Doctors Without Borders/Médecins Sans Frontières (MSF) is very concerned about how the COVID-19 pandemic will affect people in countries with already fragile health systems and vulnerable communities worldwide. In many of the places where we work, there is limited capacity to respond to an influx of patients with a new disease that may require intensive care.
COVID-19 is a contagious disease caused by a new coronavirus, and much remains to be understood about it. Unlike influenza, there is no known pre-immunity, no vaccine, and no specific treatment. Everyone is presumed to be susceptible.
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
MSF is extremely concerned about how COVID-19 may affect people living in already precarious conditions, such as those who are homeless, or living in refugee camps in Greece or Bangladesh, or in conflict-affected countries like Yemen or Syria. These people are already facing harsh and often unhygienic conditions, and their access to health care is severely compromised. They may have greater difficulties implementing preventive measures to stop the spread of COVID-19, and face additional obstacles to access health care if they get sick. It is very important to inform people that they have the means to protect themselves—including by washing hands and self-isolation in case of high-risk contact with COVID-19 patients.
Generally, MSF is very concerned about how COVID-19 outbreaks will affect countries with already fragile health systems, such as in Yemen or Central African Republic. In many areas where we work, there are few medical actors in a position to respond to an overload of patients. We want to make sure that we continue to ensure care for all patients where we work today, and that our medical teams are prepared to manage potential cases of COVID-19.
It is clear that we must do everything we can to prevent and delay the further spread of this coronavirus. The pandemic is already straining some of the world’s most advanced health care systems. Preserving access to health care, both for COVID-19 patients as well as for any other patient, is paramount. This means ensuring that hospitals don’t become overwhelmed, and that health staff can cope with the number of patients requiring intensive care and continue providing treatment to other patients who need it too.
Safety for health care workers should be a top priority in every health facility. Infections of health workers can happen easily in structures that are overwhelmed by large numbers of patients, and that have to deal with limited supplies of personal protective equipment for staff and a likely reduced workforce. (Health care staff will also be among the confirmed cases due to community transmission.) Any staff members who are infected in the course of their essential work will further reduce the capacity to admit and treat patients.
We know from our experience that an essential component in outbreak control is trust in the health authorities and in the response. Clear, timely, measured, and honest communication and guidance are necessary. People must be empowered to protect themselves and each other.
MSF seeks to ensure that the medical tools urgently needed to respond to COVID-19 are accessible, affordable, and available. All concerned stakeholders—including governments, pharmaceutical corporations, and other research organizations developing treatments, diagnostics, and vaccines—should take the necessary measures to:
- prevent patents and monopolies from limiting production and affordable access
- guarantee access to repurposed drugs for patients suffering from diseases that are the original indication for use to ensure continuation of care
- prioritize the availability of the medical tools for protection and treatment of frontline health care workers
- improve transparency and coordination, making sure an evidence-based approach is put in place to continuously monitor the risk of the potential supply chain vulnerability on essential medical tools, and to adapt mitigate measures when needed through international collaboration.
How can I prevent myself from being infected with the coronavirus?
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 infected droplets have landed and then touching your mouth or nose. That’s why simple infection control measures such as proper handwashing and maintaining good cough and sneeze etiquette are effective and important to change the course of the epidemic.
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’s no visible dirt on your hands, an alcohol-based gel is also a good option.
In places with local transmission of the virus, social distancing is advised. As the virus is passed on from person to person, not being too close to other people can prevent infections. Avoid crowded places and large gatherings.
If you cough or sneeze, cover your mouth and nose with a tissue, or with the inside of your elbow. Dispose of used tissues immediately and wash your hands.
With masks and other protective equipment in short supply, the needs of health care staff should be prioritized.
For more comprehensive information about COVID-19 and how to protect yourself against coronavirus, visit the WHO website.