Getting ready for the inevitable

This is part of our Coronavirus Update series in which Harvard specialists in epidemiology, infectious disease, economics, politics, and other disciplines offer insights into what the latest developments in the COVID-19 outbreak may bring.

Harvard Medical School faculty members and their colleagues at Partners In Health (PIH) are collaborating with local communities and national governments to help prepare some of the world’s most vulnerable people for the COVID-19 pandemic.

PIH is launching a comprehensive effort to support this response across its network of supported countries to:

• contain and control the spread of the virus,
• ensure that patients are provided with dignified care, and
• demonstrate to the world what aggressive action in vulnerable settings can achieve.

While the impact of the novel coronavirus pandemic is having an unprecedented impact on developed nations including the U.S., Italy, and China, it’s an all-too familiar progression in the places where PIH works, which have faced devastating earthquakes and hurricanes, massive outbreaks of Ebola and cholera, and simmering epidemics of HIV and tuberculosis in recent years, all in the context of crushing poverty and fractured or nonexistent health systems.

Paul Farmer, the Kolokotrones University Professor of Global Health and Social Medicine in the Blavatnik Institute at Harvard, has seen these crises firsthand many times, as an anthropologist, an infectious disease doctor, and as co-founder and chief strategist of PIH.

“Communicable pathogens almost always have some treatment,” he said in a recent online forum. “We’re not talking about the specific therapies but rather the nonspecific ones, supportive and critical care.”

In combating infectious disease outbreaks for the last three-plus decades, PIH has developed a methodology that builds strong partnership with national governments and local community members and combines screening and prevention efforts with the best available treatment for the disease.

This comprehensive model for care delivery, combined with long-term collaboration at the community and national level, also creates a platform for performing crucial research to develop and test new care delivery models, diagnostic tools and treatment regimens for a broad swath of illnesses.

“Since this is a communicable pathogen, protecting the caregivers is a prime concern,” said Farmer, who is head of the HMS Department of Global Health and Social Medicine. “Once we link this to our mission to make a preferential option for the poor, we’re going to find ourselves needing more staff, stuff, space and better systems. And that’s what our colleagues are doing from Haiti to Rwanda to Russia.”

COVID-19 continues to spread around the world at an alarming rate, demanding global action to contain the spread and ensure that care is available for the most vulnerable.

As hard hit as more developed nations have been, COVID-19 will likely disproportionately affect the most vulnerable and hit hardest in countries with weak health systems. The currently reported case fatality rate cannot be used to predict how this virus will devastate many areas globally where there are not high functioning and resourced health systems that can respond to an aggressive infectious disease and where the population suffers from conditions such as malnutrition, HIV and tuberculosis. Mortality is anticipated to be far worse in the places where PIH works, and it is unclear if the current global response accounts for the factors in these settings.

This story is adapted from articles and updates from Partners In Health.