SARS-CoV-2 attack rate in reception and accommodation centres for asylum seekers during the first wave: systematic review of outbreak media reports in Germany

(Over)crowded house: exploring asylum seekers' experiences of the COVID-19 pandemic while living at accommodation centers in Sweden

BACKGROUND

The COVID-19 pandemic has made visible the scale of health disparities in society, highlighting how the distribution of infection and deaths differs between population subgroups within countries. Asylum seekers represent a potentially vulnerable group; early in the pandemic, concerns were raised about their housing situation, usually involving overcrowded, camp-like accommodations, and the effects of COVID-19 in relation to this. Hence, this study aimed to explore asylum seekers' experiences of the COVID-19 pandemic while living at accommodation centers.

METHODS

In this qualitative study, 14 semi-structured interviews were conducted with asylum seekers at two accommodation centers in Sweden. Participants represented a diverse group of asylum seekers in regard to age, educational background, and gender. Data were analyzed using qualitative content analysis.

RESULTS

Experiences related to COVID-19 were highly dependent on the living situation at the accommodation centers and the experience of feeling unsafe in shared spaces. This was enhanced by the experiences of a challenging mix of COVID-19 messages where different understandings of COVID-19 and related measures existed, together with a feeling of loss of control and safety in shared rooms. Additionally, participants felt more isolated from the outside society and missed prior social activities. Adding to this experience of isolation was an increasing mistrust regarding the authorities' pandemic response.

CONCLUSION

This study highlights the importance of understanding the specific challenges and vulnerabilities of asylum seekers at accommodation centers during the pandemic, shaped by their housing situation and legal status. The findings underscore the need for context-specific support, holistic disease prevention approaches, and tailored health communication strategies using diverse formats. Additionally, the findings emphasize the crucial need to identify and mobilize existing community resources in planning and implementing pandemic control measures. Furthermore, the study emphasizes governmental responsibility in providing secure housing, and to address long-term vulnerabilities beyond pandemics.

Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: A cross-sectional, population-based, multi-level analysis in a German federal state

Asylum seekers and refugees (ASR) in Germany are dispersed quasi-randomly to state-provided, collective accommodation centres. We aimed to analyse contextual effects of post-migration housing environment on their mental health. We drew a balanced random sample of 54 from 1 938 accommodation centres with 70 634 ASR in Germany's 3rd largest federal state. Individual-level data on depression and anxiety as well as sociodemographic- and asylum-related covariates, were collected and linked to contextual geo-referenced data on housing environment ('Small-area Housing Environment Deterioration' index, number of residents, remoteness, urbanity, and German Index of Multiple Deprivation). We fitted two-level random-intercept models to exploratively estimate adjusted contextual effects. Of 411 surveyed participants, 45.53% and 44.83%, respectively, reported symptoms of depression or anxiety. 52.8% lived in centres with highest deterioration, 46.2% in centres with > = 50 residents, 76.9% in urban, and 56% in deprived districts. 7.4% of centres were remote. We found statistically significant clustering in reporting anxiety on the level of accommodation centres. The model resulted in an intraclass correlation of 0.16 which translated into a median odds ratio of 2.10 for the accommodation-level effects. No significant clustering was found for symptoms of depression. The highest degree of deterioration, large accommodation size, remoteness, and district urbanity showed higher, but statistically not significant, odds for reporting anxiety or depression. District deprivation demonstrated higher odds for anxiety and lower odds for depression yet remained statistically insignificant for both. Evidence for contextual effects of housing environment on mental health of ASR could not be established but residual confounding by length of stay in the accommodation centre cannot be ruled out. Confirmatory analyses with prior power calculations are needed to complement these exploratory estimates.

[Determinants of asylum seekers' health and medical care in Germany]

Asylum seekers in Germany are exposed to a variety of health-related stressors, while their access to medical care is impaired. This review explains some of the determinants that structure this situation, for example by elaborating on how the Asylum Seekers' Benefits Act (ASBA), billing via treatment vouchers, and accommodation in refugee shelters affect asylum seekers' health and healthcare utilization. Hereby, it becomes clear that the exclusion of asylum seekers from the welfare system is detrimental to their health, is expensive, and raises ethical and legal questions. In particular, the huge discretionary scope of the social welfare offices in the assumption of costs as well as the different models for billing medical services for asylum seekers are potentially unjust and lead to a plurality of care, which lacks legal and ethical justification.The second part of the article shows that asylum seekers generally suffer from the same health problems as people with statutory health insurance-with the exception of mental illnesses, which are substantially more common among asylum seekers, but are often undiagnosed and frequently inadequately treated.This leads to three practical conclusions: (1) asylum seekers should be integrated into statutory health insurance, (2) from a public health point of view, accommodation in refugee shelters should be avoided in favor of decentralized accommodation, and (3) to ensure diversity-sensitive care for all patients, the healthcare system must make adjustments to its structures and practices.

[Early crisis response to the COVID-19 pandemic in collective accommodation facilities for refugees : Analysis of cross-actor working arrangements from the perspective of the reception authorities in Germany]

BACKGROUND

Refugees in collective accommodation facilities are at increased risk of COVID-19-infections due to high occupancy density and shared spaces. It is unclear which (organisational) actors the reception authorities were working with in their crisis response and how. The aim of this paper is to examine the working arrangements between reception authorities and other actors involved in accommodation and (health) care during the first wave of the COVID-19 pandemic and to derive recommendations for future crisis responses.

METHODS

The analysis was based on qualitative interviews with representatives responsible for the reception and accommodation of refugees (N = 46) conducted from May to July 2020. Cross-actor networks were visualised, and a qualitative analysis of the data material was carried out using the framework method.

RESULTS

The reception authorities worked with a multitude of other (organisational) actors. Health authorities, social workers and security personnel were mentioned most frequently. The crisis response was found to be highly heterogeneous due to its dependence on the commitment, knowledge and attitude of the individuals and organisations involved. In the absence of a coordinating actor, there may also be delays due to a "wait-and-see" attitude of the actors involved.

CONCLUSION

Crisis response in collective accommodation facilities for refugees would benefit from a clear allocation of the coordinating role to an appropriate actor. Instead of improvised ad hoc solutions, sustainable improvements in terms of transformative resilience are needed to reduce structural vulnerabilities.

Seropositivity and flight-associated risk factors for SARS-CoV-2 infection among asylum seekers arriving in Berlin, Germany - a cross-sectional study

Introduction

Refugees and asylum seekers might be at increased risk of SARS-CoV-2 infection due to precarious living conditions during flight.

Methods

Between March 24th and June 15th 2021, we conducted a cross-sectional study among adult asylum seekers arriving in Berlin. Each participant was tested for acute SARS-CoV-2 infection with a nasopharyngeal swab using reverse transcriptase PCR (rt-PCR), and for anti-SARS-CoV-2-S1 IgG antibodies using ELISA. Seropositivity, antibody avidity, and data on flight history were used to categorize individuals into two groups according to the estimated time of infection before or during flight. Sociodemographic characteristics, COVID-19 related symptoms, hygiene behaviors, and living conditions during transit were assessed using two self-report questionnaires.

Results

Among 1041 participants (34·5% female, mean age 32·6 years), most frequently reported countries of origin were Moldova (20·5%), Georgia (18·9%), Syria (13·0%), Afghanistan (11·3%), and Vietnam (9·1%). Seropositivity rate was 25·1% and incidence rate of acute SARS-CoV-2 infection was 2·8%. A higher likelihood for seropositivity was observed in women (OR [95%CI]=1·64 [1·05-2·57]) but reduced by frequent hygiene behaviors (OR [95%CI]=0·75 [0·59-0·96]) or traveling by plane (OR [95%CI]=0·58 [0·35-0·96]). Other associated factors were lower educational level, accommodation in refugee shelters, traveling with children or by foot, and COVID-19 information seeking.

Conclusion

Flight-associated risk factors such as accommodation in a refugee shelter and poor hygiene behaviors are associated with an elevated risk of infection, which should be addressed by public health interventions.

Clinical trial registration

[https://doi.org/10.1186/ISRCTN17401860], identifier [17401860].

A Mobile-Based Preventive Program for Young, Arabic-Speaking Asylum Seekers during the COVID-19 Pandemic in Germany: Design, Feasibility, and Implementation

BACKGROUND

A majority of individuals seeking asylum in Germany are living in collective housings and thus exposed to a higher risk of contagion during the COVID-19 pandemic.

OBJECTIVE

To test feasibility and efficacy of a culture-sensitive approach combining mobile app-based interventions and a face-to-face group intervention to improve knowledge about COVID-19 and promote vaccination readiness among collectively accommodated Arabic-speaking adolescents and young adults.

METHODS

We developed a mobile app that was composed of short video clips to explain the biological basis of COVID-19, demonstrate behavior to prevent transmission, and combat misconceptions and myths about vaccination. Explanations were given in a YouTube-like interview setting by a native Arabic-speaking physician. Elements of gamification (quizzes, rewards for solving test items) were also used. Consecutive videos and quizzes were presented over an intervention period of six weeks, the group intervention was scheduled as an add-on for half of participants in week 6. The manual of the group intervention was designed to provide actual behavior planning on the basis of the health action process approach. Sociodemographic information, mental health status, and knowledge about Covid-19 and available vaccines were assessed with questionnaire-based interviews at baseline and after six weeks. Interpreters assisted with the interviews in all cases.

RESULTS

Enrollment in the study proved to be very challenging as among other things, the housing facilities allowed contact with potentially eligible participants only during certain periods because of the pandemic situation. Also due to tightened contact restrictions, the face-to-face group interventions could not be held as planned. A total of 88 participants from 8 collective housing institutions were included in the study. 61 participants completed the full intake interview. Most participants had already been vaccinated at study enrollment (76.5%). They also yet claimed to comply with preventive measures to a very high extent (e.g., "always wearing masks" was indicated by 66% of participants), but practicing behavior that was not considered as effective against Covid-19 transmission was also frequently reported as a preventive measure (e.g., mouth rinsing). On the other hand, factual disease knowledge for COVID-19 was limited. Preoccupation with the information materials presented in the app steeply declined after study enrollment (e.g., 19% of participants watched the videos scheduled for week 3). Only 18 participants could be reached for the follow-up interview. Their COVID-19 disease knowledge did not shown to have increased after the intervention period (p=0.558).

CONCLUSIONS

The results indicate that vaccine uptake was high and seemed to be depending on organizational determinants for the target group. The current mobile app-based intervention demonstrated low feasibility, which might have been related to various obstacles faced during the delivery: Learning from mobile phone content based on short videos requires a basic understanding of biological and IT-aspects as well as sufficient literacy and a living situation enabling the practical application of the learned behavioral prevention strategies. Therefore, in case of future pandemics, transmission prevention in the specific target group should rely more on structural aspects instead on sophisticated psychological interventions.

CLINICALTRIAL

https://www.drks.de, identifier: DRKS00028825.

Covid-19 case management in a Greek migrant camp: The Hellenic Red Cross Mobile Health Unit intervention in Nea Malakasa temporary accommodation center

Introduction

Since the outbreak of the Covid-19 pandemic the scientific community had expressed its concerns about increased transmission of the virus within asylum seeker accommodation centers due to substandard living conditions and poor sanitation. Studies regarding management of Covid-19 cases in such facilities are urgently needed in order to guide international strategies on future pandemics within the humanitarian setting. Our study's paradigm of Covid-19 case management in a Greek migrant camp aims to add on existing data.

Data and Methods

A retrospective analysis of epidemiological and demographical data collected as part of a healthcare intervention in a Greek migrant camp during three Covid-19 epidemic waves is presented in this study. Descriptive statistics were generated using STATA 12.

Results

During the first wave, the camp's administration adopted a 2-month strict lockdown strategy and no positive cases were recorded. During the second wave, suspected coronavirus cases were referred for PCR testing and, in case of positivity were hospitalized. 3% (n=28) of the camp's population were referred for PCR, with 1% of the population (n=10) being tested positive for Covid-19 and admitted to hospital. Close contacts of positive cases were encouraged to comply with non-pharmaceutical interventions and were offered medical care if symptoms developed. During the third epidemic wave, in-camp management was decided by on-site operators, with rapid antigen testing of symptomatic individuals, daily monitoring of positive cases by the medical team and mass screening of their closed contacts. 4% (n=33) of the camp's residents were tested positive, while none was hospitalized. 19% (n=148) of the camp's population were considered close contacts, were advised to self-isolate and were offered mass screening with rapid antigen test, from which another 21 positive cases emerged. In total, 7% (n=54) of the camp population, (n=21) female adults, (n=24) male adults and (n=9) children, were infected with SARS-CoV-2 during the third epidemic wave, with no deaths being recorded. During the study period, only 50 residents had received one dose of Covid-19 vaccines.

Conclusion

We recommend an in-camp Covid-19 response featuring regular follow up of positive cases and prompt referral to tertiary centers based on clinical criteria, while overemphasizing the need for equitable access to primary healthcare for asylum seekers in Greece, primarily during the current pandemic. Prolonged camp lockdowns should be avoided as they pose substantial health risks for their vulnerable population.

Between Care and Coercion: Asylum Seekers’ Experiences With COVID-19 Containment and Mitigation Measures in German Reception Centres

Objectives: COVID-19 containment and mitigation measures have been criticised for amplifying pre-existing individual and structural vulnerabilities among asylum seekers. We qualitatively explored their experiences with and attitudes towards pandemic measures to inform people-centred responses in future health emergencies.

Methods: We interviewed eleven asylum seekers in a German reception centre (July-December 2020). The semi-structured interviews were recorded, transcribed, and analysed thematically with an inductive-deductive approach.

Results: Quarantine was experienced as burdensome by participants. Shortcomings in social support, everyday necessities, information, hygiene, and daily activities exacerbated the strains of quarantine. Interviewees held different opinions about the usefulness and appropriateness of the various containment and mitigation measures. These opinions differed by individual risk perception and the measures’ comprehensibility and compatibility with personal needs. Power asymmetries related to the asylum system furthermore impacted on preventive behaviour.

Conclusion: Quarantine can amplify mental health burdens and power asymmetries and can therefore constitute a considerable stressor for asylum seekers. Provision of diversity-sensitive information, daily necessities, and accessible psychosocial support is required to counteract adverse psychosocial impacts of pandemic measures and safeguard wellbeing in this population.

Situation marginalisierter Menschen während der Pandemie am Beispiel Migration und Flucht: ein Sachverständigenbeitrag zur Enquete Kommission „Krisenfeste Gesellschaft“

Wie steht es um die Resilienz des Systems während der Pandemie, wenn es um marginalisierte Bevölkerungsgruppen geht? Dieser Frage ging der folgende Sachverständigenbeitrag zur Enquete Kommission „Krisenfeste Gesellschaft“ des Landtags Baden-Württemberg 1 am Beispiel der gesundheitlichen Folgen der Corona-Pandemie bei geflüchteten Menschen nach. Hierzu wurden Befunde zum Gesundheitsschutz in Sammelunterkünften aus der empirischen Public Health Forschung präsentiert. Die Ergebnisse fokussierten die Bereiche die Bereiche der Pandemievorsorge, der akuten Krisenreaktion, sowie der Adaptionen von Prozessen und Verfahren im weiteren Verlauf der Pandemie. Ein weiterer Fokus liegt auf der intersektoralen Zusammenarbeit und der Rolle des Öffentlichen Gesundheitsdienst bei der Umsetzung von Maßnahmen der Prävention bei marginalisierten Gruppen am Beispiel Fluchtmigration.

Comparable worth of life for all? Conducting and disseminating health economic evaluations for refugees in Germany

Comparative health economic evaluation is based on premise of being able to compare the worth of a year of life lived in full quality across different patients, population groups, settings and interventions. Given the rising numbers of forcibly displaced people, the nexus of economics, migration and health has emerged as a central theme in recent conceptual and empirical approaches. However, some of the assumptions made in conventional economic approaches do not hold true in the decision-making context of migration and the health of forcibly displaced populations. Using the experience of conducting and disseminating economic analyses to support decision-making on health screening policies for refugees in Germany, we show that in particular the assumptions of individual utility with no positive externalities, equity-blind utilitarian ethical stances and stable budgets are challenged. The further development of methods to address these challenges are required to support decision-makers in this contentious and politically fraught context and continue to make choices and decisions transparent.