2.1 IMPACT ON PEOPLE IN INSTITUTIONAL SETTINGS Containing the spread of COVID-19 through institutions where people live in close quarters, such as prisons, nursing homes or refugee camps poses particular challenges. Measures such as physical distancing are not effective in overcrowded settings, yet failure to contain the spread of COVID-19 in such institutions, poses serious risks to the right to health, and sometimes even to life. ACCESS TO HEALTH AND AVAILABILITY OF HEALTH SUPPLIES The prioritisation of tackling the spread of COVID-19 puts the right to equal access to healthcare enshrined in Article 35 of the Charter at risk. Several Member States have postponed non-urgent surgical interventions and diverted resources from other health issues to free up health workers to treat those affected by COVID-19. This may present risks to patients suffering from other illnesses. Members of the Lithuanian parliament expressed unease that new measures may impact patients with critical conditions, such as cancer. 262 Media in some Member States, for example France,263 reported that the high number of severe cases of COVID-19 and stretched resources may force doctors to make difficult choices about which patients to prioritise for treatment. There are reports that older patients have been de-prioritised. For example, doctors working in Strasbourg, on the French-German border, expressed concern that only 26 patients under the age of 80 would be provided with ventilation, with the age threshold being lower in other municipalities.264 Medical guidelines supporting doctors to determine which patients to prioritise for life-saving treatment were published in some Member States, for instance Italy265 and Spain.266 Certain of these suggest a patient’s age as a key criteria for this decision, together with other factors such as comorbidity. Concerns have also been raised about access to healthcare for certain groups. Members of ethnic minorities might be at increased risk of infection due to their disadvantaged living conditions, for example. In Sweden, at least five of the first 15 COVID-19 related deaths in the Stockholm area were of people of Somali descent who lived in the same overcrowded and socio-economically deprived area.267 The National Assembly in Bulgaria raised concerns about the situation of segregated ethnic groups, who may not have access to preventative equipment.268 Accessing preventive healthcare may also be difficult for people in prisons and asylum reception facilities, for example (see also Sections 2.1.2 and 2.1.3). The European Public Health Association expressed concerns about the impact of confinement on undocumented migrants’ mental health and wellbeing given their often already difficult social and economic living conditions.269 Access to health supplies can also affect consumer rights, if prices increase amid high demand for certain supplies during the pandemic. Several countries adopted exceptional price control measures to protect consumers from an abnormal market situation, which can disproportionately affect people on low incomes or who have lost their jobs because of the COVID-19 outbreak. Bulgaria, Czechia and France270 introduced upper price limits, while Portugal initiated criminal proceedings for those making illegitimate profit on the sale of alcohol-based gel.271