Many countries – previously considered Covid-19 hotspots – have moved into new phases of their response, lifting multi-month lockdowns and reopening public spaces. While the changes signal progress for some, other countries, spared in the early stages of the pandemic, are now reporting dramatic surges in case totals.
The progression of the virus is of particular concern in countries with fragile healthcare systems where Covid-19 could be especially lethal without the resources needed to stymie its spread or care for critical patients. Even in well-resourced countries, Covid-19 has proven to be an all-consuming crisis capable of overwhelming even the most sophisticated healthcare systems.
In anticipation, Direct Relief is sending 66 kits of protective gear, intensive care medications, oxygen concentrators and ventilators to health facilities in 22 countries across Latin America, the Caribbean, Asia, the Middle East, Africa, and Southeastern Europe.
While the impacts are widespread, determining who needs what most is a difficult choice, especially when resources are limited. To understand how supplies are allocated and why, we speak with Direct Relief’s deputy director of emergency response, Gordon Willcock, about the three-part framework guiding the organization’s international response to Covid-19.
AMARICA RAFANELLI: Are there any regions that stand out to you as particularly vulnerable at this time?
GORDON WILLCOCK: There’s definitely countries and regions that have increasing case counts. Brazil has increasing numbers, Russia, India, Peru has high case numbers and they’re increasing, and a lot of South American countries. Colombia is a bit of a worry right now.
We’re also looking with some concern at Africa. In Sub-Saharan Africa, the case counts aren’t necessarily high, but there’s a high degree of vulnerability and the impacts of the spread of the disease will have a really great effect. The health system are not necessarily strong, there’s high levels of co-morbidities.
You just imagine as the virus spreads, it creates a systemic crisis in the fact that every health worker has to be protected. So, regardless of what they’re doing, they are then vulnerable to the disease and they obviously don’t want to become a node of spreading it. So whether they a maternal child health worker in a rural area or they do normal health outreach, or whether it’s a health center that does vaccination campaigns, they all now need to protect themselves as front line health workers, so that creates a huge flow on effect and a huge challenge for various countries.
RAFANELLI: With that said, given shortages of PPE and the widespread need, how does Direct Relief decide how and where to send supplies?
WILLCOCK: Yeah. Well, that’s the big question. I think there’s a tendency, and I hear this quite a bit, to understand the need as critical and everywhere right now. And that can lead to a couple of ways of thinking about the allocation of resources.
One of them being: It’s easy. Everywhere has a need, so we’ll just send [supplies] anywhere. And then it’s done. Or, there’s decision paralysis because everyone needs it right now. So how do we allocate these finite resources between these partners? But in reality, that’s an inaccurate and unhelpful assumption to start with.
We have to realize that though the virus presents a clear and present danger for all countries, it’s not all at once and it’s not even. So, certain countries are critical right now, certain countries may be critical in the coming period, certain countries are OK at the moment, and other countries may be getting impacted but are dealing with it quite well.
So that’s what we have to drill down on and it’s really based on three main sources of information. I understand those as one: our existing knowledge as an organization and our relationships we’ve built over time, two: the ongoing communication we have with an extensive partner network, and three: looking and drilling down on the data.
To break those down a bit further: In terms of our experience and knowledge, Direct Relief works in all 50 U.S. States and we work in about a hundred countries, and that means we’ve got multiple partners in all of those one hundred countries and 50 States.
Our program staff and our team working with these communities have that existing relationship with doctors, nurses, chiefs of hospitals. They have an understanding of where the vulnerabilities were before this crisis and they have a good understanding of where those vulnerabilities are right now. So, these partnerships and this network is a really useful source of information right now.
That leads through to the other one, which is communication. It’s almost like [Direct Relief] has a humanitarian health intelligence network. We’re constantly in communication with these partners in these hundred countries, and they’re feeding us information: they’re asking for help, they’re telling us what the situation is like at their facility, which is at the front line. We’re also able to request information from them, so it gives us a really good idea of the needs at the frontline at any one time.
Just this year alone we’ve sent, internationally, 282 individual donations to 184 partners in 75 countries. So that gives you an idea of the sort of interactions that we’re having with health facilities and health staff at the front lines of the coronavirus pandemic around the world. So that’s a really good basis of information.
Then we take all of that and triangulate it with data. Our research and analysis team have been doing an amazing job in terms of drilling down into the details. So not only looking at how the coronavirus is spreading, but looking at what are the social and medical vulnerabilities within the community that makes them more vulnerable than another community. It give us some idea of how to predict where the next crisis might be. We can reach out and get resources to where it’s needed as fast as we can.
Recently [the Research and Analysis team] produced a Covid-19 international vulnerability map and we were able to, not only crosscheck the information we’re getting from our partnership network, but also use it to identify what we’re missing and try to understand where’s the need going to be in the next few weeks.
So I guess I would break down [our strategy] into those three categories: Our experience and knowledge that we have built over time,
communication we’re having with them on an ongoing basis, and then we can cross check with the data as best we can.
RAFANELLI: How do you anticipate or predict this pandemic to unfold in the next few months?
WILLCOCK: Yeah, it’s a big question. We’re already seeing it starting to affect the countries that we would expect it to affect. In countries like Haiti, we’re getting a lot of calls for support and we can see that the case numbers are increasing. Their next-door neighbor, the Dominican Republic, has high case numbers, and so those are spreading into Haiti.
These are countries where there’s high vulnerability in terms of co-morbidities and a weak health system. Haiti is a good example, but other areas in South America, also countries in Asia and in Sub-Saharan Africa are a real concern because the threshold at which their health systems can be overwhelmed is a lot lower.
For instance, Sub-Saharan Africa. Their vulnerability is low in terms of the fact that they have a young population. But they also live with high rates of HIV, tuberculosis, and malaria, which increases their risk. Plus they have weak health systems. So, when you look at the data and the information the vulnerability is really high as the outbreak spreads.
RAFANELLI: Can you walk me through the process of digesting this data and information from health facilities—our partners at Direct Relief—and then translating that into a shipment?
WILLCOCK: Yeah, sure. There are multiple interesting case I could bring up, but just last week one of our team members was talking to a partner in Tanzania, and in terms of the data, the case numbers are not very high, but the partner is reporting that the hospital is getting overwhelmed.
So, on one level you can look at the data and the case numbers are not high. But when you talk to the staff on the ground and you get into the information a bit further, they’re getting inundated. So anecdotally, based on information from them, the virus is spreading and it’s going to be a real problem.
Then we can drill in on that country and say, alright, what do we have that we can offer? We can look at our PPE supplies—our personal protective equipment—or equipment like oxygen concentrators. Ultimately, that then leads to sending a shipment out to support that facility.
We’re looking at the data, we’re speaking to the partner on the ground, and the program staff team member has a good understanding because of the history they have of working with those partners in that country. Balancing that all together we can decide, yes, we need to send supplies out to support them.