Community health workers, not technology, are best equipped to manage COVID-19 related contact tracing, especially in immigrant and low-income communities, said HealthBegins president and CEO Rishi Manchanda, at a Sept. 26 briefing organized by EPPIC Global.
“Contact tracing is not about technology, it’s a people problem. Techno-solutionism doesn’t work,” said the Indian American physician and public health specialist.
Contact tracing helps public health officials identify people who have been in contact with an individual who has tested positive for the coronavirus. Those individuals are advised to get tested and self-quarantine until their test results come back negative.
Apple and Google are developing contact tracing apps which allow users’ phones to interact with each other and determine the length of the interaction. If a user reports themselves as positive or being exposed to a positive person, the app sends out a notification to all of the people the user has come in contact with. They can then get tested and self-quarantine until results are out, theoretically slowing down the spread.
But Manchanda said there were several issues with app-based contact tracing. At least 60 percent of the population would have to adopt it, and different apps may not store each other’s data. Privacy would also be a concern, he said.
“I’m not looking to Google to save myself or my community,” said Manchanda at the briefing, which was moderated by EPPIC Global board member Raji Pillai, founder and president of Medical Affairs Consulting. Manchanda later told India-West that broad swaths of minority and immigrant communities would be left out of app-based contact tracing. “The digital divide continues to be a major issue, and hinders the potential impact of strategies reliant on high-tech,” he said.
Manchanda advocated for community health workers to serve as contact tracers. “They are a crucial element in the public health response,” he said, characterizing CHWs as trusted members of communities who serve as intermediaries for people in that community to access public health services. California has just 5,270 CHWs: the physician stated many more were needed to meet the needs of the state. Community health workers, who already provide a range of services, can take an online course to learn how to be effective contact tracers.
“A community based workforce can solve health inequities,” said Manchanda, stating that the COVID pandemic has laid bare the “caste system” of health care delivery in the U.S. Structural racism has played a huge role in health care access, he said, noting that the poorest neighborhoods and communities in which people of color make up the majority of residents consistently have the highest rates of infection and death.
Several countries and several states in India have effectively used contact tracing and community health workers to slow the spread of the virus. In Mumbai’s Dharavi — Asia’s largest slum in which 500,000 people on one square mile of land — 2,450 health workers were deployed to go door to door to identify those testing positive for COVID, and immediately quarantined them. At the end of July, just 79 people in Dharavi had died of a COVID infection.
Manchanda noted that Kerala, a state with a population of over 35 million, had also employed a similar method to contain the virus, limiting deaths to just 742 people, from 196,000 infections, as of Oct. 2. The state has an army of 28,000 community health workers.
The state contained its death tolls by distributing resources equitably and marshaling them to those who are most vulnerable, Manchanda explained, adding: “It’s not ideology, it’s based on science.”
“The pandemic is experienced differently. It works when leaders act quickly and coordinate effectively, putting experts in charge, and building leverage and trust,” said Manchanda, who has spent time in Kerala studying public health systems in the state.
India, with a population of 1.3 billion, has experienced almost 6.4 million infections, the second highest in the world, but with only 99,773 deaths, according to data released by Johns Hopkins University Oct. 2. But its infection rate is rising: more than one million new cases have been identified in the past two weeks.