What can health care providers in poor countries do about COVID-19?
Last Saturday night, a massive livestreamed concert honored front-line health care workers around the world and raised money to support the World Health Organization’s (WHO) work in response to the coronavirus pandemic.
Yes, the pandemic is giving the U.S. a taste of what it’s like to be a low- or middle-income country in a health emergency. Americans are experiencing shortages of critical medical supplies, overwhelmed health care systems, exposed and exhausted health professionals, and dysfunctional political leadership.
Ultimately, U.S. health care workers can be reassured that our economic resources and health care system strengths will enable us to survive this pandemic, although mismanaged U.S government preparedness and rapid response may have contributed to many lives lost.
The situation faced by health care workers in poorer countries is very different from what we face here in the United States. We know because we reached out to colleagues around the world.
We work at the Center for Global Health of the University of Illinois in Chicago and have ongoing relationships with health care organizations in 15 countries across four continents. We launched a rapid-turnaround survey to check in with our colleagues in order to better understand their readiness and responses to COVID-19. Here’s what we learned.
Health care organizations reported facing the greatest difficulties in providing intensive medical care for COVID-19 given the lack of ICU beds (in 80 percent) and ventilators (in 75 percent). One partner from Ethiopia wrote, “Since we have no test kits for COVID-19, we are not able to diagnose patients. We have no personal protective devices. We have two ventilators but both are non-functional.”
Health care organizations in these countries were somewhat better able to prevent spread in their organizations and to support the health care workforce, but they also face major obstacles, given that more than 70 percent lack personal protective equipment (PPE) and COVID-19 testing kits.
Sixty-five percent showed confidence in hospital staff’s knowledge about precautions to be taken to prevent COVID-19 infection among hospital personnel. This is despite the fact that, since 2005, the WHO has promoted an effective campaign to promote hand hygiene and other infection prevention measures in health facilities.
The role of protecting health care workers at the forefront of the response cannot be overemphasized, as demonstrated by Taiwan in the early days of the COVID-19 outbreak. Yet, in resource-poor countries’ health care facilities, staff shortages relative to the high patient volumes are a major challenge.
Their ability to quarantine health care providers whenever needed was 70 percent. To make matters worse for the providers, family and community members fear infection from the health care workers, which further stigmatizes and isolates those who are already exhausted and traumatized from their work.
Health care organizations had limited confidence (60 percent) in the communities’ ability to adopt hand-washing as an easy, effective method for protection in a pandemic situation, despite our several decades of awareness about the causal link between hand hygiene and infection.
Just 50 percent of health care organizations had confidence that their patients could practice social distancing because of crowded urban settings and large multi-generational households. In India, one health care worker summed it up: “We need to ensure the safety of the most vulnerable economically weaker populations who don’t have access to maintaining social distancing or practicing hand hygiene and are also the ones mostly affected by lockdowns and economic fallouts.”
What explains this picture? We found that the degree of readiness and response to the COVID-19 pandemic can be explained statistically by the level of available economic and medical resources in a country. This means pandemic response, or inadequate responses and resultant deaths, is to a very significant degree caused by failures to invest in and build decent public health and health care systems by national governments and international agencies.
So what should be done — both now as the outbreak spreads in low- and middle-income countries and in the months and years after — to prepare for the next outbreak or pandemic?
The international community must provide additional support for these countries to control the pandemic, including PPE, other medical supplies, drugs and equipment, health care facilities and workforce training. Expenditures should be focused on building the health care facilities’ capacity for active surveillance, early detection, isolation and contact tracing.
The results also indicate that, despite the obvious resource limitations, health care organizations in poor countries can do more to strengthen their capacities for isolating COVID-19 patients, for protecting older persons and other vulnerable groups, and for supporting health care workers.
A global effort is needed to strengthen public health infrastructure and disease control in all countries, but especially in poor countries, for COVID-19 and other preventable diseases. Given the interconnectivity of all the world’s countries, we should assume that viral transmission between countries is a certainty.
Health care workers in low- and middle-income countries cannot solve this problem alone and require international assistance. The funds and leadership must come from the United States, other high-income countries, and international organizations such as the WHO and other United Nations agencies. Supporting health care organizations and public health systems in poor countries is an essential part of the answer for our long-term survival and prosperity.
Stevan Weine, M.D., is a professor of psychiatry at the University of Illinois at Chicago College of Medicine, where he also is director of global medicine and director of the Center for Global Health.
Nayanjeet Chaudhury, M.D., MPH, is senior global technical adviser to Medtronic Foundation and adviser to Ramaiah International Centre for Public Health Innovations in India.