Responding to the coronavirus pandemic

MSF staff in Brussels, Belgium, discuss how to treat a patient with a suspected case of COVID-19.
Belgium 2020 © Jeffrey Monnier/MSF
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In the space of just a few months, a newly discovered coronavirus has spread around the world threatening the lives of millions—as well as entire health systems, economies, and the nature of society itself. By late March, more than 300,000 cases of the new coronavirus disease, known as COVID-19, have been reported from almost every country and region in the world. The World Health Organization (WHO) declared that “the pandemic is accelerating.”

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Much remains to be understood about the new coronavirus. Unlike influenza, there is no known preexisting immunity to the virus, no vaccine, and no proven treatment for COVID-19. Everyone is presumed to be susceptible.

This epidemic is very different from those—such as measles, cholera, or Ebola—in which Doctors Without Borders/Médecins Sans Frontières (MSF) has developed our expertise over the last few decades. This pandemic requires solidarity— not only between countries but at all levels, based on mutual aid, cooperation, transparency, the sharing of resources—and, in the affected areas, with caregivers and the most vulnerable people.

Clair Mills, MSF medical director

For most people, COVID-19 will be a mild or moderate respiratory illness. However, compared to the flu, it has a higher rate of quite severe complications for vulnerable people, including the elderly and those suffering from other infections or ailments. According to a February report by the WHO-China joint mission on COVID-19, as many as 20 percent of confirmed cases will be severe and require hospitalization for monitoring and supportive treatment. The report indicates that 6 percent of total confirmed cases (or about 30 percent of people hospitalized) will become critical and require special intensive care, such as the use of mechanical ventilators.

The sudden surge in demand for intensive care threatens to overwhelm some of the most well-resourced health systems in the world, including in the United States and across Western Europe. Essential supplies and equipment, including ventilators for critically ill patients as well as personal protective gear for health workers, are already running dangerously low. “In [countries] such as Central African Republic, South Sudan, and Yemen—where fragile or war-torn health systems are already struggling to meet the health needs of people—protecting health care personnel and limiting the risks of spreading the disease as much as possible are needed,” warned Mills. 

Lesbos and Samos Oct2019
Inside Moria camp on the Greek island of Lesbos, where thousands of people are stranded in dire conditions.
Greece 2019 © Anna Pantelia/MSF

Teams are working across our medical projects to fight the spread of coronavirus, strengthen infection prevention and control measures, and sustain other lifesaving care for communities that are further threatened by this pandemic. MSF is extremely concerned about how the spread of this coronavirus could 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 Afghanistan or Syria. In many of the places where we work, there are very few medical actors able to respond to a sudden explosion of cases. We want to make sure that we can continue to care for all patients where we work today—and that our medical teams are prepared to manage potential cases of COVID-19.

How MSF is mobilizing

Our teams are tackling 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 coordinating with both the WHO and local authorities in most of the countries where we have existing medical projects to help prepare for the impact of COVID-19. A key priority is keeping our regular medical programs running for the tens of thousands of patients and extremely vulnerable communities that we support.

“In countries where MSF has a longstanding presence, we want to contribute to efforts against COVID-19 while ensuring continuity of care against malaria, measles, respiratory infections, and other illnesses,” said Mills. In countries like Italy or France, which have robust health care systems that are nonetheless struggling to manage the volume of cases, MSF staff will focus on supporting or relieving national medical staff when needed.

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In February, we sent 3.5 metric tons of medical protective equipment to China’s Wuhan Jinyintan hospital, which was then at the forefront of treating patients suffering from COVID-19. We also sent one metric ton of personal protective equipment to the Hong Kong St. John Ambulance service, and we are still running a project in Hong Kong to provide health information and mental health support to vulnerable people.

In mid-March, we began supporting three hospitals in northern Italy, which has become the epicenter of the coronavirus outbreak in Europe. The MSF team working in the region is composed of Italian infectious disease specialists, anesthetists, nurses, and logisticians, who bring their experience managing epidemics in the many and diverse countries where MSF operates. These staff are working with local health authorities and Italian hospital personnel on a number of lifesaving activities, including disease prevention and care for patients.


MSF IS EXTREMELY CONCERNED ABOUT HOW THE SPREAD OF THIS CORONAVIRUS COULD AFFECT PEOPLE LIVING IN ALREADY PRECARIOUS CONDITIONS, SUCH AS THOSE WHO ARE HOMELESS, OR LIVING IN REFUGEE CAMPS, OR IN CONFLICT-AFFECTED COUNTRIES.


 

Teams are also assisting vulnerable communities in France, including migrants, homeless people, and unaccompanied minors. Many of these people have no choice but to live in unsanitary conditions in substandard housing or overcrowded, makeshift encampments. These living conditions can contribute to the spread of infectious diseases like coronavirus.

MSF has also offered training and support in a number of other countries, including Greece, Syria, Afghanistan, Libya, and Cambodia (see map).

MSF starts COVID-19 coronavirus activities in France
People sleep on cots inside an emergency shelter erected for vulnerable populations, including migrants and the homeless, near Paris, France. MSF teams are working in these facilities to provide health evaluations and identify cases of COVID-19.
France 2020 © Agnes Varraine-Leca/MSF

Facing the challenges

MSF’s international medical programs are severely impacted by current travel restrictions aimed at slowing the spread of the virus, but which limit our ability to move staff between countries. Despite these constraints, we can still rely on locally hired staff, who represent around 90 percent of employees in our medical projects around the world.

Another challenge is dealing with the consequences of global shortages of medical supplies, particularly personal protective equipment for health care staff. So far, MSF teams are able to continue medical activities, but securing future supplies of essential items—such as surgical masks, swabs, gloves, and chemicals used to diagnose COVID-19—is a matter of deep concern.

MSF’s regular health care programs around the world are also preparing to deal with cases of COVID-19. We must be able to safely receive people with the virus while ensuring that no one else is consequently infected in our facilities—including both other patients and staff. This means ensuring that infection prevention and control measures are in place, setting up screening at triage, maintaining isolation areas, and providing health education.

This unprecedented crisis will require all the skills and expertise we have developed over decades of medical humanitarian work—as well as bold new ideas to adapt to the new realities. As the world scrambles to develop new tools to fight the coronavirus, we also call on both governments and private companies to ensure that new vaccines, diagnostics, and therapeutics be made accessible to all who need them. So far, Germany, the United States, the European Union, and others have collectively committed more than a billion dollars of public funds to develop a new vaccine. Given the massive scale of these contributions—and the urgent public health needs—governments must ensure that the return on these investments comes in the form of lifesaving health services that are free for patients and affordable for health systems—not in the form of high profits for private companies.

THIS UNPRECEDENTED CRISIS WILL REQUIRE ALL THE SKILLS AND EXPERTISE WE HAVE DEVELOPED OVER DECADES OF MEDICAL HUMANITARIAN WORK—AS WELL AS BOLD NEW IDEAS TO ADAPT TO THE NEW REALITIES.