Groceries And Rent Money: Why Support For COVID Isolation Is More Important Than Ever

Mar 19, 2021
Originally published on June 17, 2021 2:15 pm

While everyone's hopes are trained on COVID-19 vaccines to lead the way out of the pandemic, public health experts say that other public health tools are still crucial for stopping the virus.

One of those tools — contact tracing — may finally be ready to have its moment, says Crystal Watson, senior scholar at the Johns Hopkins Center for Health Security. During the winter surge, contact tracers were overwhelmed; they couldn't possibly reach everyone who tested positive — and their close contacts — to tell them to stay home to slow the spread.

That's starting to change, Watson says. Case numbers are entering the zone where contact tracers can get on top of transmission. Vaccinations are ramping up and injecting hope into the public health response.

And there's finally billions of dollars — in the American Rescue Plan — to boost these efforts, so that if concerning coronavirus variants continue to spread through the summer and beyond, health departments can be ready, Watson says.

Contact tracing only works to stop the spread, though, if everyone who's infected or exposed is able to follow the public health guidance to stay home for days or weeks. For people who can't — because they don't have money to pay for utilities or rent, or friends who are willing to get groceries for them and drop them off — health departments have a fix.

It's called care resource coordination. It's so little known, it's like a secret weapon in the pandemic public health response — one that can make it more effective and more equitable. And public health experts urge that this is the time to take advantage of new funding opportunities and expand the reach of this service.

"Why are you calling?"

Karina Acuna has been doing this work since July, when the public health department in Pima County, Ariz., started its care resource coordination program.

"Almost every call that we have it starts off — it's like, 'Why are you calling and how do you have my number?' " says Acuna. The people she's calling have either just been diagnosed with COVID-19 or have just found out they're a close contact and need to quarantine. They're often stressed or sick; it can be a scary time.

She talks them through what they might need for the time they need to stay home — groceries, prescription medications, cleaning supplies. Then she looks through her list of 95 local health and social service agencies and connects them to programs that might be able to help.

"It always ends up being a good call for them because they're getting the help that they might need or didn't even know that they had available to them," Acuna says.

Sometimes, it's simple things that people need, like extra masks. Larissa Morgan, a community health representative who does this work for the Navajo Nation, says for people there, it's often cleaning supplies.

"[It's been] hard to get Clorox wipes; it's hard to get Lysol sprays," she says. "I would say that food would come next and then water, because we do have individuals who still don't have running water."

Sometimes, the needs are even more substantial. People need help planning funeral services for loved ones who died of COVID-19. Care coordinators describe comforting people who are grieving in isolation. Or helping them find housing.

"I can tell you, I have had to help a client where they were actually being evicted — the marshal was at the residence, putting them out," says Sharonda Wright, a care resource coordinator at the Fulton County health department in Georgia. "They were needing shelter and needing financial support and trying to gather their belongings at the same time."

The person was able to stay with a relative briefly, and then Wright connected them to transitional housing, she says.

Meeting these needs isn't just important for those individuals. If staying at home isn't possible for people who are infected, the virus has more opportunities to spread, which makes it a public health problem. Care resource coordinators provide a kind of temporary safety net that helps people stay nourished with chicken soup when they're sick with COVID-19, and helps families take care of each other by providing them with masks and cleaning supplies.

The best and the rest

These programs exist all over the country. An NPR survey done in December in collaboration with the Center for Health Security and the nonprofit Partners In Health found that the vast majority of state health departments that responded to the survey do ask about social needs as part of the contact tracing process.

But an analysis of these findings published Friday shows the size and reach of these programs varies a lot — from a basic help line people can call if they need help, to dedicated specialists who know their communities and resources deeply.

For this process to work, the details matter, says Dr. Shada Rouhani, who advises Partners In Health on care resource coordination and collaborated with NPR and Johns Hopkins on the survey.

Rouhani's analysis found that only 39% of states that responded said that their contact tracing teams included dedicated care coordinators. Nearly a third of these programs don't do systematic follow-up with people to make sure their needs were met.

And 1 in 5 programs just hand out a phone number like 211. "Simply giving somebody a phone number to call to try to find a resource or to connect with a food bank or to connect with their resource bank can be difficult, particularly if there are language barriers, if that person has limited access to technology or even something as simple as limited phone minutes to make that phone call," explains Rouhani.

Actively making those connections for people can make a big difference, she says.

In Pima County, Ariz., when Acuna figures out which local agencies can help someone, "we can transfer them on the spot." Sometimes, though, it makes sense to email or text the information so they can follow up later.

"Some of these people are too sick to talk — to be on the phone for that long," she explains.

Wright keeps close tabs on what the requirements are for each local program in Fulton County, Ga. — which ones have wait lists and which don't. She sometimes actually enrolls people in programs they qualify for — especially seniors without Internet access. "With their permission, we can go forward and complete those applications for them," she says.

In New Mexico, Larissa Morgan's team includes people who will actually drop off supplies and groceries for people who have to isolate at home. "They don't have anybody who is willing to go get [supplies for] them because they were afraid to come by their home because they didn't want to be infected by COVID," she explains.

Her expertise — in public health resources and in the part of the Navajo Nation she serves — has started to be stretched in new directions as the pandemic evolves.

"We've been working with our public health nurse to get individuals who are homebound their vaccination at home," she says. They may live in remote areas or lack transportation. So far, she and a public health nurse have driven out to vaccinate five people at home, and more are in the works.

Finally, funding on the horizon

If state and local health departments want to scale up programs like these, they should soon have access to federal funding to help make that happen. The American Rescue Plan, signed into law by President Biden last week, has earmarked $47.8 billion for testing and contact tracing and other mitigation measures.

The law also includes $7.7 billion for a new public health workforce. "It's still being worked out how that's going to be implemented," says Watson of Johns Hopkins.

During a pandemic, that workforce could work with contact tracers to support people who need to stay home, but more broadly, "the main goal of that program is to hire people for the long term so we can bolster our public health infrastructure," she explains.

There is also funding for some of the support programs care resource coordinators connect people with, like rental assistance and paid leave for employees. "That, I think, is a big boost to contact tracing in and of itself," Watson says.

Shada Rouhani is hopeful that lots of public health departments will seize this opportunity to expand this piece of the pandemic response, even as the vaccination effort has the nation's focus.

"We are all incredibly hopeful that the vaccine progress will continue to be great and that we are all looking forward to returning more towards normal," she says. But investing in these programs and designing them to be effective is still important.

"These care resource coordination structures that we're building now and using now very well may come into play in the future," she says.

That's true when it comes to preventing new COVID-19 outbreaks if the current vaccines are less effective against emerging variants than we hope, she says. These programs could also be important to help the country mount a more equitable and effective public health response when the next pandemic hits.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

AILSA CHANG, HOST:

Even with vaccinations running ahead of schedule, public health experts warn it will take more than that to get us out of this pandemic. Other public health tools like contact tracing can help speed the way to lower case numbers and prepare us for future outbreaks. As NPR's Selena Simmons-Duffin reports, contact tracing has a secret weapon to help make it more effective and equitable. That secret weapon is called care resource coordination.

SELENA SIMMONS-DUFFIN, BYLINE: If you get a call from Karina Acuna of the public health department in Pima County, Ariz., she won't be surprised if you're caught off guard.

KARINA ACUNA: I think almost every call that we have, you know, it starts off - it's like, why are you calling, and how do you have my number?

SIMMONS-DUFFIN: The people she's calling have either just been diagnosed with COVID-19 or have just found out from a contact tracer that they're a close contact of someone who's sick, so they need to quarantine. It can be a scary time. They're often stressed or sick. She walks them through what they might need to stay home for days or weeks - grocery deliveries, prescription medications, money for rent, cleaning supplies. Then she looks through her list of 95 local agencies and programs and connects them to those resources.

ACUNA: It always ends up being a good call for them because they're getting the help that they might need or didn't even know that they had available to them.

SIMMONS-DUFFIN: For many people, following public health guidelines to stay home isn't feasible without this kind of help. And that's not just a personal problem. If someone who's infected leaves their house, the virus has more opportunities to spread, and that makes it a public health problem. Care resource coordinators like Acuna provide a kind of temporary safety net that helps people stay nourished with chicken soup when they're sick with COVID-19 and helps families take care of each other by providing them with masks and cleaning supplies. They can even help people find a place to stay.

SHARONDA WRIGHT: I have had to help a client where they were actually being evicted, where the marshal was at the residence, putting them out. And they were needing shelter and needing financial support and trying to gather their belongings at the same time.

SIMMONS-DUFFIN: Sharonda Wright, a care resource coordinator in Fulton County, Ga., connected that COVID-19-positive person to transitional housing.

This work is happening all over the country. NPR surveyed state health departments in December in collaboration with the Johns Hopkins Center for Health Security and the nonprofit Partners in Health. The survey found that the vast majority of contact tracing programs do ask about social needs, but there's a lot of variation in what that looks like, from just a basic question in a phone call - do you have everything you need? - to dedicated specialists like Wright and Acuna.

Crystal Watson of Johns Hopkins oversaw the survey with NPR. She says it's understandable that not all health departments have been able to fully invest in this.

CRYSTAL WATSON: I mean, it's a really hard thing to do, especially when health departments are understaffed to begin with and then pulled in a million different directions.

SIMMONS-DUFFIN: Watson is hopeful that the American Rescue Plan, with $48 billion for testing and contact tracing and $8 billion for a new public health workforce, might mean more investment in care resource coordination. She says this work helps address big concerns about equity. Black and Latino and Native American communities have been hardest hit throughout the pandemic.

WATSON: That's really what this care resource coordination component does. It helps get resources to the people who need it most and make this response less inequitable.

SIMMONS-DUFFIN: Getting the details of this process right, though, is really key to making it work. Dr. Shada Rouhani of Partners in Health collaborated on the state health department survey with NPR and just published an analysis of the results.

SHADA ROUHANI: Right now we see that only just over half of programs are asking questions about specific needs, like do you have enough food, or do you need a safe space to isolate in?

SIMMONS-DUFFIN: That's important because when people are sick or stressed, they might need help thinking through everything they'll need, and 1 in 5 programs just hand out a hotline number. Rouhani says some people just can't follow up and connect with the food bank or the utility assistance they need.

ROUHANI: Particularly if there are language barriers, if that person has limited access to technology or even something as simple as limited phone minutes to make that phone call.

SIMMONS-DUFFIN: In other words, there's room for improvement, and Rouhani argues it's not too late for health departments to invest in contact tracing, even as the vaccine campaign continues to ramp up. Watson of Johns Hopkins agrees. She says just because the vaccines are here doesn't mean they can conquer the pandemic all on their own. There's still a need for contact tracing.

WATSON: I think it is a time to really focus on getting us to exactly where we want to be before we face another fall and winter with this virus.

SIMMONS-DUFFIN: Even after the initial vaccine rollout, there may still be COVID-19 outbreaks, she says. And contact tracing with care resource coordination can help tamp down those small fires before they spread.

Selena Simmons-Duffin, NPR News.

(SOUNDBITE OF BIG STAR SONG, "THE BALLAD OF EL GOODO") Transcript provided by NPR, Copyright NPR.