More than 100 countries have now reported cases, and on 11 March, the WHO declared COVID-19 as a pandemic. Most countries still have only sporadic cases or defined clusters. 90% of the 118K cases are being reported from four countries: cases in China are now decreasing, but there are major outbreaks in Italy, Iran and South Korea. In other countries, including Europe, the numbers are growing exponentially.
Unlike influenza, there is no known pre-immunity, no vaccine, no specific treatment and everyone is presumed to be susceptible. This will be a mild respiratory illness for the vast majority (estimated 80% of confirmed cases) but it has a higher rate of quite severe complications for vulnerable people (elderly and people with comorbidities), than other viruses such as flu.
Public measures such as isolation, quarantine and social distancing are generally put in place to limit uncontrolled community transmission, slow down number of cases and severely ill patients and protect the most vulnerable and manage the collective health resources.
This epidemic, in terms of scale and global spread and rapidity, has a huge effect on health care systems in the countries affected. Hospitalising so many people for such a long time at such a high level of care poses a real challenge to even the most advanced healthcare systems. We are very concerned about the consequences in countries with weaker healthcare systems, who will struggle even more if they have to deal with a large number of patients with COVID-19.
A) Ensuring continuity of medical care
MSF supports extremely vulnerable communities with our medical programmes around the world. In any given day we are treating hundreds of thousands of patients for a variety of ailments. We need to ensure we can continue to provide adequate and live saving medical care in our ongoing projects. This is challenging because current travel restrictions are limiting our ability to move staff between different countries. There is also global pressure on the production of some medical supplies, in particular specialised personal protective equipment for healthcare workers.
Our projects are still able to continue medical activities, but ascertaining future supplies of certain key items, such as surgical masks, swabs, gloves and chemicals for diagnosis of COVID-19 is of concern. There is also a risk of supply shortages due to lack of production of generic drugs and difficulties to import essential drugs (such as antibiotics and antiretroviral drugs) due to lockdowns, reduced production of basic products, exportation stops or repurposing/stocking of drugs and material for COVID-19.
B) Protecting our patients and healthcare workers
Protecting patients and healthcare workers is essential, so our medical teams are also preparing for potential cases of COVID-19 in our projects. In places where there is a higher chance of cases, this means ensuring infection control measures are in place, setting up screening at triage, isolation areas, and health education. In most countries where MSF works, we are coordinating with the WHO and the Ministries of Health to see how MSF could help in case of a high load of COVID-19 patients and are providing training on infection control for health facilities.
C) Our actions against the epidemic
In Italy, which is now the second-most affected country (after China), this week MSF has begun supporting four hospitals in the epicentre of the outbreak with infection control, as well as patient care.
In Hong Kong, we are providing health education and mental health support for vulnerable groups.
In Iran, MSF has submitted a proposal to the authorities to help caring for patients with COVID-19. Whether we’ll be able to make similar offers to other countries will depend on the nature of the outbreak but also on our capacity to deploy.
MSF is extremely concerned how COVID-19 might affect populations living in precarious environments such as the homeless, those living in refugee camps in Greece or Bangladesh, or conflict affected populations in Yemen or Syria. These people are already living under harsh and often unhygienic conditions and their access to health care is already severely compromised.
Generally, we are very concerned how COVID-19 outbreaks will affect countries with already fragile health systems, such as in Central African Republic (CAR) or Yemen.
Infections of healthcare staff can happen easily in structures that are overwhelmed by large numbers of patients, and that have to deal with limited supplies of personal protective equipment for staff and probable reduced workforce. Infected healthcare staff will further reduce the capacity to admit and treat patients. Safety for healthcare workers should be a top priority in every healthcare facility.
In order to ensure that the medical tools urgently needed to respond to COVID-19 are accessible, affordable, and available; concerned stakeholders including governments, pharmaceutical corporations and other research organizations developing treatments, diagnostics, and vaccines should take the necessary measures to:
- prevent patents and monopolies from limiting production and affordable access;
- guarantee access to repurposed drugs for patients suffering from diseases that are the original indication for use to ensure continuation of care;
- prioritise the availability of the medical tools for protection and treatment of front-line healthcare workers; and
- Improve transparency and coordination, making sure an evidence-based approach is put in place to continuously monitor the risk of the potential supply chain vulnerability on essential medical tools, and to adapt mitigate measures when needed through international collaboration.
We are very concerned about the consequences in countries with weaker healthcare systems, who will struggle even more if they have to deal with a large number of patients with COVID-19.