Sustained suppression

COVID-19 in the least developed, fragile, and conflict-affected countries — How can the most vulnerable be protected?

“…The compounded impact will further stress the already dysfunctional health systems due to reduced allocations to health and social services with the shrunken gross domestic product (GDP). Lockdowns without adequate online options and unemployment could further deteriorate the food crisis, encourage economic migration, and thereby reverse Even when a vaccine is developed, vaccine-induced immunity against SARS-CoV-2 is not a given, as the benefits could be partial, population-dependent, or transient (Editorial, 2020). The finding that 95% of the population in France and Spain remain susceptible to the virus does not offer much hope for relying on herd immunity (Kirkcaldy et al, 2020;Salje et al, 2020;Editorial, 2020).…”

“…The extension of the declaration of coronavirus disease 2019 as a Public Health Emergency of International Concern by the World Health Organization (WHO) on April 30, 2020, underscores its continued pandemic spread beyond the initial epicenters. The transmission dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, including the high transmission rate (an estimated R 0 of between 2 and 3.5), large numbers of asymptomatic transmitters, and uncertainty about post-infection immunity, mean that the battle against COVID-19 will not be won until every country in the world can mitigate and ultimately control it (Inglesby, 2020;Kirkcaldy et al, 2020;Miller et al, 2020;Salje et al, 2020;Editorial, 2020). Other recent diseases of global concern (for example, Ebola) evolved and remained largely contained in a few developing countries.…”

“…People in refugee camps face a heightened risk of COVID-19 due to more densely populated conditions than even the Diamond Princess (24 persons/1000 m 2 ); for example Moria Camp, Greece (204/1000 m 2 ) and Cox's Bazar, Bangladesh (40/1000 m 2 ) (McLauglin, 2020). Given the disruption to health systems during conflicts, surveillance systems may be non-existent in conflict-affected countries (McLauglin, 2020;Editorial, 2017). When most refugee-host governments themselves are facing economic challenges and are unable to achieve adequate support even for their own citizens, refugees are unlikely to be a priority in host government budgets for current or future pandemic countermeasures.…”

Digital Health Solutions for Mental Health Disorders During COVID-19

“…These methods can be leveraged for useful applications during lockdowns, such as early detection of mental health disease onset or progression. However, unresolved barriers to implementation include ethical and privacy issues of populationlevel monitoring such as with big data systems for contact tracing, that would similarly apply to systems for mental health surveillance (28). Measures to facilitate implementation include the use of high quality input data and clinical validation using formal diagnostic criteria, robust methodology, and actionable outcomes (29).…”

“…Direct potential applications of OHCs for patients at-risk of mental health disorders include lowering the barrier to access care and support for stigmatized illnesses such as anxiety and depression, by allowing patients to seek initial medical advice anonymously (43). Apart from the provision of basic demographic information such as gender and age that are required to contextualize medical advice; otherwise, anonymous engagement also helps to address limitations such as privacy issues similar to those with big data systems (28).…”