The potential impact of COVID-19 in refugee camps in Bangladesh and beyond: A modeling study
The potential impact of COVID-19 in refugee camps in Bangladesh and beyond: A modeling study
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DOI：
10.1371/journal.pmed.1003144
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发表时间：
2020-06-01
期刊：
影响因子：
15.8
通讯作者：
Spiegel, Paul
中科院分区：
文献类型：
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作者：
Truelove, Shaun;Abrahim, Orit;Spiegel, Paul
背景2019冠状病毒病对难民营的影响可能比对一般人群的影响更为严重。孟加拉国已确诊COVID-19病例，并收容了近100万来自缅甸的罗兴亚难民，其中60万集中在库图帕隆-巴鲁卡里扩建点（平均年龄21岁，标准差为18岁，52%为女性）。在这种情况下，对COVID-19潜在负担、流行速度和医疗保健需求的预测对防范规划至关重要。为了探讨严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）在Kutupalong-Balukhali扩展站点引入的潜在影响，我们使用了一个随机易感暴露感染恢复（SEIR）传播模型，该模型的参数来自新兴文献，年龄是感染严重程度的主要决定因素。我们考虑了三种情况，对SARS-CoV-2的传播潜力有不同的假设。从模拟感染中，我们估计了住院率、死亡率和预期的医疗保健需求，并根据Kutupalong-Balukhali扩展站点的年龄分布进行了年龄调整。我们的研究结果表明，在将病毒引入营地后，可能会发生大规模爆发，61%-92%的模拟导致至少1000人感染。平均而言，在疫情暴发的前30天，我们预计在低、中、高传播情景中分别有18人（95%预测区间[PI]， 2-65）、54人（95% PI, 3-223）和370人（95% PI, 4- 1850）受到感染。12个月内感染人数分别达到421,500人（95% PI, 376,300-463,500人）、546,800人（95% PI, 499,300-567,000人）和589,800人（95% PI, 578,800-595,600人）。55-136天后，在低传播情景和高传播情景之间，住院需求超过了现有340张病床的住院能力。我们估计，在低、中、高传播情况下，分别有2040例（95% PI, 1660 - 2500）、2650例（95% PI, 2030 - 3380）和2880例（95% PI, 2090 - 3830）死亡。由于分析时数据有限，我们假设年龄是感染严重程度和住院的主要决定因素。我们预计合并症、有限的住院治疗和重症监护能力可能会增加这种风险；因此，我们可能低估了潜在的负担。研究结果表明，2019冠状病毒病在难民安置点的流行可能会产生深远的影响，需要大幅增加医疗保健能力和基础设施，这可能超出目前在这些环境中可行的水平。现在必须开始为库图帕隆-巴鲁卡里和全世界所有难民营的最坏情况进行详细和现实的规划。计划应考虑采取新颖和激进的战略，以减少传染性接触并填补卫生工作者的空白，同时认识到难民可能无法获得国家卫生系统的服务。
BackgroundCOVID-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 findingsTo 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.ConclusionsOur 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.