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COVID-19 (Coronavirus Disease)

COVID-19 is a new viral disease that affects the respiratory system
As of 29 March, there are more than 664,900 cases worldwide, and more than 30,800 deaths.
As of 29 March, 3,966 cases of COVID-19 have been confirmed in Australia, according to the Australian Government Department of Health.

The World Health Organization (WHO) declared COVID-19 a pandemic on 11 March 2020.

More than 100 countries are now reporting cases. Roughly 80 percent of confirmed cases of COVID-19 experience a mild respiratory illness but it has a higher rate of severe complications for vulnerable people – such as the elderly and people with compromised immune systems – than other viruses such as flu. 

The high level of supportive and intensive care required has placed a heavy burden on some of the world’s most advanced healthcare systems.  

Given this is a pandemic, MSF’s ability to respond on the scale required will be limited, but we are currently responding in multiple countries.

We are deeply concerned about how COVID-19 might affect people living in precarious environments such as the homeless, those living in refugee camps in Greece or Bangladesh, or conflict-affected groups in Yemen or Syria.

We must do everything to prevent and delay further spreading of the virus. We know from our experience that trust in the response and health authorities is an essential component for outbreak control.

Clear, timely and honest communication and guidance is needed. People need to be empowered to protect themselves. 

What is the new COVID-19 coronavirus disease?

COVID-19 (short for "coronavirus disease") is caused by a virus discovered in early January in China. It appears to be transmitted through droplets spread by coughing. The virus affects the respiratory system. The main symptoms include general weakness and fever; coughing; and in later stages sometimes pneumonia and difficulty breathing.
Identified by Chinese scientists, the virus is now called SARS-CoV-2 because of its similarities to the virus that causes Severe Acute Respiratory Syndrome (SARS). The coronaviruses are a large family of viruses, most of which are harmless to humans. Four types are known to cause colds, while two other types can cause severe lung infections (SARS and MERS – Middle East Respiratory Syndrome), similar to COVID-19.
Like all viruses, SARS-CoV-2 needs the cells of living beings to multiply. This virus seems to target cells in the lungs and possibly other cells in the respiratory system, too. Cells infected by the virus will produce more virus particles, which can then spread to other people, by coughing for instance.

How is MSF responding?

COVID-19 Preparation

Protecting patients and healthcare workers is essential, so our medical teams are preparing for potential cases of COVID-19 in our projects.

In places where there is a higher chance of cases, this means ensuring infection control measures are in place, setting up screening at triage, isolation areas, and health education.

In most countries where we work, we are coordinating with the WHO and Ministries of Health to see how we can help in case of a high load of COVID-19 patients and are providing training on infection control for health facilities.

 

The next wave of the pandemic - Africa, Middle East, Latin America

We see that this virus has crippled some of the most advanced health systems, in countries that have a social safety net where most people have access to running water and space to self-isolate. This is simply not possible for people in many of the countries where we typically work. Our greatest concern is if the virus takes hold in places with weaker health systems with vulnerable people who can’t protect themselves. International solidarity will be crucial, whilst the response to COVID-19 will have to be tailored to every setting, community, and local capacities.

Countries MSF is responding in

Asia-Pacific

China

Specialised medical protective equipment from MSF was sent to Wuhan Jinyintan Hospital in mid February in the capital city of Hubei province, China, the epicentre of the current coronavirus COVID-19 outbreak.

Weighing 3.5 tonnes, these supplies were dispatched from MSF Supply in Brussels, Belgium through the Hubei Charity Federation, to reach Wuhan Jinyintan Hospital, one of the hospitals on the forefront of treating patients with COVID-19.

Hong Kong

An MSF team in Hong Kong opened a project at the end of January focusing on health education for vulnerable people. Community engagement is a crucial activity of any outbreak response and in Hong Kong, this focuses on groups who are less likely to have access to important medical information, such as the socio-economically disadvantaged. The team is also targeting those who are more vulnerable to developing severe disease if they are infected, such as the elderly.

“Our teams have already conducted 20 face-to-face sessions with street cleaners, refugees and asylum seekers and the visually impaired in recent weeks,” says Karin Huster, who is in charge of MSF’s project in Hong Kong. “We share up-to-date, evidence-based medical information, but perhaps even more crucially, we’re there to listen and answer the many questions that this new disease has generated. Fear can often spread faster than a virus, so helping people manage their stress and anxiety is a key focus for us.”

In addition, we’re sending a donation of one tonne of personal protective equipment to the Hong Kong St John Ambulance service to help them carry over until their stocks can be replenished. The staff are transporting high-risk patients, and therefore, it is important to ensure that they have the specialised protection they need to work safely.

In addition, the team has also started providing "coping with stress and anxiety" workshops to the same target groups to address their mental health needs. A number of mythbuster videos on COVID-19 related topics have been produced, as well as a video providing tips to address stress and anxiety during this pandemic.

The Philippines

Our regular activities have been put on hold, both in Manila and Marawi. We are conducting ongoing assessments for COVID-19 activities.

Indonesia

MSF’s medical coordinator in Indonesia, Dr. Nyi Wynn Soe, facilitates a training on COVID-19 response for the organisation’s staff in Labuan, Banten province. The training is part of MSF’s emergency preparedness to respond to a possible COVID-19 outbreak. On 2 March, the Indonesian government announced 2 confirmed COVID-19 cases in the country.

Pakistan

In Timurgara, the team is running the isolation ward, waiting for the Ministry of Health to dispatch human resources, as well as doing screening for the OPD, ER and MCH departments. 

Bangladesh

In out patient departments in our hospitals, we’ve put in place a specific waiting area for patients who show symptoms of COVID-19. A dedicated ward and isolation rooms have been put in place in one of our hospitals for eventual COVID-19 cases.

Cambodia

Tankred Stöbe, MSF emergency coordinator, visited several countries in South-East Asia to assess their preparedness for potential outbreaks of COVID-19 and the support MSF could provide at this stage. He participated in training sessions with healthcare staff in a hepatitis C clinic in Phnom Penh, Cambodia.

The team is contributing to the development of national guidelines for IPC and clinical care of COVID-19 –cases. Once validated, we’ll roll out trainings in eight hospitals around the country which have been defined as referral hospitals.

Papua New Guinea

Tankred Stöbe, MSF emergency coordinator, visited several countries in South-East Asia to assess their preparedness for potential outbreaks of COVID-19 and the support MSF could provide at this stage. He participated in training sessions with healthcare staff in a hospital in Port Moresby, Papua New Guinea, where MSF treats patients with tuberculosis. The training sessions helped to improve knowledge and reduce fear among the staff, two prerequisites for providing the best level of care to our patients.

Our regular tuberculosis activities are now on hold. Teams have started providing trainings, screening and triage in 22 provinces across the country.

Europe & Central Asia

Italy

In the week beginning 9 March in Italy, which is now the second-most affected country after China, MSF began supporting four hospitals in the epicentre of the outbreak with infection control, as well as patient care.

Outside the hospitals we are starting activities to support family doctors and healthcare workers assisting people under isolation at home, and the staff of a nursing home for the elderly where cases have been detected.

We have also started activities in one of the five most affected regions, Marche in central Italy, where the number of cases is increasing. We support a network of nursing homes in several cities, to prevent cases to spread in such vulnerable locations, which have no specialized medical staff to manage the patients. Today there are about thirty MSF staff involved in the response to coronavirus in Italy

France

We're setting up activities to help detect and manage COVID-19 cases among the most vulnerable populations in Paris and the surrounding region. MSF teams are currently working out the details of their activities with partner medico-social associations and the Ile-de-France Regional Health Agency. They are to include mobile consultations and screening to be able to reach out to the most vulnerable, and support with diagnosis, isolation and case management in both existing and prospective shelters.

 

Greece

People trapped in squalid camps at entry points for asylum seekers and refugees on the Greek islands are in especially high-risk environments for COVID-19 transmission and should be evacuated immediately. Earlier this week, a Greek citizen was confirmed to be the first case of COVID-19 on the island of Lesvos, making evacuation of the camps extremely urgent. MSF is urging for people to be evacuated as the sanitary and living conditions make prevention almost impossible, and accessing healthcare facilities are problematic.

In Samos, we're supporting isolation for simple cases and deployed an emergency prep team to help with PHC and screening. We have also prepared an emergency plan in case the refugee camp of Moria should the epidemic spread on the island. 

Belgium

We are supporting organisations that work with vulnerable groups such as homeless people and undocumented migrants, with triage and IPC measures. Support to hospitals in case they get overwhelmed is being set up, as is IPC and medical support to closed settings such as homes for the elderly.

In total, MSF is supporting 7 facilities in Belgium with human resources, technical advice, and material.

Spain

25 March - We're stepping up our response in Spain by starting medical, logistical and strategic support activities. We will be leveraging our experience and expertise in managing epidemics in fragile contexts, in working in the country.

One of the first priorities is to tackle infections within healthcare structures and treating people with COVID-19 in a manner that would contribute to reducing the risk for patients with other illnesses from getting infected.

The second priority aims to decongest hospitals and healthcare centres by setting up temporary hospitals for people with mild and moderate symptoms of COVID-19 so that intensive care units can focus on treating people with severe symptoms.

Following the green light from Madrid’s Regional Government, we've set up a 100-bed temporary hospital to accommodate people with moderate symptoms at the University of Alcalá de Henares, located 31 kilometres east of the capital. Treatment of patients will be handled by the staff of the nearby Hospital Príncipe de Asturia, relieving pressure on the hospital’s emergency department, where severe patients that require hospitalisation in the intensive care unit will be sent to.

We have established another temporary hospital in a sports centre near the Hospital Severo Ochoa in Leganés, 11 kilometres southwest of Madrid. Discussions with local health authorities are also ongoing in identifying other locations to set up temporary hospitals in Catalonia.

The third priority looks outside of healthcare facilities, where we are providing advice to the steering committees of nursing homes for the elderly. Our teams are working on risk assessments and implementation of hygiene and protection measures to reduce transmission of the coronavirus within residences, as well as improving patient care.

Switzerland

We're providing logistician and sanitation support to areas where vulnerable people are living targeting 1,300 families in Geneva.

We have an ongoing exchange of medical expertise with the University teaching hospital in Geneva (HUG), with a MSF medic there focusing on case management and management of medical teams. We're also providing support in the management of dead bodies (evaluation and recommendations).

Norway

In Norway we're providing strategic advice and IPC support to a hospital hosting 10-12% of the hospitalised patients in Norway, situated geographically in one of the main clusters in the country.

Afghanistan

Our teams are supporting the authorities with technical advice and assessing the situation in Herat where cases have been declared.

After an assessment in the Afghanistan-Japan Hospital in Kabul, which is the referral hospital for COVID cases, we're providing IPC training. We intend to looking into ways to support case management in Herat.

Africa

Ivory Coast

In Abidjan, MSF supported the Ministry of Health at a transit centre to screen and refer people with COVID-19 symptoms to the care centre. In Bouake, training activities for health workers and screening at the different entry points to the city are already underway. Water and sanitation activities are also being implemented.

Mali

MSF supports the management of a COVID-19 unit in Bamako, within the grounds of the hospital where we run our oncology programme. Eight ICU beds, 100 individual IDP capacity have been set up by Ministry of Health. We're providing a team to help.

Cameroon

Authorities have asked MSF to support hospitals in Yaounde and in Buea (South West Region). Currently, we're looking for isolation capacity outside healthcare facilities.

Burkina Faso

We're offering patient support in Fada health centre as needed.  MSF is also training of Ministry of Health staff regarding best practices in responding to the COVID-19 pandemic. We're also surveillancing the community as part of our regular activities and health promotion.

South Africa

MSF has re-purposed existing project staff from all 4 projects to COVID-19 responses in Gauteng, KwaZulu-Natal and Western Cape provinces. Our staff members are assisting with contact tracing, both physical and telephonic, the development and dissemination of health promotion materials, the decanting of health care facilities, and we are now making plans for potentially partnering on triage, isolation and treatment interventions.

Libya

Since Monday 16 March MSF medics provided two first trainings on COVID-19 infection control and case management to nurses and doctors of Tripoli hospitals, in an effort to support the Libyan health authorities in confronting the outbreak : prevention and preparation are key.

Tanzania

Our health promotion team in Nduta camp, Tanzania, are working to sensitise and educate the community on hygiene and best health practices, to improve preparedness for a potential threat of COVID-19 within the camp. MSF is the main healthcare provider at Nduta refugee camp in Western Tanzania, which hosts over 73,000 Burundian refugees.

Currently MSF teams on the ground are strengthening systems and implementing measures to enhance our capacity for a potential outbreak of COVID-19 in the camp.

The Middle East

Gaza

We're providing support through case management, as there are two confirmed cases of COVID-19 over the past weekend (21/22 March).

Syria

We're offering training and technical support (identification and setting-up of isolation areas, patient flowdesign) in our supported facilities in Azaz and Idlib.

Iran

23 March - In Iran, we have sent a 50-bed inflatable treatment unit and an emergency team of nine people to Isfahan, the second worst affected province in Iran, to increase hospital capacity for treating the critically ill. An MSF emergency team comprised of nine emergency and Intensive Care Unit (ICU) medical doctors and logisticians will run the unit. The team will work with local medical staff and in close coordination with the Iranian health authorities.

The situation is on hold for now and we're meeting with authorities for ongoing for clarification. We are not sure whether we will deploy in the end.

Iraq

An MSF team is intervening in a COVID-19 centre in Baghdad, to improve IPC.

Yemen

An MSF team is providing support Ministry of Health in Aden as they set up an isolation facility.

The Americas

El Salvador

We're working with the Ministry of Health to respond to the COVID-19 pandemic by increasing ambulance services coverage & capacity in order to deal with the non-COVID-19 cases. We are also adapting mobile clinics services in neighborhoods & the exploring the potential of switching to home-based care services.

We are also doing assessment statuses of deported people from USA & Mexico, who are confined in hotels, to identify needs regarding IPC/isolation/diagnosis/treatment and how a response can be made.

Brazil

We are currently conducting three exploratory missions in San Paolo, Rio de Janeiro, and Mina Gerais, to see about protection of health care staff, with focus on vulnerable groups.

Pre-existing projects

On any given day we are treating hundreds of thousands of patients for a variety of illnesses. We need to ensure we can continue to provide adequate and life-saving medical care in our ongoing projects.

This is challenging because current travel restrictions are limiting our ability to move staff between different countries.

Establishing future supplies of certain key items, such as surgical masks, swabs, gloves and chemicals for diagnosis of COVID-19 is also of concern.

There is a risk of supply shortages due to lack of production of generic drugs and difficulties to import essential drugs (such as antibiotics and antiretroviral drugs) due to lockdowns, reduced production of basic products, exportation stops or repurposing/stocking of drugs and material for COVID-19.

"This is what matters in the end: doctors and nurses need to be equipped to provide the best possible care to patients in what might be a chaotic situation."

Tankred Stöbe
MSF emergency coordinator

What needs to be done

We must do everything to prevent and delay further spreading of the virus. It is already straining some of the world’s most advanced healthcare systems. 

Access to healthcare

Preserving access to healthcare, both for COVID-19 patients as well as for any other patient, is paramount. This means ensuring that hospitals don’t become overwhelmed and that health staff can cope with the number of patients requiring intensive care and continue providing treatment to other patients who need it too.

Currently, much of our international staff are unable to travel to project sites, for example 50% of international staff are coming from Europe, and they’re no longer going to projects, so we’re trying to find ways to manage this, as it can particularly impact some projects needing specialist profiles such as surgeons. Having said this, international staff represent 8% of MSF global workforce, most of our projects are run by locally hired team members.

Protecting healthcare staff

Infections of healthcare staff can happen easily in places that are overwhelmed by large numbers of patients. Places dealing with limited supplies of personal protective equipment for staff and a probable reduced workforce (as healthcare staff will also be part of confirmed cases through transmission in the community) are also at risk. 

Infected healthcare staff will further reduce the capacity to admit and treat patients. Safety for healthcare workers should be a top priority in every healthcare facility.

Ensuring trust

We know from our experience that trust in the response and in health authorities is an essential component for outbreak control. Clear, timely, measured and honest communication and guidance is needed. People need to be empowered to protect themselves.  

To ensure that the medical tools urgently needed to respond to COVID-19 are accessible, affordable, and available concerned stakeholders including governments, pharmaceutical corporations and other research organisations developing treatments, diagnostics, and vaccines should take the necessary measures to:

  • prevent patents and monopolies from limiting production and affordable access;
  • guarantee access to repurposed drugs for patients suffering from disease;
  • prioritise the availability of the medical tools for protection and treatment of frontline healthcare workers; and  
  • improve transparency and coordination, making sure an evidence-based approach is put in place to continuously monitor the risk of the potential supply chain vulnerability on essential medical tools

How dangerous is the disease COVID-19?

Our understanding of the virus and the disease is still evolving. The latest estimates are that 80% of the people who get infected will only suffer from a mild or moderate form of disease. 15% will develop a severe form of the disease, which requires hospitalisation. Some 5% will be critically ill.

Sophisticated health care systems may be able to cure even the most critically ill patients, but the danger is that healthcare systems get overwhelmed by the large number of patients to be hospitalised, so those patients can’t access that level of care.

It’s clear that there are also infected people who show no or almost no symptoms of the disease. There are no good estimates of what percentage of infections these asymptomatic or pauci-symptomatic people make up of the total number of infections.

The disease is 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. Children, on the other hand, seem to be less affected by the disease. The mortality rates vary a lot from place to place, so it’s difficult to make a general point about how deadly COVID-19 is.

More than 80% of the people who died of COVID-19 were over 60 years old, and over 75% had underlying medical conditions.

How contagious is the disease?

Our understanding of the virus and the disease is still evolving. The virus certainly can be spread by the coughing of sick people. But it seems it can also be spread by people that have no or almost no symptoms. This doesn’t make the disease more contagious per se, but it makes it much harder to get a good picture of the way it’s spreading. It is unknown what percentage of all infections these ‘asymptomatic’ infections make up.

As more than 120,000 people have been reported to be infected in more than 100 countries, this virus has already spread widely. Many countries report exponentially growing figures of new cases, so the virus clearly has the potential to spread quickly. But many details about the infectivity of the virus are still unknown (how long it can survive in different circumstances outside the human body, how many viral particles are required for an infection, etc.).

 

How can I prevent myself from being infected?

It’s important to protect yourself and protect others too. As with other coronaviruses, droplet infection seems to be the main mode of transmission. The virus enters the human body through the mouth or nose. This can happen by breathing in infected droplets, or by touching with your hands a surface in which droplets have landed, and then touching your mouth or nose later.

Hence, simple infection control measures such as hand-washing and cough and sneeze etiquette are effective and 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.

In places with local transmission of the virus, social distancing is advised. As the virus is passed on from person to person, not being too close to other person can prevent infections. Avoid crowded places and large gatherings.

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 and wash your hands.

Given the current problems with the supply of masks and other protective equipment, healthcare staff should be prioritised.