A new coronavirus was first reported in Wuhan, China, on December 31, 2019. This new virus presents particular dangers: there is no known pre-immunity, no vaccine, and no specific treatment. The virus is contagious, and everyone is presumed to be susceptible. Doctors Without Borders/Médecins Sans Frontières (MSF) teams are working in projects around the world to fight the spread of coronavirus, and to sustain other lifesaving medical aid for communities who are further threatened by this pandemic.
Coronaviruses are a large family of viruses, most of which are harmless for humans. Four types are known to cause colds, and two other types can cause severe lung infections: Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). The novel coronavirus is now known as SARS-CoV-2, because of its similarities to the virus that causes SARS.
This new coronavirus seems to target cells in the lungs, and possibly other cells in the respiratory system too. Cells infected by the virus will produce more virus particles, which can then spread to other people, for instance by coughing.
On February 11, the World Health Organization named the disease caused by the new coronavirus: COVID-19. Both the virus and the disease were unknown before the outbreak began in Wuhan. The overwhelming majority of cases were initially concentrated in China, however the disease has now spread worldwide. On March 11, the WHO declared the COVID-19 outbreak a pandemic. As of April 7, there were more than 1,360,039 confirmed cases of coronavirus in 206 countries, territories, or areas, and 75,973 people have lost their lives. There are now more cases in the United States (367,776) than in any other country.
Our understanding of this new coronavirus and COVID-19 is still evolving. The virus can spread from person to person, including by people who appear to have no symptoms. This makes it much harder to get a good picture of the way it’s spreading.
The WHO notes that coronavirus can be transmitted through small droplets from the nose or mouth which are spread when an infected person coughs or exhales. People can catch COVID-19 by touching objects or surfaces contaminated with the virus, and then touching their eyes, nose, or mouth. People can also be infected if they breathe in droplets from a person with coronavirus who coughs out or exhales droplets. The WHO recommends staying more than three feet away from a person who is sick.
The latest estimates are that 80 percent of the people who get infected with the new coronavirus will experience a mild or moderate form of disease. Roughly 15 percent will develop a severe form of the disease requiring hospitalization. Some 5 percent will become critically ill. Sophisticated health care systems may be able to cure some critically ill patients, but the danger is that even the most advanced systems may be overwhelmed by the large numbers of people who will need to be hospitalized.
The high level of supportive and intensive care required to treat patients with COVID-19 places real challenges to even the most advanced health care systems. MSF is very concerned about the potential consequences in countries with weak or fragile health care systems.
COVID-19 is more dangerous for elderly people or people suffering from other infections or ailments. Children so far seem to be less affected by the disease. The mortality rates vary significantly from place to place.
Public health measures such as isolation, quarantine, and social distancing are generally put in place to limit community transmission, reduce the number of new cases and severely ill patients, protect the most vulnerable people, and manage health resources.
It’s important to protect yourself and protect others too. As with other coronaviruses, droplet infection seems to be the main mode of transmission. The virus enters the human body through the mouth or nose. This can happen by breathing in infected droplets, or by touching with your hands a surface on which droplets have landed, and then touching your eyes, nose, or mouth later.
Simple infection control measures such as good handwashing and proper cough and sneeze etiquette are effective and important for prevention.
Hand hygiene is paramount, so wash your hands often with soap and water. Use enough soap, and make sure all parts of both your hands are washed. Spend at least 20 seconds washing your hands. If there is no visible dirt on your hands, an alcohol-based gel is also a good option.
Stay home when you are sick, and avoid contact with other people. If you cough or sneeze, cover your mouth and nose with a tissue or with the inside of your elbow. Throw used tissues into a wastebasket immediately and wash your hands.
Social distancing is advised in places with community transmission of the virus. Avoid crowded places and large gatherings, and generally keep some physical distance between you and other people.
Given the current problems with the supply of masks, gloves, and other personal protective equipment, the needs of health care staff should be prioritized.
Our teams are responding to the coronavirus emergency on multiple fronts—caring for patients, offering health education and mental health support, and providing training for vital infection control measures in health facilities around the world. MSF is working with local authorities in many of the countries where we have medical projects to help prepare for the impact of COVID-19. A key priority is to keep our regular medical programs running for the tens of thousands of patients and extremely vulnerable communities we help support. This pandemic threatens the lives of people around the world, and presents even greater risks in countries with weak or fragile health systems.
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Note: This is a selective list of projects specifically related to MSF’s COVID-19 response, as of March 30, 2020. Our activities are evolving on a daily basis, and teams are working on epidemic preparedness in practically all our medical projects across the world. Preparedness may include a range of activities, such as how we reorganize triage and waiting areas; strengthen infection prevention and control (IPC) measures; and provide technical advice and training on IPC to other health workers and national ministries of health staff.
Highlights of our global response so far include:
- In Hong Kong, MSF sent one metric ton of personal protective equipment and is running a project to provide health information and mental health support to vulnerable communities. We also sent 3.5 metric tons of protective equipment to China’s Wuhan Jinyintan hospital—which was at the forefront of treating patients with COVID-19.
- In Italy—the epicenter of the pandemic in Europe—MSF is currently providing support to three hospitals in northern Italy to strengthen IPC measures. We have started activities in central Italy, where the number of cases is increasing. We also support a network of nursing homes in several cities to prevent cases from spreading in these vulnerable facilities.
- In Greece, MSF is providing medical aid on the islands of Samos and Lesbos, including support for people under isolation with mild to moderate cases of COVID-19. We are also calling for the immediate evacuation of refugees and asylum seekers trapped in squalid camps, high-risk environments for COVID-19 transmission.
- In Syria, teams are providing training and technical assistance in MSF-supported facilities in Azaz and Idlib, including help with the identification and set-up of isolation areas and the management of patient flow.
- In South Africa, the epicenter of the pandemic in Africa, teams from all four of our medical projects are now supporting the COVID-19 response in Gauteng, KwaZulu-Natal, and Western Cape provinces. Staff are assisting with contact tracing and the development and dissemination of health promotion materials.
- Burkina Faso: We are providing patient support in Fada health center as needed, training Ministry of Health staff, and doing epidemiological surveillance as part of our regular activities and health promotion. We are adapting triage and infection prevention and control measures at our projects in Djibo, Kaya, and Barsalogho, none of which have yet been affected by COVID-19. We're also training staff and assessing the capacity for patient treatment in Ouagadougou. Discussions with health authorities on how to support the COVID-19 response are ongoing.
- Cameroon: MSF is setting up a 20-bed isolation ward in Buea regional hospital. In Yaounde we are supporting health authorities in the General Hospital and implementing a safer patient circuit and infection prevention and control measures. We are also preparing the 54-bed facility in Djongolo for COVID-19 cases and constructing four new rooms with 20 beds to increase capacity. Once completed we will provide support for case management.
- Democratic Republic of Congo: In Kinsasa, MSF is preparing a unit at the Centre Hospitalier Kabinda for COVID-19 isolation of HIV-positive patients.
- Eswatini: We are supporting the Ministry of Health with infection prevention and control measures and triage at health facilities. We are also implementing adjust models of care for patients living with HIV, tuberculosis, and noncommunicable diseases in order to reduce their risk of coronavirus infection.
- Ivory Coast: In Abidjan, MSF is supporting the Ministry of Health at a transit center to screen and provide referrals to people with COVID-19 symptoms. In Bouake, teams are training health workers and conducting screenings at the different entry points to the city. MSF is also implementing water and sanitation activities.
- Liberia: MSF teams are supporting the Ministry of Health’s efforts to prevent and treat COVID-19. MSF has donated medical supplies and provided technical support to the MoH-run COVID-19 treatment center. Teams are also engaged in community health promotion to prevent the spread of the coronavirus.
- Mali: MSF is supporting the management of a COVID-19 unit in a hospital in Bamako, where we already run an oncology program. There are eight ICU beds and capacity for 100 in-patients in the facility, set up by the Ministry of Health. MSF has dispatched a team from its regular project in Koutiala. In and around Niono we have launched awareness-raising activities and installed water points for handwashing at the regional referral hospital. In Tominian, at the border with Burkina Faso, we have installed an isolation tent for suspected cases of COVID-19 and a handwashing point. And in Bamako we are providing water and sanitation services in the triage and isolation zone at the Hôpital du Mali.
- Mozambique: MSF is implementing infection prevention and control measures and triage in all health facilities where we work, including 16 new handwashing points. We are also adapting models of care to maintain social distancing measures and working with local authorities to improve patient flows in two referral hospitals in Maputo.
- Niger: We are adapting triage and infection prevention and control measures in our facilities in Magaria, where we run a 450-bed pediatric hospital with particularly vulnerable patients during the seasonal peak for malaria and malnutrition. In Niamey we are building a 45-bed treatment center near the Hôpital National Lamordé. We're also planning to train health workers on COVID-19 preparedness and have launched health promotion activities in Niamey and Magaria.
- Nigeria: MSF is working to maintain its operations in Nigeria while also establishing isolation facilities, adapting triage processes, launching additional community-based health promotion activities, and setting up handwashing points and isolation areas in local communities and camps for internally displaced people. In Ngala, MSF teams are focusing on reinforcing infection prevention and control.
- Senegal: In Dakar we are supporting health authorities at the Hopital Dalal Jamm, where we provide training and support for water, sanitation, and hygiene activities.
- South Africa: MSF has sent staff from all four of our projects to help support the COVID-19 response in Gauteng, KwaZulu-Natal, and Western Cape provinces. Staff are assisting with contact tracing, both in person and over the telephone; the development and dissemination of health promotion materials; and the decanting of health care facilities; and we're working to ensure HIV and tuberculosis patients get medication refills delivered to their homes. In Tshwane, we're providing care for vulnerable asylum seekers and elderly homeless people to mitigate the impact of the national 21-day lockdown.
- Sudan: MSF teams are in contact with the Ministry of Health and are supporting preparedness efforts, including infection prevention and control measures, trainings, logistics, and setting up a treatment center.
- Tanzania: Our health promotion team in Nduta refugee camp are working with the community to prepare for a potential outbreak of COVID-19 in the camp. MSF is the main health care provider at Nduta camp, in western Tanzania, which hosts more than 73,000 Burundian refugees.
- El Salvador: MSF is preparing to support the COVID-19 response, in coordination with the Ministry of Health. We are increasing ambulance service coverage and capacity in order to deal with non-COVID cases and adapting mobile clinic services.
- Haiti: MSF has stopped admissions in the Drouillard burn hospital in Port-au-Prince in order to respond to the COVID-19 outbreak. MSF has reorganized the emergency center in the capital's Martissant neighborhood to isolate and refer patients with suspected cases of COVID-19. MSF is also supporting epidemic preparedness at two public health facilities in Port-à-Piment and Port Salut.
- Mexico: We have increased medical activities in the border city of Matamoros, where some 2,000 asylum seekers are stranded in dire conditions. We are providing both physical and mental health services and health promotion.
ASIA & PACIFIC
- Afghanistan: After conducting a needs assessment, MSF is providing IPC training in the Afghanistan-Japan Hospital in Kabul, the referral hospital for patients with COVID-19. MSF is looking into ways to support case management in Herat.
- Bangladesh: In addition to maintaining regular medical activities in the Rohingya refugee camps, teams are organizing dedicated waiting areas for people with symptoms of COVID-19. In MSF hospitals we have set up dedicated wards and isolation rooms to prepare for patients with COVID-19.
- Cambodia: MSF provided training for staff in health facilities and is contributing to the development of national guidelines for IPC and clinical care for COVID-19 patients.
- Hong Kong: Teams are providing health education and mental health support for vulnerable groups, including street cleaners, refugees and asylum seekers, and visually impaired people.
- Kyrgyzstan: MSF is working closely with the Ministry of Health to support COVID-19 preparedness planning, with a specific focus on our operations in Kadamjay Rayon and Batken Oblast. We have also provided the Ministry of Health with personal protective equipment, including N-95 masks, gloves, thermometers, and sanitization supplies.
- Malaysia: We are prepared to increase support to the Ministry of Health and district authorities with contact tracing and testing. We have also called on the Malaysian government to repeal a directive that public health facilities report "irregular migrants," including refugees and asylum seekers. In Penang we are providing COVID-19 health education in multiple languages, including Rohingya and Burmese, and translation services in hospitals. Though we've had to suspend mobile clinics, patients can still reach our teams via a phone hotline.
- Pakistan: In Timurgara, northern Pakistan, the team is running an isolation ward and screening people for the virus in a number of departments at the local hospital.
- Papua New Guinea: Teams have provided training on IPC, screening, and triage in 22 provinces.
- Uzbekistan: In Karakalpakstan, MSF has launched a Karakalpak-language health promotion campaign directed at people living with tuberculosis to educate them about the risks of the coronavirus.
- Belgium: MSF’s COVID-19 intervention has three components: support to hospitals to increase their admission capacity; support to nursing homes for the elderly; and support for vulnerable groups such as homeless people and undocumented migrants. MSF is supporting seven facilities with human resources, technical advice, and material.
- France: Teams are running medical projects for vulnerable groups, including homeless people and migrants, in Paris and surrounding areas. Activities include mobile clinics and help screening people for the novel coronavirus. On March 24, some 700 people were evacuated from a camp in Aubervilliers and sent to emergency shelters in Paris and Ile de France. MSF teams are deployed in some of these shelters to evaluate their health and identify people with potential cases of COVID-19. Another team is screening homeless people for COVID-19 and other medical conditions. Teams are also assessing the situation in referral hospitals in Paris and elsewhere, exploring options for case management support.
- Greece: MSF is providing support on the islands of Samos and Lesbos. We are currently doing health promotion for residents of the camps and have procedures in place to support referral of patients presenting symptoms of COVID-19. At the same time we have adapted our facilities and procedures in order to ensure the safety of both patients and staff, increased provision of water and sanitation services in the camps, and scaled up operations with recruitment of more medical, paramedical, and support staff. We are in discussions with the Ministry of Health to coordinate further action and support. We continue to call for the immediate evacuation of refugees and asylum seekers trapped in squalid camps, high-risk environments for the transmission of COVID-19.
- Italy: MSF is currently supporting three hospitals at the epicenter of the outbreak in Europe, in the Lombardia region in northern Italy, to strengthen infection prevention and control measures and provide additional doctors. Outside the hospitals we are conducting outreach activities to reach vulnerable people, supporting family doctors and health care workers, and assisting people living under home isolation with a telemedicine program. We have also started activities in the Marche region in central Italy, where the number of cases is increasing. We support a network of nursing homes in several cities to prevent cases from spreading in these vulnerable facilities, which have no specialized medical staff to manage the patients. There are about 40 MSF staff involved in the response to coronavirus in Italy.
- Netherlands: We are providing mental health support, including stress management tools, to psychologists in one hospital, and monitoring the situation for homeless people across the Netherlands including asylum seekers.
- Norway: MSF is providing strategic advice and IPC support to a hospital hosting up to 12 percent of the hospitalized patients in the country.
- Spain: Two temporary health structures with more than 200 combined beds set up in Alcalá de Henares and Legané in Madrid will be operational this week. MSF teams are supporting several hospitals in the city with guidance on decongestion. In Barcelona, we participated in the design of external structures and patient circuits of the city's main hospitals, including Fira de Barcelona. We're also operating in central Catalonia, tending to the needs of municipal hospitals. In the Basque country we are supporting homes for the elderly, providing guidance on personal protective equipment for personnel and more.
- Switzerland: In Geneva, MSF is providing logistical and sanitation support to vulnerable communities, aimed at reaching 1,300 families. Staff are exchanging medical expertise with the the university teaching hospital in Geneva, Hôpitaux Universitaires de Genève (HUG). MSF medical staff detached to HUG are focusing on patient care and managing medical teams.
- Ukraine: We have expanded health education activities for all patients and staff and are increasing infection prevention and control measures at our projects and offices.
MIDDLE EAST AND NORTH AFRICA
- Iran: MSF had reached an agreement with authorities to provide care for patients with COVID-19 in the city of Isfahan. We had flown over cargo, including an inflatable hospital and staff, and were preparing to start activities when authorities unexpectedly revoked permission. Activities are currently on hold, but we remain willing and able to respond if asked.
- Iraq: We are supporting Baghdad's Ibn al-Khatib hospital, one of the city's three quarantine hospitals designated by the Ministry of Health, donating personal protective equipment and training staff on its use. In Mosul a hospital rebuilt by MSF is now being used as the main COVID-19 referral hospital in Nineveh governorate. We've also equipped a building for isolation. Our existing projects in Nineveh, Diyala, Kirkuk, and Baghdad continue to provide lifesaving health care while reinforcing capacity to identify COVID-19 patients, support infection prevention and control, and refer patients to Ministry of Health hospitals in accordance with established protocols.
- Libya: MSF has provided training on IPC and case management to nurses and doctors in hospitals in Tripoli.
- Palestinian Territories: Regular activities have been reduced in Gaza as we prepare staff and facilities to manage cases of COVID-19.
- Syria: In northwestern Syria we are reviewing triage and patient flow in several MSF-supported hospitals to ensure quick detection and isolation of COVID-19 cases. We have also set up hygiene committees in these facilities and donated personal protective equipment to staff. In camps for displaced people we have adapted triage systems and implemented social distancing measures for mobile clinics to ensure safe continued distribution of non-food relief items and health care services. In Al Salama hospital in Azaz and in supported facilities in Idlib our teams are carrying out COVID-19 training for medical staff. Isolation units and sample and case referral pathways are being identified and infection prevention and control measures are being implemented in inpatient wards and emergency rooms.
MSF’s international medical programs are impacted by the current travel restrictions, which limit our ability to move staff between countries. We also are dealing with the consequences of global shortages of medical supplies, in particular personal protective equipment for health care staff. Our regular health care programs are also preparing to deal with potential cases of COVID-19, especially making sure infection prevention measures are respected. We must be able to receive people with COVID-19, while making sure that no one is consequently infected in our structures, including other patients as well as staff.
We need to ensure that we can continue to provide lifesaving medical care in our ongoing projects. So far, teams are able to continue medical activities, but securing future supplies of key items—such as surgical masks, swabs, gloves, and chemicals used to diagnose COVID-19—is a matter of concern. There is also a risk of supply shortages due to a lack of production of generic drugs and difficulties to import essential drugs due to lockdowns, reduced production of basic products, exportation stops, or the repurposing and stocking of drugs and material for COVID-19.
MSF also seeks to ensure that any new treatments or vaccines developed to respond to COVID-19 are accessible, affordable, and available to all.
Teams are also preparing for potential cases of COVID-19 in our projects. Protecting patients and health care workers affected by the pandemic is essential. In places where there is a higher chance of cases, this means ensuring that infection prevention and control measures are in place, setting up screening at triage, maintaining isolation areas, and providing health education. In most countries where MSF works, we are coordinating with the WHO and the respective Ministries of Health to see how MSF could help in case of a high load of COVID-19 patients. We are also providing training on infection control for health facilities.