DRC: COVID-19 continues to spread, with potentially deadly secondary impacts

Covid-19 response in Kinshasa

Democratic Republic of Congo 2020 © Anne Boher/MSF

Since Democratic Republic of Congo (DRC) declared its first case of COVID-19 on March 10, the coronavirus has gradually spread across the country.

Congolese authorities are working to reduce the spread of disease, especially in the capital, Kinshasa, with some 13 million residents. The government implemented preventive measures, including movement restrictions, a partial lockdown of certain districts, and the compulsory wearing of masks in public. They also raised awareness about protective measures such as handwashing, cough etiquette, and physical distancing.

Despite these measures, however, cases have continued to multiply. Within three months, more than 4,500 people across 11 of the country's provinces were confirmed to be infected with the coronavirus—a likely underestimate given the limited COVID-19 testing capabilities within the country.

Faced with the dangers posed by the new coronavirus, MSF quickly set up COVID-specific responses across DRC in all the areas where its teams work, including in Kinshasa—which has reported 90 percent of the country’s cases. Teams are strengthening facilities’ preventive measures, installing isolation spaces, and carrying out health promotion and awareness-raising activities in local communities.

"In Kinshasa, we quickly organized mobile teams to support 50 health facilities," said Karel Janssens, MSF head of mission in DRC, a country already struggling with measles and Ebola epidemics. "Our teams have reinforced hygiene measures there, provided masks and handwashing facilities, and trained medical staff and community workers in infection prevention and control. The protection of health staff and patients was immediately our main priority."

More and more serious cases

A few weeks into the pandemic in DRC, MSF started supporting Saint Joseph hospital in Kinshasa’s Limete health zone. Teams set up a 40-bed treatment center for people with mild to moderate symptoms and are currently treating dozens of people each day, an increasing number of whom have severe symptoms and need oxygen therapy.

“From early May to early June, an average of 30 patients were treated in the center each day,” Janssens said.  “At the start of our response, most patients suffered from mild forms of the virus. But since mid-May, we have been receiving more and more patients in serious condition. By June 11, 14 of the 29 inpatients were on oxygen therapy.”

Jean-Pierre is one of the many patients admitted to Saint Joseph. After more than 10 days of treatment, he is getting ready to go back home.

“Before coming, I had headaches, aches, and I was coughing,” he said. “I had taken medicine, but there was no change. Encouraged by my wife and children, I went to Saint Joseph to have a voluntary test. When the results came back, I was admitted. After more than 10 days of treatment, I feel good. I had another sample taken for another test, but I’m waiting for the results.”

As the country has only one laboratory to run tests for COVID-19, many people have to wait for days—and sometimes for weeks—before they receive their results. In Saint Joseph hospital, more than 10 percent of patients had to wait more than two weeks to get those results. This situation is difficult for people with suspected cases of COVID-19 as they are forced to wait without knowing their status. It’s also difficult for people who have recovered but cannot leave the hospital until they receive the all-clear, despite the mounting pressure for hospital beds desperately needed by others who are sick.

COVID-19’s impact on access to care

As well as the direct impact of COVID-19 on individuals, the pandemic is having severe secondary impacts on people’s access to medical care for other conditions in Kinshasa.

Since the declaration of the pandemic, MSF teams have seen a startling drop in the number of consultations and admissions in the health facilities they support in Kinshasa, including in MSF’s center for people living with HIV/AIDS, the Kabinda Hospital Center.

"At the Kabinda Hospital Center, the number of HIV consultations fell by 30 percent between January and May,” said Gisèle Mucinya, medical coordinator at MSF’s HIV/AIDS project in Kinshasa. “And in Ngaba Mother and Child Center, which we support, a 44 percent drop in general consultations was recorded between January and April. It’s very disturbing."

The same observation was made by Dr. Rany Mbayabu, director of Kinshasa’s Mudishi Liboke private hospital. "Since March, consultations here have dropped by more than half, from about 250 to 100 patients per month. Our patients tell us that they are afraid of being contaminated by COVID-19 when coming in for a consult. Others are affected by the difficulties of movement and the economic impact of preventative measures."

This drop in medical appointment attendance is a cause for concern for MSF teams. If patient numbers have fallen in facilities that MSF supports, which offer free health care and take adequate protective measures, then they are likely to have fallen in medical facilities across the capital. As a result, many more people may die of non-COVID-19 medical conditions that could have been prevented. In fact, the mortality rate linked to other medical conditions is expected to be much higher than that currently observed in people with COVID-19.

"Many people fear they will be infected with the virus by going to health facilities deemed under-equipped with protective equipment, or they fear being isolated and stigmatized for a long time due to the delays in obtaining test results," Janssens said. “This situation affects the care of sick people and the monitoring of their treatment, especially for conditions such as diabetes, tuberculosis, malaria, and HIV/AIDS."

To help address this situation, MSF is advocating for health centers to be better supplied with personal protective equipment.

"This helps improve patients' confidence in going to health facilities and, in turn, strengthens efforts to contain the spread of COVID-19 while providing essential medical services," Janssens said. “Faced with a pandemic like COVID-19—and in view of the increase in respiratory infections that accompany the dry season—it is vital to ensure the proper functioning of frontline health facilities to prevent a further reduction in patients’ access to care."