MSF activities, Moria Clinic
A pediatric clinic outside Moria camp where our patients pass through a series of screenings for COVID-19.
Greece 2020 © Peter Casaer/MSF
Click to hide Text

Let's talk COVID-19: Emergency physicians on the front lines

A live online discussion series hosted by MSF-USA Executive Director Avril Benoît

April 16 2020, 1:00pm - 1:45pm ET

Read transcript here

Avril Benoît:

Hello, welcome once again. Thanks for joining us for our weekly series called Let's Talk COVID-19. I'm Avril Benoît, I'm the executive director of Doctors Without Borders, Médecins Sans Frontières, in the United States. I'm joining you from my apartment in New York City. And for Doctors Without Borders, you might know us also by our international name, Médecins Sans Frontières, which is why we get the MSF acronym that you might hear over the course of this discussion today. And I'm really excited today because we're going to be focusing on emergency medicine, emergency care during the COVID-19 pandemic, and lessons that our organization, MSF, has learned from past outbreaks, medical emergencies, and conflicts. The kinds of places where we work, we have a lot that we're able to apply in our response to this particular pandemic.

We're going to speak for about 45 minutes. And wherever you're joining us, you can contribute your questions. This is a live broadcast. Submit your questions on Zoom, if you're watching through Zoom, into the Q&A box, the option that's there. And if you're watching us on Facebook Live or Twitch, you can send your questions through the comments sections. Those will be directed to me and then I'll ask them of our panelists. So I'll get right to the introductions.

Now, joining me from London, is Dr. Javid Abdelmoneim. He's an emergency physician. He's also the President of the Board of Directors of MSF in the UK. And these days he's working at his regular job at the National Health Service Hospital in London, responding to COVID-19 outbreak there. Hello, Javid! How are you doing today?

Javid Abdelmoneim:

I'm doing well, Avril. Nice to see you, nice to see you, Craig. Welcome, everybody. I'm in my home at this moment in London, yes, coming to you at two in the afternoon.

Avril Benoît:

And all quiet over there?

Javid Abdelmoneim:

Today, yes. I think my dog ... I can just hear my dog, actually, coming home from his walk, so you may get a scattering in a second, but all good. It's my day off, I'm in my MSF role today. I'm back in the NHS, in hospital, on Sunday.

Avril Benoît:

Great. Well, as you mentioned, we've also got Craig Spencer. Craig is an emergency physician in New York. He's a member of MSF's Board of Directors in the United States, and also Director of the Global Health in Emergency Medicine, and an Assistant Professor of Medicine and Population and Family Health at Columbia University Medical Center. And these days, he's been working in the emergency room at his hospital in New York City. How are you doing, Craig?

Craig Spencer:

I am doing great. I don't have a dog but I do have a 17-month-old, who's going to go down for a nap soon, so she may make an appearance either vocally or in person.

Avril Benoît:

It's fantastic to connect the two of you, across the ocean, as it might be. You know each other, don't you? Tell me, Craig, what you know of Javid that we ought to know for the sake of this discussion.

Craig Spencer:

Well, I first met Javid ... We were both going out to Ebola in September 2014. We did a training in Brussels, they had like a ... For the Ebola trainers, for the people that were going to deploy, they had kind of like a makeshift Ebola treatment center in the middle of Brussels. So we were there for a couple days, doing some training before we both deployed. So we were able to meet them and our paths have crossed a couple times since then. Myself, on the Mediterranean search and rescue boat through Doctors Without Borders, I was there, Javid was there. I think we both made a couple of appearances there.

Avril Benoît:

Javid, what do we need to know about Craig, from your experience of him?

Javid Abdelmoneim:

As Greg detailed, that's how our paths have crossed. I've had some interactions with the Board of Directors of the MSF USA as well. We've conversed through last summer, I believe, if I recall well, on MSF matters. But yes, I've been seeing Craig being very vocal on social media through this COVID-19 pandemic, and I have to say I agree wholeheartedly with all the sentiments and everything that he's said. He seems to have had a different experience in his emergency room than I have here in London, and perhaps we'll explore some of that later.

Avril Benoît:

Let's start with that, actually. Javid, what is it like where you're working? What kinds of things are you encountering in London?

Javid Abdelmoneim:

It's interesting. In the ER, where I work, across the entire National Health Service in England and the whole of the UK, we've moved to a binary system, a triage where everything at the door is filtered for either being possibly COVID or not, and so we have green and red zones. Overall, in the green zone, we're seeing fewer cases of what might be ordinary ER attendances. But what's coming through the red zone is all ... all one disease, that people are coming through, tend to be a lot sicker, and the entire health service behind us, the whole hospital, has been geared towards the reception of that one illness. So in that sense, it's all ... it's odd.

I have to say we've been very well prepared, we've been able to quadruple our intensive care and ventilator bed capacity in my hospital networks in West London. We've had good supplies, good training, and morale is high. We've managed the flow of patients well. And yeah, in that sense, it's been as good as an experience as it can possibly be given the circumstances.

Avril Benoît:

Craig, how does that compare to your own experience in New York City?

Craig Spencer:

I imagine we're seeing the same patients with the same symptoms and doing a lot of the same stuff, the same treatment. But I think the difference is that, whereas for you, you have a national health system that can put out guidelines and you can help direct different ... whether it be PPE or whether it be ventilators or whatever, all throughout the country were needed, what we're seeing here in the US has been more of a fractured response. We have a big hospital systems. I think what we're seeing here in New York City is really a spotlight on the health inequities that have existed for so long, not only in New York but in the US.

We just got disaggregated information about a week ago and how this is impacting New Yorkers. And unsurprisingly for anyone who's been working in the emergency room, the death rate for Latino or Hispanic New Yorkers, as well as black and African American New Yorkers, is double what it is for white New Yorkers. The impact has been huge in the outer boroughs, so the areas where people do not have the same economic capacity to socially distance or stay at home, like what we've been messaging so much here in New York City. So, this has really highlighted so much of the inadequacies and, really, efficiencies in our health system, and I'm hoping that's something we address after.

But a lot of what we're seeing is quite similar to Javid. A lot of really sick patients. I just worked up until two o'clock this morning, yesterday was a little bit better. I'm hoping that's because the cases are going down, and we think that that's true, but we've also expanded capacity in our ICUs. We've opened up field hospitals, there's field hospitals in Central Park, and stadiums, and ships in the harbor. So we've expanded capacity, we've got a lot more professionals here. Everyone is on the front line, doing whatever they can, and morale is still, thankfully, high.

Avril Benoît:

What connects all three of us is that we work with Doctors without Borders, with MSF, Médecins Sans Frontières. And we know that our colleagues around the world are readying themselves, are transforming our medical approaches in light of the arrival of these COVID-19 patients. But for the two of you, you're among the legions who are essentially grounded in our home countries, and who are practicing medicine and offering to support in your local communities. Tell us what you have learned, particularly from the Ebola outbreak in West Africa. That experience, that muscle memory that you have been able to apply to your work in New York. Maybe start with you, Craig.

Craig Spencer:

Sure. So yeah, I worked in West Africa for ... I did two different missions, one in 2014 and one in 2015, after I had survived Ebola myself. And so I have a different and kind of unique perspective on the disease, both as a patient and as a provider. The skills that I learned in West Africa were critical in what I'm doing right now, in my West Harlem ... my Washington Heights hospital. And the way that I try to describe it is that we can drill, we can drill, we can do a bunch of experiential discussions and debriefs, but nothing is like the real thing.

When I was a patient here in New York City, the ICU nurse who took care of me, who had been doing this for over two decades, missed an IV on me two times, and then a third time, hit a nerve. I'm sure she could get blood from an orange, this woman's incredible, but she was so scared because she was so worried. I think that my big concern is that we had so many people respond globally in West Africa to provide critical care, but so few from the United States due to the legal restrictions, other concerns.

The result is that right now in the US, we have so few people that are capable, that have had this experience, that feel comfortable taking care of patients with a potentially deadly disease, and I think it's really shortchanged us. It's really taken away the tools that so many of us could have, both in terms of understanding infection prevention and control, as well as these more critical care things that we need and those experiences that would do us, I think, a big favor in taking care of patients right now.

Avril Benoît:

Javid, how about you? When you think of what you learned from your experience of working with people with Ebola, how have you been able to apply that to your response in the COVID-19 pandemic?

Javid Abdelmoneim:

Yeah, on a very personal level ... I connect with some of the things that Craig has mentioned. But on a personal level, in the ER, where I work, I was able to predict or put on my colleagues' radars some of the difficulties and challenges that they were going to face in not having a cure and potentially having overwhelmed resources and some of the morally distressing or moral injuries that we might face, potentially having to make decisions about who should get what type of care in a frequency that we wouldn't normally have to make. Life ... CPR decisions, so forth. So talking about moral distress, bringing that to my colleagues in a way that ... I've been there, it was like that in Ebola, and it was a very uncomfortable place to be, and it was a tough experience, and I had help with MSF. And I wanted to put that on my colleagues' radar.

Also, in a much more practical sense, when we first opened the red zone, as Craig said, you can drill all you like, but taking off the PPE in the correct way, ensuring the flow is correct, just paying attention to some little, little kinks in the chain. You need every part of the chain of infection prevention and control to be strong. And I was able, just with my only one-time Ebola experience, add a little bit extra to what had been put in place. And, actually, that sort of helped the team feel a lot more confident in what was there. Because PPE guidance evolved, and we were using, what was felt to members of staff, to be a lower level of PPE than they wished. So with a little bit of support and help and input that I'd had previously, I was able to really help in that small way, and I think it was valuable.

Avril Benoît:

It's tricky to make the comparisons and certainly there were many comparisons made in the early days when there was so much skepticism around, "Ah, this is like the flu, isn't it? It's just a new kind of flu, it's no worse. Flu is deadly, this will be deadly." And with Ebola, I hear a lot of our own medical teams making the links with their history with Ebola. We have a question here, actually, from somebody who's asking, from the patient perspective, how does it compare?

Craig Spencer:

Yeah, I'm happy to-

Avril Benoît:

Maybe you, Javid.

Craig Spencer:

Yeah, go ahead, please please please-

Javid Abdelmoneim:

I'll start and then you finish off for us, Craig. From my perspective, again, it was about the feelings that patients would have of fear, being magnified. You're presented with a healthcare worker whose face you can't necessarily see. So communication, they know it's a disease that doesn't have a cure. These types of fears play on a patient, as well as the fact that they're not necessarily going to have the same visiting rights as they might have with their families. So communication externally and support socially once in hospital. And so, again, I was really keen. That was one of my biggest things from Ebola, was that disconnect that patients had from their caregivers, be they professional or informal, their family. And I really wanted that not to be the case, again, here because that hurt me personally.

And I was able to do that. I'd be in recess, if we're about to put someone on a ventilator, they may not be able to finish a sentence, but I wanted them to be on the phone to their loved one, just to say the words they needed to say because it could have been their last. And so in that way, it's a very similar experience.

Craig Spencer:

Yeah. 100 percent, we've been struggling here. That moral injury that you referred to, Javid, is so important. My providers that I work with here, are not used to this. They'll show up for this, but this is not what they signed up for. From a personal perspective, I've written about this on my Twitter page and in the Washington Post a couple days ago, this feeling that as a patient, looking up, trying to understand a provider who's talking to you through a mask that is muffled, or through goggles that are foggy. And that the whole time ... the same time, feeling toxic. That you could potentially infect that person that's trying to do everything they can to take care of you, while also being completely disoriented, both because you're sick, but being in a place, seeing things you've never seen before. I can't even imagine, even as someone that's been a patient, what it's like for so many ... the people that are coming through our doors right now.

And I think the big difference with what we saw in West Africa ... I mean, think of the inhumanity of all this, not having someone at your side to hold your hand when you die. Right now, I have FaceTime, I have WhatsApp, I have video to do that, but that's something that we didn't have in Guinea, Liberia, or Sierra Leone. And that caused, I think, a lot of problems in terms of community trust, but it also was problems for patients themselves and providers who felt this horrible loss every time somebody died and they weren't able to connect with their family.

Avril Benoît:

We're taking questions on Zoom, in the Q&A option, and also on Facebook Live and Twitch, in the questions and comments section ... or the comments section. And we have a few here that have come in. Craig, I'll address this one to you, and it's about the World Health Organization, the WHO. President Trump announced that he was displeased with the WHO and wanted to cut its funding. It remains to be seen whether he has the power to do that. But certainly, this is a political question, it's one that you've been thinking about. Can you give me your take on what is going on with that, and how you would recommend that people process this kind of discussion about blame? Who's to blame for the pandemic being as bad as it is, who's to blame for knowing things and not sharing, etc.

Craig Spencer:

Yeah. That's a really important and good question. I wrote about this also yesterday in USA Today as an opinion piece. I'm just really concerned about this, I'm concerned for what it represents in terms of the World Health Organization. We can talk about their inefficiencies, they absolutely do need improvement, I completely agree. At the same time, the World Health Organization, this is me speaking as a private citizen and a Director of Global Health at an academic institution, what this represents, I think, is just a dangerous diversion from the fact that our preparedness here in the United States has been suspect and has, unfortunately, been lacking.

We didn't ramp up testing the way that we should have. We're scrounging for personal protective equipment. I've got friends in Ohio and Michigan who are asking me to send them N95 masks because their hospital systems are giving them one a week. This is an absolute crisis, and unfortunately I think that we're diverting some of the blame from ourselves on to organizations like the WHO who, yes, are political organization, not by their own desire, but that's the way that they're funded. This is the way this has changed in the past couple decades. They are funded by countries who do strings attached allotments of money. Many of them, Western countries, especially the United States.

I think that if this administration is so serious about improving global response to pandemics, be it coronavirus or the next one that will undoubtedly hit us, they need to extend a hand and not rip up a check.

Avril Benoît:

All right, we have another question. I'm going to direct this one to you, Javid. It's from Donald asking, "How long will this last? And when to open the parts of the economy that have been shut down." Any sense of that, Javid? I mean, I think we all would like to know. I don't know if you have the answers.

Javid Abdelmoneim:

That is golden eye question, isn't it?

Avril Benoît:

I'm hoping you have- Yeah.

Javid Abdelmoneim:

"It's impossible to say," is the short answer. We've just had our distancing measures extended by three weeks here in the UK, France have just said to mid-May. I think New York just said the same. This will last as long as it needs to last, I'm afraid, in terms of if you look at it purely from the health outcome of ... the primary health outcome that COVID-19 represents. There will be ... the issues that the social distancing measures could have created for the economy, for people's health, otherwise. People are not presenting to health systems as much as they ought to for non-COVID related items. So this is impacting many things and that are negatively. And so that will have to come into consideration, but I don't believe I can answer when this will end. It won't be in the next month, put it that way.

Craig Spencer:

Yeah.

Avril Benoît:

We know that it's reached hundreds of countries around the world. The countries were MSF, Médecins Sans Frontières, or Doctors without Borders, has medical teams operating and just hoping that they can continue with the medical work that we do. As it spreads, what do you expect to happen in those places? Based on ... Both of you have worked in South Sudan, both of you have worked in Lebanon, Syria, and things like this. What is on your mind, as you see how the numbers seem to be picking up in the kinds of places that are already in the midst of some form of humanitarian crisis? Craig?

Craig Spencer:

Yeah, I'm happy to start with that. Look, it's no surprise that we've heard about the greatest number of cases in the economies with the greatest GDP. Like this is China, this is places in Western Europe and in the United States. There are cases and there have been cases in West Africa, and other places in Southeast Asia. We haven't been picking them up and we're seeing them a lot more now. I have worked in Burundi, a small, very dense country of 11 million people in East Africa, for over a year, part of that with Doctors Without Borders, part of it independently with a group of Burundian doctors that have started a health system there. I was talking to one of my friends, he mentioned that they have maybe 10 ventilators in the whole country.

I've seen numbers that CAR, Central African Republic, has maybe half a dozen. We know that in many sick patients with COVID, the only thing that can save their lives is a ventilator in addition to high-level intensive care. Maybe there will be some blunting of the worst part of this impact because populations, especially in Sub-Saharan Africa are younger. But they also have much greater incidence of HIV, malnutrition, other things that we know will likely increase the morbidity and mortality from this disease.

I am so, so, so concerned about the impact this is going to have all over the world. We have now stopped exporting a lot of our personal protective equipment from wealthier nations, so it's much harder and much more expensive for people to get them in places where we're working. We've also not talked about it, right? Like if you're here in the United States, somehow this is a global pandemic that is only impacting the US and maybe Italy. Every time I talk to a news reporter and say, "Hey, these are the things that I want to talk about," they all listen beforehand, say, "Okay, we can talk about the international," but no one ever asked me about that in an actual interview. So I think it's so important for us to really continue to highlight, and I think that's where organizations like the WHO, like Médecins Sans Frontières, other organizations that are working in these contexts and are trusted, and operational in this context, that's where our role is. It's to highlight the impact this is going to have and think about what impact we can have in blunting that impact, from Bolivia to Burundi.

Avril Benoît:

Javid, you've been paying attention to the work that MSF is trying to do to actually scale up, ramp up, get the PPE and other equipment where it needs to go. Can you describe some of that effort for us?

Javid Abdelmoneim:

Yes. It's quite extraordinary, actually, when one looks at what the effort is required. For example, Avril, Craig, you'll know we'll get these internal operational updates three times a week from various corners of the movement, and just yesterday it's had 25 countries in it. And often this would be two or three countries that we'd hear about a big item coming out of that place. And it's 25! That's one third of where we're working around the world and it's all COVID related. Bar one, one was about the measles outbreak. But I worry that, firstly, maintaining operations, as they are in these countries, is under threat, simply because of supply, be they people or equipment. And the second question really for us is ... There are too many questions, I don't even know where to go with it.

I'll answer your question first. Within-

Avril Benoît:

It's a question from Wu, asking-

Javid Abdelmoneim:

Yeah, well-

Avril Benoît:

... what are we doing.

Javid Abdelmoneim:

Yeah. Within all of the projects, as far as I can see and read, where we work and in all of the countries, there has been a pivot towards at the very least doing infection prevention and control teaching of all the staff and the communities as well. So community engagement was one of the biggest learning points from Ebola, was until you convince the community, get their support, and have their understanding of what the measures are required to control the outbreak, then you're really not going to be going anywhere far. Everywhere I read, from Bangladesh and Cox's Bazar, to Juba in South Sudan, to Jordan to, as you said, Burundi, even Brazil, community engagement, and infection prevention and control. Already have set up several isolation units in most of the big fixed hospitals that we have around the world, from Haiti to Afghanistan.

So those are the operations that we've done globally, already. And then it's a case ... Setting aside what's been done in Europe, working with the homeless, with the vulnerable, with elderly populations. Always to look for the most vulnerable, where the people are most going to be disadvantaged by these really difficult social distancing measures that are going to be coming in place.

Avril Benoît:

Javid, we have a question from Alice about how can MSF tackle issues of health promotion in low-resource settings in the midst of an environment of possible contagion, that would be my part to add to it. How would we go about that? Health promotion being ... And maybe you can just highlight what would be the key messages around hand washing, social isolation, stuff like that.

Javid Abdelmoneim:

Yeah, that would be an integral part of everything that we're doing now. So when I was just talking about community engagement, perhaps I should have actually said it as that. It's health promotion. It's getting those key messages, in this instance, it will be, "Catch it, kill it ... " What is it? Now what do we say in the UK? "Catch it, kill it, bin it"? When you have to catch a sneeze, wash your hands, that type of thing. So it's avoiding anything that might increase transmission. So try to catch that cough and sneeze, wash your hands as much as possible.

If you are feeling symptoms, do stay at home. But of course, it's a very privileged ... "Stay at home" message is a very privileged message for us. But even in New York, in London, and particularly in the places where we work, there will be a large number of members of society and communities for whom staying at home is a really, really difficult thing to do. You need to go out and work, and to go out and find your work. You might be in a domestic violence situation, you might be in a situation where you can't get your food or overcrowded.

Those messages are going to have to be tailored specifically to each community where we work, and they will be.

Avril Benoît:

That links to a question from Millie, "Do you think that all countries must have the same inflexibility around quarantine, the same measures. Because if we compare Europe with some countries in Latin America, Asia, or Africa, measures are different from place to place." Craig, how do you see this expectation that countries will have to impose quarantines, but it's just not possible to have the same kind everywhere?

Craig Spencer:

I think that's absolutely true. Look, we're seeing that even here ...

Avril Benoît:

I don't know if I'm the only one having difficulty hearing.

Javid Abdelmoneim:

No, I couldn't hear him.

Avril Benoît:

Okay, let's ask you that question, Javid, while we try to sort out Craig's sound. So the idea of quarantine rules applying pretty much everywhere, but having to be a little different from place to place.

Javid Abdelmoneim:

They're going to have to be different. But let's face it, on some level, just about the only weapon, or the only tool we have in our toolbox in controlling the spread of this disease, has been an element of social distancing, that's what we call it in the UK. It's an element of reducing that RO, that number of infection rate to below one. So, there's going to have to be an element of that, but it will not be the same everywhere simply because of the circumstances of the population, as I alluded to earlier. It takes a heavy toll, and we saw that in Ebola, we've seen that in the UK. People who are self-employed, or people who have to go out and earn money that day to pay for that meal that day, how are they going to be supported in the places where we work, if they're being told to stay at home for the next three months? It's going to be very difficult.

Avril Benoît:

Yeah. Craig, Javid picked up where your mic left off, but I think you're back on. We have a question from Facebook, from Maria, asking, "What do you think about refugee camps, like Moria in Greece, and the effect of COVID-19 in overcrowded camps like those? Craig?

Craig Spencer:

This is one of my greatest concerns and one of my greatest passions. My academic research is focused on migrants, it's focused on the human rights, and the health impact of migrants, primarily, in West Africa, in Niger. That's where I spend a lot of my time studying this issue. And even today, I was reflecting on the fact that this year I'm not going to be able to get out there in the next couple of months, I have a project that's funded, I'm not going to be able to understand the reality in the ground. We know through reporting that's coming out right now, that COVID is being used, not only in Niger, but in the United States and in many countries all over the world, as a tool to both continue to limit migration as well as to continue to push policies that have negative impacts, particularly health impacts, on migrants and refugee populations all over the world.

This happened very early on in all of this. I remember this was in February, I believe, when one of Doctors Without Borders' boats in the Mediterranean was basically quarantined off the coast of Italy before there were really any cases and really for no other concern other than as a way, basically, to continue to highlight this migrant crisis that has been a problem for years. We're seeing it with the impact here in the United States. The Trump administration has put in place measures, through the CDC, to basically stop all asylum applications and all ... Basically, shut down the southern border even further than it had. And so this is something that, unfortunately, is magnifying this increasingly nationalistic and anti-migrant sentiment and policies that have been increasing around the world.

And, in addition to these policies being harsher, the impact on refugee camps, places where water and sanitation is already limited, places where access to health care is already limited, it's going to be absolutely huge. And again, very few people are talking about the impact of that.

Avril Benoît:

One question has come in around aspiring doctors. They want to help, they want to help us, they want to help MSF or Doctors Without Borders. What would you recommend for them or somebody who wants to help in their local community? Craig?

Craig Spencer:

What I've been recommending to even my doctor, nurse, and healthcare friends in our local community here in New York City, is thinking about the vulnerable populations here. My downstairs neighbor, who could probably hear me talking right now, has been in this building for over 50 years. We've done everything we can to prevent her from going out. If she needs groceries, if she needs anything ... I think this all starts small. We talk about community and it can be a small community. Even if you are a health care professional, thinking about the people in your network, in your small community, is really the most important and best place to start.

I think the other thing that we can be doing, as healthcare professionals, is highlighting public health messaging. Highlighting health messaging and trying to separate, especially here in the US, this kind of public health truth from a lot of the political partisan messaging that we've been hearing. And so anyone trained in healthcare, I think can, hopefully, see through that. Sharing that information with your friends, with your loved ones, with your enemies, whomever it may be, in a way that is helpful to highlight what people actually need to know and help them cut through a lot of misinformation which has been so deadly here in the United States.

Avril Benoît:

I have one very practical question. For somebody who starts to have symptoms of COVID-19, maybe they start to have a fever and coughing or they lose their sense of taste, that's been one of the things that we talked about, and it's not so serious that they need to go into the hospital and, possibly, they're in a place where the testing is not really available, so this could happen anywhere in the world, what should they be doing in terms of looking after themselves in their own homes? My first thought, when I have a cold, is to drink tea or eat chicken soup, and things like this. But what are the best ways to alleviate the symptoms and to just get through it, in the hopes that it never become so severe that you have to end up in an emergency room and be treated by either of you, very fine doctors? Javid, maybe you want to take that? What tips do you have for your friends and family who find themselves at home with symptoms of this?

Javid Abdelmoneim:

Yes, that's what I've been telling my friends and family, it's simply just to take care and rest! At the end of the day, it's a viral illness, your body will do what it can to fight it off and you need to support it in doing that. So eat well, rest well, take good sleep, and see it through, as simply as that. And if you have symptoms of pain, try a simple painkiller. If you have a symptom of fever, some people have diarrhea, some people have headache, just manage the minor symptoms any which way you prefer and it's your choice.

What I've been telling my friends to look out for in terms of when I might be interested in seeing them in my ER, not that that's how it works, but a patient ... I've been telling everybody, "If you think you're breathless unnecessarily, especially sitting down, that's something that would make me concerned and that's when I would seek medical attention. But up until that point, essentially, if you think you can manage your symptoms, then do so in the simple ways that you normally might." It's what I'm telling my family.

Avril Benoît:

And what about moving around, even if your body doesn't feel like it? As opposed to just lying down and trying to sleep it off for a week.

Javid Abdelmoneim:

Listen, I'm a fan of rest, rest, rest, and rest for fighting off illnesses. Your body can do marvelous things if you give it a chance. Have some patience, eat well, sleep well, stay hydrated, and take it from there. There is of course, with this being an infectious disease, the added advice that you should be trying to self-isolate and minimize your contacts with others, especially those who we in the UK are calling shielders. People who are particularly susceptible to COVID-19, who currently have got instructions to stay indoors for the next three months, at least two meters away from even their loved ones within their own houses. So there are different classes of patients that you should be trying to stay away from ... if you have symptoms.

Avril Benoît:

A question here for you, Javid, from Ali on Facebook, "Are frontline physicians getting adequate mental health support?"

Javid Abdelmoneim:

The short answer is, "Yes, I hope so." In MSF, we have, at least since Ebola days, five years ago in West Africa, but even before then, when I joined in 2010, we've always had access to psychological support, at the very least, on the way in. And then on the way out and for a year after our time in the field. Since Ebola, we ... Because of the particular moral distress and injuries that were evident there, it's become something that's a lot more ingrained within your time there. So you get face-to-face time with a psychologist, you know who to contact back home in headquarters if you need it.

I think we do support our staff well. I feel supported when I'm in the field, in that way. And it's really, really important because you might not even feel that moral distress at the time, it might hit you long after. So I encourage all my colleagues in MSF to engage with the support that they're given, live, in that situation, and don't wait until you might de-compensate mentally years later.

Avril Benoît:

Craig, you have a young child at home. You're doing long overnight shifts and late shifts in an emergency room. You're trying to raise awareness through articles you're writing and your Twitter threads. How are you managing with all the stress of this?

Craig Spencer:

I think for a lot of people maybe like myself ... I'm drawn to Doctors Without Borders, I'm drawn to public health, because in some sense this is where I thrive. This is horrible and this is a global disaster, but this is where I find energy, this ability to help and hopefully provide some assistance, especially, to our frontline staff not only here in New York, but also in places where we work. Think about how we can support them, commit my time. As a board member, to think about what are the best things that we can be doing for our national staff, how do we adapt our operations when maybe we can't be sending people like myself as often. Of course, because of the risk that, me as a frontline provider here in New York City, I could bring this disease somewhere else. What do we need to be doing, as an organization, to not only help our members here and to help our people in our own societies, but how do we do that in the hundreds of projects we have all over the world?

I think this is where I thrive. This is where I really love thinking about how we can help and hopefully that's what we're all committing our time and our passion to. That's how I do it. And less sleep and probably a little bit more whiskey than baseline.

Avril Benoît:

I think it's not just me worried about you, Charlotte asked the question, "How is this affecting you, personally?" But to hear that you're thriving is like ... You're very special and different! But you're probably a lot like a lot of our colleagues. But I have to say, I am so worried when I think of COVID-19 raging into a region that is already in the midst of a crisis, and the kind of mettle that our teams are going to have to have. Julia on Facebook is asking, "How can MSF operate and tackle COVID in countries where there's an ongoing crisis?" And she's giving an example of Democratic Republic of Congo, the DRC, where there's a threat of stigmatizing the foreigners. Thinking that maybe foreigners have brought it in, foreigners are getting rich off of the intervention, the kinds of things that we saw with the Ebola outbreak in eastern DRC over the last year or two. Javid, how can we work in those kind of environments?

Javid Abdelmoneim:

With the specific example of DRC, it's all about engaging the community and ensuring they understand what we're trying to do. But also ensuring that we are meeting their needs as they perceive them, which is even more important. So, in that instance in DRC, I think even we would say ourselves we could have done more. And three, was it? Ebola ... The three attacks on Ebola management centers, in the space of as many months, at the tail end of the year before last. It could have been done better. Overall, the question was really about how, in these difficult contexts, we're going to be providing COVID-19 care. We're there already, providing some care. So there is a pivot, somehow, to additionally adding on COVID-19 care. In the sense that, say in Afghanistan, in one of our projects that's a maternity hospital, we're going to need to maintain that operationality, and keep COVID-19 out of the hospital. Or at least have a way of filtering it to one side and managing those cases separately.

So, it's very much the case of slightly pivoting in what we're doing already, in all of these contexts, to try and catch or at least ensure the safety of our current ops, and then move on to doing COVID-19. In Yemen, I think the first cases have come through. In Idlib, in northeast Syria, I think the first case has come through. It's going to be hard. I don't envy the task of my colleagues in the field at this time.

Avril Benoît:

Amber is asking a question, "As this eases in the wealthier countries, that we've seen it really rage in, and the United States being at the pinnacle of it right now, what does this mean for MSF staffing in high-risk areas?" Craig, we have, for many countries, travel restrictions.

Craig Spencer:

Mm-hmm (affirmative).

Avril Benoît:

The inability ... Well, forget about the airlines canceling flights, but very serious difficulties. Or countries imposing the 14-day quarantine upon arrival. What is going through your mind, as you grapple with all of that complexity?

Craig Spencer:

I think what this is highlighting, not only for MSF, which is thinking about how we operationally adapt in a situation like this. This is a humanitarian crisis, all over the world, that's going to force us to rethink our global health security agenda, how we are prepared. I think MSF has done a better job than a lot of organizations. Over 90 percent of our staff is national, people that live and work in the communities that they're from, which is super helpful in having a response that's adaptable. We don't have to fly as many people in, and I think that our focus has been on increasing that percentage as high as possible so that people like Javid and I don't need to come in. We have the resources, we train the resources, and they're in place.

The problem is that the way that we've been set up, MSF, other organizations, is that we have supplies in places where they can't leave. We have people in places where they can't leave, or they're not accepted into places where they may be going. We know that some places, some countries, you mentioned Israel, I know for Puerto Rico, for a couple of other places, there are restrictions on who is coming in, and for good reason!

It's worth pointing out that the first three cases in eastern Congo, were from international NGO workers, from these international staff that came in. And so, it makes sense for a lot of places that don't have the same infrastructure as the United States, or the UK, or other wealthier countries, to think about how they can protect themselves. Because, quite frankly, many places don't have the same access to resources, due to export restrictions, due to other things in this global economy, and the way that we're set up, to be able to attack it in the same way that Javid and I can in our own home countries.

Avril Benoît:

We have a really good question coming in from Meredith, who says, "What's the top concern for MSF in terms of ancillary illness or even care of underlying illness, resulting from those that become unemployed or potentially homeless in this crisis?" She has a friend in Ghana that's more worried about starvation than COVID-19. Javid?

Javid Abdelmoneim:

Yes-

Avril Benoît:

What can we expect in terms of other things that would be impacted by all of this?

Javid Abdelmoneim:

I think we can expect that all the ordinary or usual morbidities that we see, all the usual illnesses that we see out there ... The death rates or the illness rates will get worse. And it's a horrible thing to say or to expect, but we will see it in the UK, it is not just going to be everywhere else. When you have to have a total diversion of the health system towards fighting one illness ... We wish it otherwise, but especially when resources are constrained, there will be some reduction in the health status of the remaining population. And that's going through the same, world over. I fully expect it in the UK, and I would be very surprised if that is not the case in areas where we work also.

Avril Benoît:

Let's-

Javid Abdelmoneim:

To give some ... diseases there, the treatment of tuberculosis, the treatment of HIV, the treatment of infectious diseases, otherwise. So diarrheal diseases in camps, vaccination programs, measles outbreaks. All of these things that are going to be interrupted, potentially, we'll see worsened outcomes in every ... Maternal death rates in labor. If this is interrupted service or not done ... If we don't have PPE, how will our staff able to do those things? It's potentially a question that many health services where we are working, and MSF itself, will have to ask itself. And so it's quite daunting.

Avril Benoît:

We have a final question. In fact, we've received several questions based on, I think, what's been in the news lately. And I'll leave this one with you to reflect on, Craig, and that's about reinfection. When you are in the ER, and you're discharging a patient and sending them home, what do you tell them about reinfection?

Craig Spencer:

That's a good question, because we're getting some conflicting information every day. Look, we think the overwhelming likelihood is that you're infected with this once and that you have some immunity to it afterwards. And this is going to be true for, again, the overwhelming majority of people. We don't know if it's 96 percent or if it's 99.9 percent, but, again, the overwhelming majority. We know that you make antibodies, that's been documented. And you will likely have immunity for at least a couple months, maybe longer. We don't know yet. There have been cases reported of possible reinfection, but it's important to recognize that the test, despite it being very good, are not often administered very well. Meaning, that a positive patient can have a negative tests based on how the test is done.

So it may be that people were positive, and then negative, and then positive again. It may be something with a false negative or a false positive in the test. These are scattered reports. What we're seeing is most people who get the disease, thankfully, do well, recover, and then are not getting the disease again. Time will only tell. We learned a lot with Ebola, for example. We saw some people were still harboring virus, either in their protected sites, or even in the brain and the fluid around the brain. We know it's a possibility and it may happen for a very small subset of patients, but I think that there is a lot of other things that we need to be focused and worried about, as opposed to this potential risk of reinfection.

Avril Benoît:

All right, well thank you so much, both of you. And I wish you good health, and continued energy, motivation, and a sense of purpose in the work that you're doing at home, but also in your work as board members with Doctors Without Borders. Thanks a lot, Javid! Thanks, Craig!

Craig Spencer:

Thank you.

Javid Abdelmoneim:

Thank you, both. Thank you, everybody, for tuning in.

Avril Benoît:

Javid Abdelmoneim in the UK, Craig Spencer in the United States. We would love to keep you informed about MSF's work, including our response with the COVID-19 pandemic, and we very much welcome your support. Become a monthly donor. And to find us, if you just go into your search engine and you type in Doctors Without Borders, you will find the national website in your country. And you can find out how to support us, how to sign up for our e-newsletters, how to find out more about these online webcast events. You can also find us, of course, look for us on Twitter, on YouTube. We have channels on Facebook, in different languages, and we really welcome every opportunity that we have to engage with you. Even though we're socially distant, we try to stay connected. So thanks a lot! I'm Avril Benoît signing off from New York. Take good care. Bye for now.

 

 

Join us for this live online discussion series to find out how Doctors Without Borders/Médecins Sans Frontières (MSF) is responding to the evolving COVID-19 emergency.

During the event, MSF aid workers and medical experts will answer your questions about the humanitarian impacts of COVID-19.

On Thursday, April 16, MSF-USA Executive Director Avril Benoît welcomes MSF aid workers and emergency physicians Dr. Javid Abdelmoneim and Dr. Craig Spencer. Both are currently working independently from MSF, responding to the COVID-19 pandemic in hospitals in their home cities of London and New York.

Together they will share previous MSF experiences including responding to the Ebola outbreak in West Africa, providing care for displaced people in places like South Sudan and Lebanon, working in conflict settings such as Raqqa, Syria, and their shared experience on board The Aquarius, MSF’s medical search and rescue ship on the Mediterranean Sea. 

After you register, you'll receive an email confirmation with the Zoom link to attend online. You'll also receive email reminders before the event.
 

Featuring:

Avril Benoît, MSF-USA executive director, has worked with the international medical humanitarian organization since 2006 in various operational management and executive leadership roles, most recently as the director of communications and development at MSF’s operational center in Geneva from November 2015 until June 2019. Throughout her career with MSF, Avril has contributed to major movement-wide initiatives, including the global mobilization to end attacks on hospitals and health workers. She has worked as a country director and project coordinator for MSF, leading operations to provide aid to refugees, asylum seekers, and migrants in Mauritania, South Sudan, and South Africa. Avril’s strategic analysis and communications assignments have taken her to countries including Democratic Republic of Congo, Eswatini, Haiti, Iraq, Lebanon, Mexico, Mozambique, Nigeria, Sudan, and Syria. From 2006 to 2012, Avril served as director of communications with MSF-Canada.

Dr. Javid Abdelmoneim is an emergency physician and president of MSF-UK. A member of the Royal College of Physicians, he joined MSF in 2009 for his first field assignment to Iraq. Since then, he has worked as a doctor with MSF in Haiti, Lebanon (for Syria), South Sudan, Sierra Leone (for Ebola), on the Mediterranean on one of MSF’s search and rescue vessels, and in Raqqa in North Syria. Javid is also a reporter for the TV health magazine show The Cure, broadcasting on the Al Jazeera network. He is the winner of the 2016 Foreign Press Association award for best science story of the year for the episode “Operation Gaza” among other honors. Javid currently works as a registrar in Emergency Medicine in Imperial College Healthcare NHS Trust in London. Javid has been the president of MSF-UK since May 2017. 

Dr. Craig Spencer, emergency physician and MSF-USA board member, is the director of Global Health in Emergency Medicine and an assistant professor of Medicine and Population and Family Health at the Columbia University Medical Center. He divides his time between providing clinical care in New York and working internationally in public health and humanitarian response. He has worked in Africa and Southeast Asia as a field epidemiologist on numerous projects, as well as coordinating MSF’s national epidemiological response in Guinea during the Ebola outbreak. In addition to his international public health work, Craig has provided medical care in the Caribbean, Central America, West and East Africa, and most recently with MSF onboard a medical search and rescue boat in the Mediterranean. He is currently working as an emergency room doctor, responding to the COVID-19 outbreak in New York City. 

 

Past Events in this series:

Thursday, April 09, 2020

  • Let's Talk COVID-19: Mental Health - featuring Dr. Kaz de Jong, clinical and health psychologist and head of the staff health department for MSF based in Amsterdam, and Athena Viscusi, clinical social worker and psychosocial care specialist for MSF-USA.

Thursday, April 02, 2020

Thursday, March 26, 2020