Last updated: 1 April 2020
Evidence indicates that the best way to address COVID-19 is to break the chains of transmission, by testing people, isolating patients, and tracing contacts, while providing care for those who need it. However, people in many contexts where we work don’t have easy access to testing, and self-isolation and handwashing can be very difficult.
Protecting people living in precarious conditions
Of particular concern is how coronavirus COVID-19 might affect people in precarious environments, such as the homeless, refugees living in camps in Greece or Bangladesh, or conflict-affected populations in Yemen or Syria. These people live under harsh, often unhygienic and overcrowded conditions, where their access to healthcare is already compromised.
How can we ask people to protect themselves when they don’t have easy access to water? Or to stay at home and self-isolate if they rely on daily jobs to make ends meet, or share a room with 10 other people? Nonetheless, it is very important to inform people of protective measures (such as washing their hands often) and help ensure they have the means to protect themselves (including self-isolation in case of contact with a person infected with COVID-19).
If COVID-19 starts to be transmitted in fragile settings like these, it will be practically impossible to contain. Basic health screening and, ideally, decentralised testing for high-risk settings such as refugee camps (Cox’s Bazaar in Bangladesh or on the Greek islands, for example) or high-density slum dwellings (Kibera in Kenya or Khayelitsha) needs to be implemented immediately.
Keeping healthcare workers safe
Protecting healthcare workers from contracting the virus is paramount for ensuring the continuity of care for general and COVID-19-related health needs. However, global shortages of personal protective equipment (PPE) pose a great threat. Healthcare workers must have access to the equipment they need to do their jobs safely and effectively.
As research and development is underway to find effective treatment for coronavirus COVID-19, we are closely tracking the trials and evidence concerning the potential medicines in the pipeline.
Any drugs, tests and vaccines for COVID-19 should be made available to all those who need them. It is crucial that governments prepare to suspend or override patents for COVID-19 medical tools by issuing compulsory licences. Removing patents and other barriers will be essential in helping ensure that suppliers can sell tests and treatments at prices everyone can afford.
Challenges in ensuring continuous care in MSF projects
We want to ensure continuous care for all patients where we work today and prepare our medical teams to manage potential cases of COVID-19. Protecting patients and healthcare workers is essential, so our medical teams are also preparing for potential cases of coronavirus disease COVID-19 in our projects. This means ensuring infection prevention and control measures are in place, including setting up screening at triage zones, creating isolation areas, and providing health education.
Our projects are still able to continue medical activities, but ascertaining future supplies of certain key items, such as surgical masks, swabs, gloves and chemicals for diagnosis of COVID-19, is a concern. There is also a risk of supply shortages for other diseases due to a lack of production of generic drugs and difficulties to import essential drugs (such as antibiotics, antimalarial and antiretroviral drugs), caused by community lockdowns, reduced production of active pharmaceutical ingredients, and reduction in export movements.
We face additional challenges because travel restrictions linked to COVID-19 are limiting our ability to move staff between different countries. We are trying to find ways to manage this, to avoid heavily impacting projects needing specialist profiles, such as surgeons. However, international staff represent just eight per cent of our total global workforce, so most MSF projects are run by locally hired team members.
MSF response to coronavirus disease COVID-19
It is clear that healthcare workers need support and patients need care. Given the size of this pandemic, MSF’s ability to respond on the scale required will be limited.
In March, we started assisting the COVID-19 response in Europe. Our teams are working in Italy, Spain, Switzerland, France, Norway, Greece and Belgium.
Our decades of experience in delivering medical humanitarian aid in countries where infectious diseases are endemic enable us to offer strategic advice ─ notably on infection prevention and control measures ─ technical support and training.
MSF doctors, nurses and hygiene experts are working with European hospitals, homes for the elderly and supporting healthcare workers and local authorities to implement protective measures.
In Spain, we have also set up health units to receive patients less severely affected by COVID-19 to decongest the hospitals’ emergency and intensive care services. We also work in northern Italy, in collaboration with local health authorities and health personnel, on a number of activities, including disease prevention and care for patients.
We are supporting the diagnosis, isolation and care of vulnerable people such as migrants in Belgium (Brussels, Hainaut and Antwerp), France (Paris and the Île-de-France region) and Switzerland (Geneva). We have started similar activities in our projects in the migrant hotspots of Greece’s islands Samos and Lesbos. In Lesbos, we have also devised an emergency plan for Moria refugee camp in case the disease spreads on the island. We are in discussion with the Greek Ministry of Health to see how we can coordinate with them and offer more support.
Middle East and North Africa
Our staff are providing training and technical support in the facilities we support in Azaz and Idlib, Syria. In Iraq, our teams’ focus is on treating people with COVID-19 who do not require intensive care. We are also improving infection and control measures in a Bagdad-based COVID-19 treatment centre.
In Yemen, we assisted the Ministry of Health in setting up an isolation facility in Aden. In Tripoli, Libya, we trained hospital staff in infection control and case management.
In Iran, MSF had reached an agreement with authorities to provide care for patients with COVID-19 in the city of Isfahan. We had flown over cargo, including an inflatable hospital, and staff, and were preparing to start activities, before authorities unexpectedly revoked permission. Our activities are on now hold, but we remain willing to respond if asked.
In Hong Kong, we are providing health education and mental health support for vulnerable groups. Our teams have trained staff in infection prevention control in Afghanistan, Papua New Guinea and in Cambodia, where we also helped develop development the country’s national treatment protocols.
In Timurgara, northern Pakistan, an MSF team is running an isolation ward and screening people for the virus in a number of departments in the local hospital.
In South Africa, we have sent staff from our existing projects to assist with the COVID-19 response in Gauteng, KwaZulu-Natal and Western Cape provinces. We are also helping with contact tracing, and the development and dissemination of health promotion materials.
In Burkina Faso, we are providing patient support in Fada health centre. We are also training Ministry of Health staff and conducting disease surveillance and health promotion activities.
We are supporting the management of a COVID-19 unit in Bamako, Mali, within the grounds of the hospital where we run an oncology programme. The unit includes eight intensive care beds.
In Abidjan, Côte d’Ivoire, we are supporting the Ministry of Health at a transit centre to screen and refer people with coronavirus symptoms to the care centre. In Bouake, training for health workers and screening at the city’s entry points are underway. Water and sanitation activities are also being implemented.
In Tanzania, our health promotion team in Nduta refugee camp is raising awareness among the community on hygiene and best health practices.
Whether we’ll be able to make similar offers to other countries will depend on the nature of the outbreak but also on our capacity to send staff.
About coronavirus disease COVID-19
COVID-19 will be a mild respiratory illness for the vast majority of people (estimated 80 per cent of confirmed cases) but it has a higher rate of quite severe complications for vulnerable people (elderly and people with comorbidities), than other viruses such as flu.
Most of the world's countries have now reported cases. On 11 March, the WHO declared COVID-19 as a pandemic. By March 31, the number of reported confirmed cases had reached 820,000 globally, although this is certainly an underestimate, given the lack of testing. While it took more than three months to reach 100,000 cases, it took only 12 days to reach the next 100,000. The epicentre of the pandemic is currently in Europe, with four countries reporting the highest number of cases: Italy, Spain, Germany, and France. The US is recording an exponential growth in cases which have surpassed the number of confirmed cases reported in China.
Based on current data from the WHO, 20 per cent of people confirmed to have COVID-19 will be severe and those people will require hospitalisation for sustained monitoring and supportive treatment. Six per cent of total confirmed cases will require critical care provision (around 30 per cent of those hospitalised).
For comprehensive information, including how to protect yourself against the disease, please visit the World Health Organization's (WHO) COVID-19 webpage. For updated technical information and details on the evolution of the pandemic please see WHO's COVID-19 situational report page.