War in Ukraine could reverse the decline in COVID cases in the region with a combination of low vaccination rates and residents pushed together in hiding or packing on transports to leave the country, experts say.
Those who do get severely infected in cities under siege could face hospitals already crowded with COVID patients and people with war injuries amid a growing lack of supplies including oxygen — which is important to many patients, not just those with COVID.
"That's a toxic mix of COVID patients with battle injuries," Eric Toner, MD, senior scholar at the Johns Hopkins Center for Health Security in Baltimore, Maryland, told Medscape Medical News.
Toner said that transporting liquid and bottled oxygen is "problematic and dangerous in a war zone" and adds to the risk for injury.
Before the Russian invasion last week, Toner said, COVID cases in Ukraine had dropped about 30% from their Omicron peak but were still high at 62 cases per 100,000. For comparison, the United States is currently at about 20 cases daily per 100,000, according to The New York Times tracker.
In the crisis, he said, tracking the spread will be difficult. "I would have to think there's going to be an uptick in COVID cases, but no one will know how big or how bad because there will be no data," Toner said.
He noted that news photographs and videos show unmasked crowds huddled in subway stations, basements, and packed on transports to countries including Hungary, Poland, Romania, and Slovakia.
Additionally, he said, "Ukraine had a low rate of vaccination — about 35% or so — before the war started and I'm sure no one's doing vaccinations now."
Toner said surrounding countries need to prepare for an uptick in those needing medical care for COVID.
Fortunately, he said, many of the surrounding countries have high vaccination rates but they presumably are going to be seeing many refugees who aren't vaccinated. Also fortunate is that surrounding countries have already had their Omicron surges and coupled with high vaccination rates will have high levels of immunity.
Toner said managing COVID numbers is likely to drop in priority.
"People will not be focusing on the pandemic in Ukraine for quite a while," he said.
Ron Waldman, MD, MPH, professor emeritus of global health at George Washington University in Washington, DC, told Medscape Medical News that cause for alarm regarding COVID spread may be premature, though.
Waldman, who currently lives in Portugal, said although COVID is surging in some parts of the world, the number of cases in Europe, as in the United States, are plunging rapidly.
"The incidence of COVID seems to be declining everywhere regardless of vaccination status," he said.
Waldman acknowledged that with a higher population density, infected people may come in contact more easily with people who are not infected and high mobility is also considered to be an increased risk factor for COVID spread.
However, he said, "Refugees are frequently viewed with fear and with suspicion and are frequently tagged with labels they don't deserve. We're going to be looking at a lot of people — I think the numbers are about a half million now — who are fleeing an armed conflict out of fear for their lives and the lives of their families. And to tag them with a label of 'COVID spreaders' does not have any business in the equation."
Waldman said given the positive epidemiological trend of decreasing cases and milder infection from the Omicron variant, "I don't think we can allow fear of COVID from refugees to interfere with our humanity."
Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick
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Image 1: Johns Hopkins Center for Health Security
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Cite this: Crowds, Shortages, and War Injuries a 'Toxic Mix' for COVID in Ukraine - Medscape - Feb 28, 2022.