The COVID-19 pandemic has already spread to more than 100 countries around the world. These include countries whose health systems are fragile and where MSF teams have a long-standing presence, as well as regions such as Europe, where the capacities are more robust but where the epidemic is particularly virulent. Travel restrictions generated by the outbreak also directly affect MSF’s work around the world.
What questions does MSF face in this context? Clair Mills, MSF’s medical director, explains the challenges.
Are we right to be afraid of COVID-19?
Several factors make this virus particularly worrying. Being a new virus, there is no acquired immunity; as many as 35 candidate vaccines are currently in the study phase, but experts agree that no widely usable vaccine will be available for at least 12 to 18 months.
The case-fatality rate, which by definition is calculated only on the basis of identified patients and is therefore currently difficult to estimate accurately, appears to be around one per cent. It is known that at least some of those people infected can transmit the disease before developing symptoms – or even in the absence of any symptoms. In addition, a very high proportion – around 80 per cent – of people develop very mild forms of the disease, which makes it difficult to identify and isolate cases quickly.
Confirmation of the diagnosis requires laboratory and/or medical imaging capabilities that are only available in reference structures, like teaching hospitals. It’s therefore not surprising that it’s proved impossible to contain the spread of the virus, which is now present in more than 100 countries around the world.
This epidemic then is very different from those – such as measles, cholera, or Ebola – in which Doctors Without Borders/Médecins Sans Frontières has developed our expertise over the last few decades.
CLAIR MILLS, MSF MEDICAL DIRECTOR
“Even though they cannot prevent the outbreak from spreading, the measures currently being taken by many countries can slow it down by reducing the increase in cases and limiting the number of severe patients that health systems have to manage.”
Furthermore, it is estimated today that approximately 15-20 per cent of patients with COVID-19 require hospitalisation and six per cent require intensive care for a duration of between 3 and 6 weeks.
This can quickly saturate the healthcare system – this was the case in China at the beginning of the pandemic and is now the case in Italy. There are currently more than 1,100 patients in intensive care units in Italy and the hospital system in the country’s north, although well developed, has been overwhelmed by the rapid increase in the number of patients.
As is often the case during this type of pandemic, medical staff members themselves are particularly exposed to infection. Between mid-January and mid-February in China more than 2,000 health care workers were infected with the coronavirus (representing 3.7% of all patients).
This pandemic is likely to lead to the disruption of basic medical services and emergency facilities, the de-prioritisation of treatment for other life-threatening diseases, conditions and for other chronic infectious diseases everywhere but especially in some developing countries, where the health system is already fragile.
Some feel that the response to this epidemic is an overreaction, and that the remedies – border closures, quarantine, etc – are likely to be worse than the disease. Is this justified?
Even though they cannot prevent the outbreak from spreading, the measures currently being taken by many countries can slow it down by reducing the increase in cases and limiting the number of severe patients that health systems have to manage at the same time.
The aim is not only to reduce the number of cases but also to spread them over time, avoiding congestion in emergency and intensive care units.
What are MSF’s priorities in this context, and its main concerns?
Priorities for intervention vary from one context to another.
In some areas that seem to be spared today, such as Central African Republic, South Sudan and Yemen, where fragile or war-torn health systems are already struggling to meet the health needs of people, protecting healthcare personnel and limiting the risks of spreading the disease as much as possible are needed.
This is done by implementing prevention programmes – identifying areas or populations at risk; running health awareness and information activities; distributing soap and protective equipment for healthcare personnel; and reinforcing hygiene measures in medical structures – to prevent our hospitals and clinics from becoming places where the disease is transmitted.
In countries where MSF has a longstanding presence we want to contribute to these efforts against COVID-19 while ensuring continuity of care against malaria, measles, respiratory infections, and other illnesses.
This continuity is now weakened by the restrictions (a ban on entering the country, preventive isolation for 14 days, etc.) imposed by governments on staff from certain countries, such as Italy, France and Japan, where some of our international staff come from, as well as the closure of borders and the suspension of certain air links.
Despite these constraints, our strength lies in the fact that we can rely on locally recruited staff in our countries of intervention. They represent 90 per cent of our employees in the field.
In countries where health systems are more robust but where the epidemic is particularly active, such as in Italy or Iran, the main challenge is to avoid overloading hospital care capacities. In these contexts, we can contribute to the efforts of national medical teams by making MSF staff available to support or relieve them when needed.
We can also help by sharing our experiences in triage and control procedures for infections acquired during epidemics. We have provided teams to support four hospitals in northern Italy and have also offered support to the Iranian authorities to support them in caring for severe patients. Depending on the evolution of the epidemic in France, we will make our experience, logistics and the know-how of our staff available to the response, if they can be useful.
One of the keys in the fight against COVID-19 is the availability of protective equipment, in particular masks and gloves used for medical examinations. The anticipation of shortages leads to requisitions by many countries, which can in turn become a reflex on the part of countries to monopolise these precious resources.
Right now, such equipment should rather be considered as a common good, to be used rationally and appropriately, and to be allocated as a priority to health workers exposed to the virus, wherever they are in the world.
Generally speaking, this pandemic requires solidarity not only between countries but at all levels, based on mutual aid, cooperation, transparency, the sharing of resources, and, in the affected areas, towards the most vulnerable populations and towards caregivers.