Overlooked : the Cornerstone of Outbreak Response
What China’s response to coronavirus teaches us for low-resource countries
Fear of the latest coronavirus, the novel respiratory illness that was first identified in Wuhan, Hubei Province, China, has crippled the world and tested the capacity of multiple public health emergency response systems. As of February 7, there have been 31,420 reported cases and more than 600 deaths. The virus has reached 27 countries outside of China with 32 suspected cases in various African countries. As the virus continues to spread widely, and with the recent World Health Organization (WHO) declaration of a global emergency, fear and measures to prevent the further spread of the virus have intensified. While it is important not to spread fear, the prospect of the virus reaching resource-constrained countries is particularly concerning. As WHO Director General, Tedros Adhanom Ghebreyesus expressed, the “greatest concern is the potential for the virus to spread to countries with weaker health systems.”
With each public health emergency that arises, it becomes more and more clear that emergency response will continue to be an incredibly difficult and expensive task if countries around the world are unable to build resilient healthcare systems. The most recent examples being this new coronavirus and Ebola- both the 2014–2016 West African outbreak and the more recent outbreak that has continued to ravage the Democratic Republic of Congo. Sufficient, resilient health infrastructure must be in place so that health systems are able to quickly identify and mitigate the spread of disease, while providing the best possible care to individuals who are already affected.
With the novel coronavirus proliferating wildly — case numbers have now surpassed those of the 2003 SARS outbreak — China has taken unprecedented measures to mitigate the virus’ spread, including imposing travel restrictions on millions of people living in the Hubei Province. In addition to travel restrictions, the Chinese Government has built emergency infrastructure, including two hospitals in Wuhan in less than two weeks. These prefabricated, military-run 1000- and 1600-bed hospitals are equipped with intensive care units and several isolation wards. The city’s government has also announced plans to convert three existing venues, including a gymnasium, into make-shift hospitals to alleviate overcrowding. Hospitals around the country, which have been perpetually overwhelmed since the beginning of the outbreak, have experienced severe shortages of testing kits, personal protective equipment, and other medical supplies. Reports from Wuhan have shown that the situation is dire and residents have complained that it has been nearly impossible to get the healthcare they need to treat, or even diagnose the virus — a symptom of addressing infrastructure needs as they arise instead of having them already in place. The impact of these newly built hospitals will not be immediately clear in the midst of the virus spreading. Nonetheless, it is quite remarkable that the Chinese government has the capacity to place more than 11 million people under lockdown and construct two hospitals in less than two weeks. The reality is that most countries do not have the same capacity. They do not have the resources, manpower or technology to do as China has done and build additional hospital facilities on such short notice.
If the coronavirus comes to most resource-poor nations, their health systems and infrastructure will undoubtedly be overwhelmed and the virus will spread unchecked, disproportionately affecting the poorest and most vulnerable. What will happen in the densely populated informal settlements of Nairobi or Mumbai should this coronavirus, or any other novel or known disease, emerge or reemerge in those settings? The Cholera outbreak that Haiti faced in the wake of the earthquake gives us some indication. The effects would be devastating.
Many countries around the continent are taking different measures to protect their borders- Mozambique has suspended visas to travelers from China, the Nigerian government has announced that it will begin screening Chinese nationals travelling to the country for the virus, and Ethiopia and Kenya have placed travelers from China under isolation. These measures however, require significant resources and coordination and do not ensure sure prevention. Furthermore, these measures do not prevent the same challenges from arising the next time a virus sweeps across the region or the world.
I am by no means the first person to identify infrastructure and health systems strengthening as key to effective and sustainable emergency response. The WHO has also raised concerns about confirmed cases reaching the African continent, given that most African countries do not have the capacity to contain the virus. Concerningly, suspected cases of coronavirus have already been identified in multiple African countries. When suspected cases were identified in Ethiopia’s capital city, Addis Ababa, the Ethiopian Ministry of Health sent blood samples to South Africa to be analyzed. Until early this week, South Africa and Senegal were the only countries on the continent able to confirm coronavirus cases. As long as this remains true, valuable time will be lost and response efforts will be undermined in all African countries. The 2014–2016 West Africa Ebola outbreak demonstrated how tragic this can be and highlighted the importance of health infrastructure and systems in the face of such outbreaks.
As the world sees more and more outbreaks of this magnitude, we must continuously prioritize health system strengthening and infrastructure, to protect every person’s right to healthcare and foster emergency response preparedness. The measures we have seen countries take so far in the form of travel and trade restrictions such as border closures, visa restrictions, and the quarantining of asymptomatic travelers from the affected region are often not very effective and the WHO has opposed these measures, which they argue have no scientific rationale. Other interventions such as entry and exit screening and contact tracing also have limited success in containing outbreaks. My recent international travel reminded me of this fact- seas of travelers, many coughing and sneezing, unable to reliably and systematically undergo any screening measures. The best measures to contain such outbreaks are proactive, not reactive: invest in developing sustainable and resilient public health systems and infrastructure that may shake, but won’t break when public health concerns arise.
Last updated: February 7, 2020
