06Jun

An army of workers is being recruited across the US to help “box-in” the coronavirus to prevent its spread and reduce the chance of new outbreaks.

Tens of thousands – 100,000 at least — of these special workers will be deployed to track down and counsel individuals who may have come into contact with an infected person. When they do, they’ll ask them about their health, informing them they were potentially exposed to the virus and advising them about what steps to take.

These contact tracers may also ask them who they’ve been in contact with and then reach out to those individuals as well.

Contact tracing is a key part of how public health officials will contain the spread of COVID-19.

Described in a document prepared by the Association of State and Territorial Health Officials, boxing-in the virus involves four tactics: “(1) testing, (2) isolation of all infected people, (3) finding everyone who has been in contact with infected people, (4) quarantine all contacts for 14 days, and (1) re-testing of those people.”

Each piece is essential to containing the pandemic, but success depends first on identifying the infected and who they may have infected, which is why so many cities and states have begun beefing up the ranks of their public health investigators.

“Contact tracing, monitoring, and provision of social supports to infected individuals and their contacts is an urgent priority of local, state, territorial, and tribal health departments,” says the association, “And will require rapid and massive scaling up of existing contact investigation resources in every community in the United States and its territories.”

As recruiting for these positions gets underway, agencies are making a determined effort to recruit from the ethnic and minority communities most impacted by COVID-19, reports Kaiser Health News.

“There are some communities that aren’t going to respond to a phone call, a text message or a letter,” explains Dr. Kara Odom Walker, secretary of the Delaware Department of Health and Social Services. “That could be due to health literacy issues, which could be due to fear, or documentation status.”

In Long Beach, California, which has a substantial Cambodian, Vietnamese, Samoan, Pilipino and Spanish-speaking population, the city weeks ago assembled a team of 60 contact tracers and interpreters from among its bilingual municipal workers.

Virginia, which plans to hire 1,300 tracers and support staff, is recruiting speakers of Mandarin, Haitian Creole, Spanish and Bengali, according to the Kaiser report.

Having a tracer who understands the culture as well as speaks the language can make a big difference in how much cooperation – and success – public health agencies will have.

Says Walker, “You need someone to be a cultural broker to say, not only are these policies in place to protect you, but I’m telling you to trust me that this will be OK.”

Photo by Martin Sanchez on Unsplash

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Jun 6, 2023

In-Home Colon Screening Is Rising as a COVID Alternative

The sharp decline in cancer screenings due to the suspension of elective medical procedures has prompted doctors to turn to alternatives, and none have seen a greater increase than in-home colon screening tests.

Screening for colorectal cancer has typically meant a trip to an outpatient surgical center for a colonoscopy or for a somewhat less invasive sigmoidoscopy. During the initial months of the pandemic when COVID disrupted medical care, there was an 86% decline in colon cancer screening, according to the Epic Health Research Network.

Decades ago, medical researchers found testing for the presence of blood in stool could be an effective indicator for potential colon cancer. Patients with abnormal fecal immunochemical test (FIT) results are referred for colonoscopies.

Despite the ready availability of FIT and a second type that detects cancer biomarkers, most doctors continued to recommend colonoscopies for all their over 50 year old patients. Many doctors never even discuss other options, so few patients are aware there are alternatives.

“Some patients are definitely surprised that there are options for colon cancer screening other than colonoscopy,” Lisa Ravindra, MD, an assistant professor of medicine at Rush University Medical Center in Chicago, said in an article on the JAMA Network.

Yet the in-home tests are as good at early detection as a colonoscopy, said Dr. Alex Krist, chairman of the U.S. Preventive Services Task Force. “The data show the tests are equally effective at saving lives,” he told The New York Times.

Because of the rising incidence of colon cancer, the Task Force is expected to recommend lowering the age at which screening should begin to 45. Colonoscopies should be done every 10 years, annually for FIT and every 3 years for Cologuard, the biomarker test.

While routine screenings have increased, Michael Sapienza, chief executive officer of the Colorectal Cancer Alliance, said, “I’m still hearing from a lot of people that we’re not seeing a ton of [routine] screening colonoscopies.”

As a result of the COVID-caused delay in diagnostic testing and the consequent delay in treatment, the National Cancer Institute predicts 4,500 more deaths from colorectal cancers over the next decade. A Lancet study estimated a 15.3–16.6% increase.

Speaking to The Times, Dr. Rachel Issaka, a gastroenterologist at the University of Washington and the Fred Hutchinson Cancer Research Center, said colon cancer screenings, of any type, “are considered non-urgent, but they’re not optional.”

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