The Potential Impact of COVID-19 in Refugee Camps in Bangladesh and Beyond: a modeling study

Abstract

<jats:p>Background: COVID-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 Kutupalong-Balukhali Expansion Site (age mean: 21 years, 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 Findings: To explore the potential impact of the introduction of SARS-CoV-2 in Kutupalong-Balukhali Expansion Site, we used a stochastic 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 and limited hospitalization and intensive care capacity may increase this risk, thus we may be underestimating the potential burden. Conclusions: Our 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.</jats:p>

COVID-19 Outbreaks in Refugee Camps

“…In our knowledge, there is only one other study that estimated the potential impact of COVID-19 in refugee camps. This is a study conducted by John Hopkins University on the Kutupalong-Balukhali Extension Site, Cox's Bazar, Bangladesh [23]. We first compare the results of this study with the results of our study on the Za'atari refugee camp in Jordan and then compare the two models used by these studies applying our SIZ model to Kutupalong-Balukhali Extension Site.…”

“…Some initial comparisons can instead be done between the results of the [23] Kutupalong-Balukhali Site simulations and the evolving situation on the ground. The first refugee COVID-19 case in the Cox's Bazaar refugee camp was registered around May 15th, 2020 4 , and, according to the WHO "As on 28 June, as many as 2,456 cases of infection have been confirmed in Cox's Bazar District and 50 refugees have tested positive in the Rohingya camps."…”

“…5 Therefore, the virus is widely present in the district and in the camp, particularly if one considers the still limited number of tests per day conducted in the region and the number of observed infections went We know from studies worldwide that the true number of infections may be as large as ten times what is observed, even in countries where testing is widespread. According to the simulations provided by [23], "On average, in the first 30 days of the outbreak, we expect 18 (95% prediction interval [PI], 265), 54 (95% PI, 3223), and 370 (95% PI, 41,850) people infected in the low, moderate, and high transmission scenarios, respectively." The study focused on the Kutupalong-Balukhali Expansion Site which is home of about 600,000 of the more than 1 m refugees in the Cox's bazaar district of Bangladesh, and we do not know how many of the 50 infected cases were found in this particular zone.…”

“…If we reduce the contact rate by 1/3, the epidemic size is reduced to 79% of the population. Both strategies combined will reduce the epidemic size to 58%, although achieving this reduction would be difficult in refugee camps [23].…”

“…Since a small fraction of individuals will develop symptoms that require hospitalization, this means that, on average, there will be many infections before the first infected individual is noticed (the time to first death is on average over 6-7 weeks), which makes a lock-down ineffective. Individual isolation is also difficult [23], mainly because it requires the isolation of at least all members of a family.…”