According to François Grünewald and Jean-Luc Poncelet (URD), we should draw inspiration from the protection measures implemented in Africa and Asia during previous health crises. Until a vaccine is ready, personal prevention measures remain needed more than ever.
In recent months, a tiny agglomeration of molecules, SARS-CoV-2, has been penetrating human cells all over the planet. It spreads by air, from one individual to another. People’s immune systems react differently to eliminate the virus.
Some people are asymptomatic and don’t realize they have the virus, while others suffer from more or less heavy symptoms. Still others lack a strong enough immune response or have other pathologies (chronic respiratory or cardiovascular problems, etc.), which prevent them from resisting the side effects of this viral invasion. Number of those winded up dying at home, in care homes for the elderly, or in intensive care units.
It is these extreme situations (severe symptoms or death) and the fact that the virus is easily transmissible that—in just a few weeks—changed everyday life on the planet and resulted in lockdowns for more than 4 billion people.
The Western world seems to be focusing much of its medical action on producing treatments, searching for a vaccine, and equipping hospitals and clinics. But other parts of the world, especially Asia and Africa, are concentrating their efforts on prevention. But what is the ideal balance between prevention and life-saving efforts? We still know very little about the disease and face a great deal of uncertainty regarding development of treatments and a vaccine. Given this situation, the only way to limit the spread of the pandemic and thereby protect people—including health workers—is to systematically apply personal preventive measures and preventive behavior.
Widespread lockdowns to fight Covid-19: the default option
Without treatments or a vaccine, only our immune system has the ability to eliminate SARS-CoV-2 once invaded. Medicine can only provide support to the body in its struggle against infection. But in many countries hospitals were swiftly overwhelmed, forcing authorities to resort to the only available solution to reduce the strain on health services: widespread lockdowns.
Moreover, some of the international response was largely inspired by the difficulties encountered by Western health systems, which had to equip hospitals and deliver biomedical equipment. But equipping health services with sophisticated and unfamiliar equipment poses great risk. As has happened after other crisis situations, it may end up stored away in hospital corridors and courtyards, broken down and irreparable without biomedical maintenance systems and decipherable user manuals.
Even if the absolute number of people in need of intensive care were to remain much lower than what was experienced in many so-called rich countries, the virus could quickly overwhelm hospital capacity in other countries, where even fewer hospital beds (and especially emergency beds) are available per capita.
In addition, the hospitalization of a Covid-19 patient in a cramped hospital ward lacking basic equipment represents a considerable risk for the staff. Furthermore, when health facilities are overwhelmed, it becomes difficult to treat other pathologies, and the fear of catching the virus then acts as an impediment to patients who need to consult a doctor.
That’s why we must imagine other solutions that are simple and inexpensive.
Personal protection measures: the indispensable role of community health workers
Community health workers are on the front lines when it comes to epidemics and disseminating good practices and health information. Indeed, they play a key role in the health systems of many countries in the South. Recognizing their importance, providing them training, and giving them the resources needed to take action and protect themselves should be priority actions.
In the absence of treatment, the capacity to carry out the following actions is crucial: assisting the vast majority of patients who have every chance of surviving in their community, working to break the chains of transmission, and of course protecting the vital grassroots level of the health chain.
We have witnessed Ebola epidemics in the Gulf of Guinea and Democratic Republic of the Congo as well as cholera epidemics in Chad, Haiti, and Yemen. Such epidemics have shown us that management of epidemics heavily depends on how well and how energetically prevention mechanisms work. Shouldn’t this management be the focus of response strategies?
Given the large number of asymptomatic individuals and the high rate of communicability of the virus, wearing masks, especially in enclosed areas, seems to be the best way to protect people. If carried out properly, this measure alone could interrupt transmission enough to bring it to a rate of less than 1. Together with handwashing, it would increase the chances of stopping the spread of Covid-19. It would simultaneously promote hygiene, which is essential for dealing with other diseases as well.
These simple and easy-to-follow basic prevention rules have long been practiced in Asia and Africa thanks to awareness campaigns. Educational posters and visuals are used there in markets, schools, and at border posts, and simple messages are also broadcast in the main spoken languages. Basic public health behavior such as handwashing, wearing masks, and social distancing will make it possible to fight effectively against this tiny but ferocious aggregate of molecules.
Covid-19: managing medical information in a world of rumors
We live in a world where every news item is available instantaneously, out of its context. The scientific world and the major international institutions no longer have the time they need to evaluate pass judgment on such information. The free movement of information, which is sometimes generated intentionally by interest groups, leads to an increase in rumors, false claims, and slander campaigns, etc. The press is obliged to report on them, and the result is an over-saturation of information that hinders the development and dissemination of prevention messages.
It has become increasingly necessary to work in-depth with the media to promote dispassionate discussions on health risks, on their systemic effects, and on the preventive measures to be taken and the possible impacts of the latter on economies and societies. The same applies to the management of health risks in most countries of the world.
The opinions expressed on this blog are those of the authors and do not necessarily reflect the official position of their institutions or of AFD.