With many health systems in resource-limited settings across the globe already struggling to meet the needs of their patients, how can health officials cope with the rising COVID-19 pandemic?

The challenges are clear. Without adequate hospital space, intensive care units or ventilators, the options for treating severely ill patients are few. Strategies to stop the community spread of the disease, such physical distancing and shelter in place orders are often not possible due to close working and living conditions and the need to personally secure food and other resources.

To address these challenges, it’s important to look back at what worked during previous disease outbreaks such as the 2010 cholera epidemic in Haiti and the 2014 Ebola outbreak in West Africa. This includes using strong community health networks to communicate about the disease, finding creative ways to increase patient capacity such as constructing open-air tents and building trust through open and honest communication.

This was the message from a team of global health experts during a Grand Rounds session at Massachusetts General Hospital on March 19, 2020.

Louise Ivers, MD, MPH
Louise Ivers, MD, MPHB
Executive Director,
Center for Global Health

“As a Boston medical community, we have the utmost concern for how the COVID-19 pandemic will evolve in low resource settings,” said Louise Ivers, MD, MPH, executive director of the Center for Global Health at Mass General. “This crisis requires us to recall our shared humanity and to work together for solutions so that no one is left behind.”

Dr. Ivers was joined by David Walton, MD, MPH, of Build Health International and Brigham and Women’s Hospital; Inobert Pierre, MD, of Health Equity International and St. Boniface Haiti; Quarraisha Abdool Karim, PhD, of the Centre for the Programme of AIDS Research in South Africa, Columbia University; and Paul Farmer, MD, PhD, of Partners In Health and Brigham and Women’s Hospital.

Here are some key takeaways from the presentation:

  • In the U.S., there are 568,000 individuals experiencing homelessness, two million individuals incarcerated in prison (over 40% with preexisting conditions) and 90,000 in ICE detention. Without preemptive measures, these shelters and detention centers will experience intense outbreaks
  • There are opportunities in low- and middle-income countries to make interventions that could help suppress the virus and save lives, such as devising strategies for triaging patients, building temporary housing for COVID-19 patients and increasing communication and outreach efforts
  • There are strengths in health systems serving rural and low-income communities that we can draw from:
    • Previous experience dealing with outbreaks of infectious diseases such as cholera and the Ebola virus, as well as responding to large-scale natural disasters
    • Deep integration of health services with community organizations will help with communication and outreach efforts
  • Infection control strategies such social distancing may be materially impossible in some settings—in Haiti, for example, many people live in small two-room dwellings with a high population density of about five inhabitants
  • Temporary patient housing strategies that incorporate natural ventilation, if properly designed, can achieve the same goal as negative pressure rooms. For example, large tents that roll up on the sides allow for the 12 air changes per hour that a negative pressure room provides
  • In South Africa, there are concerns about how the virus will impact the 40% of HIV-positive individuals who have not been tested yet or initiated treatment, as well as those with co-occurring HIV and tuberculosis. As the epidemic continues, there are concerns on how it will impact the supply chain for HIV medications and the continuation of patient care
  • Additional concerns in South Africa include rising instances of hoarding, misuse of social media platforms, panic, fear, stigma and discrimination
  • Given the legacy of mistrust that has built up by decades of colonial exploitation in African countries, building good relationships across the community will be important to get messages about the disease across to the population

The Center for Global Health is hosting weekly seminars on the impact of COVID-19 in resource limited settings. Visit their website for a schedule of upcoming seminars, videos of past presentations and additional COVID-19 resources.