Gender disparities in social and economic outcomes, already larger in the developing world than in the rich countries, have been exacerbated by the pandemic. Policy action is vital to address the compounding of existing inequalities and to protect the most vulnerable women.

The Cox’s Bazar Panel Survey (CBPS) tracks representative samples of Rohingya refugees and host communities in Cox’s Bazar district in southern Bangladesh. A phone-based follow-up survey from April 2020 reveals that, despite widespread knowledge of COVID-19, attendance at religious gatherings is high, representing a potentially important pathway for disease spread in refugee camps and host communities in Cox’s Bazar. Even after the imposition of lockdown restrictions in early April, attendance to religious events was still common in refugee camps and host communities alike. Over 75% of men in refugee camps and over 50% of men in host communities reported attending religious services at least once in the week prior to the survey (April 9-16, 2020).1 Most male respondents who attended religious gatherings did so regularly, for an average of 4.0 days and 2.2 days in the last week for refugees and hosts, respectively. These behaviors are prevalent despite widespread awareness of the sources of COVID-19 transmission. When asked about trusted sources of advice on COVID-19, both hosts and refugees identified friends, acquaintances, and community leaders – including religious leaders – as important. In fact, 44% of refugees place their trust in community leaders such as block majhees; putting them in front of other trusted sources of information including family, relatives, and informational campaigns.

In a separate survey of Imams from around Bangladesh, we find considerable willingness to make changes: almost every respondent had adjusted their practices in some way. Still, some important measures remain uncommon, including discouraging attendance of the elderly, removal of the communal prayer mat, and postponing congregational prayer. This may be due to respondents’ subjective assessment of the risk posed by COVID-19. About two thirds of Imams felt that COVID-19 posed no or low risk to their communities. Given the ongoing attendance of religious gatherings and the trust placed in religious leaders, policies should be targeted towards decreasing prayer gathering sizes, reducing frequency of prayer attendance, and disseminating public health and social distancing advice through a key trusted source of information: Imams and religious leaders themselves.

COVID-19 is spread through face-to-face contact, and migration therefore plays an outsized role in its global transmission. Effective mitigation policies include limitations on mobility. However, labor migration is a fundamental component of income for large numbers of households, especially in low- and middle-income countries. Using detailed microdata, we document how migration-dependent households have been hit with the dual shocks of higher infection prevalence and greater economic disruption as a result of COVID-19.

In phone surveys conducted in Bangladesh and Nepal in April–May, 2020, we find that households with returning international migrants are twice as likely to report experiencing symptoms of COVID-19. At the same time, households that previously engaged in labor migration experience greater declines in household income and food security than those that did not. Bangladeshi households that won a visa lottery to migrate internationally in 2013 experienced sharper drops in income in May 2020 after the COVID-lockdown than lottery-losers. Food insecurity among migrant-dependent Bangladeshi rural households in April, 2020 exceeded that observed during typical agricultural lean seasons. Declines in household welfare are driven by both lower rates of migration and less remittance income from remaining migrants. These losses are not recovered in home labor markets because migrants face difficulty reintegrating.
COVID-19 creates a new barrier to migrant reintegration due to stigma associated with the health
risks posed by migration.

This brief reports changes in economic activity, incomes, food security and mental health by tracking 2636 rural households in Nepal between September 2019 and May 2020 using six rounds of surveys during both lean and harvest seasons, before and after the COVID-19 lockdown. Labor supply in the village, labor migration, remittance earnings, and total incomes have fallen dramatically compared to harvest periods, and even relative to the pre-harvest lean season. The COVID-19 pandemic luckily hit rural Nepal several months prior to the period of peak seasonal hunger, but this implies that economic outcomes are likely to continue to worsen over the next few months until the next rice harvest in October.

We study the prevalence of COVID-19 symptoms in refugee and host communities and their correlates with current and pre-COVID-19 living conditions. We administered a phone-based survey to a sample of 909 households in Cox’s Bazar which was drawn from a household panel representative of Rohingya refugees and the host population. We conducted a symptoms checklist to assess COVID-19 risk based on the WHO guidelines. We included questions covering returning migration, employment, and food security. We asked additional questions on health knowledge and behaviors to a random subsample (n=460).

24.6% of camp residents and 13.4% of those in host communities report at least one common symptom of COVID-19. Among those seeking treatment, a plurality did so at a pharmacy (42.3% in camps, 69.6% in host communities). While most respondents report good respiratory hygiene, between 76.7% (camps) and 52.2% (host community) had attended a communal prayer in the previous week. Another 47.4% (camps) 34.4% (host community) had attended a non-religious social gathering. The presence of returning migrants, respondent mobility, and food insecurity strongly predict COVID-19 symptoms.

COVID-19 symptoms are highly prevalent in Cox’s Bazar, especially in refugee camps. Attendance at religious and social events threatens efforts to contain the spread of the disease. Pharmacies and religious leaders are promising outlets to disseminate life-saving information.

Full brief: Lopez-Pena P, Austin Davis C, Mushfiq Mobarak A & Raihan S. Prevalence of COVID-19 symptoms, risk factors, and health behaviors in host and refugee communities in Cox’s Bazar: a representative panel study. [Preprint]. Bull World Health Organ. E-pub: 11 May 2020. doi: http://dx.doi.org/10.2471/BLT.20.265173

Inadequate COVID-19 testing capabilities is producing testing data that cannot be reliably compared across countries or across jurisdictions within low- and middle-income countries (LMICs). This is hampering the ability of LMICs to devise timely and effective policy responses, such as identifying hotspots and spatially targeting public health responses or economic relief. We develop a methodology to make indirect inferences about the spatial distribution of COVID-19 risk using the insight that migration is a primary driver of disease spread across jurisdictional borders. We use bilateral migration flows and prevalence of COVID-19 cases in all migration destinations (such as Italy, Spain, United States, Singapore, and South Korea) to construct a country-level index of COVID-19 risk exposure. We then use sub-district and municipality level data on the origins of migrants, and airport disembarkation data on recent returnees, to create sub-national heat maps of COVID-19 risk within Bangladesh and the Philippines. We validate our indices by comparing them to data on confirmed cases, COVID-19 deaths, location of quarantines and distress calls to a government hotline. We use multiple data sources in Bangladesh to evaluate the broad applicability of our method to other LMICs where only a subset of such data may be publicly accessible.

Policies imposed in rich countries to fight the coronavirus could have adverse effects in low-income nations, potentially endangering more lives than they save. We combine country specific estimates of economic benefits of disease suppression with an epidemiological model to demonstrate that while the benefits of social distancing translate to a 59% savings in US GDP, it only translates to savings of 14% of Bangladesh’s GDP or 19% of India’s GDP. Not only are the epidemiological and economic benefits of social distancing much smaller in poorer countries, such policies may also exact a heavy toll on the poorest and most vulnerable. More work is needed to determine if the low mortality estimates of developing countries hold if the prevalence of comorbidities and exposure to pollution are taken into account.