Essential needs delivery plan: From the beginning, one of the key domains identified as having considerable equity considerations was the challenge posed by isolation and quarantine. A centralized isolation/quarantine site was opened, initially for unhoused people. When it became apparent people were living in crowded conditions or with someone at high risk for complications from COVID-19, this program was expanded to a 100-room hotel to ensure a safe place was available to any resident who wanted it. For people isolating or quarantining at home, our team quickly identified a need to provide culturally responsive food, household cleaning supplies, and durable goods like personal protective equipment (PPE) and prescription medication delivery. Additionally, we worked with a local provider and pharmacy to provide Medication-Assisted Treatment to those who were either in a similar program currently or wanted to be initiated into an MAT program.

Lastly, a plan to send care kits to people with positive test results to support isolating at home, including items like a pulse oximeter and thermometer to provide data points for case callers, as well as herbal tea and coloring books to promote a relaxing, recuperative environment.

Testing, tracing, and direct support to high-risk communities: Due to their disproportionate representation in essential employment and disproportionately crowded housing, Louisville’s immigrant and refugee communities were at high-risk for COVID-19. Quickly leveraging existing relationships through the Louisville Metro Government’s Office of Globalization and local community-based organizations, the response team created targeted messaging and special testing events. When contract tracers later had difficulty engaging non-English speaking residents for contact tracing, the team worked with trusted non-profits to visit people in person. Lastly, the city was able to use Coronavirus Aid, Relief, and Economic Security (CARES) Act funds to provide direct financial assistance to immigrant and refugee households affected by the pandemic through embedded community organizations.

Additionally, an early round of surveillance testing in our unhoused population helped us understand the prevalence of COVID-19 in this community (out of thousands tested, less than a hundred were positive). Restrooms and handwashing stations were installed early to enable residents to follow public health guidance to prevent spread.

The response team also worked early on with our Corrections department to support the health and safety of staff and incarcerated persons. This included providing information on cleaning and disinfecting, supplying at least 2 cloth masks per person incarcerated, advocating for the quarantine of newly arrested persons, cohorting residents in the jail dorms, and providing both testing for symptomatic individuals as well as surveillance testing of both staff and persons incarcerated. LMPHW’s response team has continued an ongoing relationship with Corrections, our Criminal Justice Commission, and their Jail Policy Committee to advocate for policies that will better protect those incarcerated such as eliminating cash bail and reducing the number of people in pre-trial detention.

Initial Results: As of December, the racial demographics of Louisville residents who have died of COVID-19 nearly match the racial demographic of the city’s general population. Hispanic and Latinx residents make up a disproportionately high number of people with confirmed COVID-19 infections and disproportionately low number of deaths. The higher rates of infection have been attributed to an overrepresentation in essential jobs while the lower rates of death are attributed to a significantly lower average age than the general population.

Innovation: The target population for our equity crisis response interventions were people with limited income, people experiencing homelessness, people with an opioid use disorder, people incarcerated, and people in our immigrant and refugee communities. The response team aimed to reduce community spread by supporting all essential needs for residents to safely isolate and quarantine. Resources were prioritized for the city’s immigrant and refugee residents due to an identified gap in support programs available for them during the pandemic alongside a reluctance to participate in existing programs. Immigrant and refugee workers are also disproportionately employed in essential sectors, especially meatpacking and processing plants that were sites of early outbreaks. While emergency responses have attempted to proactively address potential health inequities in the past, the concerted approach of centering equity in the planning of all Incident Management Team plans was an innovative response to a pandemic that has worsened inequity worldwide.

The Incident Management Team was able to target initiatives to underserved members of our community by focusing on identifying unmet needs. The program offering a safe, comfortable hotel room for people to stay during their isolation or quarantine period was overwhelmingly utilized by people experiencing homelessness or living in crowded settings including multi-generational households and congregate settings. Food delivery was available to anyone in quarantine or isolation who reported needing assistance, with no means-testing to ensure that there were as few barriers to service as possible. The Medication Assisted Treatment plan directly addressed the needs of people with opioid use disorder. Resources were efficiently targeted for the immigrant and refugee communities through partnerships with trusted community organizations.

Health Equity During a Pandemic

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