On March 11, the COVID-19 outbreak was declared a pandemic by the World Health Organization. As of today, there were 132,536 confirmed cases of the disease in 123 countries, and 4,947 people have died. The vast majority of cases have been in China, where the outbreak was first reported in December 2019. However the epicenter of the outbreak has moved to Europe, and Italy now has the highest number of cases outside China. Iran, South Korea, and the United States are also reporting large numbers of cases. This pandemic is having huge impacts on health care systems in the countries affected.
What is COVID-19?
COVID-19 will be a mild or moderate respiratory illness for the vast majority of people, estimated at around 80 percent of confirmed cases. However, compared to the flu, it has a higher rate of quite severe complications for vulnerable people, including the elderly and people suffering from other infections or ailments.
Based on a recent report by the WHO-China joint mission on COVID-19, 20 percent of the confirmed cases will be severe and require hospitalization for sustained monitoring and supportive treatment. The report indicates that 6 percent of total confirmed cases (or about 30 percent of those hospitalized) will become critical and require specialized intensive care, such as mechanical ventilators.
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 weaker health care systems. We have limited knowledge about this new coronavirus: including how widely it could be transmitted in tropical areas and the possibilities for coinfection with other diseases, such as malaria, dengue, tuberculosis, and measles.
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. However, these measures should not lead to an increased risk of transmission within households, and particularly among more vulnerable family members.
How is Doctors Without Borders responding to 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 around the world. These 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. These 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 (such as antibiotics and antiretroviral drugs) caused by lockdowns, reduced production of basic products, exportation stops, or the repurposing and stocking of drugs and material for COVID-19.
MSF 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.
Given the size of this pandemic, it is clear that health care workers and patients need additional support and care. MSF’s ability to respond on the scale required will be limited, however we have started operations or offered support in the following places:
- In Italy, the second most affected country after China, MSF has begun supporting four hospitals at the epicenter of the outbreak. Teams are supporting infection control as well as patient care.
- In Hong Kong, teams are providing health education and mental health support for vulnerable groups.
- In Iran, the third most affected country, MSF has submitted a proposal to the authorities to help care for patients with COVID-19.
Key concerns for the future