H5N1

Dr. Joanne Liu: 100 days of solitude during COVID-19

An excerpt from today's Globe and Mail: Opinion: 100 Days of Solitude: 18 experiences of isolation during the pandemic.

Joanne Liu is a pediatric emergency specialist at Montreal’s Sainte-Justine Hospital and the former international director of Médecins sans frontières. 

In March, the invisible enemy was at everyone’s door – including mine, at the monastic lakeside writers’ retreat I was attending just outside of Geneva.

I had been fortunate enough to get a year-long sabbatical to write a book, but when I saw people were dying in the thousands from COVID-19, I knew had to help. I had already seen too many people die alone in places such as Yemen, Liberia and Sierra Leone, as we worked to staunch cholera and Ebola. 

From that version of isolation, I returned to Montreal and I self-isolated for 14 days. That was tough in its own way: While I was used to contributing concretely in health crises abroad, I was suddenly powerless in my own country, just waiting to get my hospital privileges reactivated. 

Eventually, I was lucky to find a way to contribute. I offered advice to governments in Ottawa, Quebec and New Brunswick, and did shifts in the ER and in our devastated senior-care homes. I always thought this was the best way to own a crisis – taking calls and going out into the field. 

 But one memory kept racing through my mind during this pandemic, just as it did during the Ebola crisis: seeing a child in Liberia, bawling in his bed as his nose bled, surrounded not by loved ones, but by medical staff rushing around in triage mode. Human beings are not meant to die alone. Full stop.  

The doctors who joined me then vowed to never feel so powerless again – to never be caught without diagnostic tests, treatments and vaccines. Yet here I was, in my own G7 country in 2020, where we were realizing too late that epidemics have no mercy – that if there are vulnerabilities in the chain, diseases will break them. 

Hopefully, no one will ever judge any country overwhelmed by an epidemic again. It’s been a hard 100 days, but in the days still to come, we need to understand that we are only as strong as our weakest link. We’re not over COVID-19 until all of us are over COVID-19.

DR Congo: Government to support Equateur in the fight against COVID-19 and Ebola

Via 7sur7.cd: DRC: Government to support Equateur in the fight against covid-19 and Ebola (Eteni Longondo). The Google translation:

The Minister of Health of the Democratic Republic of Congo, Doctor Eteni Longondo, arrived on Friday 05 June 2020 in Mbandaka, chief town of the province of Equateur.  

The latter used his stay in this part of the country to announce to the provincial authorities that the government will support them in the fight against the Ebola epidemic and the coronavirus pandemic. 

"We have thought about the eradication of these two diseases that are here. It is Ebola and covid-19 because we have a first case of covid-19 here in the province of Equateur. And I told the province that the government will support it technically and financially in the eradication of these two diseases,'' said the Minister of Health.  

He also presented to the provincial executive of Equateur the partners who made the trip with him as part of this mission. These include the delegation from OXFAM, UNICEF and the World Health Organization.  

It should be noted that the province of Ecuador has registered to date 11 cases of Ebola including 10 in Mbandaka and 1 in Bikoro, among which there are 6 deaths. However, 1 case of covid-19 is confirmed in Mbandaka, in the town of Wangata by the National Biomedical Research Institute. 

MSF opens coronavirus COVID-19 centre in Venezuela

Via MSF.org: MSF opens coronavirus COVID-19 centre in Venezuela.

More than 100 professionals from different disciplines have set up a specialist COVID-19 centre in a wing of the Ana Francisca Pérez de León II hospital in Petare, northeast Caracas, Venezuela. 

The plan to rehabilitate the hospital’s infrastructure and create an inpatient unit, including intensive care beds, where COVID-19 patients can receive medical and psychological care, is being carried out by Médecins Sans Frontières (MSF) in collaboration with Venezuelan authorities and the hospital's management team. Hospital staff have also received personal protective equipment (PPE) and training.    

MSF staff working with hospital staff across disciplines 

A team, made up of MSF and hospital staff and including doctors, nurses, epidemiologists, psychologists, technicians and transport and maintenance staff, has already begun caring for patients with COVID-19 symptoms. 

“It has been hard work and not without its challenges, due to the urgency of the situation and the need to adapt the hospital structure to the biosecurity measures, without compromising the rest of its emergency activities,” says Isaac Alcalde, coordinating MSF's emergency responses in Caracas and Miranda. “This has been possible thanks to the willingness of MSF staff and the hospital’s management team to find the best solutions for patients. It's a new situation for everyone.” 

Challenges in providing protective equipment 

So far, one of the biggest challenges for MSF in our global response to COVID-19 has been the shortage of PPE for our medical teams.

“We know that, in many countries, health workers have been exposed to risk, and there have been many infections due to the lack of PPE,” says Alcalde. “We will do our best to ensure that this does not happen here.”  

“But even with sufficient protection, the medical teams will face very difficult situations, both personally and professionally,” continues Alcalde. “We will make sure to provide them with all the support they need, including psychological support, to minimise the impact of this extraordinary situation.”   

MSF providing contact tracing, psychological care 

People arriving at the Ana Francisca Pérez de León II hospital with suspected COVID-19 are received by a medical team and questioned about their symptoms before being tested, either with a rapid test or with a polymerase chain reaction (PCR) test. Those who test positive are taken to the isolation area to be stabilised and to receive medical and psychological care. 

An MSF team visits patients’ families to provide health information and psychological support, while actively tracing the patient’s contacts and searching for other people with symptoms within their community. 

The COVID-19 centre has 22 beds, including 16 inpatient beds and 6 intensive care beds. We are also operating three ambulances, and have rehabilitated a further five public ambulances, for transporting patients between hospitals and between local diagnosis centres and hospitals. These are available not only for coronavirus patients but for patients suffering from other medical emergencies.

MSF opens a COVID-19 treatment centre in Haiti

Via MSF.org, a May 18 report: MSF opens a coronavirus COVID-19 treatment centre in Haiti. Excerpt and then a comment:

Médecins Sans Frontières (MSF) continues to respond to the global COVID-19 pandemic by opening a treatment centre in Port-Au-Prince, Haiti’s capital city, to help provide a coordinated response to the new coronavirus outbreak and strengthen the capacity of the Haitian healthcare system. 

MSF has re-purposed the Grands Brûlés hospital in Drouillard, a neighbourhood of the capital, to support patients who have tested positive for COVID-19 and have been referred by the Ministry of Public Health and Population, with hospitalisation and oxygen. The COVID-19 Centre is launching its activities with a 20-bed capacity, but can accommodate up to 45 beds, as the outbreak evolves.  

Our COVID-19 global response is focused on three main priorities: supporting health authorities to provide care for patients with COVID-19; protecting people who are vulnerable and at risk; and keeping essential medical services running.  

Protective equipment is scarce 

However, the COVID-19 pandemic is posing numerous challenges for health systems worldwide. In Haiti, there is a scarcity of personal protective equipment (PPE), including crucial items such as masks and aprons, and medical tools such as COVID-19 tests. 

“These challenges, including a shortage of medical staff due to travel restrictions, have forced us to reorient our activities at the Grands Brûlés hospital, and rely on our existing staff, who are working tirelessly to respond to this emergency,” said Hassan Issa, MSF Head of Mission in Haiti. 

"We have made preparations to prevent the spread of COVID-19 at our medical facilities by strengthening infection prevention and control, and working to ensure proper PPE is in stock. Triage and isolation spaces have been set up in the health structures we manage, and in those we support across the country.  Currently, we are supporting health institutions in Martissant, Port-à-Piment, Port Salut, Les Cayes, Croix-des-Bouquets, and Gonaïves."

The Haitian Ministry of Public Health and Population reports 812 confirmed COVID-19 cases and 25 deaths as of May 21.

MSF: New Ebola cases confirmed in DR Congo

Thanks to Mary Marshall for sending the link to this MSF report: New Ebola cases confirmed in DRC. Excerpt:

On 10 April 2020, a new case of Ebola was confirmed in the city of Beni, North-Kivu, northeastern Democratic Republic of Congo. The news came after a long interval without new confirmed cases: 52 days had passed since the notification of the previous confirmed case and 40 days had elapsed since the last patient was declared free of Ebola.  

Only two days remained before the expected declaration of the end of the outbreak (i.e. 42 days after the clearance of the last confirmed case) and the new confirmed diagnosis erased any expectation of such declaration.  

Unclear transmission of new case 

It is still unclear how the patient confirmed positive on 10 April contracted the virus:  he was diagnosed after his death, had no known contacts with previous Ebola patients and was not a former survivor of the virus who might have relapsed. Since the notification of this new case, five more Ebola cases have been confirmed in Beni, reaching a total of six new confirmed cases since 10 April. 

These new cases generated frustration and a certain level of suspicion within the community, and protests were held in the city of Beni, highlighting the need for strong communication efforts and community engagement.  

Flare-ups of disease still possible 

Although the end of the outbreak was in sight, flare-ups are likely according to World Health Organization, which highlights four main reasons why cases could resurge in DRC: Ebola transmission might have gone undetected due to gaps in the surveillance system or in areas where access for humanitarian organisations is limited due to the complex security environment.  

• The Ebola virus can persist in used needles, syringes or vials for several weeks. 

• The Ebola virus can persist in the body fluids of survivors for many months, and can be transmitted for a long time after a patient’s recovery (for example via sexual transmission or breastmilk), or in rare cases, a convalescent patient can relapse - as observed already during this outbreak. 

• The Ebola virus may be present in an animal reservoir in the region, and there is always a risk of a new introduction to humans.

COVID-19 turns the clock back on the war in Ukraine, as needs grow

Via The New Humanitarian: COVID-19 turns the clock back on the war in Ukraine, as needs grow. Excerpt:

In the six years Nataliia Kyrkach has been providing assistance in conflict-affected eastern Ukraine, she has seen aid programmes move from urgent crisis response to resilience and development, as people living amidst this ongoing war have slowly begun to rebuild their lives. 

2020 had brought some hopes for peace, after Russian President Vladimir Putin met his Ukrainian counterpart Volodymyr Zelensky for talks in Paris in December. But over the last month, as COVID-19 has swept the world, Krykach says the region is tumbling back to the dark days of 2014-15, at the beginning of the conflict. 

“The situation is going backwards by 100 percent,” Kyrkach told The New Humanitarian by phone from the town of Sviatohirsk in the eastern Donetsk region where the NGO she heads, Slavic Heart, is based.  

In the second half of March, Slavic Heart – which provides a range of humanitarian aid from psychosocial services to food, hygiene items, and medicines – saw a more than 200 percent increase in pleas for assistance on its hotline. This was after Ukraine introduced strict quarantine measures, closing its borders, shuttering schools and all non-essential business, and halting public transport.  

Ukraine has yet to see COVID-19 infection figures comparable to the worst-hit countries in Europe – as of 20 April, there were 5,710 registered cases in a population of 42 million, and 151 deaths. However, with a chaotic and underfunded national health system, and as the country’s politics and economy has been weakened by this low-intensity but still deadly war, its fallout is likely to hit hard. And nowhere more so than in the war-torn east, where sporadic clashes continue between government forces and two breakaway regions backed by Russia: Donetsk, and neighbouring Luhansk. 

Even before the epidemic, the UN estimated that 3.4 million Ukrainians were in need of humanitarian assistance in 2020. Most live in the so-called “grey zone” – a sliver of territory along both sides of the “contact line” that divides Ukrainian government-controlled land from separatist-run areas.  

Adapting aid to the new normal 

Sixty percent of Slavic Heart’s clients – mostly women – have lost most or all of their income since quarantine measures were imposed, said Kyrkach.  

With already limited public transport in frontline areas now completely stopped, many people are unable to access healthcare or get food and hygiene supplies, and most are rapidly running out of funds. 

Already high levels of domestic violence are reportedly soaring. Social workers, reliant on public transport and lacking basic protective equipment, are unable to visit their vulnerable clients.  

The contact line – which used to see up to a million crossings each month by people claiming social and pension payments or travelling for work, health, and family reasons – is now closed.

“Families are entirely alone,” said Kyrkach. Her NGO is using its three mobile support brigades for victims of domestic and gender-based violence to deliver food and hygiene parcels, and has moved its support groups online. But many settlements in the grey zone lack internet access.  

International aid groups like the UN’s refugee agency, UNHCR, and the International Committee of the Red Cross, which had previously scaled back direct assistance to focus on income generation and infrastructure projects, are also reinstating food and hygiene deliveries – all the while rushing to put their own anti-epidemic measures in place to protect both staff and beneficiaries in a war zone.

COVID-19 in Canada: Quebec snubs doctor who helped lead fight against Ebola

Via CBC News, a little more on a Canadian scandal: Quebec snubs doctor who helped lead fight against Ebola. Excerpt and then a comment:

Dr. Joanne Liu, the former president of Doctors Without Borders who steered the organization through its Ebola response and has 25 years of experience in pandemic preparedness, says the Quebec government refused her offer to help with its planning.  

Liu says she has been part of a team of volunteer doctors advising the federal government in its fight against the spread of COVID-19, but that her proposals to assist the provincial one have gone unheeded.   

Liu says she also put her name in the hat of doctors the government requested to step in at the province's beleaguered long-term care homes.   

Finally, Friday evening, Health Minister Danielle McCann tweeted that her department would reach out to Liu so that she could help in the CHSLDs.  

But McCann ignored Liu's offer to help in planning. The doctor is already slated to help at Montreal's Geriatric Institute, which has been hard-hit by a COVID-19 outbreak that has infected at least 132 people and killed 33 between its two wings.  

Liu is a pediatric emergency specialist at Montreal's Sainte-Justine Hospital. She has more than 25 years of experience in pandemic response, and was featured in TIME Magazine's 100 Most Influential People in 2015.  

Under her leadership, Doctors Without Borders called for global action in response to the spread of Ebola, demanding stronger action.  

In an interview on CBC Montreal's Daybreak Friday morning, Liu recounted how she and others had been in touch with Quebec officials suggesting she help out with the province's COVID-19 response. 

Liu says she was told her services were not needed.  

"It feels like being in a hockey game and being on the penalty bench, and waiting to jump in the ice, but your time is not up yet," Liu said.  

"I think I have something to offer and I think that me, and many other people, do. But right now, we have a government that's really, really overwhelmed by the situation and isn't able to take up the offer that everybody is giving." 

François Audet, the director of the Université du Québec à Montréal's international studies school, in another tweet, compared the situation to sidelining a world-renowned general in times of war.  

"When you have the best general in the world, you don't send them to the infantry," Audet said of Liu working in a CHSLD instead of providing expertise. 

Quebec's response more 'reactive than anticipatory' 

The Quebec government has been criticized for not acting swiftly enough when the virus began to spread in the province's seniors' and long-term care homes.

Liu says she sees a number of missed opportunities in how the government attempted to prevent spread of the coronavirus inside the institutions, noting the strategy appeared more "reactive than anticipatory." 

Stopping visitors from coming in was a good first step, Liu says, calling it "radical shielding," but it should have been accompanied by other measures.  

"[They] never inquired: was there enough people to care for them? Did they have enough infection and prevention control in place? Did they have the right [personal protection equipment] and did they know how to use them? We just put them apart," she said.   

"You need to do radical shielding but you need to be able as well to support the system in making sure there's enough care and there's enough protection."  

Not having those things in place allowed the virus to enter the facilities unnoticed at first, and spread among the residents and staff, Liu explained.

She added she had sympathy for decision-makers because the pandemic is "unprecedented." 

In their daily briefings to the media, Legault and McCann repeatedly said there was a shortfall of thousands of staff in the homes — which had been beset by shortages before the pandemic and are now missing even more people after hundreds had to go into isolation.

Unlike health agencies like WHO and CDC, MSF is independently funded (I'm proud to have been a donor since 2004). This gives it freedom of action and speech, and it can be sharply critical of governments. Dr. Liu was blunt in her criticism of the international response to Ebola in West Africa, and embarrassed governments have long memories.

So I can well believe that when Dr. Liu returned to Quebec she was considered more dangerous than useful to the provincial government's COVID-19 response.

 

Still, the response would have done far better to have welcomed her with open arms, and then enjoyed the bragging rights of having such a heavy hitter in the vanguard of the fight against COVID-19.

COVID-19: Health minister says Quebec doctor who oversaw Ebola outbreak will be called quickly to contribute

Via CTV News: Health minister says Quebec doctor who oversaw Ebola outbreak will be called quickly to contribute.

MONTREAL -- Quebec's Health Minister Danielle McCann tweeted Friday evening that the Quebec physician who worked oversaw efforts to battle the Ebola outbreak in West Africa would be called quickly to help combat the COVID-19 empidemic after initially being barred from assisting.  

Joanne Liu, who once appeared on the Time Magazine list of the 100 most influential people in the world, said she was told she would not be able to help in the province's long-term care facilities.  

Liu, a former president of Medecins Sans Frontieres who oversaw the organization's efforts to battle an Ebola outbreak in West Africa, told TVA that she had been refused when she volunteered to help.  

“I was told I didn't have the experience to respond to epidemics in an environment like Quebec,” she said to host Paul Larocque. 

Health Minister Danielle McCann quickly stepped in, saying on Twitter that Liu's help would be welcome. “Thank you to Dr. Liu and Paul Larocque for bringing this to my attention,” she tweeted. “We need everyone's contributions to take care of seniors in CHSLDs. My office will ensure Dr. Liu is called quickly to contribute to this collective effort.” 

Liu said she was looking forward to the opportunity to help.  

Liu, 54, began working for Medecins Sans Frontieres in 1996 and participated in 20 missions in Central Asia, Africa and the Middle East. During her mandate as president, the organization operated in several dozen countries, including African nations during the 2014 Ebola crisis.  

When she appeared in the Time list, United States Center for Disease Control and Prevention Director Tom Frieden praised her in his article. 

"In extremely difficult circumstances, Joanne Liu remained focused while being flexible," he wrote. "More importantly, she worked tirelessly to prepare the world to better respond to crises."

Syria: MSF provides relief items and adapts response for coronavirus COVID-19

Via MSF.org: MSF provides relief items and adapts response for coronavirus COVID-19. Excerpt:

Deir Hassan camp in Idlib province, northwestern Syria, is one of the many camps to which hundreds of thousands of displaced families fled, to escape the military offensive by Syrian government forces with their Russian allies between December 2019 and early March 2020. Deir Hassan camp hosts more than 164,000 people in settlements scattered over the hills and, as is the case across northwest Syria, it lacks basic services. It is now also threatened by the potential spread of COVID-19. 

On 16 March, after assessing the needs in Deir Hassan camp, Médecins Sans Frontières (MSF) distributed essential items to 180 families in the Latamneh and Al-Habeet settlements, including family tents, mats, plastic sheeting, blankets, cooking sets and hygiene kits. 

“We witnessed people living in the open; we also saw two or three families sharing a tent which did not protect them from the cold or the rain,” says Ahmed, MSF project team leader. “There were too few tents to accommodate the new arrivals.” 

The next day, the MSF team distributed the same relief items to 115 families in Abo Obeidah, another settlement in Deir Hassan. 

“Thanks to MSF, we got tents,” says Manaf Shamma, a displaced mother living in Latamneh. “This camp was set up eight months ago, but it needs latrines, sewage, proper roads.” 

COVID-19 pandemic adds to health risks 

In Deir Hassan camp, the water and sanitation facilities are inadequate for such large numbers of people, raising the risk of water-borne diseases. So far, upper respiratory infections have been the main condition seen by the MSF mobile clinics. But now the coronavirus COVID-19 pandemic has become a huge challenge worldwide and in Syria. 

The Syrian government reported the first case of COVID-19 in Syria on 23 March. While no cases have been declared in Idlib province, the last rebel stronghold, the disease may spread very quickly through the region, especially in camps, where people live in large settlements, in overcrowded conditions with little sanitation.  

MSF has suspended our mobile clinics in Deir Hassan camp to allow our staff to attend training on infection prevention and control (IPC), and to make sure they won’t spread the virus. In the coming days, MSF community health workers will hold health education sessions on COVID-19 with displaced families in 10 settlements in Deir Hassan camp, and will distribute leaflets and specific hygiene kits.  

As our teams are now focusing their work on infection prevention and control measures, they are providing assistance for the triage and screening of patients in the two MSF-supported health centres, in Deir Hassan and Tal Karama.

MSF on COVID-19: Urgent help needed across European borders to protect medical staff

Via MSF.org: COVID-19: Urgent help needed across European borders to protect medical staff. Excerpt:

BRUSSELS – As the number of people with COVID-19 continues to rise rapidly across many countries in Europe - now the epicentre of the pandemic - Médecins Sans Frontières (MSF) urges European Member States to demonstrate solidarity beyond their national borders. Essential medical supplies, including personal protective equipment starting from face masks to protect healthcare staff, must be urgently channelled to where they are most critically needed.    

In Italy, where MSF began working in four hospitals in the country’s epicentre last week, shortages of personal protective equipment are increasingly commonplace, leaving healthcare workers on the frontline exposed. Protective equipment shortages are fuelling the epidemic and hampering the ability to save lives. 

Nearly 1,700 healthcare workers, or eight per cent of the total COVID-19 cases in Italy, have been infected whilst tirelessly caring for the rising number of severely ill patients who require long-term hospitalisation and specialised intensive care. 

“Even in high-level European hospitals we see health workers are overwhelmed, coping with up to 80 ambulances per day, with dramatic shortages of protective equipment that puts them at great risk,” says Dr Claudia Lodesani, President of MSF in Italy and lead of the MSF COVID-19 response in the country. “Some doctors are forced to wear the same face mask for 12 hours.”  

“Every day we are receiving new calls for help, for more staff, for more supplies,” Dr Lodesani says. “Without an influx of urgently needed protective equipment, more healthcare workers will fall ill, reducing the availability of care for patients, generating new clusters of cases, and dangerously weakening the fight against the disease.” 

At this moment of crisis, no country can cope or produce the supplies they need alone. European Member States need to urgently implement the solidarity mechanisms put in place by the European Union. Resources must be shared to fight the pandemic where it is currently raging.  

“Today it is Italy that urgently needs supplies of medical equipment to protect healthcare workers, but in a few weeks, it may also be the case elsewhere. Along with increased production, European governments must ensure that supplies can then be shipped easily to the virus hotspots,” says Brice de le Vingne, head of the MSF COVID-19 task force in Brussels. “Meanwhile, threats to close borders risk harming the flow of resources and staff to the most affected areas.”