The COVID-19 epidemic has already spread to more than 100 countries around the world. These include countries whose health systems are fragile and where MSF teams have a long-standing presence, as well as regions such as Europe, where the capacities are more robust but where the epidemic is particularly virulent. Travel restrictions generated by the outbreak also directly affect MSF's work around the world. What questions does MSF face in this context? An interview with Clair Mills, MSF medical director.
Are we right to be afraid of COVID-19?
Several factors make this virus particularly worrying. Being a new virus, there is no acquired immunity. As many as 35 candidate vaccines are currently in the study phase, but experts agree that no widely usable vaccine will be available for at least 12 to 18 months. The case-fatality rate, which by definition is calculated only on the basis of identified patients and is therefore currently difficult to estimate accurately, appears to be around 1 per cent.
It is known that at least some of those affected can transmit the disease before developing symptoms—or even in the absence of any symptoms. In addition, a very high proportion—around 80 per cent—of people develop very mild forms of the disease, which makes it difficult to identify and isolate cases quickly. Confirmation of the diagnosis requires laboratory and/or medical imaging capabilities that are only available in referral facilities. It is therefore not surprising that it has proven impossible to contain the spread of the virus, which is now present in more than 100 countries around the world.
Furthermore, it is estimated today that approximately 15-20 per cent of patients with COVID-19 require hospitalisation and six per cent require intensive care for a duration of between three and six weeks. This can, of course, quickly saturate the healthcare system. This was the case in China at the beginning of the epidemic, and is currently the case in Italy. There are currently more than 1,100 patients in intensive care units in Italy and the hospital system in the north of the country, although well developed, has been overwhelmed by the rapid increase in the number of patients.
As is often the case during this type of epidemic, medical staff members themselves are particularly exposed to infection. Between mid-January and mid-February in China more than 2,000 healthcare workers were infected with this coronavirus (3.7 per cent of all patients).
This epidemic is likely to lead to the disruption of basic medical services and emergency facilities, the de-prioritisation of treatment for other life-threatening diseases and conditions and for other chronic infectious diseases everywhere. But this is especially the case in some developing countries, where the health system is already fragile.
"The aim is not only to reduce the number of cases but also to spread them out over time, avoiding congestion in emergency and intensive care units."
Some feel that the response to this epidemic is an overreactiong, and that remedies such as border closures and quarantine, for example are likely to be worse than the disease. Is this justified?
Even though they cannot prevent the outbreak from spreading, the measures currently being taken by many countries can slow it down by reducing the increase in cases, and limiting the number of severe patients that health systems have to manage at the same time. The aim is not only to reduce the number of cases but also to spread them out over time, avoiding congestion in emergency and intensive care units.
What are MSF's priorities in this context, and its main concerns?
Priorities for intervention vary from one context to another.
In some areas that seem to be spared today, such as the Central African Republic, South Sudan and Yemen, where fragile or war-torn health systems are already struggling to meet the health needs of the population, it is necessary to protect healthcare personnel and to limit the risks of spreading the epidemic as much as possible.
This is done by implementing prevention programmes to prevent our hospitals and clinics from becoming places where the disease is transmitted. These include identifying areas or populations at risk; running health awareness and information activities; distributing soap and protective equipment for healthcare personnel; and reinforcing hygiene measures in medical structures. In such countries where MSF has had a longstanding presence we want to contribute to these efforts against COVID-19 while ensuring continuity of care against malaria, measles and respiratory infections, for example.
This healthcare continuity is now weakened by the restrictions (e.g. a ban on entering the country, preventive isolation for 14 days) imposed by governments on staff from certain countries, such as Italy, France and Japan, where some of our international staff come from, as well as the closure of borders and the suspension of certain air links. Despite these constraints, our strength lies in the fact that we can rely on locally recruited staff in our countries of intervention. They represent 90 per cent of our employees in the field.
"One of the keys of the fight against COVID-19 is the availability of protective equipment, in particular masks and gloves used for medical examinations."
In countries where health systems are more robust but where the epidemic is particularly active, such as Italy or Iran, the main challenge is to avoid overloading hospital care capacities. In these contexts we can contribute to the efforts of national medical teams by making MSF staff available to support or relieve them when needed. We can also help by sharing our experience in triage and control procedures for infections acquired during epidemics. We have provided teams to support four hospitals in northern Italy and have also offered support to the Iranian authorities in caring for severe patients. Depending on the evolution of the epidemic in France, we will make our experience, our logistics and the know-how of our staff available to the response, if they can be useful.
One of the keys of the fight against COVID-19 is the availability of protective equipment, in particular masks and gloves used for medical examinations. Anticipating shortages can lead to governmental requisition, which can in turn develop as a reflex to monopolise these precious resources. In the current context such equipment should, on the contrary, be considered as a common good—to be used rationally and appropriately and therefore to be allocated as a priority to health workers exposed to the virus, wherever they are in the world.
Generally speaking, this pandemic requires solidarity not only between countries and states but at all levels, based on mutual aid, cooperation, transparency, the sharing of resources and, in the affected areas, solidarity with the most vulnerable populations and their caregivers.