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      The Impact of the Covid-19 Pandemic and the Lockdown on the Health and Living Conditions of Undocumented Migrants and Migrants Undergoing Legal Status Regularization

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          Abstract

          Introduction: Undocumented migrants are at high risk of adverse consequences during crises because of a lack of access to essential securities and sources of support. This study aims to describe the impact of the COVID-19 crisis on the health and living circumstances of precarious migrants in Switzerland and to assess whether those undergoing legal status regularization fared better than undocumented migrants.

          Materials and methods: This cross-sectional mixed methods study was conducted during the COVID-19 lockdown in April–May 2020. Undocumented and recently regularized migrants taking part in an ongoing cohort study were asked to respond to an online questionnaire. A subsample was selected to undergo semi-directed phone interviews.

          Results: Overall, 117 of the 379 (30.9%) cohort study participants responded to the questionnaire. Seventeen interviews were conducted. Migrants faced cumulative and rapidly progressive difficulties in essential life domains. As a consequence, they showed high prevalence of exposure to COVID-19, poor mental health along with frequent avoidance of health care. Moreover, the loss of working hours and the related income overlapped with frequent food and housing insecurity. Around one participant in four had experienced hunger. Despite these unmet needs, half of the participants had not sought external assistance for reasons that differ by legal status. Both groups felt that seeking assistance might represent a threat for the renewal or a future application for a residency permit. While documented migrants were less severely affected in some domains by having accumulated more reserves previously, they also frequently renounced to sources of support.

          Conclusions: The cumulated difficulties faced by migrants in this period of crisis and their limited search for assistance highlight the need to implement trust-building strategies to bridge the access gap to sources of support along with policies protecting them against the rapid loss of income, the risk of losing their residency permit and the exposure to multi-fold insecurities.

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          A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.

          Regression methods were used to select and score 12 items from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) to reproduce the Physical Component Summary and Mental Component Summary scales in the general US population (n=2,333). The resulting 12-item short-form (SF-12) achieved multiple R squares of 0.911 and 0.918 in predictions of the SF-36 Physical Component Summary and SF-36 Mental Component Summary scores, respectively. Scoring algorithms from the general population used to score 12-item versions of the two components (Physical Components Summary and Mental Component Summary) achieved R squares of 0.905 with the SF-36 Physical Component Summary and 0.938 with SF-36 Mental Component Summary when cross-validated in the Medical Outcomes Study. Test-retest (2-week)correlations of 0.89 and 0.76 were observed for the 12-item Physical Component Summary and the 12-item Mental Component Summary, respectively, in the general US population (n=232). Twenty cross-sectional and longitudinal tests of empirical validity previously published for the 36-item short-form scales and summary measures were replicated for the 12-item Physical Component Summary and the 12-item Mental Component Summary, including comparisons between patient groups known to differ or to change in terms of the presence and seriousness of physical and mental conditions, acute symptoms, age and aging, self-reported 1-year changes in health, and recovery for depression. In 14 validity tests involving physical criteria, relative validity estimates for the 12-item Physical Component Summary ranged from 0.43 to 0.93 (median=0.67) in comparison with the best 36-item short-form scale. Relative validity estimates for the 12-item Mental Component Summary in 6 tests involving mental criteria ranged from 0.60 to 107 (median=0.97) in relation to the best 36-item short-form scale. Average scores for the 2 summary measures, and those for most scales in the 8-scale profile based on the 12-item short-form, closely mirrored those for the 36-item short-form, although standard errors were nearly always larger for the 12-item short-form.
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            Social distancing responses to COVID-19 emergency declarations strongly differentiated by income

            In the absence of a vaccine, social distancing measures are one of the primary tools to reduce the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, which causes coronavirus disease 2019 (COVID-19). We show that social distancing following US state-level emergency declarations substantially varies by income. Using mobility measures derived from mobile device location pings, we find that wealthier areas decreased mobility significantly more than poorer areas, and this general pattern holds across income quantiles, data sources, and mobility measures. Using an event study design focusing on behavior subsequent to state emergency orders, we document a reversal in the ordering of social distancing by income: Wealthy areas went from most mobile before the pandemic to least mobile, while, for multiple measures, the poorest areas went from least mobile to most. Previous research has shown that lower income communities have higher levels of preexisting health conditions and lower access to healthcare. Combining this with our core finding—that lower income communities exhibit less social distancing—suggests a double burden of the COVID-19 pandemic with stark distributional implications.
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              Refugee and migrant health in the COVID-19 response

              In a continued effort to curb the spread of coronavirus disease 2019 (COVID-19), countries have been tightening borders and putting travel restrictions in place. These actions have affected refugees and migrants worldwide. The International Organization for Migration and UNHCR announced on March 10, 2020, that resettlement travel for refugees will be temporarily suspended, although the agencies have appealed to states to ensure emergency cases are exempted. 1 The COVID-19 pandemic has prompted some countries to take steps towards further reducing population movement that affects humanitarian corridors around the world. At the same time, there could be cases of refoulement with asylum seekers being returned to their countries of origin, where they are at risk of persecution and in an apparent breach of international law. As of March 29, 2020, WHO reported 146 countries and territories with cases of COVID-19 from local transmission of severe acute respiratory syndrome coronavirus 2, many of which have large refugee populations. 2 Search and rescue operations in the central Mediterranean, where more than 16 000 migrants have died since 2015, 3 have been suspended due to logistical difficulties caused by COVID-19. The few search and rescue operations conducted before the COVID-19 nationwide lockdowns led to the immediate quarantine of migrants in reception centres. These measures were taken even though there was no confirmed case of COVID-19 in Africa at that time. In fact, some refugees and migrants are travelling from countries not yet substantially affected by COVID-19 and entering countries with increasing numbers of COVID-19 cases. Measures to respond to the COVID-19 pandemic are a focus of communities in countries, but preparedness plans should consider refugees and migrants and their needs. Evidence shows that this vulnerable population has a low risk of transmitting communicable diseases to host populations in general. 4 However, refugees and migrants are potentially at increased risk of contracting diseases, including COVID-19, because they typically live in overcrowded conditions without access to basic sanitation. The ability to access health-care services in humanitarian settings is usually compromised and exacerbated by shortages of medicines and lack of health-care facilities. Moreover, refugees typically face administrative, financial, legal, and language barriers to access the health system. 4 Conditions in refugee camps are concerning. Many people who have been affected by humanitarian crises live in camps or camp-like settings in host countries. These camps usually provide inadequate and overcrowded living arrangements that present a severe health risk to inhabitants and host populations. The absence of basic amenities, such as clean running water and soap, insufficient medical personnel presence, and poor access to adequate health information are major problems in these settings. Basic public health measures, such as social distancing, proper hand hygiene, and self-isolation are thus not possible or extremely difficult to implement in refugee camps. If no immediate measures to improve conditions are put in place, the concern about an outbreak of COVID-19 in the camps cannot be overstated. Site-specific epidemiological risk assessments must be done to determine the extent of the risk of COVID-19 introduction and transmission in such settlements, together with case management protocols and rapid deployment of outbreak response teams if needed. Migrants and refugees are particularly vulnerable to the impact of COVID-19 in the wider community. They are over-represented among the homeless population in most member states—a growing trend in EU-15 and border and transit countries. 5 Living conditions for homeless refugees and migrants can undermine the ability to follow public health advice, including basic hygiene measures, quarantine, or self-isolation, because many people are in close contact and gather in large groups. Furthermore, international migrant workers and refugees can be affected by income loss, health-care insecurity, and the ramifications that come with postponement of decisions on their legal status or reduction of employment, legal, and administrative services. There is also scarce culturally and linguistically accessible information about COVID-19 and how to protect oneself and others, which further increases risks to refugees and migrants as well as host populations. © 2020 Alkis Konstantinidis/Reuters 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. Additionally, states of emergency and lockdowns to deal with the pandemic have affected refugee and migrant volunteer community service provision for this population group. An inclusive approach to refugee and migrant health that leaves no one behind during the COVID-19 pandemic should guide our public health efforts. As governments tighten border controls and implement other measures in response to COVID-19, they need to consider the impacts on refugees and migrants and ensure that such actions do not prevent people from accessing safety, health-care services, and information. There must be no forced returns and refoulement justified by or based on fears or suspicion of COVID-19 transmission, especially because there is estimated to be low risk of transmitting communicable disease from refugee and migrant populations to host populations in the WHO European region. 4 Yet migrants and refugees are often stigmatised and unjustly discriminated against for spreading disease and such unacceptable attitudes further risk wider public health outcomes, including for host populations, since refugees and migrants could be fearful to seek treatment or disclose symptoms. 6 Refugees and migrants must be included in national public health systems, with no risk of financial or legal consequences for them. This approach is of the utmost importance, as there can be no public health without refugee and migrant health.
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                16 December 2020
                2020
                16 December 2020
                : 8
                : 596887
                Affiliations
                [1] 1Institute of Sociological Research, University of Geneva , Geneva, Switzerland
                [2] 2Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives”, University of Geneva , Geneva, Switzerland
                [3] 3Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva , Geneva, Switzerland
                [4] 4Faculty of Public Health and Policy, London School of Tropical Medicine and Hygiene , London, United Kingdom
                [5] 5Division of Primary Care Medicine, Geneva University Hospital and University of Geneva , Geneva, Switzerland
                Author notes

                Edited by: Joao Sollari Lopes, National Statistical Institute of Portugal, Portugal

                Reviewed by: Tony Kuo, UCLA Fielding School of Public Health, United States; Alexander C. Tsai, Massachusetts General Hospital and Harvard Medical School, United States

                *Correspondence: Yves Jackson Yves.jackson@ 123456hcuge.ch

                This article was submitted to Life-Course Epidemiology and Social Inequalities in Health, a section of the journal Frontiers in Public Health

                Article
                10.3389/fpubh.2020.596887
                7772178
                33392134
                896e5be0-79ba-4104-8b07-c7b006a520d3
                Copyright © 2020 Burton-Jeangros, Duvoisin, Lachat, Consoli, Fakhoury and Jackson.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 20 August 2020
                : 25 November 2020
                Page count
                Figures: 2, Tables: 4, Equations: 0, References: 32, Pages: 11, Words: 8041
                Funding
                Funded by: Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung 10.13039/501100001711
                Categories
                Public Health
                Original Research

                covid-19,migrant,impact,lockdown,undocumented,health,living conditions

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