COVID-19 Update: DRC’s triple burden

DRC declared its first case of COVID-19 on 10 March. The virus has gradually spread across the country, with more than 6,000 COVID-19 cases being reported—a likely underestimate, considering the limited testing available. Authorities in DRC quickly implemented preventative measures to help prevent the spread, but patient numbers continue to rise.

Faced with the danger posed by the new coronavirus, MSF has established COVID-specific responses in all the areas where our teams work, working to strengthen preventive measures, install isolation spaces, and carrying out health promotion and awareness-raising activities among communities. In the capital of Kinshasa, we’ve organised teams to support 50 health facilities. But as the situation progresses, more challenges continue to arise in a country that is fighting three different outbreaks simultaneously. 

More—and more serious—cases

The fear around the transmission of the virus can be counterproductive for those with symptoms. In DRC, as in other countries, including Yemen, many of those with COVID-19 symptoms are waiting too long to present at a health facility. This delay means that staff are seeing an increase of patients in a serious condition—cases so far advanced they are much more difficult to treat, and with less time to treat them.

“At the start of our response, most patients suffered from mild forms of the virus,” says Karel Janssens, who is leading MSF’s response in DRC. “But since mid-May, we have been receiving more and more patients in a serious condition. By 11 June, half of our inpatients were on oxygen therapy.”

As the country has only one laboratory to perform the tests for COVID-19, many people have to wait for days, and sometimes for weeks, before they receive their results. In Saint Joseph, more than 10 per cent of patients had to wait more than two weeks to get those results. This situation is difficult for people with suspected coronavirus, and also for recovered patients, who cannot leave hospital until they receive the all-clear, despite the mounting pressure on hospital beds. 

To ease the mounting pressure on health facilities, MSF teams are supporting Saint Joseph hospital in Kinshasa’s Limete health zone, where our teams have set up a 40-bed treatment centre for patients with mild to moderate symptoms. Providing beds for those with milder symptoms helps free up hospital beds for those who have more serious cases, giving them a greater chance of receiving the life-saving treatment they need.

The hidden impacts 

But the low capacity for testing and the delays in communicating the results are not the only challenges being experienced by COVID-19 response teams. Since the declaration of the pandemic, MSF teams have seen a marked drop in the number of consultations and admissions in the health facilities they support in Kinshasa, including in MSF’s centre for people living with HIV/AIDS, the Kabinda Hospital Centre. The reduction of consults indicates that many people are no longer able to access the care they need during the COVID-19 crisis.

“It’s very disturbing,” says Gisèle Mucinya, MSF Medical Coordinator at the HIV/AIDS project in Kinshasa. "At the Kabinda Hospital Centre, the number of HIV consultations fell by 30 per cent between January and May. In Ngaba Mother and Child Centre we recorded a 44 per cent drop in general consultations between January and April.”

This drop in medical attendance is a cause for concern for MSF teams. If patient numbers have fallen in facilities that MSF supports—facilities that offer free healthcare and adequate protective measures—then they are likely to have fallen in medical facilities across the capital. As a result, many more patients may die of conditions that could have been prevented. 

“Our patients tell us that they are afraid of being contaminated by COVID-19 when coming in to consult,” says Dr Rany Mbayabu, director of Kinshasa’s Mudishi Liboke Hospital. “Others are affected by the difficulties of movement and the economic impact of preventive measures."

"Many people fear they will be infected with the virus by going to health facilities deemed under-equipped with protective equipment, or they fear being isolated and stigmatised for a long time due to the delays in obtaining test results," says Janssens. “This situation affects the care of sick people and the monitoring of their treatment, especially for conditions such as diabetes, tuberculosis, malaria and HIV/AIDS."

In addition to missing treatments, many people in DRC are also missing out on essential preventative measures like measles vaccines—vaccinations that could be the difference between life and death during the current measles outbreak. With lockdowns in place to prevent the spread of the virus, parents and children unable to access these services are left at risk.

“Implementing preventive measures to reduce the spread of COVID-19 is vital to protect communities and health workers, especially in a country where the health system is very limited,” says Emmanuel Lampaert, MSF Operations Coordinator in the DRC.

“Unfortunately, these measures are having an impact on the overall measles response, including transporting vaccines, assembling dedicated teams and launching vaccination campaigns. We need to make sure that COVID-19 containment measures do not jeopardise the battle against silent killers such as measles, malaria, pneumonia or malnutrition.”

The long-term effects are likely to be dire. The mortality rate linked to untreated medical conditions is expected to be much higher than that currently observed in patients with COVID-19.

Protecting frontline workers

The lack of personal protective equipment (PPE) is a matter of life of death. To protect frontline healthcare workers, as well as those with pre-existing conditions traveling to clinics for essential treatments, MSF is advocating for health centres to be better supplied with personal protective equipment. 

“The protection of health staff and patients is our main priority," says Janssens. “Faced with a pandemic like COVID-19, and in view of the increase in respiratory infections that accompany the dry season, it is vital to ensure the proper functioning of frontline health facilities to prevent a further reduction in patients’ access to care. 

“Greater access to PPE would improve patients' confidence in going to health facilities and, in turn, strengthen efforts to contain the spread of COVID-19 while providing essential medical services.”