Fabrice Weissman, who is a member of the MSF COVID-19 response team in Malawi, describes the situation in Malawi.
The pandemic has been developing at a rapid pace since mid-December. At that time, the majority of new cases was found among Malawian workers returning from South Africa, while today almost all the new cases are the result of local transmission.
There is a very high probability that the COVID-19 variant 500Y.V2, identified in South Africa, is responsible for this second wave. According to current scientific knowledge, this variant is 50 per cent more transmissible than the original strain, leading to a quick surge in the number of people needing hospitalisation. This number has doubled every week since the beginning of January.
If the epidemic in the country follows the same pattern as in South Africa (where the peak of the second wave was reached after nine weeks), we can expect the number of severe patients in need of hospital care to increase unabated up to mid-February. The hotspots of the outbreak are the two main cities in the country, Lilongwe in the centre and Blantyre in the south, which account for around two million people.
The number of severe COVID-19 patients hospitalised at QECH has increased from 12 to 107 between 1 and 21 January, exceeding the hospital’s maximum capacity for COVID-19 patients, which is currently 80 patients. This puts a great stress on the facility, in particular with regard to human resources, medical equipment and consumables and oxygen supplies – in all three areas, the hospital director has asked for emergency support, which we have begun to provide.
The most critical priority now is to protect the frontline staff, if only to keep the workforce operational. More than 10 members of the MSF team have been diagnosed with the new coronavirus in the past 10 days (fortunately none of them have developed severe symptoms so far). This is putting a huge strain on our operational capacity.
Our second objective is to reduce deaths among the patients coming to Queen Elizabeth Central Hospital, which is the only public facility providing care for severe patients in Blantyre, where more than one-third of the cases are reported. The hospital is doing a great job in dire circumstances.
We hired 50 extra health workers to reinforce their team and are helping to manage oxygen supplies. Oxygen is the lifeline in the treatment of patients, but the demand far exceeds the national production capacity and has to be met by imported cylinders and concentrators, which are in short supply.
In addition to providing manpower, oxygen and technical support to Queen Elizabeth Central Hospital’s COVID-19 wards, we are setting up an additional ward of 40 beds dedicated to COVID-19 patients. It will be fully equipped and staffed by MSF, in response to a call for help from the hospital director and the district health officer.
Another issue is that while the number of patients coming to the hospital is already overwhelming, there are indications that quite a few of the severe cases do not even reach the hospital and many people are probably dying at home. Our next objective therefore is to improve the early referral of severe patients, in order to maximise their chances of survival.
But to contain the number of infections and deaths caused by this new wave of the disease, Malawi urgently needs access to vaccination – which unfortunately is unlikely to happen before April 2021, and even then, only for a portion of its people. By that time, the pandemic might have already peaked, and killed many who could have been protected by vaccination.