Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
Front Public Health. 2023 May 5;11:1000617. doi: 10.3389/fpubh.2023.1000617. eCollection 2023.
In Antwerp, Belgium's second largest city, a COVID-19 surge in July 2020 predominantly affected neighborhoods with high ethnic diversity. Local volunteers reacted and set up an initiative to support contact tracing and self-isolation. We describe the origin, implementation, and transfer of this local initiative, based on semi-structured interviews of five key informants and document review. The initiative started in July 2020, when family physicians signaled a surge of SARS-CoV-2 infections among people of Moroccan descent. Family physicians feared that the mainstream contact tracing organized by the Flemish government through centralized call centers would not be efficient in halting this outbreak. They anticipated language barriers, mistrust, inability to investigate case clusters, and practical problems with self-isolation. It took 11 days to start up the initiative, with logistical support from the province and city of Antwerp. Family physicians referred SARS-CoV-2-infected index cases with complex needs (including language and social situation) to the initiative. Volunteer COVID coaches contacted cases, got a contextualized understanding of their living conditions, assisted with backward and forward contact tracing, offered support during self-isolation, and checked if infected contacts also needed support. Interviewed coaches were positive about the quality of the interaction: they described extensive open conversations with cases. The coaches reported back to referring family physicians and coordinators of the local initiative, who took additional action if necessary. Although interactions with affected communities were perceived as good, respondents considered that the number of referrals by family physicians was too low to have a meaningful impact on the outbreak. In September 2020, the Flemish government assigned the tasks of local contact tracing and case support to the local health system level (primary care zones). While doing so, they adopted elements of this local initiative, such as COVID coaches, tracing system, and extended questionnaires to talk with cases and contacts. This community case study illustrates how urgency can motivate people to action yet support from people with access to resources and coordination capacity is vital for effective organization and transition to long-term sustainability. From their conception, health policies should consider adaptability of new interventions to local contexts.
在比利时第二大城市安特卫普，2020 年 7 月的 COVID-19 疫情主要影响了族裔多样性较高的社区。当地志愿者做出反应，发起了一项支持接触者追踪和自我隔离的倡议。我们基于对五位关键知情人的半结构化访谈和文件审查，描述了这一地方倡议的起源、实施和转移。该倡议始于 2020 年 7 月，当时家庭医生报告说，摩洛哥裔人群中 SARS-CoV-2 感染人数激增。家庭医生担心，弗拉芒政府通过集中式呼叫中心组织的主流接触者追踪，无法有效阻止疫情爆发。他们预计会遇到语言障碍、不信任、无法调查病例群集以及自我隔离的实际问题。该倡议启动耗时 11 天，得到了安特卫普省和市的后勤支持。家庭医生将有复杂需求（包括语言和社会状况）的 SARS-CoV-2 感染的索引病例转介给该倡议。志愿者 COVID 教练联系病例，了解其生活状况的背景信息，协助进行回溯和向前接触者追踪，在自我隔离期间提供支持，并检查感染的接触者是否也需要支持。接受采访的教练对互动的质量表示肯定：他们描述了与病例的广泛开放对话。教练们向转介的家庭医生和地方倡议协调员报告，如有必要，协调员会采取进一步行动。尽管与受影响社区的互动被认为是良好的，但受访者认为家庭医生的转介人数太少，无法对疫情产生有意义的影响。2020 年 9 月，弗拉芒政府将当地接触者追踪和病例支持的任务分配给地方卫生系统层面（初级保健区）。在这样做的过程中，他们采用了该地方倡议的一些元素，如 COVID 教练、追踪系统和扩展问卷，以便与病例和接触者交谈。这项社区案例研究说明了紧迫感如何促使人们采取行动，但来自有资源和协调能力的人的支持对于有效的组织和向长期可持续性过渡至关重要。从一开始，卫生政策就应该考虑新干预措施适应当地情况的适应性。
