NEW YORK — As international relief organizations ramp up their prevention work on the novel coronavirus, known as COVID-19, Médecins Sans Frontières is taking a page out of its playbook on the severe acute respiratory syndrome response.
“In a normal emergency, you have a fairly limited target population, and in this emergency, at one level you have every human on the planet.”— Gwen Eamer, senior public health official, IFRC
Karin Huster, MSF’s former emergency coordinator to the Ebola epidemic, arrived in Hong Kong at the beginning of February to oversee coronavirus prevention efforts in the special administrative region of China. The approach is focused on targeting some of the most potentially vulnerable populations, including migrant workers and asylum-seekers, with public health education.
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“We intervened during the SARS outbreak with community engagement and health promotion. We felt it was the right thing to come back and try to do exactly the same, from a public health standpoint,” Huster said.
“Hong Kong has a very strong health system. ... But the place we felt we could add value was with the groups that we typically target anyways, which are the vulnerable populations that might have difficulties in accessing care, or would be at higher risk in becoming sick because of their vulnerability to start with,” Huster continued.
While SARS infected 8,098 people from late 2002 through 2003, COVID-19 has so far been transmitted to 78,191 people in China, with 2,918 cases in 37 other countries, according to estimates from the World Health Organization. On Wednesday, WHO Director-General Tedros Adhanom Ghebreyesus cautioned against officially declaring the outbreak a pandemic, even though the latest WHO situation report shows that more new cases were reported outside of China than within.
“We should not be too eager to declare a pandemic without a careful and clear-minded analysis of the fact. WHO has already declared a public health emergency of international concern — our highest level of alarm,” Tedros said during a situation briefing in Geneva on Wednesday. “Using the word ‘pandemic’ carelessly has no tangible benefit, but it does have significant risk in terms of amplifying unnecessary and unjustified fear and stigma and paralyzing systems.”
Huster said that in Hong Kong, where there are currently 85 confirmed virus cases, MSF is taking a “back-to-basics” approach, meeting with communities to discuss infection prevention and offering in-person training sessions to other health workers on control measures.
“There are questions that still need to be answered, but I think that from our standpoint, we feel that very good hand hygiene, good cough etiquette as soon as you're sick, you wear a mask if you start sneezing, or you don’t go out — we feel that this is, for now, is what we need to protect ourselves,” Huster said.
“If we felt that there was a real risk created and there was a very strong chance for us to be infected, then of course we would stop our activities there or find a different way to communicate with folks.”
So far, the virus has not been identified among the vulnerable populations that MSF is engaging with, according to Huster. But migrants have had a harder time accessing masks and other protective equipment such as hand sanitizer.
“We have heard of some people who are elderly or poor washing their masks, steaming them, and ironing them,” Huster said. “It has bolstered our logic behind targeting those populations most.”
MSF announced in mid-February that, like other international relief organizations, it will provide hospitals in China with specialized medical protective equipment. It is also in contact with health authorities in other countries in South and Southeast Asia on health education approaches, according to Brienne Prusak, spokesperson for MSF.
Various national societies of the International Federation of Red Cross and Red Crescent Societies are also expanding their public health work in countries such as North Korea, Nepal, and Myanmar. IFRC has an open emergency appeal for 32 million Swiss francs ($33 million) to support its public engagement and has received about 2.8 million Swiss francs to date.
“We are working specifically in countries that have active cases and countries that are at high risk of importation or have weak and vulnerable health systems. Where we have a particular value to add is those communities and countries where the ability to rapidly detect, isolate, and treat cases may be lower,” said Gwen Eamer, a senior IFRC public health official specializing in emergencies.
A challenge in IFRC’s public health risk communications work is the quickly expanding scope of potentially impacted communities across the world, according to Eamer.
“In a normal emergency, you have a fairly limited target population, and in this emergency, at one level you have every human on the planet,” Eamer said. “There is the element of identifying how you communicate at the micro and macro level as well, to make sure the messaging is adapted to what people need.”