INFECTION PREVENTION AND CONTROL MEASURES ARE KEY TO SAVING LIVES IN ALREADY FRAGILE HEALTHCARE SYSTEMS. MAINTAINING OTHER CRITICAL HEALTHCARE IS ESSENTIAL
In more than 70 countries around the world, Doctors Without Borders/Médecins Sans Frontières (MSF) teams are responding to the COVID-19 pandemic, including opening projects in new places as they become pandemic hotspots.
Across our projects, MSF teams have been improving infection prevention and control measures to protect patients and staff and prevent further spread of the new coronavirus. It is crucial to prevent health facilities from amplifying the pandemic or being forced to close their doors.
Health systems worldwide urgently need personal protective equipment (PPE) such as masks and aprons so that essential medical services can stay open and medics can do their work.
Having access to protective equipment, to COVID-19 tests, to oxygen and drugs for supportive care, becomes more and more urgent as COVID-19 spreads in countries with already limited access to these tools.
KEY CONCERNS DURING COVID-19
The new coronavirus has overwhelmed some of the world’s most advanced health systems, in countries with a social safety net where most people have access to running water and the space to self-isolate. Our greatest concern is for when the virus takes hold in places with more fragile health systems and no, or limited, basic safety net. Other concerns we have include:
Protecting vulnerable people
People living in overcrowded conditions, on the streets, in makeshift camps or substandard housing are at particular risk of COVID-19. Many are already excluded from formal healthcare. We know social or physical distancing is infinitely more difficult or impossible for them. We have to find other ways to help people protect themselves, such as mass distributions of soap, water, and, in carefully considered circumstances, reusable cloth masks.
During the pandemic, babies will still be born, people will still need treatment for diseases like HIV and TB. Maintaining healthcare for non-COVID-19 needs is essential. Around the world, MSF teams are ensuring infection prevention and control measures are in place, setting up screenings, creating isolation areas and providing health education to locally hired staff.
Protecting healthcare workers
Protecting healthcare workers from contracting the virus is paramount to ensuring continuity of care for general and COVID-related health needs. However, the global shortages of PPE pose a great threat. Healthcare workers must have access to the equipment they need to do their jobs safely and effectively; countries should show solidarity and share protective equipment wherever possible.
Protecting people most at risk
We also must protect those most at risk of severe forms of the illness. With COVID-19, that largely means the elderly. It also concerns those who have another illness, such as diabetes, HIV or tuberculosis. We don’t yet know what the impact will be for children who suffer from severe malnutrition, or for communities that have been hard hit by measles epidemics, such as in Democratic Republic of Congo or Chad.
There should be no profiteering on drugs, tests, vaccines and other tools for this pandemic. Governments must take any necessary measures – including overriding patents and other monopolies and introducing price controls – to ensure production, supply and availability of essential tools at an affordable price for all. High prices and monopolies will only result in rationing, which will then prolong the pandemic. Costs of other essential supplies such as masks and different PPE must be kept accessible. Once approved or available, tools must be prioritized for healthcare and frontline workers first and then supplied based on equity and need.
Our COVID-19 response focuses on three main priorities:
• supporting health authorities to provide care for COVID-19 patients
• protecting people who are vulnerable and at-risk
• keeping essential medical services running
MSF HAS RESPONDED TO COVID-19 IN EVERY COUNTRY WHERE WE WORK. THREE EXAMPLES OF OUR MEDICAL WORK AND SUPPORT:
Six years of fighting has caused Yemen’s healthcare system to collapse in large parts, and now COVID-19 has made the collapse complete. Many hospitals have closed for fear of the virus or for lack of staff and personal protective equipment (PPE).
Since May, MSF has been treating severely ill patients at its COVID-19 centre in Aden. Our teams face an enormously difficult situation, with a very high number of deaths in the centre, and work with incredibly limited supplies, including oxygen. Patients often arrive late and in critical condition, making it harder to save their lives. From April 30 to May 24, the centre admitted 228 patients, 99 of whom died.
Aden was already struggling with a weak healthcare system before COVID-19 arrived, and the authorities lack the means to properly respond to the outbreak. There is no money to pay staff, little PPE and very few tests, so the exact numbers of cases cannot be known.
“Many people will die of this virus, but we fear that many others will also die from what should have been preventable deaths, because healthcare is simply not available,” says Claire Haduong, MSF head of mission in Aden.
MSF is doing all we can to both keep our regular healthcare programs open and respond to the now country-wide COVID-19 outbreak, but the scale of needs is massive and it remains difficult to bring staff and supplies into Yemen.
In April, MSF began supporting the national response to COVID-19 in Niamey, the epicentre of the new coronavirus pandemic in Niger. MSF teams also implemented a number of measures as the virus spread to other regions.
After six weeks of construction, the MSF treatment centre for COVID-19 patients at the Amirou Boubacar Diallo National hospital in Niamey opened. The centre has 50 beds and can accommodate up to 100 beds in case of a peak in patient numbers.
“In just a few weeks, we set up a semi-permanent, completely autonomous structure to treat patients and limit the risk of transmission to the neighbouring hospital,” says Denis Dupuis, MSF logistics and technical coordinator.
To ensure the smooth running of this facility, MSF recruited and trained more than 100 new staff. They work together with hospital teams. For example, patients requiring oxygen are jointly treated by MSF and the Ministry of Public Health staff.
CALL CENTRE SUPPORT AND MOBILE TEAMS
Beyond the treatment centre, MSF is supporting the Ministry of Public Health emergency medical assistance service call centre, which runs 24 hours a day, seven days a week, and mobile teams that operate in five districts of Niamey.
“This work within communities is crucial because the response to a pandemic cannot be done only in health centres,” says Audace Ntezukobagira, MSF mobile emergency team co-ordinator. “It is a commitment we must keep.”
Brazil faces some of the highest rates of COVID-19 infection in the world. MSF is supporting local efforts and offering treatment as well as infection prevention and control education to deal with COVID-19 for some of the country’s most vulnerable, including people experiencing homelessness, youth in detention, people who use drugs, the elderly, migrants and refugees, in São Paulo, Rio de Janeiro, Manaus and in Boa Vista.
MSF RESPONDS IN AMAZONAS
In May, MSF scaled up its work in the state of Amazonas to respond to the COVID-19 pandemic. Despite its relatively small population, the state is among the regions with the highest absolute number of deaths caused by the new coronavirus in Brazil. It caused not only the collapse of the health system, but also of the funeral system in the state. Because of the gravity of the situation, MSF’s response includes intensive care for critically ill patients as well as medical isolation for mild or moderate cases and substantial health promotion actions in urban and rural areas.
The health of indigenous communities who struggle to reach healthcare is of major concern, and MSF is consulting with indigenous leaders and organizations to guide our response. “The situation in Amazonas is very worrying. We believe that our work can make a difference,” said Dr Cecilia Hirata, MSF field coordinator.