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The potential impact of COVID-19 in refugee camps in Bangladesh and beyond:  A modeling study

BACKGROUND: COVID-19 could have even more dire consequences in refugees camps than in general populations. Bangladesh has confirmed COVID-19 cases and hosts almost 1 million Rohingya refugees from Myanmar, with 600,000 concentrated in the Kutupalong-Balukhali Expansion Site (mean age, 21 years; stan...

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Autores principales: Truelove, Shaun, Abrahim, Orit, Altare, Chiara, Lauer, Stephen A., Grantz, Krya H., Azman, Andrew S., Spiegel, Paul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297408/
https://www.ncbi.nlm.nih.gov/pubmed/32544156
http://dx.doi.org/10.1371/journal.pmed.1003144
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author Truelove, Shaun
Abrahim, Orit
Altare, Chiara
Lauer, Stephen A.
Grantz, Krya H.
Azman, Andrew S.
Spiegel, Paul
author_facet Truelove, Shaun
Abrahim, Orit
Altare, Chiara
Lauer, Stephen A.
Grantz, Krya H.
Azman, Andrew S.
Spiegel, Paul
author_sort Truelove, Shaun
collection PubMed
description BACKGROUND: COVID-19 could have even more dire consequences in refugees camps than in general populations. Bangladesh has confirmed COVID-19 cases and hosts almost 1 million Rohingya refugees from Myanmar, with 600,000 concentrated in the Kutupalong-Balukhali Expansion Site (mean age, 21 years; standard deviation [SD], 18 years; 52% female). Projections of the potential COVID-19 burden, epidemic speed, and healthcare needs in such settings are critical for preparedness planning. METHODS AND FINDINGS: To explore the potential impact of the introduction of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Kutupalong-Balukhali Expansion Site, we used a stochastic Susceptible Exposed Infectious Recovered (SEIR) transmission model with parameters derived from emerging literature and age as the primary determinant of infection severity. We considered three scenarios with different assumptions about the transmission potential of SARS-CoV-2. From the simulated infections, we estimated hospitalizations, deaths, and healthcare needs expected, age-adjusted for the Kutupalong-Balukhali Expansion Site age distribution. Our findings suggest that a large-scale outbreak is likely after a single introduction of the virus into the camp, with 61%–92% of simulations leading to at least 1,000 people infected across scenarios. On average, in the first 30 days of the outbreak, we expect 18 (95% prediction interval [PI], 2–65), 54 (95% PI, 3–223), and 370 (95% PI, 4–1,850) people infected in the low, moderate, and high transmission scenarios, respectively. These reach 421,500 (95% PI, 376,300–463,500), 546,800 (95% PI, 499,300–567,000), and 589,800 (95% PI, 578,800–595,600) people infected in 12 months, respectively. Hospitalization needs exceeded the existing hospitalization capacity of 340 beds after 55–136 days, between the low and high transmission scenarios. We estimate 2,040 (95% PI, 1,660–2,500), 2,650 (95% PI, 2,030–3,380), and 2,880 (95% PI, 2,090–3,830) deaths in the low, moderate, and high transmission scenarios, respectively. Due to limited data at the time of analyses, we assumed that age was the primary determinant of infection severity and hospitalization. We expect that comorbidities, limited hospitalization, and intensive care capacity may increase this risk; thus, we may be underestimating the potential burden. CONCLUSIONS: Our findings suggest that a COVID-19 epidemic in a refugee settlement may have profound consequences, requiring large increases in healthcare capacity and infrastructure that may exceed what is currently feasible in these settings. Detailed and realistic planning for the worst case in Kutupalong-Balukhali and all refugee camps worldwide must begin now. Plans should consider novel and radical strategies to reduce infectious contacts and fill health worker gaps while recognizing that refugees may not have access to national health systems.
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spelling pubmed-72974082020-06-19 The potential impact of COVID-19 in refugee camps in Bangladesh and beyond:  A modeling study Truelove, Shaun Abrahim, Orit Altare, Chiara Lauer, Stephen A. Grantz, Krya H. Azman, Andrew S. Spiegel, Paul PLoS Med Research Article BACKGROUND: COVID-19 could have even more dire consequences in refugees camps than in general populations. Bangladesh has confirmed COVID-19 cases and hosts almost 1 million Rohingya refugees from Myanmar, with 600,000 concentrated in the Kutupalong-Balukhali Expansion Site (mean age, 21 years; standard deviation [SD], 18 years; 52% female). Projections of the potential COVID-19 burden, epidemic speed, and healthcare needs in such settings are critical for preparedness planning. METHODS AND FINDINGS: To explore the potential impact of the introduction of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Kutupalong-Balukhali Expansion Site, we used a stochastic Susceptible Exposed Infectious Recovered (SEIR) transmission model with parameters derived from emerging literature and age as the primary determinant of infection severity. We considered three scenarios with different assumptions about the transmission potential of SARS-CoV-2. From the simulated infections, we estimated hospitalizations, deaths, and healthcare needs expected, age-adjusted for the Kutupalong-Balukhali Expansion Site age distribution. Our findings suggest that a large-scale outbreak is likely after a single introduction of the virus into the camp, with 61%–92% of simulations leading to at least 1,000 people infected across scenarios. On average, in the first 30 days of the outbreak, we expect 18 (95% prediction interval [PI], 2–65), 54 (95% PI, 3–223), and 370 (95% PI, 4–1,850) people infected in the low, moderate, and high transmission scenarios, respectively. These reach 421,500 (95% PI, 376,300–463,500), 546,800 (95% PI, 499,300–567,000), and 589,800 (95% PI, 578,800–595,600) people infected in 12 months, respectively. Hospitalization needs exceeded the existing hospitalization capacity of 340 beds after 55–136 days, between the low and high transmission scenarios. We estimate 2,040 (95% PI, 1,660–2,500), 2,650 (95% PI, 2,030–3,380), and 2,880 (95% PI, 2,090–3,830) deaths in the low, moderate, and high transmission scenarios, respectively. Due to limited data at the time of analyses, we assumed that age was the primary determinant of infection severity and hospitalization. We expect that comorbidities, limited hospitalization, and intensive care capacity may increase this risk; thus, we may be underestimating the potential burden. CONCLUSIONS: Our findings suggest that a COVID-19 epidemic in a refugee settlement may have profound consequences, requiring large increases in healthcare capacity and infrastructure that may exceed what is currently feasible in these settings. Detailed and realistic planning for the worst case in Kutupalong-Balukhali and all refugee camps worldwide must begin now. Plans should consider novel and radical strategies to reduce infectious contacts and fill health worker gaps while recognizing that refugees may not have access to national health systems. Public Library of Science 2020-06-16 /pmc/articles/PMC7297408/ /pubmed/32544156 http://dx.doi.org/10.1371/journal.pmed.1003144 Text en © 2020 Truelove et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Truelove, Shaun
Abrahim, Orit
Altare, Chiara
Lauer, Stephen A.
Grantz, Krya H.
Azman, Andrew S.
Spiegel, Paul
The potential impact of COVID-19 in refugee camps in Bangladesh and beyond:  A modeling study
title The potential impact of COVID-19 in refugee camps in Bangladesh and beyond:  A modeling study
title_full The potential impact of COVID-19 in refugee camps in Bangladesh and beyond:  A modeling study
title_fullStr The potential impact of COVID-19 in refugee camps in Bangladesh and beyond:  A modeling study
title_full_unstemmed The potential impact of COVID-19 in refugee camps in Bangladesh and beyond:  A modeling study
title_short The potential impact of COVID-19 in refugee camps in Bangladesh and beyond:  A modeling study
title_sort potential impact of covid-19 in refugee camps in bangladesh and beyond:  a modeling study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297408/
https://www.ncbi.nlm.nih.gov/pubmed/32544156
http://dx.doi.org/10.1371/journal.pmed.1003144
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