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

Background: This study was performed to create a longitudinal, multi-modal and multi-level surveillance cohort that targeted early detection of symptomatic and asymptomatic COVID-19 cases among Marshallese, Native Hawaiian, and Pacific Islanders. The study also characterized the social contact network among surveillance cohort members to identify community structures and networks that put individuals at increased risk of acquiring COVID-19. In addition, the study aimed to 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, and Pacific Islanders population.

Materials/Methods: This study used innovative, culturally tailored participatory surveillance methods to identify and evaluate strategies to reduce the spread of COVID-19 on a high-risk, clustered population. Cohorts were recruited to deploy a multi-modal, multi-level surveillance system in two of the largest Marshallese, Native Hawaiian, and Pacific Islanders communities in the United States: Spokane County in Arkansas, and Seattle area Washington. Cohorts were followed longitudinally for at least 12 months while 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. Additionally, 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.

Outcome/Impact: The results of this study 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 underserved by public health efforts. The findings can be disseminated and implemented for improved surveillance and disease prevention in other high-risk, non-institutionalized U.S. minority groups.