key: cord-0859678-ipbwpw26
authors: Fawad, Muhammad; Rawashdeh, Fatima; Parmar, Parveen K.; Ratnayake, Ruwan
title: Simple ideas to mitigate the impacts of the COVID-19 epidemic on refugees with chronic diseases
date: 2020-05-06
journal: Confl Health
DOI: 10.1186/s13031-020-00277-x
sha: 0b000e9cf8f5e41abd214cd771e5d5c5217621a6
doc_id: 859678
cord_uid: ipbwpw26

nan

Simple ideas to mitigate the impacts of the COVID-19 epidemic on refugees with chronic diseases Muhammad Fawad 1 , Fatima Rawashdeh 1 , Parveen K. Parmar 2 and Ruwan Ratnayake 1*

Disease control amongst refugee populations is a critical component of the global response with COVID-19 [1] . Another critical issue for refugees is the maintenance of life-saving care for non-communicable and chronic infectious diseases, including diabetes and HIV/AIDS. In Jordan, Syrian refugees with non-communicable diseases typically access clinical care and medications at no cost through clinics supported by humanitarian organizations. Since January, the International Rescue Committee in Jordan has been conducting a study on the impact of supplementing clinical care with out-of-clinic support through a Syrian community health volunteer network, on adherence to medications and prevention of severe outcomes among Syrians and uninsured Jordanians with poorly controlled diabetes and/or hypertension (Clinical-Trials.gov, NCT04229667). It is notable that these patients (elderly, with multi-morbidities, and tenuous access to care), are also a major risk group for poor outcomes from COVID-19 infection [2] .

On March 21, 2020, the Government of Jordan implemented national curfews to impel social distancing, including the temporary closure of clinics for refugees [3] . As clinical care is resumed, it is important to think about how to use community health volunteers to mitigate the impact of COVID-19 in this population. First, using clinic lists of diabetics and hypertensives, CHVs could help patients connect with pharmacies to ensure access to a two-month supply of medication and insulin and provide monthly follow-up by telephone for monitoring and assessment for complications from pre-existing disease. This would serve dually as infection prevention for elderly patients, minimizing their potential exposure to infected persons at primary care clinics, and would mitigate the impact of interruptions to lifesaving treatment [4] . Second, community health volunteers could provide refugees with a trusted connection to surveillance systems, risk communication, and the epidemic response, which is a major aim of community engagement [5] .

Such "switching-on" of remote strategies to reach patients cut-off from care is common but less documented in the literature. This has included providing "run-away" bags of antiretrovirals and a hotline for HIV/AIDS patients, and using community health volunteers to refer malnourished children and provide counseling on infant and young child feeding during deteriorations in security in Yemen [6, 7] . As with acute conflict, for COVID-19, the decision to use CHVs or other health workers to reach households is critically-dependent on operating safely (e.g. not entering households and using protection), defining a necessarily-reductive role without excessive duties, providing a critical link with health services, and securing the trust of a willing workforce. Ministries of Health and humanitarian organizations are likely thinking of such strategies for reaching vulnerable populations. We should support them with technical guidance.

COVID-19 control in low-income settings and displaced populations: what can realistically be done? London: London School of Hygiene & Tropical Medicine

Clinical Characteristics of Coronavirus Disease 2019 in China

Round-the-clock curfew in Jordan to battle coronavirus outbreak

Challenges associated with providing diabetes care in humanitarian settings

Risk Communication and Community Engagement Working Group on COVID-19 Preparedness and Response, WHO, IFRC, OCHA: COVID-19: How to include marginalized and vulnerable people in risk communication and community engagement

Provision and continuation of antiretroviral therapy during acute conflict: the experience of MSF in Central African Republic and Yemen

Protecting public health in Yemen

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This study referenced in this letter is funded by Elrha's Research for Health in Humanitarian Crises programme, which aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises (project no. 28368). The Research for Health in Humanitarian Crises programme is funded equally by the Wellcome Trust and the UK Department for International Development. Visit www.elrha.org/ r2hc for more information. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had final responsibility for the decision to submit for publication.Availability of data and materials Not applicable.Ethics approval and consent to participate Not applicable.

Not applicable.

The authors declare that they have no competing interests. Received: 20 April 2020 Accepted: 27 April 2020