Considerations for planning COVID-19 treatment services in humanitarian responses
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RESEARCH IN PRACTICE
Open Access
Considerations for planning COVID-19 treatment services in humanitarian responses Sylvia Garry1*, Nada Abdelmagid1, Louisa Baxter2, Natalie Roberts3, Olivier le Polain de Waroux1,4, Sharif Ismail5, Ruwan Ratnayake1, Caroline Favas1, Elizabeth Lewis1 and Francesco Checchi1
Abstract The COVID-19 pandemic has the potential to cause high morbidity and mortality in crisis-affected populations. Delivering COVID-19 treatment services in crisis settings will likely entail complex trade-offs between offering services of clinical benefit and minimising risks of nosocomial infection, while allocating resources appropriately and safeguarding other essential services. This paper outlines considerations for humanitarian actors planning COVID-19 treatment services where vaccination is not yet widely available. We suggest key decision-making considerations: allocation of resources to COVID-19 treatment services and the design of clinical services should be based on community preferences, likely opportunity costs, and a clearly articulated package of care across different health system levels. Moreover, appropriate service planning requires information on the expected COVID-19 burden and the resilience of the health system. We explore COVID-19 treatment service options at the patient level (diagnosis, management, location and level of treatment) and measures to reduce nosocomial transmission (cohorting patients, protecting healthcare workers). Lastly, we propose key indicators for monitoring COVID-19 health services. Keywords: COVID-19, SARS-CoV-2, Coronavirus, Africa, Low-income, Humanitarian, Crisis, Fragile, COVID-19 treatment service delivery, Treatment
Background The challenge of treating COVID-19 in humanitarian responses
COVID-19 epidemics are resulting in high excess morbidity and mortality across high-income countries. The virus is expected to cause even more pernicious effects in crisis-affected populations, defined here as forcibly displaced people within or across national borders and non-displaced persons affected by armed conflict, exceptional food insecurity and/or natural disasters, and in need of humanitarian assistance. These populations may * Correspondence: [email protected] 1 Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK Full list of author information is available at the end of the article
face higher COVID-19 attack rates due to large household sizes, inadequate hygiene and access to safe water and sanitation, and camp or urban overcrowding; they may also experience higher disease severity and poorer outcomes due to untreated co-morbidities and limited access to health services [1]. COVID-19 treatment services may prove particularly challenging in settings with low baseline healthcare capacity, fragile supply chains and limited access to testing. Aside from the complexities of adapting clinical protocols to these conditions, humanitarian actors are
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