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      The impact of the COVID-19 pandemic among migrants in shelters in Tijuana, Baja California, Mexico

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          Abstract

          Introduction

          Migrants, especially those in temporary accommodations like camps and shelters, might be a vulnerable population during the COVID-19 pandemic, but little is known about the impact of the pandemic in these settings in low-income and middle-income countries. We assessed SARS-CoV-2 seropositivity and RNA prevalence, the correlates of seropositivity (emphasising socially determined conditions), and the socioeconomic impacts of the pandemic among migrants living in shelters in Tijuana, a city on the Mexico-US border.

          Methods

          We conducted a cross-sectional, non-probability survey of migrants living in shelters in Tijuana in November–December 2020 and February–April 2021. Participants completed a questionnaire and provided anterior nasal swab and blood samples for detection of SARS-CoV-2 RNA and antibodies (IgG and IgM), respectively. We explored whether SARS-CoV-2 infection was associated with sociodemographic and migration-related variables, access to sanitation, protective behaviours and health-related factors.

          Results

          Overall, 481 participants were enrolled, 67.7% from Northern Central America, 55.3% women, mean age 33.2 years. Seven (1.5%) participants had nasal swabs positive for SARS-CoV-2 RNA and 53.0% were SARS-CoV-2 seropositive. Avoiding public transportation (OR 0.59, 95% CI 0.39 to 0.90) and months living in Tijuana (OR 1.06, 95% CI 1.02 to 1.10) were associated with seropositivity. Sleeping on the streets or other risky places and having diabetes were marginally associated with seropositivity. Most participants (90.2%) had experienced some socioeconomic impact of the pandemic (eg, diminished income, job loss).

          Conclusion

          Compared with results from other studies conducted in the general population in Mexico at a similar time, migrants living in shelters were at increased risk of acquiring SARS-CoV-2, and they suffered considerable adverse socioeconomic impacts as a consequence of the pandemic. Expanded public health and other social support systems are needed to protect migrants from COVID-19 and reduce health inequities.

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          Most cited references27

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          The UCL–Lancet Commission on Migration and Health: the health of a world on the move

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            Migrants’ and refugees’ health status and healthcare in Europe: a scoping literature review

            Background There is increasing attention paid to the arrival of migrants from outwith the EU region to the European countries. Healthcare that is universally and equably accessible needs to be provided for these migrants throughout the range of national contexts and in response to complex and evolving individual needs. It is important to look at the evidence available on provision and access to healthcare for migrants to identify barriers to accessing healthcare and better plan necessary changes. Methods This review scoped 77 papers from nine European countries (Austria, Cyprus, France, Germany, Greece, Italy, Malta, Spain, and Sweden) in English and in country-specific languages in order to provide an overview of migrants’ access to healthcare. The review aims at identifying what is known about access to healthcare as well as healthcare use of migrants and refugees in the EU member states. The evidence included documents from 2011 onwards. Results The literature reviewed confirms that despite the aspiration to ensure equality of access to healthcare, there is evidence of persistent inequalities between migrants and non-migrants in access to healthcare services. The evidence shows unmet healthcare needs, especially when it comes to mental and dental health as well as the existence of legal barriers in accessing healthcare. Language and communication barriers, overuse of emergency services and underuse of primary healthcare services as well as discrimination are described. Conclusions The European situation concerning migrants’ and refugees’ health status and access to healthcare is heterogeneous and it is difficult to compare and draw any firm conclusions due to the scant evidence. Different diseases are prioritised by different countries, although these priorities do not always correspond to the expressed needs or priorities of the migrants. Mental healthcare, preventive care (immunization) and long-term care in the presence of a growing migrant older population are identified as priorities that deserve greater attention. There is a need to improve the existing data on migrants’ health status, needs and access to healthcare to be able to tailor care to the needs of migrants. To conduct research that highlights migrants’ own views on their health and barriers to access to healthcare is key.
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              Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: a systematic review

              Background Migrants in high-income countries may be at increased risk of COVID-19 due to their health and social circumstances, yet the extent to which they are affected and their predisposing risk factors are not clearly understood. We did a systematic review to assess clinical outcomes of COVID-19 in migrant populations, indirect health and social impacts, and to determine key risk factors. Methods We did a systematic review following PRISMA guidelines (PROSPERO CRD42020222135). We searched multiple databases to 18/11/2020 for peer-reviewed and grey literature on migrants (foreign-born) and COVID-19 in 82 high-income countries. We used our international networks to source national datasets and grey literature. Data were extracted on primary outcomes (cases, hospitalisations, deaths) and we evaluated secondary outcomes on indirect health and social impacts and risk factors using narrative synthesis. Results 3016 data sources were screened with 158 from 15 countries included in the analysis (35 data sources for primary outcomes: cases [21], hospitalisations [4]; deaths [15]; 123 for secondary outcomes). We found that migrants are at increased risk of infection and are disproportionately represented among COVID-19 cases. Available datasets suggest a similarly disproportionate representation of migrants in reported COVID-19 deaths, as well as increased all-cause mortality in migrants in some countries in 2020. Undocumented migrants, migrant health and care workers, and migrants housed in camps have been especially affected. Migrants experience risk factors including high-risk occupations, overcrowded accommodation, and barriers to healthcare including inadequate information, language barriers, and reduced entitlement. Conclusions Migrants in high-income countries are at high risk of exposure to, and infection with, COVID-19. These data are of immediate relevance to national public health and policy responses to the pandemic. Robust data on testing uptake and clinical outcomes in migrants, and barriers and facilitators to COVID-19 vaccination, are urgently needed, alongside strengthening engagement with diverse migrant groups.
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                Author and article information

                Journal
                BMJ Glob Health
                BMJ Glob Health
                bmjgh
                bmjgh
                BMJ Global Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2059-7908
                2022
                11 March 2022
                11 March 2022
                : 7
                : 3
                : e007202
                Affiliations
                [1 ]departmentDepartment of Population Studies , El Colegio de la Frontera Norte , Tijuana, Baja California, Mexico
                [2 ]departmentDivision of Infectious Diseases and Global Public Health, School of Medicine , University of California San Diego , La Jolla, California, USA
                [3 ]departmentDepartment of Medicine , University of California San Diego , La Jolla, California, USA
                [4 ]departmentInstitute for Global Health Sciences , University of California San Francisco , San Francisco, California, USA
                Author notes
                [Correspondence to ] Dr Jaime Sepulveda; Jaime.Sepulveda@ 123456ucsf.edu
                Article
                bmjgh-2021-007202
                10.1136/bmjgh-2021-007202
                8919131
                35277428
                a24debb1-7ac3-4ae1-af25-bda74b7f49a9
                © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 10 October 2021
                : 10 February 2022
                Funding
                Funded by: San Diego Center For AIDS Research (CFAR);
                Award ID: P30 AI036214
                Funded by: OAR;
                Award ID: R00RG2725
                Funded by: NIAID;
                Funded by: FundRef http://dx.doi.org/10.13039/100008069, University of California, San Francisco;
                Funded by: American Academy of Arts and Science;
                Award ID: N/A
                Funded by: NIH;
                Award ID: P30 AI036214
                Funded by: NIDCR;
                Funded by: NIDDK;
                Funded by: FIC;
                Funded by: NIH NIDA;
                Award ID: R01DA055491
                Funded by: NIMHD;
                Funded by: NIGMS;
                Funded by: NIMH;
                Funded by: NCI;
                Funded by: NIA;
                Funded by: NICHD;
                Funded by: NIDA;
                Categories
                Original Research
                1506
                2474
                Custom metadata
                unlocked

                covid-19,epidemiology,cross-sectional survey
                covid-19, epidemiology, cross-sectional survey

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