© Shuk Lim Cheung/MSF
MSF teams educate street cleaners in Hong Kong about the importance of prevention measures to avoid infection with COVID-19
16 Mar 20
Clair MillsClair MillsFrenchMedical directorFrance

COVID-19: “This pandemic requires solidarity”

So far, the new coronavirus disease, COVID-19, has spread to more than 100 countries across the world. 

Some countries where MSF has a longstanding presence, like Central African Republic, currently appear unaffected and we’re contributing to efforts to make sure the spread of the disease is limited.

In countries where health systems are more robust but the epidemic is particularly active, such as Italy, we are making MSF staff available to support or relieve local teams when needed. 

"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, towards the most vulnerable populations and their caregivers."
clair millsmsf MEDICAL DIRECTOR

MSF medical director Clair Mills explains how we’re responding and why we must show solidarity in the fight against COVID-19.

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Spread of virus unsurprising

“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 is calculated only on the basis of identified patients and is therefore difficult to estimate accurately, currently appears to be around one percent. 

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 percent – 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 some countries. It is therefore not surprising that it has proved impossible to contain the spread of the virus. 

COVID-19 different from other epidemics

This epidemic is very different from others MSF has responded to and developed expertise in over the last few decades, such as measles, cholera or Ebola.

It is estimated today that approximately 15 to 20 percent of patients with COVID-19 require hospitalisation, while six percent require intensive care for between three and six weeks.

This can put a huge strain on the healthcare system, as was the case in China at the beginning of the outbreak and in Italy currently. 

In Italy, there are more than 1,100 patients in intensive care units across the country and the hospital system in the north, 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, health workers are particularly exposed to infection. Between mid-January and mid-February, more than 2,000 health workers in China (3.7 percent of all patients) tested positive for COVID-19.

This global pandemic is likely to lead to the disruption of basic medical services and emergency facilities, as well as the de-prioritisation of treatment for other life-threatening conditions and chronic infectious diseases everywhere, but especially in affected developing countries where the health system is already fragile.

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Control measures justified

Even though they cannot completely prevent the virus from spreading, the measures currently being taken by many countries can slow the outbreak down by limiting increases in cases, as well as the number of severe patients health systems have to manage.

The aim is not only to reduce the number of people infected with COVID-19 but also to spread them over time, avoiding congestion in emergency and intensive care units. 

Protecting vulnerable countries 

In places such as Central African Republic, South Sudan and Yemen, fragile or war-torn health systems are already struggling to meet the health needs of the population.

While these countries so far appear to be unaffected by COVID-19, it is necessary to protect their health workers and reduce the risk of the disease spreading as much as possible. 

This is done through prevention programmes: identifying areas or populations at risk; running health awareness and information activities; distributing soap and protective equipment for health workers; and reinforcing hygiene measures in our clinics and hospitals. 

In countries where MSF has a longstanding presence, we want to contribute to these efforts against COVID-19 while ensuring continuity of care for other diseases and conditions, such as malaria and measles.

 

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Overcoming challenges of travel restrictions 

However, our ability to ensure continuity of care has been weakened by the restrictions 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 suspension of certain air links. 

Despite these constraints, our strength lies in the fact that we can rely on locally recruited staff in the countries where we work. They represent 90 percent of our employees in the field. 

In countries where health systems are more robust but the epidemic is particularly active, such as Italy or Iran, the main challenge is to avoid overloading hospitals. 

In these contexts, we can contribute to the efforts of local medical teams by making MSF staff available to support or relieve them when needed. 

We can also help by sharing our experiences in triage and control procedures for infections acquired during epidemics. 

Where we’re currently working

We are supporting four hospitals in northern Italy and have offered to help the Iranian authorities care for severe patients. 

We may also make our medical and logistical expertise available to France, depending on the evolution of the epidemic there. 

Protective equipment must be available for all 

One of the keys in the fight against COVID-19 is the availability of protective equipment, in particular masks and gloves used for medical examinations. Fears of shortages can lead to countries stockpiling these precious resources. 

But in the current climate, this equipment should be used rationally and appropriately, and allocated as a priority to health workers exposed to the virus, wherever they are in the world. 

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, towards the most vulnerable populations and their caregivers.”

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