What can we do

By Harpreet Kaur & Chaitra Dinesh – kaur@doctors.org.uk & chaitracd@outlook.com 

In this second part of a two part series looking at the impact of COVID-19 on Global Health issues, we delve a bit deeper and look at how we as individuals can get involved and advocate for what we believe in.

Whilst the COVID-19 pandemic has brought global health to the forefront, discussions around how different aspects of global health are affected are only now starting to arise. There is a realisation that the burden of disease isn’t shared equally among the global population and we need to put a spotlight on this once again. 

Global health can be defined as an area for study, research and practice that places a priority on improving health and achieving health equity for all people worldwide (1). There are various topics that come under global health, and this two-part blog addresses a few of these. It is not possible to cover each topic in the depth it requires – however, the aim of this blog is to give you a starting point to engage with the ongoing discussions and to think about how we can build back better (2) following this pandemic. 

Non-Communicable Diseases

By Lopa Banerjee (lbanerjee@doctors.org.uk) & Muha Hassan (muha.hassan@outlook.com)

From the acute threat of the virus, to lockdowns with some the heaviest peace-time restrictions placed on daily life, the COVID-19 pandemic has dramatically changed the way we all live, think and behave. This includes health behaviours, such as whether we smoke or drink alcohol or what we eat or how much we exercise; the same behaviours which may lead to Non-Communicable Diseases.

Non-Communicable Diseases or ‘NCDs’ have been a gargantuan public health issue for years, accounting for 71% of all deaths, across the world, every year (1).  NCDs are long-term diseases which aren’t typically spread from person-to-person like communicable diseases are (such as the common cold and COVID-19 itself). Examples of NCDs include diabetes, obesity, cancers, heart diseases (like heart attacks and strokes) and lung diseases (such as asthma and chronic obstructive pulmonary disease or ‘COPD’). These diseases are usually caused by a mixture of genetics, the environment we live in and our behaviours including smoking, physical activity levels, our diets and how much alcohol we drink. 

The negative relationship between COVID-19 and NCDs are two-fold, in that people who have pre-existing NCDs are unfortunately more likely to have worse outcomes should they contract COVID-19 (2), whilst simultaneously, COVID-19 will likely worsen the overall public health burden of NCDs by creating new cases and/or worsening pre-existing conditions (3).

As well as increasing the likelihood of needing a bed in ICU to overcome COVID-19 (4), a meta-analysis found that you were 2.36 times more likely to suffer a severe form of COVID-19 if you have hypertension, 2.46 times more likely if you have pre-existing lung disease, and 3.42 times more likely if you have heart disease (5). In conditions such as diabetes and COPD, which are thought to be caused by faults in the immune system, the body is less well-equipped to fight off an infection such as COVID-19 and seasonal influenza (6, 7).

Many patients with NCDs or otherwise vulnerable to more severe disease if they were to develop COVID-19 were asked to shield by the UK government – which has since downgraded that recommendation to permit people to leave their houses to take on the strictest approach to social distancing possible. Currently, those with diabetes and hypertension, for example, are not officially listed in the extremely clinically vulnerable groups that should shield (8). However, Diabetes UK and British Thoracic Society have urged those patients to shield wherever possible (9,10). It is essential for the government to review all of the emerging evidence regarding the risk to people with NCDs and to ensure their policies also protect them.

Interventions introduced to control the spread of COVID-19, such as social distancing, travel restrictions, working-from-home and full-on lockdowns, are likely to have ‘widespread health impacts’ beyond the immediate effects of the virus, according to a paper in the Lancet (3). Social distancing, lockdowns and increased amounts of time spent indoors could lead to more unhealthy behaviours linked to NCDs, such as inactivity, poor diet, smoking and increased alcohol consumption; some of which may be coping mechanisms for stress and impacted mental health. 

As well as this, routine appointments and operations to manage NCDs have been heavily impacted in both primary and secondary care; there may be shortages or delivery issues of essential medicines for NCDs such as insulins; people may be less likely to access healthcare when needed out of fear of contracting COVID-19; healthcare professionals who suffer from NCDs may not be able to work leading to staff shortages; and programmes aimed at the prevention of NCDs may have been paused. However, the Lancet paper (3) goes into detail about how some of these issues can be combated with the promotion of healthy behaviour messages throughout lockdowns, educating people about NCDs and COVID-19 risks, the use of telemedicine, prioritising NCD patients for COVID-19 testing and taking steps to make the healthcare environment safer for both patients and staff with NCDs through social distancing and personal protective equipment (PPE).

Although this may paint a bleak picture, COVID-19 and its subsequent social impacts could also present an opportunity. Never before have our populations and governments been so focused on our physical and mental health. On an individual level, this ‘unprecedented era’ may present the chance for some to pause and reflect on their health behaviours, have more spare time to do more exercise or cook healthier meals, or go for a walk or run as a chance to get out of the house during lockdown. At a more societal level, this crisis could be the wake up call that inspires governments to invest more in our healthcare and social systems as well as preventative medicine. After all, the National Health Service (NHS), one of the greatest forces for health equity in the UK, was created as a post-war policy following the turmoil of World War II. 

We are living through a unique but finite period which has had negative impacts on everyone in society at an individual, community, national and global level. Some will be affected more than others, and as with most things in public health, cruelly it will be those who are most disadvantaged will be affected the most; and the link between COVID-19 and NCDs is no different. However, as previous disasters in history have demonstrated, the human spirit can rise to challenge and that the suffering caused by COVID-19 can be minimised and this pandemic can be used as a catalyst for further innovation and progress. 

Access to essential medicines 

By Rhiannon Osborne (rhiannonosborne708@gmail.com

With the emergence of a new disease, the race is on to find a cure. Scientists around the world are testing existing drugs to know if they are able to treat COVID-19 and creating new vaccines to prevent the high death toll becoming a yearly occurrence. With talk of medicines, this brings up the global health issue of access to essential medicines. Currently, two billion people in the world don’t have access to the essential medicines they need  (1). This is due to a pharmaceutical system that is designed to prioritise profit over public health, charging extortionate prices for life-saving drugs or, not researching them in the first place because particular countries, communities and patients don’t make profitable markets. The intellectual property system provides pharmaceutical companies with decades of monopolies, allowing them to price medicines at ‘what the market can bear’ rather than what would allow sustainable and public-health oriented supply across the world. 

With COVID-19 we have the same concerns – if we do business as usual, millions of people could be excluded from the benefits of research. If a vaccine, for example, is exclusively licensed, whoever owns the monopoly will be able to charge high prices and no single company has the capacity to ramp up production on the scale needed to vaccinate the world – all diagnostics, therapeutics and vaccines need to be openly licensed to make them affordable and scalable (2). Even if the knowledge behind any future technology is shared, there is still a huge production capacity gap between the global north and the global south, and a high-risk that developed countries could stock-pile, pre-order/buy their way to the front of the queue and ban exports to countries less able to produce their own (3). 

Whilst monopolies awarded to pharmaceutical companies result in huge gains for their shareholders, they ignore the huge amount of public financing and expertise that goes into research. The UK government is currently funding 25 COVID-19-related projects at UK universities, and globally we are seeing unprecedented levels of public money being funneled into COVID-19 research, for example through the Access to COVID Tools ACT accelerator (4). While this funding is welcome, it currently comes with no or minimal conditions to ensure that the products of this research are available and affordable to everyone who needs them – a global public good (5). 

Heads of state and others have often stated the importance of equitable access to medicines, and many have followed through. For example, the president of Costa Rica proposed a global pooling mechanism for intellectual property related to COVID-19 health technologies, which has been launched and  is being led by the World Health Organisation (WHO) (6, 7). Canada, Israel, Germany and other countries have adjusted their patent laws to make sure that intellectual property won’t be a barrier to access to COVID-19 health technologies (8). But other countries have stuck to the status quo – the US “distanced itself” from two paragraphs of the WHA resolution, one of which discussed the importance of open sharing of knowledge, research and IP (9). The UK has yet to publicly support many initiatives, and was reported to have attempted to water down the WHA resolution (10), but the pressure will soon be mounting to support the Costa Rica proposal, which does, however, remain a voluntary pooling mechanism – will companies and countries sign up to it, or will they act nationalistically?

Open research and sharing of knowledge and developments is essential not only to make sure that a final product is affordable and available, but to accelerate the process of research and development itself (2). Under normal circumstances, the purely profit driven industry discourages collaboration and sharing of knowledge, as this could hamper future profits but, in the context of needing to develop things as quickly as possible, will this change? Will research be transparent and collaborative, or will narrow-interests dictate continued siloing?

Whilst the pandemic continues, we cannot forget other diseases. HIV patients using Remdesivir and lupus and malaria patients who need hydroxychloroquine could rapidly find themselves without treatment (11). Meanwhile, diabetes, tuberculosis and other conditions which are deadly alone, and also high risk factors for severe COVID-19 disease still face huge access to medicines barriers with millions of patients around the world unable to access insulin and basic tuberculosis treatment, for example (12). 

We have touched the surface of this topic, if you would like to know more have a read of one of our earlier blog pieces on this issue: https://studentsforglobalhealth.org/2019/12/05/pharmaceutical-power-and-the-general-election/ and our policy on ‘Equitable pricing of medicines’: https://medsinblog.files.wordpress.com/2020/04/sga20_ps_equitablepricing.pdf. Also, check out the work of our affiliate ‘Universities Allied for Essential Medicines’ (http://www.uaem.org/). 

Refugee and Asylum Seekers 

By Catarina Soares (csoares@doctors.org.uk)

One of the 6 key asks from the Universal Health Coverage 2030 campaign is “leave no-one behind”  – but the COVID-19 pandemic has laid bare that we are leaving our most vulnerable behind. Humanitarian settings are often fragile health systems, with limited water, sanitation and hygiene (WASH) facilities, overcrowding and limited access to healthcare services and medicines (1). It’s also important not to forget that refugees and asylum-seekers are victims of stigma and a neglected vulnerable population – and access to healthcare is impacted by factors such as cultural and language barriers, their legal status in the host country and their inclusion in risk communication and education (2, 3). Search and rescue operations in the Mediterranean sea have been suspended due to logistical difficulties in the face of COVID-19 and there have been reports of asylum-seekers being returned to their countries of origin, putting them at risk of both the illness and persecution and in contravention of international law (4).

The Inter-Agency Standing Committee (IASC) released interim guidance, in accordance with WHO guidelines for managing the COVID-19 pandemic and with cooperation of UNHCR, WHO, IFRC and IOM, for scaling up preparedness in humanitarian settings (2). This document has highlighted the need for site-specific epidemiological risk assessments, for mitigation of overcrowding, for improvement of shelter conditions, and for scaling up provision of basic cooking and hygiene facilities. Unfortunately, a guidance document is just a piece of paper until all governments commit to its recommendations.

In the UK, evictions of asylum-seekers whose claims were refused have been paused for 3 months (5) – however this leaves those whose claims were refused before this policy was declared in a state of limbo with no protection (6). There have been reports that accommodation provided to asylum-seekers and refugees is not fit for social distancing, with news outlets reporting cramped conditions, people being forced to share beds with strangers and no separation of those displaying symptoms or having tested positive for the novel coronavirus (7, 8). Asylum support payments amount to approximately £5 per day, with many recipients struggling to meet their basic needs and at risk of destitution (7).

Another concern is the risk of outbreaks in immigration detention centres – as reported by UNHCR, the UK has no limit on the length of time someone can be detained in an immigration detention centre, and cases of COVID-19 have been reported at these centres (9). New detentions have been halted, but this unfortunately does not address the risk to those already detained.

Fear of immigration charges and both patients and healthcare providers lack of knowledge about asylum-seekers’ rights were already barriers to accessing healthcare for migrant populations before this pandemic (10, 11). Under the “Hostile Environment”, hospitals and GP surgeries can share information with the Home Office if the patient has debt to the NHS or to determine eligibility (10, 11, 12). And despite COVID-19 being added to the list of conditions that don’t incur any charges, if the patient were to test negative but need care for a different condition not included on the list mentioned, they will incur costs from that point onwards (11, 12).

Lastly, the narrative surrounding migrant key workers is important to note. The new immigration points-based system announced by the Home Office in February sets no route for “low-skilled workers” and is detrimental to those with salaries below the £23,040 threshold, such as nurses (despite the “trading” system that considers shortage of certain professions) (13). So-called “low-skilled” workers have proven to form the backbone of our society in these times, risking their health for their jobs and our collective wellbeing. NHS workers have had their visas automatically extended for 1 year (14) – though this does not include care workers and other key workers who have also been on the frontlines during this pandemic. Migrants should not have to risk their lives for compassionate immigration policy. Furthermore, the immigration health surcharge, applied to non-EEA migrants as a mandatory payment for access to NHS services, including to NHS staff, is due to be increased from £400 to £624 annually and extended to EEA migrants post-Brexit (15) – despite being a form of double taxation as foreign nationals already pay taxes towards the health service (16).

For more information on migration and health, the rights of refugees and asylum-seekers and how these are affected during the COVID-19 pandemic:

Climate Change

Ways COVID has helped

By Anuradha Ponnapalli

On 22nd April, World Earth Day was celebrated in an unconventional style, briefly shining the spotlight back on the environment amidst the current monopoly COVID-19 holds (1). The threat to civilisation posed by coronavirus has been identified as being somewhat akin to the threat of climate change, should no action be taken. Some have identified the likeness in the strategies that are being employed at present to those that could be utilised to work towards a more sustainable future (2).

Here, the link between COVID-19 and climate change does not end. The virus has had devastating effects worldwide, but the subsequent measures executed, primarily involving travel restrictions, have resulted in a reduction in air pollution (3). Most visibly, Delhi, like several other conurbations around the world, has benefitted from the dramatic improvement in air quality (4). This not only is a welcomed contribution to the effort to halt climate change, but also serves to provide some relief for those suffering from respiratory conditions such as asthma, shown to be exacerbated by poor air quality (5). While these reports are encouraging, a concern remains regarding their temporary nature. As such, it is crucial that the current reduction in greenhouse gas emissions does not suffer from a rebound, as took place in 2010 following the 2008 financial crisis (6). Supporting this sentiment, Dr Campbell-Lendrum, the man leading the WHO Climate Change Unit has expressed his hope to “hang on to some of the environmental gains that we’re seeing in the COVID crisis, such as cleaner air” (7).

Over these past trying months, we have learnt that we humans have a great capacity to adapt and adapt fast. The importance of paying attention to experts sounding the alarm, or the refusal to, has been exemplified in the progression of COVID to pandemic status (8). This must not be repeated. It is imperative that those in positions of power must heed the advice of those with the knowledge to inform policies and interventions pertaining to climate change. Despite the uncertainty that remains, we must find strength in the knowledge that we can change, we can adapt, we can make a new normal. Here’s hoping we carry the responsibility to act with us, as we confront the collective challenge of halting climate change.

Ways COVID has not helped 

By Kate Beckett (kbeckett@doctors.org.uk)

It’s clear COVID-19 has had a positive short-term impact on the climate. The direct effects from fewer global emissions are hard to argue with. But it doesn’t mean we’re any closer to cracking open that beer and patting each other on the back. There’s no blessing to this tragic virus that has already claimed hundreds of thousands of lives, but if one good thing can grow from its legacy, could it be the unique opportunity we’re presented with to disrupt the current climate trajectory and reroute to a more sustainable, greener future?

Once this is all over, obviously returning to ‘business as usual’ isn’t going to cut it. As countries relax their lockdowns and international borders reopen, global economies will spring back into action with all the vigour and ferocity as before, if not more. We’ve seen it happen. Take the 2008 financial crash. Global CO2 emissions fell by a significant 1.4% as fuel combustion and cement production stalled, only to rise by 5.9% in 2010 (1). This rebound effect – catching up for lost time – is perhaps the most frightening projected impact of COVID-19.

The UN Secretary General António Guterres described 2020 as “a pivotal year” for addressing climate change (2). Countries were supposed to start updating their Nationally Determined Contributions (NDCs) – plans to reduce fossil fuel emissions and develop strategies to meet greenhouse gas mitigation targets (3). COP26 – the largest international meeting of climate experts – was all set to take place in Glasgow this November (4).

Sadly the virus seems to have overshadowed all this. To name a few examples: the EU has come under pressure to withhold important climate initiatives; the States have rolled back car emission rules that formed a central element of the US efforts to reduce greenhouse gases; Brazil have announced cutbacks on Amazon protection enforcements, exposing one of the world’s most crucial carbon sinks to accelerated deforestation (1). COP26 has been cancelled with a new date not yet set (4). And, alongside scientists the world over, climate researchers are stuck at home, unable to collect critical data to influence future climate policy (5).

On a more tangible level, single-use plastic consumption is currently soaring (6). The stock-piling of hand sanitisers and soap dispensers, ordering of take-away containers rather than dining out and the spike in individually wrapped products delivered straight to people’s homes from online retailers all contribute to the growing mountain of plastic waste we’re producing. What’s more, many recycling centres (which are financially difficult to sustain at best) have been shut down to protect their workers.

Unless we find a way to harness the chaos of this pandemic to reinvent our cities and invest in climate reduction schemes, 2020 could merely be just another blip in our downward global climate spiral and remembered in generations to come as yet another missed opportunity.

Conclusion

By Harpreet Kaur & Chaitra Dinesh – kaur@doctors.org.uk & chaitracd@outlook.com 

Thank you for reading the second part of this blog, if you  missed the first part you can find it in the Blog section of our website. During this global pandemic it is vital that we don’t forget other determinants of health and other global health issues. These issues are likely to either exacerbate or be exacerbated by the effects of the pandemic itself on individuals and on health systems. It is important that those who have power to make or influence decisions, look at these issues in a more holistic manner, work on reducing these inequalities in the longer term and also ensure when we are building back that we plan ahead for the future. 

It is also important that as individuals we do not underestimate our power to influence decisions; it can certainly seem like decisions are being made in isolation and without consultation, but by joining up our voices and ensuring concerns are heard we can affect change. In this article itself we have linked to many ways that we as individuals can do this, so make sure to have a look and to comment below with any other actions that you are aware of. 

References

Introduction

  1. Koplan, J.P., Bond, T.C., Merson, M.H., Reddy, K.S., Rodriguez, M.H., Sewankambo, N.K., & Wasserheit, J.N. (2009). Consortium of Universities for Global Health Executive Board. Towards a common definition of global health. Lancet, 373(9679),1993-1995.
  2. https://buildbackbetteruk.org/

Non-Communicable Diseases

  1. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
  2. https://pmj.bmj.com/content/early/2020/05/28/postgradmedj-2020-137742
  3. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31067-9/fulltext
  4. Wang D , Hu B , Hu C , et al . Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061.doi:10.1001/jama.2020.1585 pmid:http://www.ncbi.nlm.nih.gov/pubmed/32031570
  5. Yang J , Zheng Y , Gou X , et al . Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis 2020. doi:doi:10.1016/j.ijid.2020.03.017. [Epub ahead of print: 12 Mar 2020].pmid:http://www.ncbi.nlm.nih.gov/pubmed/32173574
  6. Geerlings SE , Hoepelman AI . Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol 1999;26:259–65.doi:10.1111/j.1574-695X.1999.tb01397.x pmid:http://www.ncbi.nlm.nih.gov/pubmed/10575137
  7. García-Valero J , Olloquequi J , Montes JF , et al . Deficient pulmonary IFN-β expression in COPD patients. PLoS One 2019;14:e0217803.doi:10.1371/journal.pone.0217803 pmid:http://www.ncbi.nlm.nih.gov/pubmed/31170225
  8. https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19
  9. https://www.rbht.nhs.uk/our-services/heart/pulmonary-hypertension-service/covid-19
  10.  https://www.diabetes.org.uk/about_us/news/coronavirus

Access to essential medicines

  1. Ten years in public health, 2007–2017: report by Dr Margaret Chan, Director-General, World Health Organization. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO
  2. MSF Access Campaign position paper on the sharing of technologies for COVID-19 to ensure equitable access for all, https://msfaccess.org/msf-access-campaign-position-paper-sharing-technologies-covid-19-ensure-equitable-access-all
  3. Overview of anticipated COVID-19 vaccine access challenges, Ava alkon, Kate Elder, MSF. https://docs.google.com/document/d/1K6NbL-UowylDKxcbNKLWdaSdkG1mtAaYl_df_JBSVLo/edit?usp=sharing 
  4. Access to COVID-19 Tools (act) Accelerator, https://www.who.int/who-documents-detail/access-to-covid-19-tools-(act)-accelerator
  5. Urgent steps are needed to define how COVID-19 medical tools can really be “global public goods”, MSF. https://msfaccess.org/urgent-steps-are-needed-define-how-covid-19-medical-tools-can-really-be-global-public-goods  
  6. WHO, Costa Rica & Chile Announce Official Launch Of COVID-19 Intellectual Property Pool, Grace Ren, Health Policy Watch. https://healthpolicy-watch.org/who-costa-rica-announce-official-launch-of-covid-19-intellectual-property-pool/ 
  7. WHO and Costa Rica launch COVID-19 Technology Access Pool, William Worley,  Devex. https://www.devex.com/news/who-and-costa-rica-launch-covid-19-technology-access-pool-9736
  8. The key COVID-19 compulsory licensing developments so far, iam media. https://www.iam-media.com/coronavirus/the-key-covid-19-compulsory-licensing-developments-so-far
  9. WHA 73 United States of America Explanation of Position “COVID-19 Response” Resolution, https://apps.who.int/gb/statements/WHA73/PDF/United_States_of_America2.pdf
  10. US and UK ‘lead push against global patent pool for Covid-19 drugs’, Sarah Boseley, The Guardian. https://www.theguardian.com/world/2020/may/17/us-and-uk-lead-push-against-global-patent-pool-for-covid-19-drugs
  11. Medical groups warn of serious shortages of hydroxychloroquine, Michael Peel, Stephanie Findlay and Donato Paolo Mancini, Financial Times. https://www.ft.com/content/e0acace3-051d-4801-af6c-3a5a5e05aac6 
  12. MSF Access Campaign on tuberculosis, https://msfaccess.org/tuberculosis

Refugees and Asylum Seekers

  1. Singh, Lucy, Neha S Singh, Behrouz Nezafat Maldonado, Sam Tweed, Karl Blanchet, and Wendy Jane Graham. “What Does ‘Leave No One behind’ Mean for Humanitarian Crises-Affected Populations in the COVID-19 Pandemic?” BMJ Global Health 5, no. 4 (April 17, 2020). https://doi.org/10.1136/bmjgh-2020-002540 
  2. “Scaling-up COVID-19 Outbreak Readiness and Response Operations in Humanitarian Situations Including Camps and Camp-like Settings.” IASC, March 17, 2020. https://interagencystandingcommittee.org/system/files/2020-03/IASC%20Interim%20Guidance%20on%20COVID-19%20for%20Outbreak%20Readiness%20and%20Response%20Operations%20-%20Camps%20and%20Camp-like%20Settings.pdf 
  3. “COVID-19: How to Include Marginalized and Vulnerable People in Risk Communication and Community Engagement.” Regional Risk Communication and Community Engagement (RCCE). Accessed April 20, 2020. https://interagencystandingcommittee.org/system/files/2020-03/COVID-19%20-%20How%20to%20include%20marginalized%20and%20vulnerable%20people%20in%20risk%20communication%20and%20community%20engagement.pdf 
  4. Kluge, Hans Henri P, Zsuzsanna Jakab, Jozef Bartovic, Veronika Danna, and Santino Severoni. “Refugee and Migrant Health in the COVID-19 Response.” The Lancet 395, no. 10232 (April 18, 2020): 1237–39. https://doi.org/10.1016/s0140-6736(20)30791-1 
  5. Philp, Chris. Accessed April 20, 2020. http://www.refugeecouncil.org.uk/wp-content/uploads/2020/03/27.03.20-Chris-Philp-Letter.pdf  
  6. “Covid-19 & Asylum – Update 3 April.” Asylum Matters, April 3, 2020. https://asylummatters.org/2020/04/03/covid-19-asylum-update-3-april/  
  7. “Our Key Policy Calls to the Home Office in Response to Covid-19.” Refugee Council, April 20, 2020. https://www.refugeecouncil.org.uk/latest/news/our-key-policy-calls-to-the-home-office-in-response-to-covid-19/  
  8. Batty, David. “Coronavirus Fears as UK Asylum Seekers Made to Share Cramped Rooms.” The Guardian, April 15, 2020. https://www.theguardian.com/world/2020/apr/15/coronavirus-fears-uk-asylum-seekers-made-share-cramped-rooms?fbclid=IwAR3CccjwDgw30K21prLlQlu9OfGHQ792NNelWsD_lHd52IqSkJIz14gohws  
  9. United Nations. “UNHCR UK FAQs on COVID-19 in Relation to Refugees and Asylum Seekers.” UNHCR. Accessed April 20, 2020. https://www.unhcr.org/uk/unhcr-uk-faqs-on-covid-19-in-relation-to-refugees-and-asylum-seekers.html  
  10. Nellums, Laura B; Hargreaves, Sally S; Friedland, Jon; Rustage, Kieran; Miller, Anna; Hiam, Lucinda; and Le Deaut, Deman. “The Lived Experiences of Access to Healthcare for People Seeking and Refused Asylum.” Equality and Human Rights Commission, November 2018. https://www.equalityhumanrights.com/sites/default/files/research-report-122-people-seeking-asylum-access-to-healthcare-lived-experiences.pdf  
  11. “Legal Blog: Why COVID-19 Is a Threat to UK Asylum Seekers.” Jesuit Refugee Service, April 16, 2020. https://www.jrsuk.net/blog/legal-blog-why-covid-19-is-a-threat-to-uk-asylum-seekers/ 
  12. Patients Not Passports COVID Resources file: https://drive.google.com/drive/folders/1XCBJG4WSO8loWEOCFwv2tGFs8am7z_IV 
  13. “The UK’s Points-Based Immigration System: Policy Statement.” GOV.UK. Accessed April 20, 2020. https://www.gov.uk/government/publications/the-uks-points-based-immigration-system-policy-statement/the-uks-points-based-immigration-system-policy-statement 
  14. Office, Home. “NHS Frontline Workers Visas Extended so They Can Focus on Fighting Coronavirus.” GOV.UK. GOV.UK, March 31, 2020. https://www.gov.uk/government/news/nhs-frontline-workers-visas-extended-so-they-can-focus-on-fighting-coronavirus 
  15. “The Immigration Health Surcharge.” House of Commons Library, March 25, 2020. https://commonslibrary.parliament.uk/research-briefings/cbp-7274/  
  16. B, James. “Scrap the Immigration Health Surcharge – Don’t Increase It.” Docs Not Cops, March 12, 2020. http://www.docsnotcops.co.uk/scrap-the-immigration-health-surcharge-dont-increase-it/ 

Climate change

Ways COVID has helped

  1. World Health Organisation. When Mother Earth sends us a message. https://www.un.org/en/observances/earth-day  (accessed 20 April 2020).
  2. Crawford V. How COVID-19 might help us win the fight against climate change. https://www.weforum.org/agenda/2020/03/covid-19-climate-change/  (accessed 20 April 2020).
  3. Larnaud N. Satellite animation shows air pollution in China and Italy clearing amid coronavirus lockdowns. https://www.cbsnews.com/news/coronavirus-satellite-animation-shows-pollution-clearing-over-china-and-italy/ (accessed 22 April 2020).
  4. Ellis-Petersen H, Ratcliffe R, Cowie S, Daniels JP, Kuo L. ‘It’s positively alpine!’: Disbelief in big cities as air pollution falls. https://www.theguardian.com/environment/2020/apr/11/positively-alpine-disbelief-air-pollution-falls-lockdown-coronavirus  (accessed 20 April 2020).
  5. Guarnieri M, Balmes JR. Outdoor air pollution and asthma. The Lancet. 2014 May 3;383(9928):1581-92.
  6. Peters GP, Marland G, Le Quéré C, Boden T, Canadell JG, Raupach MR. Rapid growth in CO 2 emissions after the 2008–2009 global financial crisis. Nature climate change. 2012 Jan;2(1):2-4.
  7. Brennan M, Micklas K. 5 things to know about climate change and coronavirus with WHO Climate Lead Dr. Campbell-Lendrum. https://www.cbsnews.com/news/earth-day-anniversary-5-things-to-know-about-climate-change-and-coronavirus-with-who-climate-lead-dr-campbell-lendrum/  (accessed 22 April 2020). 
  8. Edelman G. The Analogy Between Covid-19 and Climate Change Is Eerily Precise. https://www.wired.com/story/the-analogy-between-covid-19-and-climate-change-is-eerily-precise/  (accessed 22 April 2020).

Ways COVID has not helped

  1. How Covid-19 Could Impact the Climate Crisis [Internet]. Human Rights Watch. 2020 [cited 1 May 2020]. Available from: https://www.hrw.org/news/2020/04/16/how-covid-19-could-impact-climate-crisis
  2. Guterres A. Secretary-General’s Briefing to Member States on the 26th Session of the Conference of the Parties (COP26) [as delivered]. https://www.un.org/sg/en/content/sg/statement/2020-03-06/secretary-generals-briefing-member-states-the-26th-session-of-the-conference-of-the-parties-(cop26)-delivered; 2020.
  3. United Nations Framework Convention on Climate Change. 2020 [cited 1 May 2020]. Available from: https://unfccc.int/nationally-determined-contributions-ndcs
  4. Key COP26 climate summit postponed to ‘safeguard lives’ [Internet]. UN News. 2020 [cited 9 May 2020]. Available from: https://news.un.org/en/story/2020/04/1060902
  5. Climate monitoring and research could fall victim to coronavirus, scientists fear [Internet]. the Guardian. 2020 [cited 1 May 2020]. Available from: https://www.theguardian.com/science/2020/apr/03/climate-monitoring-research-coronavirus-scientists

Tenenbaum L. The Amount Of Plastic Waste Is Surging Because Of The Coronavirus Pandemic [Internet]. Forbes. 2020 [cited 13 May 2020]. Available from: https://www.forbes.com/sites/lauratenenbaum/2020/04/25/plastic-waste-during-the-time-of-covid-19/

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