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

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

Novel and previously untried strategies for social distancing and quarantine need to be considered. While culturally difficult and requiring socialization, isolating people over 60 years of age and those designated medically vulnerable together in certain designated areas of the camp may need to be considered. One possibility could be sub-sector-level isolation, where 50-100 high risk people could be grouped together in existing areas of the camp where they are already located. 20 Consistent monitoring of fever and other symptoms combined with appropriate testing, if sufficient tests become available, will be an integral part of this strategy. Such an isolation approach would require sufficient resources to provide comprehensive care (e.g., food and supportive services) for isolated community members. Since physical distancing will be extremely difficult, the use of facemasks among those most at risk, and possibly the whole population could be considered if there are eventually sufficient global supplies. Rapid and creative solutions for improving hand hygiene, such as the installation of a multitude of handwashing stations and distribution of hand sanitizer combined with communication campaigns, will be needed. Access to accurate and consistent health information will be critical, as already rumors and misinformation have spread among Rohingya refugees about COVID-19, partly due to camp-wide restrictions on the internet and telecommunications. 21 In the future, the use of people who have recovered from COVID-19 infections will need to be considered after more data become available as to their ability to become re-infected and transmit to others, as was done with Ebola survivors. 22 The three scenarios show varying degrees of increased mortality. Mortality due to COVID-19 is dependent upon various factors, particularly access to hospitals with ICUs and ventilators. Currently, there is only one facility with few mechanical ventilators in the camps and one facility with less than 10 ICU beds and no ventilators. Therefore, it is likely that mortality rates due to COVID-19 will be significantly higher here than in settings where nationals or refugees have such access. Reportedly, the ICUs and ventilators are not functioning in the district hospital in Cox's Bazar, and thus access to health care facilities to treat severe cases of COVID-19 may be equally challenging for nationals. Mortality in . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.