MSF SOUTHERN AFRICA OPERATIONAL UPDATE
As of Tuesday, 31 March, the confirmed number of people who tested positive for COVID-19 stand at 1 353. This includes the first patient who was confirmed to having contracted COVID-19 in Khayelitsha township in the Western Cape Province, where Doctors Without Borders (MSF) has had activities for 20 years.
Cyril Ramaphosa, South Africa’s President on Monday announced a mass screening campaign, with 10,000 field workers set to go door-to-door across the country to screen residents for symptoms.
In Khayelitsha, our team, working closely with local authorities, transported the patient who tested positive and two contacts exhibiting symptoms to a nearby treatment centre, where the two contacts were rigorously screened and the confirmed case was isolated. The team proceeded to conduct contact screenings in the community.
“The Western Cape Department of Health have been highly responsive. They have been very open to collaboration, identifying spaces where long standing non-governmental partners like MSF can assist in the COVID-19 response,” says Dr. Eric Goemaere, MSF response team leader.
“It is clear that COVID-19 is going to test the capacity of the health system but from our interactions it is very clear that the DoH is eager to apply the lessons from COVID-19 responses elsewhere, and to learn from what organisations and health authorities have developed in response to other epidemics. This is the kind of approach that will collectively help turn the tide at a time like this,” Goemaere says.
The team is conducting digital and physical health promotion, establishing tents and gazebos outside facilities for screening purposes and decanting patients on chronic medication.
In addition to what the teams are doing on the ground, our MSF drivers travelled to all Khayelitsha Eastern Sub-District health facilities on Monday, 30 March to pick up the antiretroviral treatment parcels for patients who would normally pick up themselves. The parcels were delivered to partner organisations, who will in turn deliver the medication directly to patients’ homes.
MSF is also working closely with local authorities in the following areas where we have projects, Tshwane, Eshowe in KwaZulu Natal and Rustenburg where we are doing various activities such as contact tracing and health promotion.
MSF GLOBAL OPERATIONAL UPDATE
Internationally, the number of people who have contracted COVID-19 continues to rise. According to the World Health Organisation (WHO), there are 754,948 confirmed cases, and 36,571 deaths now.
The virus has also proved that even some of the world’s most advanced healthcare systems are under severe pressure. As a medical humanitarian organisation, our teams at MSF are particularly concerned about the people in precarious conditions where access to preventative measures is nearly impossible, and where Intensive Care Unit (ICU) care is next to non-existent.
“As COVID-19 spreads further, it will continue to expose the inequalities that exist in our health systems,” says Jonathan Whittall, Doctors Without Borders (MSF) director of the Analysis Department
MSF's FOUR MAIN MESSAGES:
- Preparing for the next wave of the pandemic - Africa, Middle East, Latin America
We see 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.
- Keep healthcare workers safe
We must protect healthcare workers, everywhere. Without them, there is no response to the pandemic, or to general health needs that must be met, so keep them safe and free from infection - both to treat patients and avoid them spreading the virus further themselves so they don’t become amplifiers of the pandemic. They need to be able to keep all health services running too. The global shortages of personal protective equipment pose a grave threat. Healthcare workers must have access to the equipment they need to do their jobs safely and effectively. In the COVID-19 projects we’ve opened in Europe, we see healthcare workers today facing dilemmas that are common in humanitarian settings where we work. Where to focus energy? Who gets care and who doesn’t? How to make choices with scarce resources? Mental health support for healthcare staff is needed to get through this pandemic.
- Protect people at risk of severe disease (elderly, comorbidity)
We also must protect those most at risk of severe forms of the illness. With COVID-19, that in large part means the elderly, so many of our projects focus on strengthening the infection control measures and protection of the elderly in nursing homes. It also concerns those who have another illness, such as diabetes or tuberculosis. We do not know yet what the impact will be for children who suffer from severe malnutrition, or for communities that have been hit hard by measles epidemics, such as in the Democractic Rupublic of Congo (DRC) or Chad.
- Protect the vulnerable living in precarious settings – those who can’t self-isolate, or no access to water, overcrowding
People living in overcrowded conditions, on the streets, in makeshift camps or in substandard housing are at particular risk. Many are already in poor health, often as a result of their poor living conditions and the virus thrives in such settings, without adequate water or sanitation. In addition, many of these marginalised groups are excluded from the formal healthcare system. In some places this means that hundreds of thousands if not millions of people are vulnerable, living in slums or in camp settings, in precarious living conditions without a social safety net to help them.
COVID-19 preparation in our programmes
Protecting healthcare workers and patients is essential, so our medical teams are also preparing for potential cases of COVID-19 in our projects. In places where there is a higher chance of cases, this means ensuring adequate infection control measures are in place, setting up screening at triage, isolation areas, and health education. We must be able to receive COVID-19 patients, and make sure that no one is consequently infected in our structures, patients nor staff.
In most countries where we have projects, MSF is coordinating with the WHO and the Ministries of Health to see how MSF could help in prevention and in case of a high load of COVID-19 patients.
This can include pragmatic implementation of measures dealing with health promotion, infection prevention control, rational use of emergency equipment and triage in order to help prevent possible hospital overloads.
Keeping our programmes running
A key priority for MSF is to keep our regular medical programmes running for the extremely vulnerable communities we are supporting around the world. In any given day we are treating hundreds of thousands of patients for a variety of ailments. We need to ensure we can continue to provide adequate and life-saving medical care in our ongoing projects, and that there we have adequate infection prevention control in the health structures where we work.
Sustaining our projects faces some challenges because we are impacted by the current travel restrictions, which limits our ability to move staff between countries. There is also global pressure on the production of some medical supplies, in particular of specialised personal protective equipment for healthcare workers. Our projects are still able to continue medical activities, but ascertaining future supplies of certain key items, such as surgical masks, N-95 masks and gowns, is of concern.
More than 200 countries and territories have reported confirmed cases of COVID-19, and in Africa there are 49 countries with confirmed cases. We have passed more than half a million reported cases globally, though this number is certainly an underestimate, given the lack of testing. The epicentre of the pandemic is currently in Europe and there is an exponential increase in the US that has now surpassed China in the number of confirmed cases. We’re seeing an increased number of cases in nearly every country where we work.
Evidence indicates that the best way to address the outbreak (prevent infections & save lives) is to break the chains of transmission and provide care. To break transmission: test, isolate, and trace contacts. This is the backbone of outbreak management. However, realistically in many of the contexts where we work, we know there won’t be easy access to testing, and it is very difficult for people to isolate themselves and protect themselves with handwashing.
Focusing on preventing transmission within high-risk communities in high density settings (slums, refugee camps) will be crucial, as the impact of an outbreak in such locations could be catastrophic. Because tests are limited, it is important to ensure testing and early isolation in these communities, as well as for healthcare workers – both to ensure there are enough healthcare staff at work, as well as prevent onward transmission within health facilities.
Hospitalising so many people for such a long time at such a high level of care poses a real challenge to even the most advanced healthcare systems. We are very concerned about the consequences in countries with weaker healthcare systems, where ICU capacity is negligible, and how they will struggle even more substantially if the virus takes hold.