Working along the Continuum: North Carolina's Collaborative Response to COVID-19 for Migrant & Seasonal Farmworkers

North Carolina employs 78,000+ migrant/seasonal farmworkers (MSFWs) annually. Arrival/departure dates are crop and weather dependent. MSFWs may be employed by a grower or a farm labor contractor (FLC). Like farmworker housing, FLCs may be registered or unregistered. Primary care or enabling services are provided by the NC Farmworker Health Program or community health centers that receive dedicated federal funding for MSFWs. The arrival of NC's growing season, MSFWs, and COVID-19 brought unforeseen challenges even to those experienced in caring for MSFWs. Challenges include congregate activities, consistency/accuracy of COVID-19 related communications, availability of alternate housing, barriers to testing and contact tracing, lack of internet connectivity in farmworker housing and insufficient personal protective equipment. Challenges are discussed in no order of occurrence or level of importance as many are inter-related. To meet these challenges, a migrant health and housing workgroup was convened. Members include the NC Department of Labor-Agricultural Safety and Health Bureau, NC Department of Health and Human Services - Communicable Disease Branch and NC Farmworker Health Program, NC Community Health Center Association and NC Agromedicine Institute. Members work collaboratively along the continuum from local to state levels and across agencies and communities to facilitate strategies to address COVID-19 challenges. Implications exist for practice, research and policy including testing of MSFWs on arrival with a 14-day quarantine before moving to assigned farm, a "strike team" to do on-farm tests for workers in the event of a positive case or exposure; and, research on COVID-19 outbreaks and impact of telehealth on MSFWs wellbeing.