In the latest edition of the COVID-19 wrap, public health researcher Alison Barrett reports on some recent research findings and releases, including primary healthcare news.
COVID-19 care before, during and beyond the hospital
Rauh, AL; Linder, JA, BMJ Editorial, 22 May 2020
With more than 5.5 million confirmed cases of COVID-19 globally (as of 27 May), these medical academics from Chicago say “it’s time to shift the research focus to studies on living with this disease”.
“Without a vaccine or disappearance of the virus, we could be living with SARS-CoV-2 and COVID-19 for the foreseeable future, possibly years,” they write.
Studies to date have described populations most at risk from the virus and outcomes for those with severe cases, providing valuable insights into the epidemiology of the pandemic and important information for frontline workers.
More understanding is now required of the long-term outcomes of COVID-19 and how to support survivors in recovery.
Potential long-term outcomes from the virus discussed in this article include muscle atrophy as a result of long periods on mechanical ventilation, long-term breathing issues, and post-intensive care syndrome where patients tend to experience physical, cognitive and mental health problems after leaving intensive care.
For COVID-19 patients who have experienced severe pneumonia, they may be at a higher risk of developing kidney or cardiovascular disease.
Patients report having symptoms for weeks or months after diagnosis; understanding of the virus and ongoing support is needed. 
Without a vaccine, we may be dealing with the novel coronavirus for years and it’s important that COVID-19 patients are supported and cared for appropriately as they recover.
It’s also worth noting that learning to live with COVID-19 raises critical questions beyond clinical care, including for public health messaging and strategies.
COVID-19 response in northwest Syria: innovation and community engagement in a complex conflict
Ekzayez, A, Journal of Public Health, 21 May 2020
Years of conflict in Syria have contributed to weakening the northwest regions’ health system, resulting in a limited number of hospital and intensive care beds, minimal doctors (approximately 1.4 doctors per 10 000 people) and inadequate capacity to respond to the COVID-19 pandemic.
In northwest Syria, people are at a particularly high risk from the virus as households and refugee camps are overcrowded, there is widespread poverty and more than 2.8 million people are internally displaced.
External access to the region is challenging, which has substantially reduced foreign aid.
As of 28 April, there had been 43 confirmed cases of COVID-19 in Government-held areas of Syria; and while there had been no confirmed cases of COVID-19 in northwest Syria, due to limited testing abilities, health authorities cannot guarantee there are no cases in the region.
Ekzayez and colleagues raise concerns that if COVID-19 takes hold in the region, the impact will be devastating.
In preparation for a COVID-19 outbreak in the region, where there is no clear leadership, the following steps have been taken:
- Grassroots governance system has been created to facilitate community trust in health authorities’ COVID-19 guidelines
- Neighbourhood committees have been mobilised as part of a mass voluntary campaign to raise awareness of the virus within their communities
- A WhatsApp chat group is used by Syrian medical professionals working in UK and Europe to share latest research with health workers based in northwest Syria
- Early Warning and Response Network, responsible for testing, contact tracing and implementing hygiene and sanitation measures.
The region is also focusing on preventative measures, including controlling borders, social distancing, school closures, public health awareness campaigns and establishment of community-based isolation centres.
Idlib Health Directorate (IHD), in northwest Syria, are working on a plan to increase capacity of ICU with more ventilators; and establish triage tents in front of health facilities.
A website has been developed to reduce the burden on the health system where individuals can assess themselves for the presence of COVID-19 by collecting information on subdistrict location, travel history, signs and symptoms, risk factors and severe complications. Social media has been used widely to communicate health messages; and the IHD have set up a WhatsApp COVID-19 information number.
In conclusion, while much of the northwest Syrian’s COVID-19 response plan is hindered by limited funding and resources, high levels of poverty and household density, they have been able to implement innovative approaches in their effort to manage the pandemic.
Children at risk
At least 80 million children under one at risk of diseases such as diphtheria, measles and polio as COVID-19 disrupts routine vaccination efforts, warn Gavi, WHO and UNICEF: WHO News Release, 22 May 2020
Approximately 80 million children under the age of one won’t receive routine immunisations as a result of the COVID-19 pandemic, according to estimates from the World Health Organization (WHO), UNICEF and Gavi Vaccine Alliance.
Between March and April, disruptions to vaccination services were reported in 68 countries. Lower-income countries are at greater risk; Gavi reported that at least 24 million people are not likely to receive vaccines against diseases such as polio, measles, typhoid and rubella.
“Immunization is one of the most powerful and fundamental disease prevention tools in the history of public health,” said Dr Tedros, WHO Director-General. “Disruption to immunization programmes from the COVID-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles.”
Reasons for disruptions to vaccination services vary, but include transport delays of vaccines, limited personal protective equipment for healthcare workers, reluctance to leave home because of physical distancing or fear of being infected with COVID-19.
In March, WHO had recommended a temporary suspension of preventive immunisation campaigns while they assessed the COVID-19 situation. Since then, they have provided countries with guidelines to help them decide how and when to recommence mass vaccination campaigns.
It is vital that routine vaccination programs recommence as soon as systems are in place to do so safely, to avoid outbreaks of preventable diseases.
Postscript: COVID-19 and the legal determinants of health
Coggon, J, Public Health Ethics, 25 May 2020
Laws and government policies have been a key public health intervention during the pandemic, and these authors highlight the need to balance public health considerations with respect for human rights.
“In using law as a tool to serve the public’s health, the need for scientific evidence is clear, as are the challenges of seeking societal responses to threats that are not immediately visible,” they write.
Governments around the world have implemented stay at home measures and the closure of non-essential businesses to minimise the spread of the virus and thus, avoid overwhelming existing healthcare facilities and systems.
Ongoing reflection and evaluation of the COVID-19 response is required to understand how effective these measures have been in limiting the spread of the pandemic; and also, to determine how balanced the measures were with human rights.
The authors raise concerns about the inequities seen within and between countries; highlighting that methods of coordination and regulation of the COVID-19 response need to be equitable.
It is inevitable that responses to COVID-19 are urgent but they should still be done in accordance with the law, following scientific evidence and with a commitment to fair treatment of all.
The authors conclude by saying, “a measure of this moment, which will demand continued analysis as and after it unfolds, will be how well governments fare in protecting health with justice”.
COVID-19 Primary Healthcare Guidance
NACCHO, updated 26 May 2020
Recommendations have been developed to support healthcare teams in prevention and management of COVID-19 for Aboriginal and Torres Strait Islander peoples.
The recommendations will be added or amended as they are developed; check the website regularly.
Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.
See previous editions of the COVID wrap.
COVID-19 Twitter lists
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