Empowering the crowd: feasible strategies for epidemic management in high-density informal settlements. The case of COVID-19 in Northwest Syria

Abstract

More than 1 billion people live in informal settlements worldwide, where precarious living conditions pose unique challenges to managing a COVID-19 outbreak. Taking Northwest Syria as a case study, we simulated an outbreak in high-density informal Internally Displaced Persons (IDP) camps using a stochastic Susceptible-Exposed-Infectious-Recovered model. Expanding on previous studies, taking social conditions and population health/structure into account, we modelled several interventions feasible in these settings: moderate self-distancing, self-isolation of symptomatic cases and protection of the most vulnerable in ‘safety zones’. We considered complementary measures to these interventions that can be implemented autonomously by these communities, such as buffer zones, health checks and carers for isolated individuals, quantifying their impact on the micro-dynamics of disease transmission. All interventions significantly reduce outbreak probability and some of them reduce mortality when an outbreak does occur. Self-distancing reduces mortality by up to 35% if contacts are reduced by 50%. A reduction in mortality by up to 18% can be achieved by providing one self-isolation tent per eight people. Protecting the most vulnerable in a safety zone reduces the outbreak probability in the vulnerable population and has synergistic effects with the other interventions. Our model predicts that a combination of all simulated interventions may reduce mortality by more than 90% and delay an outbreak’s peak by almost 2 months. Our results highlight the potential for non-medical interventions to mitigate the effects of the pandemic. Similar measures may be applicable to controlling COVID-19 in other informal settlements, particularly IDP camps in conflict regions, around the world.

Lessons learnt from the first wave of COVID-19 in Damascus, Syria: a multicentre retrospective cohort study

“…This selectivity in the hospitalisation criteria restricted the possibility of comparing our findings with studies worldwide46 53 67 68 (e.g., 5% of hospitalised patients in a Chinese study needed ICU admission in comparison with 44% in ours69). Nevertheless, similar findings were reported from the northeast and northwest regions of Syria40 52 as well as Latakia,53 proving that the circumstances of the pandemic in the whole country were still poorer than neighbouring countries70 71 including Lebanon, which also suffers from grave economic and political instability 4 72 73…”

“…Such disorganised response to the pandemic in the Syrian capital raises legitimate worries about the shape of the response in smaller cities, rural areas, and the northeast and northwest regions of Syria. There, the resources are even more deficient in addition to greater difficulties in coordinating efforts52 74 and a high percentage of displaced people living in dense informal settlements 40 47 52 75 76…”

“…Nevertheless, concerns about the accuracy of these numbers were raised,33 34 especially as high numbers of cases and also deaths were unofficially reported to appear among healthcare workers 35 36. The quick spread of the pandemic in Syria, particularly in its population-dense capital, Damascus,19 34 was more likely due to several reasons including Syria’s permeable external and internal borders, military instability, limited efforts to reach out to the community,30 37 difficulties in self-isolation38 39 and displacement,17 40 which placed millions of Syrians at a higher risk of COVID-19 infection 30 41 42. However, the extreme shortage of reverse transcription-PCR kits43 in Syria forced doctors to rely on chest CT and chest radiographs (CXRs)44 to a higher extent compared with other countries worldwide.…”

“…Few original articles were published about COVID-19 in Syria and they either present mathematical simulations of the situation due to limited access to data,34 40 had too small of a sample size53 or focused on studying mortality risk factors for just PCR-positive cases 54 55. Therefore, further works are needed to unveil the gravity of the COVID-19 challenge in Syria and to draw out the lessons that can be learnt 56.…”