In South Florida, volunteer contact tracers take on language barrier in urgent COVID fight

Coronavirus disproportionately affects Latinos, while Spanish outreach lags.

By Laura Romero, Benjamin Siegel, and Dr. Jay Bhatt
This article was originally posted on abcnews.com on July 7, 2020.

After losing his job abruptly amid the coronavirus in March, Alejandro Curbelo saw a TV ad for a unique volunteering opportunity to help with contact tracing in the U.S.

At the time Curbelo, a Cuban native, was living in Cancun, Mexico, and had been working in the tourism industry before being laid off.

Without any experience in the medical field, or any knowledge of what the opportunity would entail, Curbelo told ABC News he signed up to become a contact tracer for a community hospital in South Florida – more than 500 miles from his home in Mexico. But he quickly noticed a problem: Most contact tracing training resources were in English, which could hamper efforts to reach out to Latino communities in the U.S.

Now, nearly four months later, Curbelo, along with 70 volunteers from around the world, have completed their work on a Spanish-language contact tracing course from Larkin Community Hospital in Miami, Fla. It’s adapted from the Association of State and Territorial Health Officials’ program into Spanish to better include the Latino community in the race to slow the spread of COVID-19.

As the country sets new daily infection records fueled by outbreaks in Florida, Arizona and Texas — all states with large Latino populations — efforts to corral the virus using contact tracing are coming up short. Contact tracing is a classic public health technique used to control outbreaks of sexually transmitted disease and foodborne illnesses by tracing the past contacts of the infected.

Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials, told ABC News that efforts to reach non English-speaking communities has been replicated in other parts of the country as local officials increasingly recognized the need to effectively communicate — especially with regard to Latino communities that have been hit disproportionately hard.

In some cases, there is a gap [in outreach], and people are trying to fill that gap,” she said.

In Texas, for example, health officials in Harris and Tarrant Counties have translated their website and information about COVID-19 into Spanish, held tele-town halls with bilingual staff, and run advertising campaigns in Spanish to better communicate with local residents.

The outreach to South Florida’s Spanish-speaking community comes at what experts say is a dangerous inflection point of the pandemic in the U.S.

“It’s not going well,” Dr. Anthony Fauci, the nation’s top infectious disease expert, said of contact tracing efforts to contain the virus in an interview aired by the Milken Institute late last month.

In a subsequent press conference on June 26, Fauci said that many Americans aren’t picking up the phone when health officials call. The problem is pronounced in minority communities where trust between community and institutions can be fractured or virtually non-existent, he said.

When it’s done by phone, maybe half of the people don’t even want to talk to someone they think is a government representative,” Fauci said. “If you live in a community that is mostly brown or black, you’re in a different situation … maybe 70% don’t really want to talk to you.

Even in Miami, where many local government employees are native Spanish speakers, officials must also navigate language barriers for Latinos, and other populations.

Limited non-English language resources from the federal government has also added to the challenge, according to experts. The Centers for Disease Control and Prevention does have a website including Spanish-language resources on the coronavirus and contact tracing, as does Florida’s state department of health.

In the beginning, everything was in English,” said Curbelo, the contact tracing volunteer. “But I knew that people who spoke Spanish and were sick wouldn’t want to take part in contract tracing because of the language barriers. Contact tracers need to speak with people and learn as much as they can for it to work.

Curbelo was one of 400 volunteers to take the English-language course with Miami’s Larkin Community Hospital, which has a campus in Hialeah where 95% of the residents are Hispanic.

If you speak to me in my native language, I will understand you and empathize with you,” Curbelo said.

It can take about 20 minutes for an investigator to conduct a thorough contact tracing interview, according to Larkin Community Hospital executive physician Jack Michel.

Using text messages, phone calls, calendars and emails, investigators work to reconstruct an infected person’s schedule in order to map every potential interaction — before repeating the process with each close contact.

Tracers must also work to map out a person’s contacts soon after their test results are known, in order to limit potential spread. The time-intensive and exhaustive work underscores the need for large numbers of tracers in every community — and for those who speak their language.

The Latino community is also disproportionately effected by COVID-19. Current statistics released by the CDC show the percentage of Hispanic/Latino Americans making up coronavirus cases is almost equal to whites — around 34% — despite Latinos being a significantly smaller portion of the population.

We felt there was a necessity to bring this to the community and to the rest of the country,” said Laura Salazar, a volunteer. “Our Hispanic population is getting sick and they are Spanish speakers.

This was a huge effort,” Michel said during a Zoom town hall related to the effort on Wednesday. “It turns out, there’s so much that goes into it. But we had volunteers who would immediately volunteer to take on and create videos and what they did is amazing.

The Spanish-language course translated by Larkin Community Hospital was released publicly last week, and takes about three hours to complete online.

The course, together with a digital platform designed by the hospital, are available for use by contact tracers and health care officials in Central and South America, Michel told ABC News. It’s already in use at Larkin Community Hospital, and could be rolled out by the Association of State and Territorial Health Officials (ASTHO) to the greater U.S. later this month.

The more we could get native Spanish speaking contact tracers, we would be better off in managing the virus,” Marcus Plescia, the chief medical officer for the ASTHO, told ABC News. “Larkin was an opportunity to have a partner to help us do that.

I am very proud of what we have done,” said Curbelo. “This is going to help save so many lives.

Jay Bhatt, a practicing internist and Aspen Health Innovators Fellow, is an ABC News contributor.

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