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新冠病毒疫情下孟加拉国受到约翰霍普金斯大学帮助

  • 责任编辑:siyu.zhang
  • 来源:互联网
  • 时间:2020-09-23 16:31:13

  新冠病毒在美国就引起了非常大的波澜,更不要说孟加拉国了,而约翰霍普金斯大学也在关注问题较多的疫情国家。

  边缘的紧急

  约翰霍普金斯大学的科学家们在大流行期间早期动员起来,了解新冠肺炎对罗兴亚难民的威胁,并帮助为孟加拉国的应对提供信息。他们的模型带来的问题多于答案。

  作者Saralyn Cruickshank /出版于13小时前

  今年早些时候,一种新的新冠病毒相关呼吸系统疾病正从中国传播开来的报道刚刚开始传播,约翰霍普金斯人道主义卫生中心(Johns Hopkins Center for Humanitarian Health)的研究人员就开始考虑生活在孟加拉国的难民。在考克斯的巴扎尔区,有近100万来自缅甸的宗教和少数民族罗兴亚人住在难民营里,其中大多数人(约60万人)居住在库图帕隆-俾路哈里(Kutupalong-Balukhali)扩建地。它占地约5平方英里,是世界上最大的难民营,也是地球上人口最密集的地方之一。

  “大流行尤其令人担忧,但实际上任何类型的疾病传播有关时住在难民营的难民,因为他们常常生活在高密度和可怜的水和卫生设施,”保罗•明镜表示中心的主任和教授实践的彭博公共卫生学院的国际卫生。“我们从过去的经验得知,流行病在这些环境中很容易传播是很常见的。”

  国际卫生与流行病学系助理科学家Shaun Truelove此前对白喉进行了研究,发现罗兴亚人的细菌感染传播率比其他人群高出约60%。他知道一种高度传染性的病毒传入该地区会带来毁灭性的后果。

  Truelove说:“由于我们知道这些人过去的情况和待遇,我们非常担心,如果国际社会不迅速采取行动,大流行可能会成为一场真正的灾难。”

  获得更好的理解范围的威胁,爱人和传染病动力学集团领导的发展扩张的冠状病毒传播模型基于人口统计网站,假设医疗能力考克斯的集市,和早期的数据传输潜在的病毒,在其他变量。斯皮格尔和人道主义健康中心的科学家奥里特·亚伯拉罕和基娅拉·阿特雷帮助解释和实施了这些发现。

  Truelove说:“我们的目标是尽早了解情况可能有多糟,以便鼓励各组织迅速参与和部署资源,以增加卫生保健基础设施和隔离能力。”

  该模型基于风险提出了三种传播场景。在每一种情况下,一旦病毒被引入营地,大规模爆发几乎是肯定的。

  在低传播情况下,该模型显示,至少有421,500人可能被感染。在高传输情况下,这一数字达到589,800人,几乎是扩展现场的所有人。预计死亡人数在2040至2 880人之间。该模型还表明,如果当地卫生保健系统没有适当的准备和动员,在低传播情况下,住院治疗的需要将在136天内超过能力,而在高传播情况下,仅在55天内。

  斯皮格尔与联合国难民事务高级专员和难民专员办事处卫生主任分享了调查结果。他们和斯皮格尔一样,最初的反应是谨慎地传播模型的发现。

  斯皮格尔说:“难民一直受到歧视和污名化,不仅因为他们是难民,也因为他们传播疾病,但通常情况并非如此。”“这些情况会加剧难民面临的歧视。”

  在每一种风险情况下,一旦病毒被引入营地,几乎可以保证大规模爆发。孟加拉国官员已经在为冠状病毒可能如何影响考克斯巴扎尔地区的罗兴亚人做准备。斯皮格尔说,JHU小组的模型和三层风险分析帮助官员思考不同的传播情景并制定策略。

  “你根据可能发生的事情来计划,但也要根据你的能力。他们建立了隔离中心,引进了一些用于病毒检测的PCR仪,增加了ICU病床的数量。“如果还没有发生的最糟糕的情况真的发生了,我想说,他们仍然会遇到一些重大麻烦。”

  罗兴亚人的第一批冠状病毒感染病例是在5月中旬正式报告的,此后孟加拉国的医疗服务提供者和官员收集的经验数据显示,疾病的传播远低于预期。

  Truelove说:“在近100万人口中,报告的冠状病毒病例总数约为145例。”“这些都是很小很小的数字。”

  在某种程度上,这与该团队模型的其他发现相吻合,后者表明,中国的疫情死亡率远低于疫情早期中国的死亡率。明镜周刊将这一低死亡率归因于罗兴亚人口的人口结构,其中年轻人和儿童远远多于其他人口群体。

  斯皮格尔说:“老年人是有伴生疾病的人群,因此,与中国、美国和其他国家相比,年轻人在环境中死亡的比例更低也就不足为奇了。”“罗兴亚人的实际死亡率似乎证明了这一点。”

  他说,虽然没有证据表明,但也有可能是其他形式的冠状病毒在罗兴亚人中间传播,从而使罗兴亚人接种了一种更严重的新型冠状病毒。

  “难民一直受到歧视和污名化——不仅因为他们是难民,也因为他们传播疾病,但通常情况并非如此。这些情况会加剧难民面临的歧视。”

  保罗明镜

  约翰·霍普金斯人道主义健康中心主任约翰·霍普金斯人道主义健康中心的研究人员和他们在流行病学系的同事正在迅速制定计划,进一步调查条件和因素,这些条件和因素可能是导致考克斯巴扎尔市的低感染率和死亡率的原因。他们的工作更加紧迫,因为类似的情况正在世界其他地方上演,包括印度和肯尼亚人口密集的地区。

  Truelove说,理想情况下,该小组将能够分析人群的血清抗体结果,并直接测量携带COVID-19抗体的人数,从而确定传播范围。目前还没有进行此类调查的资源,但该小组正在密切关注来自孟加拉国的报告。

  斯皮格尔表示,他将继续与联合国和非政府组织合作,研究疫情,并寻找疫情对受人道主义紧急情况影响的人的任何次生影响。例如,持续的疾病传播可能会阻止人们到诊所寻求预防性护理或治疗,或者如果孕妇不让熟练的助产士接生,可能会损害孕产妇和胎儿的健康。他和他的同事们还密切关注这一流行病的社会影响,并考虑如果有疫苗,难民和其他国内流离失所者将如何看待疫苗。

  他说:“我们需要考虑对人类生命造成的许多间接代价。”“学习很有趣——令人沮丧,但也能缓解压力。很显然,我很高兴事情没有像我们预期的那样发生,但我想更好地了解这是为什么。并不是我们不能做这样的研究,而是没有足够的资源来做。但我们会成功的。”

  张贴在卫生

  被标记的难民危机,人道主义卫生中心,冠状病毒,covid-19

  附上原文,以供参考,拒绝转载,侵权必删:

  EDGE OF EMERGENCY

  Johns Hopkins scientists mobilized early during the pandemic to understand the threat COVID-19 posed to Rohingya refugees and help inform Bangladesh's response. Their models have led to more questions than answers.

  By Saralyn Cruickshank / Published 13 hours ago

  Almost as soon as reports began circulating earlier this year that a new coronavirus-linked respiratory illness was spreading from China, researchers at the Johns Hopkins Center for Humanitarian Health thought of the refugees living in Bangladesh. In the district of Cox's Bazar, nearly 1 million religious and ethnic minorities from Myanmar called the Rohingya live in refugee camps, with the majority—roughly 600,000—residing in the Kutupalong-Balukhali Expansion Site. At about 5 square miles, it is the world's largest refugee camp and one of the most densely populated places on the planet.

  "A pandemic is particularly worrying, but really any type of disease transmission is concerning when it comes to refugees living in camps because they are often living in high density and with poor water and sanitation," says Paul Spiegel, director of the center and a professor of the practice in the Department of International Health in the Bloomberg School of Public Health. "We know from past experience that it's very common for epidemics to transmit easily in these settings."

  Shaun Truelove, an assistant scientist in the departments of International Health and Epidemiology, had conducted previous research on diphtheria and found that the transmission of the bacterial infection was about 60% higher among the Rohingya than in other populations. He knew the introduction of a highly infectious virus to the region could be devastating.

  "Knowing how this population has fared and been treated in the past, we were quite concerned that without prompt action by the international community, the pandemic could be a real disaster," Truelove says.

  To gain a better understanding of the scope of the threat, Truelove and the Infectious Disease Dynamics group led the development of a coronavirus transmission model based on the demographics of the expansion site, assumptions about the health care capacity in Cox's Bazar, and early data about the transmission potential of the virus, among other variables. Spiegel and scientists Orit Abrahim and Chiara Altare from the Center for Humanitarian Health helped interpret and operationalize the findings.

  "The goal was to get an idea early on how bad it could be, in order to encourage organizations to rapidly engage and deploy resources that would increase health care infrastructure and isolation capabilities," Truelove says.

  The model presented three transmission scenarios based on risk. In each scenario, a large-scale outbreak was almost guaranteed once the virus was introduced in the camp.

  In the low-transmission scenario, the model suggested that at least 421,500 people could become infected. In the high-transmission scenario, that number reached 589,800—or nearly every person in the expansion site. The number of deaths was expected to be between 2,040 and 2,880. The model also suggested that without proper preparation and mobilization by the local health care system, the need for hospitalization would exceed capacity in 136 days in the low-transmission scenario and in just 55 days in the high-transmission scenario.

  Spiegel shared the results with the United Nations high commissioner for refugees and the UNHCR's head of health. Their initial reactions, as well as Spiegel's, were to exercise caution in disseminating the model's findings.

  "There has always been discrimination and stigma against refugees—for just being a refugee but also for spreading disease, which often is not the case," Spiegel says. "These situations can exacerbate the discrimination refugees face."

  IN EACH RISK SCENARIO, A LARGE-SCALE OUTBREAK WAS ALMOST GUARANTEED ONCE THE VIRUS WAS INTRODUCED IN THE CAMP.Officials in Bangladesh were already preparing for how the coronavirus might affect the Rohingya living in Cox's Bazar. The JHU team's model and three-tiered risk analysis helped officials think through the different transmission scenarios and develop strategies, Spiegel says.

  "You plan according to what maybe could occur, but also according to your capacity. They set up isolation centers, they brought in some PCR machines for virus detection, and they increased the number of ICU beds available," Spiegel says. "If the worst-case scenario, which has not yet happened, does occur, they still would be in some significant trouble, I would say."

  The first cases of coronavirus infection among the Rohingya were officially reported in mid-May, and empirical data collected by health care providers and officials in Bangladesh since then have indicated the spread of disease has been far lower than expected.

  "Among a population of nearly a million people, the number of total coronavirus cases reported is around 145," Truelove says. "These are tiny, tiny numbers."

  In some ways, this coincides with other findings from the team's model, which suggested a far lower fatality rate from the disease than was experienced in China early in the pandemic. Spiegel attributes the low fatality rate to the demographics of the Rohingya population, which is made up of far more young people and children than other population groups.

  "Older people are those with concomitant diseases, and so it's maybe not surprising that the number of deaths that would occur in a setting with younger people is lower proportionally than in China, the U.S., and elsewhere," Spiegel says. "And the actual death rate among the Rohingya seems to bear that out."

  He says it's also possible, though no evidence has suggested it to be the case, that some other form of coronavirus spread among the Rohingya, conferring a type of inoculation against the more severe forms of COVID-19.

  "THERE HAS ALWAYS BEEN DISCRIMINATION AND STIGMA AGAINST REFUGEES—FOR JUST BEING A REFUGEE BUT ALSO FOR SPREADING DISEASE, WHICH OFTEN IS NOT THE CASE. THESE SITUATIONS CAN EXACERBATE THE DISCRIMINATION REFUGEES FACE."

  Paul Spiegel

  Director, Johns Hopkins Center for Humanitarian HealthStill, the Johns Hopkins Center for Humanitarian Health researchers and their colleagues in the Department of Epidemiology are rapidly developing plans to further investigate the conditions and factors that may be contributing to the low infection and fatality rates in Cox's Bazar. And their work has even more urgency, as similar scenarios are unfolding elsewhere in the world, including in densely populated parts of India and Kenya.

  Ideally, Truelove says, the team would be able to analyze the results of serosurveys of the population and directly measure the number of people with COVID-19 antibodies, thus determining the scope of transmission. The resources to conduct such a survey aren't available yet, but the team is closely monitoring reports from Bangladesh.

  For his part, Spiegel says he will continue to work with the UN and NGOs to examine the pandemic and look for any secondary effects of the pandemic among persons affected by humanitarian emergencies. Ongoing disease spread could prevent people from seeking preventive care or treatment in clinics, for example, or it could damage maternal and fetal health if expectant mothers refrain from having their babies delivered by skilled birth attendants. He and his colleagues are also paying close attention to the pandemic's social effects and thinking about how a vaccine, if available, would be perceived by refugees and other internally displaced people.

  "There are a lot of indirect costs to human life we need to think about," he says. "It's been interesting to study—frustrating but also relieving. I'm obviously very happy it hasn't happened as we expected, but I would like to better understand more about why that is. And it's not that we can't do that kind of research, it's that there aren't enough resources to do it. But we'll get there."

  Posted in Health

  Tagged refugee crisis, center for humanitarian health, coronavirus, covid-19

  Source of articles:https://hub.jhu.edu/

  Author:Saralyn Cruickshank

  以上就是新冠病毒疫情下孟加拉国的情况介绍了,希望对各位学子了解约翰霍普金斯大学有所帮助。


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