COVID-19 contact tracing: Identifying and addressing health inequities in the communities across United States

Presented at American Public Health Association (APHA) Annual Conference. Background: COVID-19 pandemic is worsening the inequities and disparities in health outcomes for older adults, persons in poor living environments, and residents of resource-poor rural communities across the United States. Objectives: Two-fold objectives for this research include (a) to describe the Social Determinants of Health (SDoH) and other factors creating inequities in COVID-19 contact tracing by the state health agencies (SHAs) and local health departments (LHDs), and (b) to identify SHAs’ and LHDs’ strategies to address health inequities. Methods: This study used a qualitative research design to collect data from 6 SHAs, 5 city health departments, and 7 county or district health departments. The transcripts were verified for completeness and quality, imported into QSR International’s NVivo 12 software, and coded by three researchers using thematic analysis methodology. Results: Health equity issues arose from some people’s lack of health literacy, inability to understand the science behind contact tracing, belief in conspiracy theories, political alignments promoting distrust in science and government, inaccurate identifying information due to change in residence for inability to pay rent, loss of phone service due to affordability, and the fear of losing employment if the workplace was identified as a source of infection. Additional health equity issues were associated with the shortage of culturally competent public health workforce and non-availability of wrap-around services such as transportation, non-availability of work from home, and lack of social support including childcare, adequate housing, food security, laundry assistance, and garbage disposal. Strong community support and provision of robust wraparound services were assured by public health agencies for keeping those exposed to Coronavirus at home. Conclusions: Health inequities have worsened during COVID-19. Public health has an opportunity to increase its visibility and demonstrate its value to the public by addressing inequities presented by COVID-19 through community connectedness for social support to underserved groups