Institute for the History of Medicine, University Justus Liebig Giessen, 35392 Giessen, Germany.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Int J Infect Dis. 2021 Dec;113 Suppl 1:S22-S27. doi: 10.1016/j.ijid.2021.03.047. Epub 2021 Mar 26.
Disruption of health services due to the COVID-19 pandemic threatens to derail progress being made in tuberculosis control efforts. Forcibly displaced people and migrant populations face particular vulnerabilities as a result of the COVID-19 pandemic, which leaves them at further risk of developing TB. They inhabit environments where measures such as "physical distancing" are impossible to realize and where facilities like camps and informal temporary settlements can easily become sites of rapid disease transmission. In this viewpoint we utilize three case studies-from Peru, South Africa, and Syria-to illustrate the lived experience of forced migration and mobile populations, and the impact of COVID-19 on TB among these populations. We discuss the dual pandemics of TB and COVID-19 in the context of migration through a syndemic lens, to systematically address the upstream social, economic, structural and political factors that - in often deleterious dynamics - foster increased vulnerabilities and risk. Addressing TB, COVID-19 and migration from a syndemic perspective, not only draws systematic attention to comorbidity and the relevance of social and structural context, but also helps to find solutions: the true reality of syndemic interactions can only be fully understood by considering a particular population and bio- social context, and ensuring that they receive the comprehensive care that they need. It also provides avenues for strengthening and expanding the existing infrastructure for TB care to tackle both COVID-19 and TB in migrants and refugees in an integrated and synergistic manner.
由于 COVID-19 大流行而中断的卫生服务可能使结核病控制工作的进展脱轨。由于 COVID-19 大流行,被迫流离失所者和移民人口面临着特别的脆弱性,使他们面临着更大的结核病发病风险。他们居住在难以实现“保持身体距离”等措施的环境中,而难民营和非正规临时住区等设施很容易成为疾病快速传播的场所。在本观点文章中,我们利用来自秘鲁、南非和叙利亚的三个案例研究来说明被迫移民和流动人口的生活经历,以及 COVID-19 对这些人群中结核病的影响。我们从传染病的角度讨论了结核病和 COVID-19 这双重大流行在移民背景下的情况,以系统地解决促进脆弱性和风险增加的社会、经济、结构和政治因素。从传染病的角度来处理结核病、COVID-19 和移民问题,不仅使共病和社会结构背景的相关性得到系统关注,还有助于找到解决方案:只有通过考虑特定的人群和生物社会背景,并确保他们得到他们需要的全面护理,才能全面理解传染病相互作用的真正现实。它还为加强和扩大现有的结核病护理基础设施提供了途径,以便以综合和协同的方式应对移民和难民中的 COVID-19 和结核病。