• World report on the health of refugees and migrants

    Worldwide, more people are on the move now than ever before, yet many refugees and migrants face poorer health outcomes than the host populations. Addressing their health needs is, therefore, a global health priority and integral to the principle of the right to health for all. The key is to strengthen and maintain health systems by ensuring that they are refugee- and migrant-sensitive and inclusive.

    Health outcomes are influenced by a whole host of determinants. However, refugees and migrants face additional determinants such as precarious legal status; discrimination; social, cultural, linguistic, administrative and financial barriers; lack of information about health entitlements; low health literacy; and fear of detention and deportation.

    This groundbreaking publication outlines current and future opportunities and challenges and provides several strategies to improve the health and well-being of refugees and migrants. It is an advocacy tool for national and international policy-makers involved in health and migration.

    Evidence on the health of refugees and migrants remains fragmented – comparable data across countries and over time are urgently needed to track progress towards the health-related United Nations Sustainable Development Goals. With only 8 years until the 2030 target date to transform our world, the time to act is now.

    https://www.who.int/publications/i/item/9789240054462
    #rapport #santé #réfugiés #migrations #asile #monde #OMS

    ping @isskein @karine4

  • Dernière mise à jour de l’#OMS sur les modes de #transmission du #SARS-CoV-2 et les implications pour la #prévention et les #précautions ;
    https://www.who.int/publications-detail-redirect/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution
    https://apps.who.int/iris/rest/bitstreams/1286634/retrieve

    L’OMS, tout en acceptant l’hypothèse de la transmission par #aérosol, continue de donner une importance plus grande aux gouttelettes et elle persiste à estimer que les cas #asymptomatiques sont peu contagieux.

    La partie sur la transmission est résumée par Helen Branswell sur Twitter : https://mobile.twitter.com/helenbranswell/status/1281274685616001024

    WHO issued an update on how #Covid19 transmits. It says:

    a) In some cases/places short-term aerosol transmission can’t be ruled out, though droplet & fomite transmission could also explain these cases.

    b) Most transmission occurs via droplets, from symptomatic people." /

    c) most transmission seems to occur when people have symptoms or just before they develop symptoms.

    d) it’s not clear how often people who are truly asymptomatic — never have symptoms — transmit. Percentage thought to be low

    e) Fomites (virus on surfaces) are considered a likely mode of transmission, but no clear cases yet.

    f) Not clear if transmission through blood is possible; risk seems low.

  • #OMS 5 juin 2020 (page 2) : transmission du #sars-cov2 selon le statut symptomatique, pré-symptomatique, asymptomatique du sujet porteur
    https://apps.who.int/iris/rest/bitstreams/1279750/retrieve

    Current evidence suggests that most transmission of #COVID- 19 is occurring from symptomatic people to others in close contact, when not wearing appropriate PPE. Among symptomatic patients, viral RNA can be detected in samples weeks after the onset of illness, but viable virus was not found after day 8 post onset of symptoms (19, 20) for mild patients, though this may be longer for severely ill patients. Prolonged RNA shedding, however, does not necessarily mean continued infectiousness.

    Transmissibility of the virus depends on the amount of viable virus being shed by a person, whether or not they are coughing and expelling more droplets, the type of contact they have with others, and what IPC measures are in place. Studies that investigate transmission should be interpreted bearing in mind the context in which they occurred.

    There is also the possibility of transmission from people who are infected and shedding virus but have not yet developed symptoms; this is called pre-symptomatic transmission. The incubation period for COVID-19, which is the time between exposure to the virus and symptom onset, is on average 5-6 days, but can be as long as 14 days.(21, 22) Additionally, data suggest that some people can test positive for COVID-19, via polymerase chain reaction (PCR) testing 1-3 days before they develop symptoms.(23) Pre-symptomatic transmission is defined as the transmission of the COVID-19 virus from someone infected and shedding virus but who has not yet developed symptoms. People who develop symptoms appear to have higher viral loads on or just prior to the day of symptom onset, relative to later on in their infection.(24)

    Some people infected with the COVID-19 virus do not ever develop any symptoms, although they can shed virus which may then be transmitted to others. One recent systematic review found that the proportion of asymptomatic cases ranged from 6% to 41%, with a pooled estimate of 16% (12%–20%), (25) although most studies included in this review have important limitations of poor reporting of symptoms, or did not properly define which symptoms they were investigating. Viable virus has been isolated from specimens of pre-symptomatic and asymptomatic individuals, suggesting, therefore, that people who do not have symptoms may be able transmit the virus to others.(26) Comprehensive studies on transmission from asymptomatic individuals are difficult to conduct, but the available evidence from contact tracing reported by Member States suggests that asymptomatically-infected individuals are much less likely to transmit the virus than those who develop symptoms.
    Among the available published studies, some have described occurrences of transmission from people who did not have symptoms.(21,25-32) For example, among 63 asymptomatically-infected individuals studied in China, there was evidence that 9 (14%) infected another person.(31) Furthermore, among two studies which carefully investigated secondary transmission from cases to contacts, one found no secondary transmission among 91 contacts of 9 asymptomatic cases,(33) while the other reported that 6.4% of cases were attributable to pre-symptomatic transmission.(32) The available data, to date, on onward infection from cases without symptoms comes from a limited number of studies with small samples that are subject to possible recall bias and for which fomite transmission cannot be ruled out.

    • WHO Says Asymptomatic Spread “Rare,” Sparking Debate | Global Health NOW
      https://www.globalhealthnow.org/2020-06/who-says-asymptomatic-spread-rare-sparking-debate

      The WHO called into question the extent that asymptomatic people are spreading COVID-19, launching a global debate, The Hill reports.

      “From the data we have, it still seems to be rare that an asymptomatic person actually transmits onward to a secondary individual,” said Maria Van Kerkhove, the WHO’s technical lead for COVID-19, citing unpublished data from detailed contact tracing reports at a briefing yesterday. She suggested that the focus should be on following symptomatic cases.

      If accurate, the implications would be huge—perhaps allowing some shutdown restrictions to ease. But if wrong, it could undo months of hard work, at a time people are chafing at the restrictions.

      Already, shutdown critics are pouncing on the news on social media.

      But Harvard Global Health Institute director Ashish Jha posited in a Twitter thread that the WHO could be using the term “asymptomatic,” when it really means “presymptomatic,”—an important distinction. Jha suggests that the agency should be more clear in its messaging, and notes that some models “suggest 40-60% of spread is from people when they didn’t have symptoms,” Forbes reports.

  • Advice on the use of masks in the community, during home care and in healthcare settings in the context of the novel coronavirus (COVID-19) outbreak
    https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-

    This document provides advice on the use of masks in communities, during home care, and in health care settings in areas that have reported cases of COVID-19. It is intended for individuals in the community, public health and infection prevention and control (IPC) professionals, health care managers, health care workers (HCWs), and community health workers. This updated version includes a section on Advice to decision makers on the use of masks for healthy people in community settings.

    20 avril, le truc est toujours en ligne.
    https://apps.who.int/iris/rest/bitstreams/1274280/retrieve

    Studies of influenza, influenza-like illness, and human
    coronaviruses provide evidence that the use of a medical
    mask can prevent the spread of infectious droplets from an
    infected person to someone else and potential contamination
    of the environment by these droplets. 13 There is limited
    evidence that wearing a medical mask by healthy individuals
    in the households or among contacts of a sick patient, or
    among attendees of mass gatherings may be beneficial as a
    preventive measure. 14-23 However, there is currently no
    evidence that wearing a mask (whether medical or other types)
    by healthy persons in the wider community setting, including
    universal community masking, can prevent them from
    infection with respiratory viruses, including COVID-19.

    Medical masks should be reserved for health care workers.
    The use of medical masks in the community may create a
    false sense of security, with neglect of other essential
    measures, such as hand hygiene practices and physical
    distancing, and may lead to touching the face under the masks
    and under the eyes, result in unnecessary costs, and take masks away from those in health care who need them most,
    especially when masks are in short supply.
    Persons with symptoms should:
    • wear a medical mask, self-isolate, and seek medical
    advice as soon as they start to feel unwell. Symptoms can
    include fever, fatigue, cough, sore throat, and difficulty
    breathing. It is important to note that early symptoms for
    some people infected with COVID-19 may be very mild;
    • follow instructions on how to put on, take off, and
    dispose of medical masks;
    • follow all additional preventive measures, in particular,
    hand hygiene and maintaining physical distance from
    other persons.

    Sauf qu’on met des #masques DIY, qu’on envoie moins de virus dans l’atmosphère et qu’on ne vas pas arrêter de se laver les mains parce qu’on est met un masque, faut arrêter de prendre les gens pour des imbéciles. Et devant une maladie avec gros temps de latence et moitié d’asymptomatiques, et pas de tests, ben on doit faire comme si on était malades par mesure de prévention.

    Pourquoi on a encore cette discussion (truc posté hier sur Twitter) ?

    Parce que ça :

    Who’s Wearing a Face Mask ? Women, Democrats and City Dwellers - The New York Times
    https://www.nytimes.com/2020/06/02/health/coronavirus-face-masks-surveys.html?smtyp=cur&smid=tw-nytimes

    A Gallup poll found that only a third of Americans said they always wore a mask outside the home. Gender, political party and education level may play roles in the decision.

    Public health officials have recommended wearing masks in public when social distancing measures are difficult to maintain.Credit...Desiree Rios for The New York Times