COVID-19: Projecting the impact in Rohingya refugee camps and beyond

Shaun A Truelove; Orit Abrahim; Chiara Altare; Andrew Azman; Paul B Spiegel

The introduction of SARS-CoV-2 into the Kutupalong-Balukhali Expansion Site or any other large refugee or internally displaced persons (IDPs) camp or settlement is likely to have serious consequences and overwhelm existing health systems. Even when transmission rates were assumed to be similar to that of influenza (low scenario), the necessary hospitalization capacities far exceeded the available capacities for the refugees in the Expansion Site in most simulations. Recent experience with other infectious disease outbreaks shows that the transmission of SARS-CoV-2 will likely be more intense in contexts such as Kutupalong-Balukhali Expansion Site than in out-of-camp settings because of high population density, inadequate water and soap to maintain hygiene, limited ability to isolate infected individuals, and large household sizes. 16 The younger demographic profile of the Rohingya camp population could reduce the overall rate of severe cases as compared with China or other upper-middle and high-income countries that have older populations. After adjusting for age, we estimate the overall severe disease rate among infections in this population (3.6%) to be approximately half that estimated for China (6.6% [95% CI, 3.7-10.4]). However, it is likely that co-morbidities such as malnutrition, concomitant diseases, and poor overall health status could cause more severe outcomes among these groups, which was not captured by our model.