Local initiative supports case isolation and contact tracing during a SARS-CoV-2 surge in summer 2020: a community case study in Antwerp, Belgium

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.

[1]  M. Rämgård,et al.  ‘No one size fits all’ – community trust-building as a strategy to reduce COVID-19-related health disparities , 2023, BMC Public Health.

[2]  C. Nöstlinger,et al.  COVID-19 as a social disease: qualitative analysis of COVID-19 prevention needs, impact of control measures and community responses among racialized/ethnic minorities in Antwerp, Belgium , 2022, International Journal for Equity in Health.

[3]  M. Kruk,et al.  COVID-19 and resilience of healthcare systems in ten countries , 2022, Nature medicine.

[4]  N. Stocks,et al.  Improving access to primary health care: a cross-case comparison based on an a priori program theory , 2021, International Journal for Equity in Health.

[5]  H. B. van der Worp,et al.  Evaluation of the First Year(s) of Physicians Collaboration on an Interdisciplinary Electronic Consultation Platform in the Netherlands: Mixed Methods Observational Study , 2021, JMIR human factors.

[6]  E. Wouters,et al.  Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study , 2021, International journal of health policy and management.

[7]  E. Schokkaert,et al.  Belgium's response to the COVID-19 pandemic , 2021, Health Economics, Policy and Law.

[8]  L. Niccolai,et al.  Implementation of a volunteer contact tracing program for COVID-19 in the United States: A qualitative focus group study , 2021, PloS one.

[9]  I. Scott,et al.  Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review , 2021, BMJ Open.

[10]  S. Willems,et al.  Community Health Workers as a Strategy to Tackle Psychosocial Suffering Due to Physical Distancing: A Randomized Controlled Trial , 2021, International journal of environmental research and public health.

[11]  Toon Van Overbeke,et al.  High politics in the Low Countries: COVID‐19 and the politics of strained multi‐level policy cooperation in Belgium and the Netherlands , 2020, European policy analysis.

[12]  Ronald W. McQuaid,et al.  Employment in the informal economy: implications of the COVID-19 pandemic , 2020, International Journal of Sociology and Social Policy.

[13]  G. Rubin,et al.  Facilitators and barriers to engagement with contact tracing during infectious disease outbreaks: A rapid review of the evidence , 2020, PloS one.

[14]  I. Moita,et al.  Effectiveness of contact tracing and quarantine on reducing COVID-19 transmission: a retrospective cohort study , 2020, Public Health.

[15]  M. Ammi,et al.  An analysis of the policy responses to the COVID-19 pandemic in France, Belgium, and Canada , 2020, Health Policy and Technology.

[16]  H. Philips,et al.  Organisation and characteristics of out-of-hours primary care during a COVID-19 outbreak: A real-time observational study , 2020, PloS one.

[17]  R. Ndejjo,et al.  Community engagement for COVID-19 prevention and control: a rapid evidence synthesis , 2020, BMJ Global Health.

[18]  P. Van Royen,et al.  Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs , 2020, BMJ Open.

[19]  Vinton G. Cerf,et al.  Implications of the COVID-19 pandemic , 2020, Commun. ACM.

[20]  H. Elsey,et al.  Community engagement interventions for communicable disease control in low- and lower- middle-income countries: evidence from a review of systematic reviews , 2020, International Journal for Equity in Health.

[21]  M. Engelbrecht,et al.  Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa , 2020, BMC Health Services Research.

[22]  J. Seeley,et al.  She knows that she will not come back: tracing patients and new thresholds of collective surveillance in PMTCT Option B+ , 2018, BMC Health Services Research.

[23]  G. Perkins,et al.  Rapid evidence synthesis , 2015 .

[24]  E. Mohammadi,et al.  Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence , 2017, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[25]  A. Sanabria,et al.  Randomized controlled trial. , 2005, World journal of surgery.

[26]  Dennis Andersson,et al.  A retrospective cohort study , 2018 .

[27]  V. Featherstone,et al.  A RAPID REVIEW OF THE EVIDENCE , 2014 .

[28]  Noël Clycq Muslims in Antwerp : at home in Europe , 2011 .

[29]  S. Merkur,et al.  Belgium: Health system review. , 2010, Health systems in transition.

[30]  S. Asia,et al.  WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR , 2003 .