Statements & Opinion
MSF’s initial response to the coronavirus outbreak
Doctors Without Borders/Médecins Sans Frontières (MSF) is following the fast-evolving development of the disease caused by the novel coronavirus. We are in contact with different medical networks to better understand the development of the disease and are deploying a team to Hong Kong.
The disease is called COVID-19 (short for Corona Virus Disease that emerged in 2019). It is caused by a virus which was discovered in early January in China and has been identified as a member of the family of coronaviruses. The virus seems to be transmitted through droplets spread by coughing that can be breathed in, or infect surfaces that people touch. This virus affects the respiratory system. The main symptoms include general weakness and fever; coughing and sometimes to pneumonia and difficulty of breathing in a later stage. In 20 per cent of the reported cases, it has led to pneumonia. The early symptoms of some patients are mild and the disease ranges in severity.
How is MSF responding?
As of 14 February, there are more than 64,000 cases, with 99 per cent of which are in mainland China. The World Health Organization (WHO) has declared coronavirus COVID-19 a ‘public health emergency of international concern', requiring a coordinated international response. MSF has offered support to the health authorities in mainland China and Hong Kong, who are leading the respective response efforts.
An MSF team is being deployed to Hong Kong with an initial focus on health education for vulnerable groups, such as the elderly and other at-risk groups. As of 17 February, 15 cases of COVID-19 have been confirmed in Australia, according to the Australian Government Department of Health.
How dangerous and contagious is the coronavirus?
Our understanding of the virus and the disease is still evolving. Many people infected with the virus will not be very sick. It is even possible that some people don’t get sick at all if they’re infected. The latest estimates are that 82% of the people who get infected will only suffer from a mild form of disease. 15% will develop moderate disease, and 3% will be severely ill.
The disease seems more dangerous for elderly people or people suffering from other infections or ailments, as often is the case with infectious diseases. More than 80% of the people who died of Covid-19 were over 60 years old, and over 75% had underlying medical conditions.
As more than 64.000 people have been reported to be infected, this virus has already spread widely, with 99% of cases in China. But how efficiently the virus is transmitted from one person another is not fully understood yet. Hence it is very difficult to make epidemiological forecasts. The mortality is higher in Wuhan (4.9%), and lower in the rest of China (2.1%). Outside China, it’s even lower (0.2%). It’s not fully understood why the mortality is different in different places. But as the epidemic evolves, these figures can still change.
What can be done to respond to the coronavirus outbreak?
For now, the health authorities are leading the response efforts including diagnosis of the virus, patient care, contact tracing, and investigations into a better understanding of the disease. Since it is a new virus, there is currently not a vaccine or specific treatment (though supportive care is given to treat symptoms), and the understanding of the virus and the disease are still evolving. Clinical trials for several antiviral drugs are ongoing in China.
Scientists in Australia have developed a lab-grown version of the disease. This has potential to help scientists determine whether a future vaccine is effective or not. This can also enable researchers to develop a test to identify people who might be infected with the virus, even before they show any symptoms.
We do know that in a respiratory disease outbreak, it is important to apply hand hygiene, coughing etiquette, avoid close contact with people showing symptoms of respiratory diseases, and inform the doctor when feeling sick. Public awareness of the virus and enhanced prevention measures such as these are key components for prevention.
How can I prevent myself from being infected?
Because the virus is new, much remains to be understood . As with all contagious infections of the respiratory system, droplet infection seems to be the main mode of transmission, so infection control measures such as hand-washing, and cough hygiene remain very important for prevention.
Hand hygiene is paramount, so wash your hands often with soap and water. Use enough soap, and make sure all parts of both your hands are washed. Spend at least 20 seconds washing your hands. If there’s no visible dirt on your hands, an alcohol-based gel is also a good option. If you cough or sneeze, cover your mouth and nose with a tissue, or with the inside of your elbow. Put used tissues in the bin immediately, just like used masks, and wash your hands. A mask is a good preventive measure to protect from breathing in the virus. However, its main use is to prevent transmitting the virus if you are sick. Only touch the strings of the mask when you take it off. Put it directly in the bin and wash your hands.
What is the link to SARS/MERS?
SARS (Severe Acute Respiratory Syndrome) and MERS (Middle Eastern Respiratory Syndrome) are both infections of the respiratory system. They are caused by types of coronavirus (SARS-CoV and MERS-CoV respectively) related to 2019-nCoV.
SARS was discovered in 2002 in mainland China and spread to a number of other countries. More than 8,000 people fell sick, and 774 of them died of the disease. Since 2004, no new cases of SARS have been recorded. MSF intervened in mainland China, Hong Kong, and Vietnam for the outbreak of SARS. MSF supported the Bach Mai Hospital in Vietnam with infection prevention and control measures and an isolation ward. In mainland China, we gave support with training of healthcare staff in Infection prevention and control in the city of Zhangjiakou in Hebei province, and in Hong Kong we provided support with training of healthcare staff in Infection prevention and control and healthcare education for the population.
MERS was discovered in 2012, when an epidemic started in Saudi Arabia. More than 1,200 people fell sick, and 449 of them died. MERS still infects people every now then, primarily in Middle Eastern countries. MSF has not intervened for outbreaks of MERS.