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Crowding has consequences: Prevention and management of COVID-19 in informal urban settlements

机译：拥挤有所后果：在非正式城市定居点中的Covid-19预防和管理

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摘要

COVID-19 spreads via aerosols, droplets, fomites and faeces. The built environment that facilitates crowding increases exposure and hence transmission of COVID-19 as evidenced by outbreaks in both cool-dry and hot-humid climates, such as in the US prison system and dormitories in Singapore, respectively. This paper explores how the built environment influences crowding and COVID-19 transmission, focusing on informal urban settlements (slums). We propose policy and practice changes that could reduce COVID-19 transmission.There are several issues on how COVID-19 affects informal urban settlements. Slum populations tend to be younger than the overall population. Lower numbers of older people lessen the morbidity and mortality of the pandemic in slum areas. Second, many slum populations are highly mobile. By returning to their ancestral villages residents can avoid the risks of overcrowding and reduce the population density in a given area but may spread COVID-19 to other areas. Third, detection and registration of COVID-19 cases depends on patients presenting to health care providers. If the risk of visiting a health care centre outweighs the potential benefits patients may prefer not to seek treatment.The control and prevention of COVID-19 in informal urban settlements starts with organizing community infrastructure for diagnosis and treatment and assuring that basic needs (food, water, sanitation, health care and public transport) are met during quarantine. Next, community members at highest risk need to be identified and protected. Low-income, informal settlements need to be recognized as a reservoir and source for persistent transmission. Solutions to overcrowding must be developed for this and future pandemics. In view of the constant risk that slums present to the entire population decisive steps need to be taken to rehabilitate and improve informal settlements, while avoiding stigmatization.
机译：Covid-19通过气溶胶，液滴，粉末和粪便蔓延。促进拥挤的建造环境增加了曝光，因此在凉爽干燥和热潮气候中的爆发中证明了Covid-19的传播，例如在新加坡的美国监狱系统和宿舍中分别所证明。本文探讨了建筑环境如何影响拥挤和Covid-19传输，专注于非正式的城市定居点（贫民窟）。我们提出了可以减少Covid-19传播的政策和实践变更。关于Covid-19如何影响非正式城市定居点的几个问题。贫民窟群体往往比整体人口更年轻。较少数量的老年人减少了贫民窟地区大流行的发病率和死亡率。其次，许多贫民窟的人口都很高兴。通过返回祖父村庄居民可以避免过度拥挤的风险，并降低给定区域中的人口密度，但可以将Covid-19传播到其他地区。第三，Covid-19案例的检测和登记取决于患者向医疗保健提供者提供。如果访问医疗中心的风险超过潜在的益处，患者可能不愿寻求治疗。非正式城市住区中的Covid-19的控制和预防始于组织社区基础设施，用于诊断和治疗，并确保基本需求（食品，在检疫期间举行了水，卫生，保健和公共交通工具。接下来，需要识别和保护以最高风险的社区成员。低收入，非正式定居点需要被认为是持续传输的水库和来源。必须为此和未来的淫乱制定过度拥挤的解决方案。鉴于贫民窟呈现给整个人口的贫民区的持续风险，需要采取恢复和改善非正式定居点，同时避免耻辱。

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