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Unprepared for the Worst: World’s Most Vulnerable Brace for Virus Unprepared for the Worst: World’s Most Vulnerable Brace for Virus
(7 days later)
In an embattled enclave in Syria, doctors have seen patients die from what looks like the coronavirus but are unable to treat them because they lack beds, protective gear and medical professionals. A refugee camp in Bangladesh is so cramped that its population density is nearly four times that of New York City, making social distancing impossible. Clinics in a refugee camp in Kenya struggle in normal times with only eight doctors for nearly 200,000 people.In an embattled enclave in Syria, doctors have seen patients die from what looks like the coronavirus but are unable to treat them because they lack beds, protective gear and medical professionals. A refugee camp in Bangladesh is so cramped that its population density is nearly four times that of New York City, making social distancing impossible. Clinics in a refugee camp in Kenya struggle in normal times with only eight doctors for nearly 200,000 people.
As wealthy countries like the United States and Italy struggle with mass outbreaks of the coronavirus, international health experts and aid workers are increasingly worried that the virus could ravage the world’s most vulnerable people: the tens of millions forced from their homes by violent conflict.As wealthy countries like the United States and Italy struggle with mass outbreaks of the coronavirus, international health experts and aid workers are increasingly worried that the virus could ravage the world’s most vulnerable people: the tens of millions forced from their homes by violent conflict.
Refugee camps across Africa, the Middle East and Asia are packed with traumatized and undernourished people with limited access to health care and basic sanitation, perfect breeding grounds for contagion. Extended families jam into tarpaulin shelters with mud floors. Food, water and soap are often lacking. Illnesses, from hacking coughs to deadly diseases, go untreated, facilitating their spread.Refugee camps across Africa, the Middle East and Asia are packed with traumatized and undernourished people with limited access to health care and basic sanitation, perfect breeding grounds for contagion. Extended families jam into tarpaulin shelters with mud floors. Food, water and soap are often lacking. Illnesses, from hacking coughs to deadly diseases, go untreated, facilitating their spread.
The coronavirus, which has already infected hundreds of thousands of people around the globe, could rip through these camps with devastating speed and mortality.The coronavirus, which has already infected hundreds of thousands of people around the globe, could rip through these camps with devastating speed and mortality.
“If we think this is a big issue in the U.S. and Europe, we haven’t seen anything yet if Covid gets into the refugee population,” said Adam Coutts, a public health researcher at Cambridge University. “People can’t even wash their kids, let alone wash their hands.”“If we think this is a big issue in the U.S. and Europe, we haven’t seen anything yet if Covid gets into the refugee population,” said Adam Coutts, a public health researcher at Cambridge University. “People can’t even wash their kids, let alone wash their hands.”
So far, the number of confirmed coronavirus cases among refugees is low, but that may be the result of a lack of testing. Testing is severely limited, and refugees are rarely a priority.So far, the number of confirmed coronavirus cases among refugees is low, but that may be the result of a lack of testing. Testing is severely limited, and refugees are rarely a priority.
Doctors treating refugees in Syria and Bangladesh say that in recent weeks they have treated and lost patients with symptoms consistent with the virus.Doctors treating refugees in Syria and Bangladesh say that in recent weeks they have treated and lost patients with symptoms consistent with the virus.
“To think that it is not in refugee and displaced populations is a bit naïve,” Mr. Coutts said.“To think that it is not in refugee and displaced populations is a bit naïve,” Mr. Coutts said.
If the virus is present, the camps are profoundly ill-equipped to handle it.If the virus is present, the camps are profoundly ill-equipped to handle it.
Many camp clinics are already struggling to fight outbreaks like dengue and cholera, leaving them without the resources to treat chronic conditions, such as diabetes or heart disease. The coronavirus, which has no vaccine or agreed upon treatment regimen for Covid-19, the respiratory disease it causes, could be even more devastating, medical experts warn.Many camp clinics are already struggling to fight outbreaks like dengue and cholera, leaving them without the resources to treat chronic conditions, such as diabetes or heart disease. The coronavirus, which has no vaccine or agreed upon treatment regimen for Covid-19, the respiratory disease it causes, could be even more devastating, medical experts warn.
“We are preparing for the worst,” said Avril Benoit, the executive director of Doctors Without Borders in the United States, which has deployed teams to work with refugees around the world. “We know that in the places where we work we are underequipped and understaffed.”“We are preparing for the worst,” said Avril Benoit, the executive director of Doctors Without Borders in the United States, which has deployed teams to work with refugees around the world. “We know that in the places where we work we are underequipped and understaffed.”
Daily life in a refugee camp is an ideal incubator for infectious disease. Many lack running water and indoor sanitation. People often stand in line for hours to get water, which is insufficient for frequent showers, much less vigilant hand washing.Daily life in a refugee camp is an ideal incubator for infectious disease. Many lack running water and indoor sanitation. People often stand in line for hours to get water, which is insufficient for frequent showers, much less vigilant hand washing.
“If it came into the camp, it would be a disaster,” said Ahmadu Yusuf, a community leader in the Bakassi camp in northeastern Nigeria, most of whose residents fled Boko Haram, the militant group. “It would be more devastating than the insurgency that brought them here.”“If it came into the camp, it would be a disaster,” said Ahmadu Yusuf, a community leader in the Bakassi camp in northeastern Nigeria, most of whose residents fled Boko Haram, the militant group. “It would be more devastating than the insurgency that brought them here.”
Refugee life also makes social distancing, the health mantra in the West, impossible.Refugee life also makes social distancing, the health mantra in the West, impossible.
In crowded, poor places like Gaza or the urban slums of Indonesia and India, which began the world’s largest lockdown in response to the virus this week, keeping six feet away from everyone else is difficult. Refugee settlements are often even denser.In crowded, poor places like Gaza or the urban slums of Indonesia and India, which began the world’s largest lockdown in response to the virus this week, keeping six feet away from everyone else is difficult. Refugee settlements are often even denser.
A refugee camp in Lesbos, Greece, was built for 3,000 people but now has 20,000 and almost no sanitation.A refugee camp in Lesbos, Greece, was built for 3,000 people but now has 20,000 and almost no sanitation.
“The one thing that everyone is stressing in combating the coronavirus is to create social distance but that is precisely what is impossible for refugees,” said Deepmala Mahla, the regional director for Asia for CARE, the humanitarian aid agency. “Where do you go to create space? There is no space.”“The one thing that everyone is stressing in combating the coronavirus is to create social distance but that is precisely what is impossible for refugees,” said Deepmala Mahla, the regional director for Asia for CARE, the humanitarian aid agency. “Where do you go to create space? There is no space.”
Nor are there adequate health systems. The same conflicts that have displaced huge numbers of people have decimated medical facilities, or forced people to live in places where there are none.Nor are there adequate health systems. The same conflicts that have displaced huge numbers of people have decimated medical facilities, or forced people to live in places where there are none.
The war in Syria has sent more than a million refugees into Lebanon, which is facing an economic crisis. Many live in cramped, squalid conditions and suffer from acute poverty.The war in Syria has sent more than a million refugees into Lebanon, which is facing an economic crisis. Many live in cramped, squalid conditions and suffer from acute poverty.
Jawahir Assaf, 42, lives with her four children in a tent with 18 other people in a refugee camp in Lebanon’s Bekaa Valley. A nearby slaughterhouse draws rats, which sometimes bite the children.Jawahir Assaf, 42, lives with her four children in a tent with 18 other people in a refugee camp in Lebanon’s Bekaa Valley. A nearby slaughterhouse draws rats, which sometimes bite the children.
For years, she and the other camp residents survived by working on nearby farms or trading basic commodities. Now, the threat of the coronavirus keeps them confined with no income.For years, she and the other camp residents survived by working on nearby farms or trading basic commodities. Now, the threat of the coronavirus keeps them confined with no income.
“After 13 days, we are running out of food,” she said.“After 13 days, we are running out of food,” she said.
Many refugees also suffer from poor nutrition and other health conditions that could leave them particularly vulnerable. In Bangladesh, where about 860,000 Rohingya Muslims fled to escape persecution in Myanmar, the authorities fear that the coming rainy season will cause sewage to overflow into flimsy shelters and possibly spread the coronavirus.Many refugees also suffer from poor nutrition and other health conditions that could leave them particularly vulnerable. In Bangladesh, where about 860,000 Rohingya Muslims fled to escape persecution in Myanmar, the authorities fear that the coming rainy season will cause sewage to overflow into flimsy shelters and possibly spread the coronavirus.
“We are scared that the virus is killing many people around the world,” said Marjuna, an 18-year-old Rohingya refugee in the Kutupalong camp. “We don’t know how to stop it.”“We are scared that the virus is killing many people around the world,” said Marjuna, an 18-year-old Rohingya refugee in the Kutupalong camp. “We don’t know how to stop it.”
A lack of information in the camps has elevated the sense of panic among people already primed for anxiety. In Bangladesh, the government has limited mobile internet access for many Rohingya, creating an information vacuum that has allowed rumors to flourish:A lack of information in the camps has elevated the sense of panic among people already primed for anxiety. In Bangladesh, the government has limited mobile internet access for many Rohingya, creating an information vacuum that has allowed rumors to flourish:
Eating garlic or the pennywort leaf will ward off the virus, Rohingya refugees have been told. The faithful will stave off disease. Those who test positive should be killed to stop the contagion.Eating garlic or the pennywort leaf will ward off the virus, Rohingya refugees have been told. The faithful will stave off disease. Those who test positive should be killed to stop the contagion.
Humanitarian workers say they have been regarded with suspicion as possible carriers of disease. At least two have been attacked, according to camp staff.Humanitarian workers say they have been regarded with suspicion as possible carriers of disease. At least two have been attacked, according to camp staff.
Updated June 16, 2020 Updated June 22, 2020
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
“We are trying to correct the misinterpretations, but the lack of mobile networks makes it very difficult to get out the right messages about health and hygiene,” said Marie Sophie Pettersson, a program specialist for United Nations Women, a gender equality agency, in the Rohingya camps.“We are trying to correct the misinterpretations, but the lack of mobile networks makes it very difficult to get out the right messages about health and hygiene,” said Marie Sophie Pettersson, a program specialist for United Nations Women, a gender equality agency, in the Rohingya camps.
Aid agencies that have contended with donor fatigue at a time when the number of displaced people is at a record high are worried that health and economic crises in the West will mean less money for refugees. Some fear that people in wealthier nations will worry less about people in poor ones when they feel threatened at home.Aid agencies that have contended with donor fatigue at a time when the number of displaced people is at a record high are worried that health and economic crises in the West will mean less money for refugees. Some fear that people in wealthier nations will worry less about people in poor ones when they feel threatened at home.
“As world leaders brace for the worst within their borders, they must not abandon those living outside them,” Jan Egeland, the secretary general of the Norwegian Refugee Council, said in a statement.“As world leaders brace for the worst within their borders, they must not abandon those living outside them,” Jan Egeland, the secretary general of the Norwegian Refugee Council, said in a statement.
Aid workers warn that the spread of the virus in the West could also hamper the ability of aid organizations to respond. Travel restrictions make it harder for aid workers to reach threatened areas.Aid workers warn that the spread of the virus in the West could also hamper the ability of aid organizations to respond. Travel restrictions make it harder for aid workers to reach threatened areas.
Others are hopeful that the pandemic will generate global empathy.Others are hopeful that the pandemic will generate global empathy.
“When we’re suddenly concerned about our own safety, it might help us understand what a Rohingya woman might be feeling,” said Ms. Mahla of CARE. “Regardless of our financial status, our borders, our caste, color or gender, we are all in the same boat, fighting the coronavirus.”“When we’re suddenly concerned about our own safety, it might help us understand what a Rohingya woman might be feeling,” said Ms. Mahla of CARE. “Regardless of our financial status, our borders, our caste, color or gender, we are all in the same boat, fighting the coronavirus.”
Lockdowns imposed by governments to slow the virus’s spread have been punishing for refugees who struggle to find food.Lockdowns imposed by governments to slow the virus’s spread have been punishing for refugees who struggle to find food.
In Lebanon, where most Syrian refugees live in cities, Nisrine Muhra, 35, said her son and daughter, 10 and 13, used to sell tissues on the street in Beirut, but have been forced to stay home. Her husband, a day laborer, risked going out to look for work but was chased off by soldiers.In Lebanon, where most Syrian refugees live in cities, Nisrine Muhra, 35, said her son and daughter, 10 and 13, used to sell tissues on the street in Beirut, but have been forced to stay home. Her husband, a day laborer, risked going out to look for work but was chased off by soldiers.
The family is three months behind on their rent and living on oil, bread and herbs, with no cash for protective gear and sanitizers.The family is three months behind on their rent and living on oil, bread and herbs, with no cash for protective gear and sanitizers.
“Instead of buying masks, it’s better to buy bread for my children,” she said. “We’re not going to die from corona, but from food shortage.”“Instead of buying masks, it’s better to buy bread for my children,” she said. “We’re not going to die from corona, but from food shortage.”
Hannah Beech reported from Bangkok and Ben Hubbard from Beirut. Abdi Latif Dahir contributed reporting from Nairobi, Kenya; Ruth Maclean from Dakar, Senegal; and Hwaida Saad from Beirut.Hannah Beech reported from Bangkok and Ben Hubbard from Beirut. Abdi Latif Dahir contributed reporting from Nairobi, Kenya; Ruth Maclean from Dakar, Senegal; and Hwaida Saad from Beirut.