NAIROBI — As the outbreak of the novel coronavirus taxes the health system in China, there is growing anxiety about the potential dire consequences of the virus on countries with weaker health systems. The fears are particularly heightened across the African continent, where NGOs are expecting to play a key role in trying to contain the spread.
“I have a great concern that if this virus makes it to a weaker health system, it will create havoc,” said Dr. Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, during a press conference Tuesday.
“If coronavirus hits a country where people are more mobile — like Kenya, Rwanda, Uganda — it will be very challenging to contain. It will be more of a disaster than Ebola.”— Margaret Asewe, interim WASH adviser for Horn, East, and Central Africa, Oxfam International
There are currently no confirmed cases of the new coronavirus — officially named COVID-19 — in Africa.
With the help of WHO, at-risk African countries have scrambled to enhance airport screenings for passengers with symptoms and increase capacity to test for the virus — originally only two laboratories on the continent had that capability.
If there is an outbreak in Africa, NGOs expect to help in areas such as patient care, support to governments, community sensitization, hygiene promotion, and contact tracing.
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NGOs can apply lessons learned from the response to the Ebola outbreak in the Democratic Republic of the Congo — which has been costly and lengthy — if there is a widespread COVID-19 outbreak, organizations told Devex. This includes the importance of early community engagement.
“It’s taken us so long to contain Ebola in DRC, and that’s just one country. If coronavirus hits a country where people are more mobile — like Kenya, Rwanda, Uganda — it will be very challenging to contain. It will be more of a disaster than Ebola,” said Margaret Asewe, interim water, sanitation and hygiene advisor for Horn, East and Central Africa forOxfam International.
Because it is a respiratory virus, COVID-19 is more contagious than Ebola, according to health experts.
Overwhelming health systems
Currently, the vast majority of cases of COVID-19 — 44,700 of the 45,100 total at the time of writing — are in China, which has a sophisticated health system capable of delivering high levels of intensive care, said Dr. Michael Ryan, executive director of WHO Health Emergencies Programme, during apress conference on Monday.
In the current outbreak about 90% to 100% of patients need supplemental oxygen, up to one quarter those patients need intensive care, and about 5% to 10% of patients may require some form of mechanical ventilation, he said — a huge demand on a system.
“This disease may appear relatively mild in the context of a sophisticated health system. That may not be the case should this disease reach a system that is not as capable as that of China,” he said.
WHO has categorized African nations into priority groups based on transport connections between those countries and China. Top priority on the continent includes Algeria, Angola, Côte d’Ivoire, DRC, Ethiopia, Ghana, Kenya, Mauritius, Nigeria, South Africa, Tanzania, Uganda, and Zambia.
“That’s what we are really concerned about because most countries have malnourished populations of people who are already suffering from diseases that may make their immune system compromised. If it were to come to those places, and the government couldn’t respond very well then communities would be particularly vulnerable,” said Erica Van Deren, senior program manager, humanitarian and emergency affairs atWorld Vision.
A major concern is if coronavirus were to spread in dense, urban areas.
“The big slums in Nairobi, for example, worry me to the maximum because I don’t know how you could contain it in a situation like that,” Asewe said.
“This disease may appear relatively mild in the context of a sophisticated health system. That may not be the case should this disease reach a system that is not as capable as that of China.”— Dr. Michael Ryan, executive director, WHO Health Emergencies Programme
NGOs gearing up, community engagement
There is a need across the continent to increase and improve isolation facilities, equipping these facilities with things such as personal protective gear and hygiene products, and prepare for community engagement, NGO representatives said.
WHO is hosting meetings with governments and NGOs to provide updates on the situation and outline preparedness measures. NGOs across the continent are passing along information to their field teams to prepare for a potential outbreak. They are also meeting with national ministries of health.
World Vision, for example, has convened a global executive oversight group for COVID-19 and its recommending all of its offices in Africa and Asia take preparedness measures such as assessing internal capacities to respond and looking into how it might procure masks, if needed. In Kenya, Médecins Sans Frontières is part of a national task force to organize preparedness. TheAlliance for International Medical Action is working with national governments to identify resource gaps in areas such as patient care, logistics and human resourcing.
Some of the structures already in place for the Ebola response could be scaled up for a COVID-19 outbreak, Asewe said. For example, NGOs in the DRC Ebola response created coalitions to improve information sharing and coordinate their work at a regional and country-level, she said.
One of the major flaws of the Ebola crisis, responders agree, was that communities were not engaged early enough — which led to the spread of misinformation, resistance to treatment, and the violence against health workers.