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PLOS BLOGS Speaking of Medicine and Health

Two storms brewing in Bangladesh

Tropical Cyclone Amphan made landfall on Wednesday, considerably weakened from its peak as a category 5 storm, but still bringing devastating winds and heavy rain to India and Bangladesh. Amphan will likely dwindle in the next week, but another storm threatens to rage, potentially for months to come, through perhaps the most vulnerable population in the region.

On May 14 Bangladesh officials reported the first confirmed COVID-19 patient in the Rohingya refugee settlements in Cox’s Bazar district, and in the week since the number of confirmed cases has reportedly grown to 11. Despite efforts to isolate the identified patients, it is unlikely that the virus will be contained in the densely populated camp with poor access to water and sanitation and limited health services.

In a modelling study recently accepted at PLOS Medicine, Paul Spiegel and colleagues model how a COVID-19 outbreak could spread through the Kutupalong-Balukhali Expansion Site that houses approximately 600,000 Rohingya refugees from Myanmar. As these findings are time sensitive, we have decided to share this article on medrxiv prior to publication. An early version (post-review, pre-copyedit) is available on MedRxiv and the published article will be available on our website on June 16th.

Spiegel and his team simulated high, moderate, and low transmission scenarios and estimated the hospitalizations, deaths, and healthcare needs expected, adjusting for the age distribution of the population at the Kutupalong-Balukhali. The predictions of the model paint a dire outlook for the settlement. They suggest that a large-scale outbreak is very likely, estimating the numbers infected in the first year to range from 421,500 (95% prediction interval [PI], 376,300–463,500) in the low-transmission scenario to 589,800 (95% PI, 578,800–595,600) in the high transmission scenario, should no effective interventions to prevent spread of the virus be put into place. Given the limited healthcare resources in the settlement, they estimate the hospitalization needs would exceed the current capacity in 55–136 days, and the outbreak could lead to between 2,040 (95% PI, 1,660–2,500) and 2,880 (95% PI, 2,090–3,830) deaths, depending on the transmission scenario.

The authors note that the known epidemiological properties of COVID-19 are based on the transmission of SARS-CoV-2 virus in non-displaced populations, and even in these populations the parameters are poorly defined. However, it is extremely unlikely transmission within the camps, where many of the tools (social distancing, basic hygiene, contact tracing and isolation) used to limit spread of infectious disease are challenging if even feasible. Spiegel and colleagues note that in this setting, innovative responses and intervention from health agencies and local governments will be necessary to quell the spread and treat the infected population.

From Academic Editor, Parveen Parmar:

The work by Spiegel and colleagues highlights the significant vulnerability of displaced populations in the time of COVID-19, both in the Rohingya refugee camps and beyond.  Health systems that are already overstretched will require significant additional support from the global community to meet new needs.  It is critical that we continue to bring the needs of the most vulnerable among us to the forefront in this manner.  Indeed, if we are ever to be successful in this battle against COVID-19, no one can be left behind—no matter what their age, ethnicity, gender, sexuality, or legal status, and no matter what side of a border they find themselves on“.

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