[Open Access] Racism and discrimination in COVID-19 responses

Racism and discrimination in COVID-19 responses


“The strength of a health system is inseparable from broader social systems that surround it. Epidemics place increased demands on scarce resources and enormous stress on social and economic systems. Health protection relies not only on a well functioning health system with universal coverage, but also on social inclusion, justice, and solidarity. In the absence of these factors, inequalities are magnified and scapegoating persists, with discrimination remaining long after. Division and fear of others will lead to worse outcomes for all.”

Read the full article here

[Open Access] Travel health risk perceptions of Chinese international students in Australia – Implications for COVID-19

Travel health risk perceptions of Chinese international students in Australia – Implications for COVID-19

Tara Maa, Anita HeywoodaC., Raina MacIntyreb
aSchool of Public Health and Community Medicine, UNSW Australia, Kensington, NSW, 2052 Australia
bBiosecurity Program, The Kirby Institute, UNSW Australia, Kensington, NSW, 2052 Australia



International students frequently return to their country of origin to visit friends and relatives (VFR), and are at increased risk of travel-associated infections. Little is known of their travel health seeking behaviours. China is the biggest source of international students studying in Australia and the unprecedented epidemic of COVID-19 in China makes this an important area of research.


Focus groups of Chinese international students were conducted to explore travel health-related knowledge, attitudes and practices. Eligible participants were studying in Sydney, and had travelled to China and Hong Kong to visit friends and relatives in the preceding 18 months. A variety of topics were explored, using a focus group guide. Thematic analysis was undertaken on the transcripts using nVivo software. The list of codes and themes were not pre-determined but developed through content analysis.


Two focus groups were held with a total of 28 participants. Risk perception about VFR travel was generally low among Chinese international students. Pre-travel healthcare was not sought. Students strongly relied on the Internet, social media, parents and friends in China for travel health advice.


This research provides insights into Chinese international students as VFR travellers. It confirms students could be a risk population for importations of infections such as COVID-19 because of low risk perception and lack of seeking travel health advice. This can inform health promotion strategies for students.

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[Open Access] COVID-19 Vaccine Development: Time to Consider SARS-CoV-2 Challenge Studies?

COVID-19 Vaccine Development: Time to Consider SARS-CoV-2 Challenge Studies?

Schaefer, G.O and Tam, Clarence C. and Savulescu, Julian and Voo, Teck Chuan, COVID-19 Vaccine Development: Time to Consider SARS-CoV-2 Challenge Studies? (March 20, 2020). Available at SSRN: https://ssrn.com/abstract=3568981 or http://dx.doi.org/10.2139/ssrn.3568981


While a human challenge study holds the prospect of accelerating the development of a vaccine for the coronavirus SARS-CoV-2, it may be opposed due to risks of harm to participants and researchers. Given the increasing number of human deaths and severe disruption to lives worldwide, we argue that a SARS-CoV-2 challenge study is ethically justifiable as its social value substantially outweighs the risks. Such a study should therefore be seriously considered as part of the global research response towards the COVID-19 pandemic. This paper contributes to the debate by addressing the misperception that a challenge study would lower scientific and ethical standards for vaccine research as well as other ethical concerns. Information that need to be disclosed to prospective participants to obtain their consent are set out.

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[Open Access] Mapping population mental health concerns related to COVID-19 and the consequences of physical distancing: a Google trends analysis

Mapping population mental health concerns related to COVID-19 and the consequences of physical distancing: a Google trends analysis

Knipe D, Evans H, Marchant A et al. Mapping population mental health concerns related to COVID-19 and the consequences of physical distancing: a Google trends analysis [version 1; peer review: 2 approved with reservations]. Wellcome Open Res 2020, 5:82 (https://doi.org/10.12688/wellcomeopenres.15870.1)


Background: The 2020 Coronavirus pandemic is a major international public health challenge.  Governments have taken public health protection measures to reduce the spread of the virus through non-pharmalogical measures. The impact of the pandemic and the public health response on individual and population mental health is unknown. 
Methods: We used Google Trends data (1 Jan 2020 – 1 Apr 2020) to investigate the impact of the pandemic and government measures to curb it on people’s concerns, as indexed by changes in search frequency for topics indicating mental distress, social and economic stressors and mental health treatment-seeking. We explored the changes of key topics in Google trends in Italy, Spain, USA, UK, and Worldwide in relation to sentinel events during the pandemic.
Results: Globally there appears to be significant concerns over the financial and work-related consequences of the pandemic, with some evidence that levels of fear are rising. Conversely searching for topics related to depression and suicide fell after the pandemic was announced, with some evidence that searches for the latter have risen recently. Concerns over education and access to medication appear to be particular social stressors. Whilst searches for face-to-face treatments have declined, those for self-care have risen.
Conclusions: Monitoring Google trends shows promise as a means of tracking changing public concerns. In weeks to come it may enable policy makers to assess the impact of their interventions including those aiming to limit negative consequences, such as government funded financial safety nets.

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[open access] Covid-19: how a virus is turning the world upside down

Covid-19: how a virus is turning the world upside down

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1336 (Published 03 April 2020)
Cite this as: BMJ 2020;369:m1336

Ilona Kickbusch, director1,  

Gabriel M Leung, dean of medicine2,  

Zulfiqar A Bhutta, co-director3,  

Malebona Precious Matsoso, director of health regulatory science platform4,  

Chikwe Ihekweazu, director general5,  

Kamran Abbasi, executive editor6

1Global Health Programme, Graduate Institute of International and Development Studies, Geneva, Switzerland

2Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China

3Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada

4Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa

5Nigeria Centre for Disease Control, Abuja, Nigeria

6The BMJ, London, UK

Correspondence to: I Kickbusch kickbusch@bluewin.ch

“Covid-19 has taught us that health is the basis of wealth, that global health is no longer defined by Western nations and must also be guided by Africa and Asia, and that international solidarity is an essential response and a superior approach to isolationism. We may emerge from this with a healthier respect for the environment and our common humanity. All citizens, governments, businesses, and organisations must heed these lessons. Covid-19 is the virus that is turning the world upside down. It will destroy the world as we know it; in the process we may learn to hold it together.”

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[Open Access] COVID-19 control in low-income settings and displaced populations: what can realistically be done?

COVID-19 control in low-income settings and displaced populations: what can realistically be done?

Maysoon Dahab1, Kevin van Zandvoort2, Stefan Flasche2, Abdihamid Warsame2, Paul B. Spiegel3, Ronald J Waldman4 5, Francesco Checchi2 *

1  Conflict & Health Research Group, King’s College London, London, UK

2 Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK

3 Centre for Humanitarian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

4 Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA

5 Doctors of the World USA, New York, NY, USA

* Corresponding author: Francesco.checchi@lshtm.ac.uk


“While modelling predictions1 suggest that uncontrolled or even partially mitigated COVID-19 epidemics in high-income countries could lead to substantial excess mortality, the virus’ impact on people living in low-income settings or affected by humanitarian crises could potentially be even more severe. Three mechanisms could determine this: (i) higher transmissibility due to larger household sizes2, intense social mixing3 between the young and elderly4, overcrowding in urban slums and displaced people’s camps, inadequate water and sanitation, and specific cultural and faith practices such as mass prayer gatherings, large weddings and funerals during which super-spreading events might propagate transmission disproportionately5; (ii) higher infection-to-case ratios and progression to severe disease due to the virus’ interaction with highly prevalent co-morbidities, including non-communicable diseases (NCDs; prevalence of hypertension and diabetes is often higher in low- than high-income settings, with a far lower treatment coverage6), undernutrition, tuberculosis7 and HIV; and (iii) higher case-fatality due to a dire lack of intensive care capacity, especially outside large cities. Moreover, extreme pressure on curative health services could result in indirect impacts resulting from disrupted care for health problems other than COVID-19.8 While these risk factors could be counterbalanced by younger age distributions and hot temperatures, on balance we believe that, given current evidence and plausible reasoning, drastic action is required immediately to protect the world’s most fragile populations from this unfolding threat.”

Read the full paper here

[Open Access] Targeting COVID-19 interventions towards migrants in humanitarian settings

COMMENT | Lancet Infectious Diseases | VOLUME 20, ISSUE 6, P645-646, JUNE 01, 202

Targeting COVID-19 interventions towards migrants in humanitarian settings

Published:April 21, 2020DOI: https://doi.org/10.1016/S1473-3099(20)30292-9

“Millions of refugees and migrants reside in countries devastated by protracted conflicts with weakened health systems, and in countries where they are forced to live in substandard conditions in camps and compounds, and high-density slum settings.1 Although many such settings have yet to feel the full impact of coronavirus disease 2019 (COVID-19), the pandemic is now having an unprecedented impact on mobility, in terms of border and migration management, as well as on the health, social, and economic situation of migrant populations globally. An urgent coordinated effort is now needed to align these populations with national and global COVID-19 responses.”

Read more here.

Risk behind bars: Coronavirus and immigration detention

Risk behind bars: Coronavirus and immigration detention


“….an outbreak in a facility threatens the outside community as well. An outbreak in a detention facility endangers all who come in contact with migrants, from immigration enforcement staff to workers at detention facilities, asylum officers, lawyers, and judges. All those people come in contact with the detainees and go home to their families at night.”

Read the full article here

[open access] Responding to the COVID-19 pandemic in complex humanitarian crises

Responding to the COVID-19 pandemic in complex humanitarian crises

International Journal for Equity in Health volume 19, Article number: 41 (2020) Cite this article

Over 168 million people across 50 countries are estimated to need humanitarian assistance in 2020 [1]. Response to epidemics in complex humanitarian crises—such as the recent cholera epidemic in Yemen and the Ebola epidemic in the Democratic Republic of Congo—is a global health challenge of increasing scale [2]. The thousands of Yemeni and Congolese who have died in these years-long epidemics demonstrate the difficulty of combatting even well-known pathogens in humanitarian settings. The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may represent a still greater threat to those in complex humanitarian crises, which lack the infrastructure, support, and health systems to mount a comprehensive response. Poor governance, public distrust, and political violence may further undermine interventions in these settings.

Migration Health Evidence Portal for COVID-19

This evidence portal is a repository of research publications and high-yield evidence briefs on COVID-19 and its intersection with migration health.

The scientific literature and knowledge base on the epidemic rapidly expand daily. Tremendous efforts are being made by the global community of clinicians, researchers and journal editors to advance scientific evidence to guide policy and decision making at the field level. However, there is a need to build evidence platforms to share and distill key findings emergent from this growing body of scientific literature that is relevant to migration, health, and human mobility to ultimately assist evidence-informed decision making from a migration lens.

The portal contains:

Research Publications on COVID-19 and Migration Health

This section reflects the output of the publication mapping exercise involving the quantitative assessment of a set of published scientific articles (i.e., bibliometric analysis) on COVID-19 with reference to migrants, migration, and human mobility. Bibliometric analysis provides an important snapshot of a specific field of interest/domain. The baseline information from bibliometric analysis helps identify research gaps that future studies can investigate. The bibliometric analysis conducted by IOM and MHADRI on international migration and health is one example.

Key messages

  • As of 30 March 2020, the publications related to COVID-19 totaled 21,779 (no restriction set in terms of language and subject area). From this, a total of 43 publications were relevant to migration health and human mobility.
  • Most of the studies investigated the cases and disease transmission dynamics of COVID-19 in the context of national and international population movement, with most studies undertaken in China. The distribution of research to date indicates the role of travel and migration in the importation of the virus.
  • Research on the epidemiology of the disease among migrant groups such as migrant workers, internally displaced persons (IDPs), refugees and asylum seekers is lacking. Evidence with attribution to migrant groups within clinical datasets are seldom reported.
  • Despite multiple studies from high-income countries (HICs) using mathematical modelling to predict spread, and model social distancing, border closures and impacts on health care system capacities, there were only a few studies that model outbreak in low-to-middle-income countries (LMICs) contexts. None hitherto have focused on camps and camp-like situations.
  • There is a real need to strengthen the current knowledge base on the epidemiology and social determinants of COVID-19 and examine health-related outcomes in specific migrant groups, especially migrant workers.
  • Investigations on COVID-19 and migration health should not be limited to the role of movement/mobility in the dynamic importation of cases in a pandemic; a more inclusive research strategy that integrates the relevant interests of migrant populations should be considered.
  • Advocating for the right to health of migrants and migrant inclusion within the global, regional, national and sub-national pandemic preparedness and response plans is of critical importance.
  • The most productive authors and institutions come from Hong Kong, whose geographical proximity to and socio-economic ties with China were likely contributing factors in their early contributions to the field.

Network map of common keywords

The network map below shows an overview of the common keywords that appear in the title, abstract, and keywords of the relevant publications retrieved on the topic of COVID-19 and migration health. Network maps of keywords reveal key topics in a research area or domain as well as the relationship (co-occurrence) between common keywords. It is a relative indicator of important research areas that are drawing attention in the field. 

  • The large circles in the figure represent the most frequently occurring author keywords in the research publications (N=43) such as ‘pneumonia’ (n=26), ‘epidemic’ (n=22), ‘travel’ (n=19), ‘quarantine’ (n=18), ‘outbreak’ (n=15), and ‘disease transmission’ (n=14). 
  • The lines connecting the circles represent the co-occurring keywords. The distance between two keywords approximates how strongly the words are related based on the number of their co-occurrences (i.e., the more publications in which two keywords co-occur, the stronger the relation between them). Thus, the strongly related words appear closer together on the map. 
  • Each distinct color represents a cluster of keywords that are strongly related to each other. In the figure, ‘pneumonia’, ‘travel’, and ‘disease transmission’ are strongly related to ‘virology’, ‘animals’, ‘nonhuman’, ‘zoonosis’, ‘fever’, ‘genetics’, and ‘pandemic’ (red cluster). The keyword ‘epidemic’ is strongly related to ‘outbreak’, ‘quarantine’, ‘mass screening’, ‘air travel’, ‘travel medicine’, ‘global health’, ‘infection control’, and ‘risk assessment’ – these keywords are shown to be closer together forming the green cluster. 
  • These topics on COVID-19 and migration health can be classified into the following thematic areas: disease epidemiology (i.e., travel, disease transmission, virology, animals, nonhuman, zoonosis, genetics, pandemic); clinical management (i.e., pneumonia and fever); and public health intervention (i.e., quarantine, control, etc.).

Note: See the full paper for the Methodology and Limitations of this analysis.