PIH's Emergency Coronavirus Response
COVID-19 continues to spread around the world at an alarming rate, demanding global action to contain the spread and ensure that care is available for the most vulnerable.
The World Health Organization (WHO) is urging countries to improve efforts to contain the disease and protect health care workers, and notes that a solution calls for “aggressive preparedness,” all around the world. On March 11, 2020, the WHO officially declared COVID-19 a pandemic.
Partners In Health (PIH) knows that COVID-19 will disproportionately affect the most vulnerable and hit countries with weak health systems the hardest. The currently reported case fatality rate cannot be used to predict how this virus will devastate many areas globally where there are not high functioning and resourced health systems that can respond to an aggressive infectious disease, and where the population suffers from conditions such as malnutrition, HIV, and tuberculosis. Mortality is anticipated to be far worse in the places where PIH works, and it is unclear if the current global response accounts for the factors in these settings.
PIH is launching a comprehensive effort to support this response across its network of supported countries around the world to:
- contain and control the spread of the virus,
- ensure that patients are provided with dignified care, and
- demonstrate to the world what aggressive action in vulnerable settings can achieve.
PIH is uniquely positioned to respond to COVID-19, leveraging deep experience in treating infectious disease outbreaks and responding to emergency situations around the world. PIH’s approach of working directly alongside Ministries of Health, our leadership’s connections to the world’s leading COVID-19 responders, and our strong relationships within the communities where we work will enable PIH to effectively mobilize high-impact programs to control the spread of the virus and ensure that the most vulnerable receive access to dignified care.
An underestimated outbreak is now a pandemic that must be controlled
- Because this is a novel virus, many countries are hesitating to enact aggressive containment measures, starting with widespread testing. Coronavirus disease 2019 (COVID-19) is now a public health emergency of international concern, a pandemic, and a massive threat to the communities PIH serves.
- While mortality rates appear to be lower than other infectious diseases (such as Ebola virus disease, MERS, and SARS), this virus has spread to pandemic levels and its mortality rate will increase dramatically once the capacity to treat patients requiring intensive care is reached.
- COVID-19 has already put enormous stress on the health systems of many developed countries.
- Some world leaders have suggested “let the virus run its course.” PIH strongly rejects this cruel, defeatist stance because we know it would be a death sentence for potentially millions of vulnerable people.
This virus will disproportionately affect developing nations
- The virus stands poised to devastate millions of people living in low- and middle-income countries where health systems are weaker and not ready to provide the level of intensive care required by patients with COVID-19.
- If we do not mobilize quickly to contain the pandemic, mortality rates could be far worse in the places where PIH works. Our educated guess is that without dramatic action now, they could end up at 30 percent—five times higher than the 6 percent mortality rate in Italy, which is itself 10 times higher than the rate in South Korea.
- A current global lack of diagnostic tests, especially in developing nations, means the virus is likely spreading undetected.
- Weaker health systems already fail to meet people’s normal health needs and will quickly collapse if the virus is not contained. Some countries have only a handful of intensive care unit (ICU) beds nationally and we estimate that as few as 200 severe cases of COVID-19 could overwhelm entire health systems in a matter of weeks.
- The economies, safety nets, and personal circumstances of our patients are not robust enough to sustain aggressive containment measures such as remote working, social distancing, or quarantine.
If not PIH, then who?
- PIH has always strived to preferentially bring the benefits of modern science to the poorest and sickest communities around the world. For over 30 years, PIH has successfully confronted outbreaks, from HIV to drug-resistant tuberculosis, from Ebola to Cholera.
- Our ranks are filled with world-class global health experts who find nimble solutions proven to work in resource-poor settings.
- We know the key to preventing and fighting any epidemic is a resilient health system, built in partnership with local ministries of health.
- Our government partners know this and have reached out to PIH to seek help. Local ministries of health--such as those in Rwanda, Liberia, and Haiti--have been more proactive than most developed nations and have scrambled to prevent transmission of the disease early on. Rwanda, for example, has installed innovative hand washing stations at bus parks, among other recent measures.
- Because of these early interventions and despite the lack of available tests, we have a duty to try to contain the virus before it spreads out of control in the countries we serve.
- PIH is a highly respected global health player and has the opportunity to lead a global coalition of public and private partners--as it has in the past--to stop this virus in its tracks and provide care for millions of patients.
What’s our plan?
PIH has already put a plan in motion to address the massive threat poor countries face. Our plan will surely evolve as the pandemic continues. Currently, the plan is divided into 4 prongs:
- There is a window of time to prevent or significantly slow the spread of COVID-19, which can only be achieved with widespread COVID-19 testing.
- Wide-scale point of care (POC) testing through skilled personnel is the only way to identify clusters, break the chain of transmission, and contain the spread of COVID-19.
- PIH plans to screen more than 200,000 people across eight countries
- Mobilize PIH-supported public hospitals and health centers and other health facilities throughout the eight countries, in collaboration with the Ministry of Health.
- Use innovative rapid diagnostic tests (RDTs)—which were developed in China deployed there and in other countries—to detect the virus at PIH-supported hospitals and communities.
- The RDTs PIH plans to deploy are innovative because they return results in as little as 15 minutes and can be done at the bedside or even outside the hospital, in the field.
- More complicated methods of diagnosis include Polymerase Chain Reaction (PCR) tests. In most countries we serve, PCR tests are only available in a handful of nationally accredited labs, if at all. The inadequate PCR capacity could hinder measures to halt the spread of the virus, as we’ve seen in the U.S.
- PIH is collaborating with local ministries of health to improve testing capacity for both RDTs and PCRs.
2. Provision of Care
- PIH will continue to provide free, dignified, high-quality treatment for everyone, as part of governments’ public systems.
- PIH will provide supportive care and treatment for patients with COVID-19, across all PIH-supported health facilities.
- PIH also knows that additional staff support will be required to properly staff 24-hour acute care needs of patients with severe symptoms. PIH investments in critical inputs will be key, including essential medications, human resources, oxygen supply, and fuel for generators (to ensure monitors and oxygen concentrators are connected to stable electricity), among other critical costs to ensure full access to care and treatment.
- PIH will work to ensure that essential routine health services are not impacted during outbreak preparedness and response efforts.
- PIH is working with MOH colleagues at more than 200 PIH-supported facilities globally to establish staffing and other response plans.
3. Assist Local Government Response to COVID-19
- PIH will provide health care workers with personal protective equipment (PPE), such as masks, gloves, gowns, and hand sanitizers.
- In some facilities, PIH will provide simple infrastructure enhancements, such as outdoor fever tents, as needed, to reduce the risk of transmission at health facilities and ensure proper triage.
- PIH will work rapidly to quickly train all health care workers in standard Infection Protection and Control (IPC) measures for COVID-19 and provide general education to patients at health facilities.
- PIH will establish triaging protocols for those meeting COVID-19 case definition to ensure designated isolated areas are available to commence treatment, as a means of preventing further infections at health facilities.
- PIH will rapidly increase its advocacy in the US to translate fear into commitments of long-term investments in global health funding that builds from PIH’s “five S” approach—focusing on staff, stuff, space, systems, and social support—and advocating for people-centered, rights-based approaches to emergency response and longer-term health systems (care vs. containment, durable investments vs. temporary quick fixes, etc.).
4. Mobilize Community Health Workers to Seek Out Those Who Are Ill
- As with any outbreak response, epidemic control relies on finding index cases before significant transmission occurs.
- Contact tracing will be immediately implemented whenever a COVID-19 patient is diagnosed. This will include family members, but also workplaces, churches, schools, and any other locations visited by a person with confirmed COVID-19.
- PIH will rely on extensive experience in mobilizing community health workers to implement similar efforts, including responses to Ebola in West Africa and cholera in Haiti.
- PIH will mobilize its networks of thousands of community health workers to find those individuals who have come into contact with COVID-19 patients, advise them on the best ways to stay healthy and avoid infecting others, and safely accompany them to hospitals and clinics if their symptoms worsen.
- For those contacts, social support (food, water, financial support, etc.) will be provided by CHWs to help families in implementing social distancing protocols, and all asymptomatic contacts will be monitored for 14 days.
The impact of our response by the numbers
- The week of March 9, we ordered the 200,000 rapid tests and are preparing to deploy them by March 30th.
- We’ve begun training some of our thousands of community health workers to keep themselves safe and trace contacts of those infected.