with lower socioeconomic status bear a disproportionate burden of illness from COVID-19. These disparities are multifactorial, and may be the result of living in more densely populated areas, food deserts, and multi-generational households. In addition, many individuals living in these communities work in essential industries, and have a lack of paid sick leave. Moreover, individuals in these communities may have higher numbers of chronic illnesses, and less access to healthcare. Thus, ensuring accurate, culturally relevant messaging about the impact of COVID-19 on minority communities, and how to stop its spread is crucial. Contact tracers will play a vital role in sharing this information. COVID-19 defects in communities of color have been widespread, impacting physical and mental health, as well as economic well being. Several factors heighten the risk of African American communities from COVID-19, including a greater prevalence of preexisting conditions, such as diabetes, hypertension, and obesity. Working in essential jobs, and structural inequities in the social determinants of health that are influenced by implicit bias in racial discrimination. These factors have contributed to a historic mistrust of the healthcare system by African American communities. As this slide demonstrates, African American individuals are more likely to die at early ages from all causes, and this may exacerbate disparities in relation to COVID-19. More information about the impact of COVID-19 on African American communities can be found in these links, which will be included in the reading section of this module. Latinx communities are also more vulnerable to COVID-19, as a result of similar factors that have put other minority communities at increased risk. Many work in low paying essential jobs that heighten potential exposure to coronavirus. And a large number lack access to healthcare, leading to higher rates of diabetes and other chronic conditions that have been associated with poor COVID-19 outcomes. More information about COVID-19 in Latinx communities can be found in the Reading section. The pandemic has had devastating impacts on Native American communities, stemming from three interlinked problems. First, Native American individuals often suffer from conditions that predispose them to pour COVID-19 outcomes, including diabetes and heart disease. Second, as many as 40% of Navajo homes lack running water. Finally, almost one-third of Native American individuals are living in poverty. As a result, many live in multi-generational family units, making social distancing difficult, and often lack basic resources, such as electricity. Additionally, federal funding has been insufficient to maintain a robust public health system in Native American communities, leading to poor outcomes among Native American individuals. More information about COVID-19 in Native American communities can be found in the Reading section. While many of the social determinants of health that impact other minority communities are also prevalent in immigrant populations. The impact of these are heightened, because immigrants often avoid seeking care, due to the risk of being targeted by immigration enforcement officials. Immigrants often live at the intersection of poverty, food and housing insecurity, and lack of access to high quality education, healthcare, and child care. Moreover, immigrant populations often work in service professions for lower wages, and have limited protection against COVID-19. Immigrant populations are particularly susceptible to negative COVID-19 outcomes, as stated previously. Please read this article for more information. This article can be found in the Reading section of this module. As a contact tracer, you may encounter additional factors that may impact your interviews with members of vulnerable populations. The readings listed here, and found in the Reading section at the end of this module, address these issues. COVID-19 also presents significant challenges to the homeless population. Those living in shelters often live in close quarters, increasing Of COVID-19 transmission. Homeless individuals have higher numbers of pre-existing conditions and less access to health care, including coronavirus testing. To limit the spread of COVID-19, adequate resources to house, quarantine, and isolate homeless individuals who are infected are needed. Please read these articles for more information about the plight of homeless populations during the COVID-19 pandemic. Older adults, age 65 years and older, are at higher risk for severe illness and death due to COVID-19, and those with chronic medical conditions are at even higher risk. Physical distancing due to COVID-19 increases the risk of social isolation and loneliness in older adults. Thus, it is important to maintain connections in this population. Please read these articles to understand more about caring for elderly individuals during this time. The presentation of COVID-19 in the elderly, and how the pandemic is impacting nursing home residents and staff. To recap, contact tracing requires that you interview people of many backgrounds. Understanding that there are many factors that can adversely affect vulnerable populations during this time, will help you develop trust within the communities where contact tracing is being conducted. In these uncertain times, how do we continue to move forward? The answer lies in drawing inspiration from those around us. We have seen our friends and family members heroically combat this virus in the workplace and at home. Thank you for joining the legions of Texans who are doing their part to flatten the curve, treat the infirmed. Maintain the food supply chain, educate students, and conduct research for effective therapies. Your work as a contact racer is vital in helping to mitigate this pandemic. In summary, contact tracers have an ethical and legal responsibility to protect the privacy of individuals participating in contact tracing. Interactions with individuals where health information is disclosed is protected under HIPAA, a federal law requiring protection of patient health information. As a contact racer, you will likely conduct interviews with individuals from a range of diverse backgrounds. Understanding the impact of COVID-19 on special populations will help you to develop trust within the communities where contact tracing is being conducted. Your work as a contact tracer is vital in helping to contain the spread of COVID-19 and prevent future outbreaks. To learn more, please review these articles.
