Promoting equity and community health in the COVID-19 pandemic

Editor’s note: Second in a series on the impact of COVID-19 on communities of color, and responses aimed at improving health equity. Click here to read part one and here for part three.

In early March 2020, as COVID-19 was declared a public health emergency in Boston, Mass General Brigham began to care for a growing number of patients with COVID-19. Even at this early stage in the pandemic, a few things were clear: our data showed that Black, Hispanic, and non-English speaking patients were testing positive and being hospitalized at the highest rates. There were large differences in COVID-19 infection rates among communities. Across the river from Boston, the city of Chelsea began reporting the highest infection rate in Massachusetts. Within Boston, several neighborhoods, including Hyde Park, Roxbury, and Dorchester, exhibited infection rates double or triple the rest of the city. COVID-19 was disproportionately harming minority and vulnerable communities.

Working toward an equitable response to COVID-19

From the start, our work was driven by examining COVID data by race, ethnicity, language, disability, gender, age, and community. As the COVID crisis intensified in Massachusetts, we sought ways to improve health equity and extend support within the communities we serve. We designed and deployed initiatives aimed at our patients, community members, and employees. Below are examples of tools to enhance equity that we found useful.

Communicating with patients

As new COVID care models were established, we worked on access to clinical communication for all patients and their families. There was a particular focus on language, since COVID greatly impacted non-English speaking communities, and on communication for people with disabilities.

• We linked COVID operations, such as our nurse hotline and telemedicine platforms, to interpreter services or bilingual staff, supported by patient tip sheets in multiple languages. Interpreters, working virtually through enhanced technology and remote communication, supported patients and families with limited English proficiency.
• We collected information on clinical and administrative staff language proficiency, so that multilingual staff could help guide patient care. For example, at two hospitals we established a care model of Spanish-speaking physicians to provide cultural and linguistic support in inpatient and intensive care units that complemented interpreter services.
• As all staff and patients began wearing masks, we ensured that deaf or hard-of-hearing patients would be able to communicate with care teams through the use of masks with a clear window, to allow for lip reading.

Providing up-to-date information for patients and employees

Guidance on how to protect yourself from COVID-19 evolved rapidly. Limited English proficiency, limited access to the Internet or to smartphones and computers, and limited tech savvy are barriers to receiving information for many of our patients and employees. We needed to identify ways to ensure that rapidly changing health information was available to everyone.

• For our patients, we created COVID education in multiple languages, which was distributed through various modes, including brief videos. We also sent text messages with COVID alerts to more than 100,000 of our patients who live in hot-spot communities, or who were not enrolled in our patient portal.
• For our employees, we initially hosted socially-distanced, in-person educational sessions in multiple languages. These sessions provided COVID education and updates on infection control protocol and human resources policies. Our employee educational effort later shifted to a remote model by enrolling 5,500 employees who do not use computers as part of their normal job function (such as environmental services and nutrition and food services staff) into a multilingual texting campaign designed to provide key information.

Expanding equity within communities

Through the COVID pandemic, we were building on our existing presence in, and partnerships with, the communities we serve in eastern Massachusetts in several ways.

• Community members lacked necessary supplies to protect themselves from COVID, such as masks. In April, we launched the production of care kits — packages which included masks, hand sanitizer, soap, and patient education materials — and distributed them within our communities at locations such as COVID testing centers, food distribution sites, and housing authorities. To date, more than 175,000 care kits have been distributed, including more than 1.3 million masks.
• We also partnered with community leaders to provide COVID education. We identified trusted community leaders to record and release brief educational videos over social media to reinforce wearing masks, social distancing, and washing hands.
• Finally, through screening for social determinants of health, it became clear that many of our most vulnerable communities were reporting high rates of food insecurity. We coupled longstanding efforts to address unmet health-related social needs among our patients and communities with our COVID response, by distributing grocery bags and meals at several COVID testing sites.

Looking forward

We made it through the peak of the pandemic in Massachusetts, launching a suite of initiatives to address inequity within Mass General Brigham’s COVID response. However, the battle is by no means over. Now is the time for action. Even in states like Massachusetts, where infections, hospitalizations, and deaths have substantially declined in recent months, we need to ready ourselves for a resurgence — one that is already occurring in parts of the US and Europe. Surveillance and early preparation are key. Increased prevention and mitigation efforts, widespread testing, and identification of emerging hot spots can help curb the impact of a fall and winter resurgence of the virus. Unless we act now, and unless we ramp up efforts aimed at improving health equity, this will once again hit minority communities hardest.