LAUSR

Correspondence to Dr Alistair Mallard; a. mallard@ uq. edu. au © Author(s) (or their employer(s)) 2021. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION SARSCoV-2 which causes COVID-19 emerged in Wuhan, China in December 2019 and has now reached pandemic status. As of 31 January 2021, COVID-19 has been detected in 188 countries/regions and all continents except Antarctica. A total of more than 100 million cases have been detected so far with some countries showing disproportionately more cases than others, in particular the USA, Brazil, Russia, India, Peru and Mexico. Currently, it is understood that SARSCoV-2 is spread through respiratory droplets and direct contact. The reproduction number (R0) of SARSCoV-2 has been estimated to be in the range of 1.40–6.49 with a mean of 3.28. Any virus with an R0 above 1 is indicative of a virus with increasing number of infections. Globally thus far, efforts to curb the spread of SARSCoV-2 have resulted with varying success. Countries such as China, Australia and New Zealand, which have implemented widespread lockdown of social gathering, restricted movement and quarantine (for returning residents), seem to have curbed the early spread of SARSCoV-2, although are susceptible to recurring waves as has occurred in many European countries recently. Contrariwise, in nations with less strict pandemic governance arrangements including social distancing policies and adherence, or a removal of once imposed restrictions (eg, USA, Brazil and Iran), the incidence of the virus continues to escalate rapidly. Even within countries that have relatively contained the spread of COVID-19, disparities have been noted among identifiable population groups such as the elderly, prisoners, healthcare workers, migrants, refugees and Indigenous peoples. Here we discuss COVID-19 cases, outcomes and challenges for Indigenous peoples globally. Indigenous peoples live in over 90 countries globally and account for some 476 million individuals or ~6.2% of the global population. Despite recent efforts to improve the health and wellbeing of Indigenous peoples, disparities exist between Indigenous and nonIndigenous peoples where data are available. Issues such as earlier life expectancy, disparate rates of infant mortality, chronic diseases and mental health continue to be common issues affecting Indigenous populations globally. Much of this burden of disease is driven by poor outcomes in many of the social determinants of health, and the ongoing impact of colonisation, marginalisation and discrimination. Indigenous peoples hold significant cultural heritage and understanding of the ways of environment and humanity living harmoniously together. Many Indigenous groups continue to use their medical traditions to address their health problems, sometimes in unison with western medical care at public health facilities. Many have endured Summary box