Epidemiologic Intelligence Network (EpI-Net) to Promote COVID-19 Testing and Prevention Practices Among Socially Vulnerable Communities in Puerto Rico

In Puerto Rico (PR), the first COVID-19 case was confirmed early March 2020. To date, cases have exponentially increased partly due to the lifting of locked-down restriction by the PR government, limited COVID-19 testing, and contact tracing. Puerto Ricans living on the island are particularly vulnerable to the current overlapping of the COVID-19 pandemic and natural disasters (earthquake, hurricanes/storms). Limited access to molecular COVID-19 testing throughout PR has been a significant challenge. Without adequate testing, estimates for SARS-CoV-2 (COVID-19) infection rates are limited and targeted prevention efforts (focused testing) may hinder. A group of epidemiologists led by Dr. Marzán (MPI) developed a web-based COVID-19 Epidemiologic Surveillance System (ESSS) in collaboration with the Puerto Rico Public Health Trust (PRPHT, community partner for this grant) with more than 46,000 surveys completed. The ESSS tool was an online geocoded survey that identified real-time data of COVID-19 signs and symptoms during the last 24 hours; and thus, prioritized communities for COVID-19 testing. Leveraging the current PHSU-PRI COVID-19 prevention efforts and the ESSS infrastructure, the research team tested the preliminary impact of an epidemic intelligence (EpI-Net) community-based intervention aimed at increasing COVID-19 testing uptake and prevention practices among socially vulnerable communities in PR. The working hypothesis was that the integration of lay community leaders, trained in the use of COVID-19 prevention technology tools (EpI-Net), resulted in increased COVID-19 testing uptake and prevention practices among the targeted socially and epidemiologically vulnerable communities in Puerto Rico. This highly innovative and impactful study shifted current COVID-19 prevention strategies by 1) establishing an epidemic intelligence infrastructure using a technology-based COVID-19 syndromic surveillance (ESSS) platform to identify in real time potential COVID-19 outbreaks and, thus, conduct targeted COVID-19 testing, 2) by implementing a population-based COVID-19 prevention intervention (EpI-Net) co-led by epidemiologists and lay community leaders trained as health promotors.