Community Collaboration to Combat COVID-19

Background: Barriers to SARS-CoV-2 testing are complex and occur at multiple levels, shaped by environmental, population, and behavioral determinants. Inequities in healthcare access, systemic racism, mistrust, language barriers, and socioeconomic constraints further reduce testing among vulnerable groups, particularly Latinx and Black populations, who are disproportionately uninsured and affected by chronic conditions at younger ages. Community-based studies are critical to understanding disparities in testing access and uptake. This study sought to define the optimal testing modality to maximize acceptance, uptake, and timeliness of results in underserved populations.

Materials/Methods: A randomized comparative effectiveness trial evaluated three testing approaches: standard-of-care fixed site testing, community-based mobile van testing, and self-collected home-based testing. A population-based sample of households within Baltimore City was recruited, with follow-up of participants for up to 12 months. The study was divided into two phases. Phase I involved informed consent and a baseline survey only. Phase II involved randomization to one of the three testing modalities and SARS-CoV-2 testing. Only participants who consented to Phase II were included in primary and secondary analyses. Clinical evaluation for symptomatic participants included multiple inflammatory markers (IL-6, LDH, ESR, CRP, CBC with differential), liver function testing, and coagulopathy measures such as D-Dimer. In addition to testing, the study examined dysregulation among these parameters in individuals who did not progress to hospitalization, as well as household and community transmission of SARS-CoV-2. Household transmission rates were compared against established data from SARS, MERS, and H1N1, with attention to distinguishing direct exposure from potential fomite-related transmission.

Outcome/Impact: This study addressed barriers to COVID-19 testing access in Baltimore City by evaluating testing strategies that reduced hesitancy, improved acceptance, and expanded access to underserved communities. Beyond testing uptake, the study provided critical information on the full spectrum of SARS-CoV-2 infection, including antibody development in non-hospitalized participants, clinical markers of disease progression, and household transmission dynamics. The intended impact was to identify the most effective testing modalities to inform public health strategies, reduce inequities in testing, and characterize the epidemiology of infection in urban communities disproportionately affected by COVID-19.