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

The Marshallese/Native Hawaiian/Pacific Islanders: Alternate Surveillance for COVID-19 in a Unique Population (MASC UP) study relied on innovative, culturally tailored participatory surveillance methods to identify and evaluate strategies to reduce the spread of COVID-19 in this high-risk, clustered population. First, a cohort was recruited to deploy a multi-modal, multi-level surveillance system in two of the largest Marshallese/Native Hawaiian/Pacific Islanders communities in the US: Northwest Arkansas (n = 300), Spokane County, and Seattle area Washington (n = 300). Each cohort member was followed longitudinally for at least 12 months. Modalities included providing kits to detect changes in body temperature, public service outreach to reduce stigma associated with reporting symptoms, and deploying social media and text message-based screening technology to augment conventional test-based surveillance. Second, a social contact network was constructed among participants from the surveillance cohort to identify community structures and networks that increased the risk of COVID-19 infection. The findings were used to integrate effective components into a surveillance ecosystem that can be disseminated to other clustered groups. The specific aims were to: 1) Create a longitudinal, multi-modal and multi-level surveillance cohort (n = 600) that targeted early detection of symptomatic and asymptomatic COVID-19 cases among Marshallese/Native Hawaiian/Pacific Islanders adults in the continental U.S.; 2) Characterize the social contact network among surveillance cohort members to identify community structures and networks that put individuals at increased risk of acquiring COVID-19; and 3) Identify effective modalities for participatory disease surveillance and sustainably integrate them into ongoing COVID-19 and other public health surveillance efforts for the Marshallese/Native Hawaiian/Pacific Islanders population. MASC UP demonstrated the value of culturally tailored, participatory disease surveillance developed and tested in real-world settings to mitigate COVID-19 disparities in a high-risk, clustered population that has been profoundly underserved by public health efforts to date. The findings can be disseminated and implemented for improved surveillance and disease prevention in other high-risk, non-institutionalized U.S. minority groups.