Fairfax County, Virginia Community Health Workers Program Supports COVID-19 Isolation and Quarantine Adherence in Minority Communities

(Washington DC, January 9, 2023) Throughout the COVID-19 pandemic communities nationwide have struggled to control the spread of the virus. Barriers to limiting virus spread were particularly acute in communities where a significant proportion of the population lived near or below the poverty line or were not English proficient. Fairfax County, Virginia is an example.

The Fairfax County Health Department (FCHD) is the largest health department in the state, serving 1.2 million residents. Fairfax Country, a suburb of Washington, DC is a relatively wealthy community based on national averages, but 15 percent of its population lives below the poverty line and 40 percent of county residents are non-English speakers. State data showed that Black and Hispanic county residents were 2.9 and 1.6 times more likely to contract the virus, respectively, than their non-Hispanic, white co-residents. Moreover, Hispanic ethnicity, contact with a case, and household crowding were analyzed as independent risk factors for infection.

In response, the county health department expanded its small, traditional community health worker program to a full-fledged pandemic response team the make-up of which was designed to be culturally and language competent and relatable to the county’s minority communities in order to share information and build trust. The task of the community health team was to increase isolation and adherence protocol within minority households in order to decrease the rate of infection for the most at-risk groups within the county.

Community outreach programs are rooted in earlier emergency events

After 9/11, H1N1, and Ebola state and local health departments across the country recognized the need to prepare all-hazards approaches to public health emergencies. FCHD did so by formulating a pandemic response plan working with various community engagement partners. These established relationships helped jump start the community health worker COVID-19 program. County health officials knew that a major contributor to adherence to isolation and quarantine (I&Q) protocols would be meeting families’ basic needs, including for groceries, medicines, and transportation to medical appointments. FCHD strategically recruited and trained their large CHW team to focus on meeting those needs when a family had a COVID exposure or infection.

The Results of the Community Health Worker Program

To assess whether its expanded community health worker program was successful Fairfax County Health conducted a 6-month, cross-sectional study contacting 1,500 individuals, 800 of whom were served by a community health worker (CHW) between February and July 2021, and 700 individuals served as controls who did not receive CHW assistance. Results were based on 161 individuals in the CHW recipient group and 179 individuals in the control group who were surveyed. Of the group of CHW recipients, most were COVID-19-positive, Hispanic, and female. Most of the services provided fell under the umbrella of basic needs, such as information, hygiene, groceries, and cleaning supplies. Of those receiving services, a large majority, 87 percent, reported satisfaction with the program.

Reducing the rate of people who were COVID-19 exposed or infected leaving their home was one of the program’s main goals. Persons who received CHW services during their isolation and quarantine (I&Q) period experienced a significantly lower frequency – 30.7 percent left the house at least once during their I&Q compared with 43.9 percent among controls. 64.3 percent of those assisted by a CHW who left home did so to see a doctor or pick up medications. Of those who left their homes during I&Q, persons that received CHW services, left 2.4 times on average compared with 6.2 times among controls.

Sustainability of the Community Health Worker Program

In August of 2022, the Fairfax County Health Department was only one of four local health departments nationally that received a National Association of County and City Health Officials (NACCHO) 2022 Gold Innovative Practice Award in recognition of its strategic community health worker program development and implementation during the COVID-19 pandemic.

Going forward, Fairfax health officials realize that these types of programs must be continuously refined and measured so they can be upheld as evidence-based programs that should not only operate during emergencies but in traditional public health roles as well.

According to Chris Revere, the Fairfax County Health Department Deputy Director for Innovation and Planning, sustaining the expanded community health worker program will require a substantial amount of financial investment, especially from the federal government; federal funds supported the expansion of the program during the pandemic. In 2022, the Centers for Disease Control and Prevention received $3.2 billion in funding to strengthen the public health workforce and infrastructure. According to Virginia state officials, roughly $67 million of those funds are headed to the Virginia Department of Health. From there, statewide grant distributions to local health departments will be coordinated.  Revere called the anticipated funding a “great start” but must be “built into baseline budgets.” Moreover, Mr. Revere stressed that policymakers need to understand that public health funding has been inadequate for over a decade.  What’s needed going forward is a decade-plus investment to ensure the sustainability of future community health worker programs, says Revere.

Conclusion

While the COVID-19 pandemic demonstrated the nation’s critical need to increase and sustain funding in public health emergency preparedness it also highlighted the need for innovation in programs to support preparedness particularly within low-income and minority communities. The Fairfax County community health workers program is an example of an initiative that should be sustained and replicated in other localities.