COVID-19 UPDATE: Second waves, shortages of supplies and overwhelmed health systems in GAZA, INDIA and NORTH-EAST SYRIA.

Gaza - Between March and April, COVID-19 infections have risen at an extraordinary rate, from less than a thousand reported cases a week to over a thousand reported each day, with an alarming increase in infections among healthcare workers. This second wave has already surpassed the first in its severity and in the number of infected patients, and hospital are struggling to cope.

Gaza now accounts for over 60 per cent of all active COVID-19 cases in the Palestinian Territories. Only around five per cent of Palestinians had been vaccinated by the end of April, and less than half of all healthcare workers have received their first dose.

The upsurge in patients with COVID-19 in Gaza has been driven by the more severe ‘UK variant’ B.1.1.7. The highly contagious variant swept through the West Bank earlier this year, overwhelming hospitals.

Since COVID-19 first arrived in the Palestinian Territories MSF has been supporting key medical facilities and intensive care units in Gaza. It has provided technical advice and hands-on training in infection prevention and control, including proper waste management and cleaning processes, oxygen therapy, how to correctly use personal protective equipment (PPE). We’ve also donated essential drugs, PPE, medical equipment and consumables such as oxygen masks, tubing and other devices and tools. We’re also running digital health promotion and misinformation campaigns reaching nearly a million people in April.

“Implementing COVID-19 infection prevention and control measures is a big challenge in the facilities due to this evolving crisis where relocated staff in COVID-19 departments need more support and training,” says Rachelle Seguin, MSF medical coordinator in Gaza. “The health authorities have now increased the COVID-19 bed capacity in nine hospitals for adults and in two hospitals for children. In parallel, we are scaling up our support to alleviate the mounting pressure on an already overburdened healthcare system”.

Maharashtra, Mumbai  -  MSF recently scaled up its COVID-19 intervention in the M-East Ward (MEW) of Mumbai, a ward with a population of over 800,000, 70% of whom live in informal settlements.

““No one was ready for the second wave. It caught everybody by surprise. In a very short time, it’s turned into a major crisis. The authorities here are well-organised and are adapting to the situation as it evolves as best they can. But as the cases increase, it’s getting harder to find beds” says Mabel Morales, MSF’s Medical Co-ordinator.

We have mobilised 60 staff and are in the process of recruiting and sending additional teams with COVID experience.  We have deployed doctors, nurses, anaesthesia technicians and psychologists to support BKC hospital (also called Jumbo Hospital) in Mumbai, a 2000 bed facility.

“The demand is just so huge. Imagine a thousand-bed hospital, there’s 28 wards as well as the emergency, casualty and triage areas. It’s a makeshift hospital in a huge metal tent. Walking into it the first time was a surreal experience; I’ve never seen anything like it. It’s like walking into a huge ship. The ceiling is really high, but the ventilation is not great. It meets some standards, but it doesn’t really suit the Mumbai environment. During the morning, Mumbai becomes very humid. It’s excruciatingly hot. And working in a protective suit for eight hours; it’s unimaginable. The heat is almost too much to take” says Gautam Hari Govind, MSF’s Medical Activity Manager in Mumbai.

We are also worried about vulnerable populations including migrant workers and people with other illnesses, such as diabetes, HIV and/or tuberculosis and their ability to access medical care, including oxygen therapy. We’re ensuring continuity of care to our drug-resistant TB patients and are scaling up screening, shielding, tele-medicine, counselling and referral activities at the hospital, in the community and at 9 health posts.

Northeast Syria — The current COVID-19 outbreak is spreading quickly through the whole of northeast Syria.  As of 26 April, there are over 15,000 confirmed cases – including at least 960 among health workers – and 640 deaths. The true numbers of people affected by COVID-19 is believed to be much higher as people continue to struggle to access testing and healthcare. 

In the two COVID-19 hospitals that MSF supports in the region, in Hassakeh and Raqqa, medical teams have seen a sharp increase in confirmed cases in the past month. With a PCR test positivity rate as high as 47% it is clear that many cases have gone unidentified which is directly linked to the limited testing capacity in the region. 

“It is shocking that after one year into the outbreak, the region of Northeast of Syria still struggles to find the essential COVID-19 supplies,” says MSF Medical Emergency Manager for Syria, Crystal Van Leeuwen. “There is a clear lack of laboratory testing, inadequate hospital capacity to manage patients, not enough oxygen to support those who need it most and limited availability of personal protective equipment (PPE) for health workers.” 

The only laboratory in the region that can test for COVID-19 is in Qamishli. It is currently experiencing critical shortages of supplies, and two weeks from now, there will be no PCR testing capacity in the region unless further supplies arrive. MSF has donated testing supplies to Qamishili laboratory on four occasions since the start of the pandemic to prevent imminent stock-outs. “With no UN cross border mechanism in place for Northeast Syria creating challenges for supplies to reach the Northeast from Damascus-based organisations, such as the WHO, the region is woefully underserved in this outbreak”, says Van Leeuwen.  

At least two COVID-19 treatment centres in Hassakeh and Raqqa have stopped activities after running out of funds and medical supplies. While many other unsupported hospitals are raising alarms and requesting basic but essential support for items like oxygen, antibiotics and PPE to be able to cope with the increasing numbers of patients with COVID-19.   

Vaccination plans in northeast Syria have fallen between the cracks, with vague promises and insufficient planning. Local authorities report that they have been promised just 20,000 vaccines for an area that hosts five million people, and it remains unclear if those vaccines will even arrive.  

“The COVID-19 response in northeast Syria is insufficient,” says Van Leeuwen. “A significant increase in assistance from health and humanitarian organisations is essential.”