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Reminder: Press Briefing by ACCESS CAMPAIGN: Mapping the Therapeutics for  COVID-19 at 2 pm today 

Responding to health emergencies is in MSF’s DNA, yet the current coronavirus pandemic is set to challenge us as an organization, just as it has some countries with the world’s most advanced health systems.
MSF is extremely concerned about the impact COVID-19 might have on states and communities which are already affected by humanitarian crises and whose health systems are fractured due to conflict, poverty or displacement. Certainly, the pandemic will disproportionately affect refugees and migrants living in poor hygienic environments like slums or refugee camps like in Greece or Bangladesh.
It will also disproportionately affect vulnerable groups with diseases such as tuberculosis (TB), HIV/AIDS, hepatitis, measles or malaria. In India, the pandemic has already affected TB patients. In this piece Disha Shetty reports that the airline shut down will affect supply chains and disrupt the supply of medicines to TB patients.
The pandemic is also making it difficult for MSF to bring in sufficient experienced staff and supplies to our projects due to travel restrictions and lack of transport. This could have a major impact in countries like the Central African Republic and South Sudan that have weaker healthcare systems and where a large population depends on services provided by MSF and other NGOs. 
MSF will continue to provide essential medical care to vulnerable and excluded communities in the countries we operate, but we are also fully aware that the needs will most likely outweigh our response capacity. Our objective in the coming months is to help where we can, show solidarity with the communities we support, but also be realistic of our impact.
As coronavirus disease COVID-19 spreads further, it will continue to expose the inequalities that exist in our health systems. It will expose the exclusion of certain groups from accessing care, either because of their legal status or because of other factors that make them a target of the state.”
                                                         - Jonathan Whittal, MSF Director of Analysis
Read more from Jonathan Whittal in his op-ed,  here.
MSF’s response
In Europe, where COVID-19 has so far hit the hardest, MSF expanded activities in Italy, Spain, Switzerland, France, Norway, Greece and Belgium. Our teams are supporting nursing homes for the elderly, assisting other vulnerable people, such as the homeless and migrants, and providing technical support and training.
In Italy, MSF is currently supporting three hospitals in Lombardia region, with infection control activities and doctors. Outside the hospitals, MSF is  conducting outreach activities to reach vulnerable people and supporting a programme of telemedicine which is assisting people under isolation at home.
In Spain, MSF is advising nursing homes on care of patients, risk assessment and the implementation of infection prevention and control (IPC). In Belgium,  health promotion and IPC measures in nursing homes are underway, as is support for vulnerable groups such as homeless people and undocumented migrants,  
With the virus disrupting health systems in countries with some of the most advanced health systems, the impact on countries with weaker health systems could be devastating. Last week, Syria confirmed its first case of COVID-19. Since then, the number of reported cases has been rising gradually. In this piece, field coordinator Cristian Reynders explains what the potential spread of COVID-19 would mean for the humanitarian situation in Idlib province, in northwest Syria.
Caption: MSF provides medical assistance for COVID-19 n Paris and the suburbs. Copyright: MSF
Potential treatment options
Any potential COVID-19 treatment must be available, accessible and affordable for everyone once they are developed. Currently, remdesivir, an antiviral drug administered intravenously, is showing promising antiviral action against SARS-CoV-2, the virus that caused COVID-19. With limited clinical data, however, it is too early to speculate about its efficacy against COVID-19.
The results of the trials are pending but it is important to know that the Gilead holds the primary patent on the base compound of remdesivir in more than 70 countries. If it is enforced, it will block the entry of generic producers until 2031. MSF believes Gilead should announce now that it will not enforce its patents that it has obtained over the last few years.
Early entry of generic production is vital to secure alternative suppliers and increase global production capacity of the drug for supply across the world.
Another promising drug is tocilizumab. While the drug does not directly target the virus, it has shown some help in treating severe lung disease in severe COVID-19 patients. Currently, a small observational study of 21 severe COVID-19 patients in China found promising discharge rates. While the patent for tocilizumab expired in 2017, Roche continues to have de facto market exclusivity on the drug, making it unaffordable for most people who need it.
Roche must facilitate access to its know-how, so that more manufacturers can produce the drug, which would bring down prices and increase patient access.
Apart from drugs, 52 vaccine candidates are currently under development, of which three are in clinical trials. MSF is monitoring the progress of many of the ongoing trials, knowing that approval of a vaccine to prevent COVID-19 is likely 12-18 months away. For affordable access to vaccines, it is important to ensure transparency in patent information, clinical trial data, and R&D contributions.
MSF supports the Bihar government in the fight against COVID-19
Across the world MSF has witnessed that shortages of personal protective equipment are commonplace, leaving healthcare workers on the frontlines exposed. This can severely hamper the ability and capacity of any healthcare system to save lives.
Last week MSF supported the Bihar state government by providing crucially needed personal protective equipment for frontline healthcare workers. This included N-95 masks, eye/face protection, gloves and high-quality body protection. Additionally, MSF also provided viral transport mediums used in the testing of COVID-19 patients. The equipment will be used by medical staff at the Nalanda Medical College and Hospital and other facilities in Bihar to ensure their safety. Do reach out to us if you would like to know more.
Caption: MSF country director (right) with Bihar state resident commissioner in Delhi (left).
“It is critical to reinforce and protect healthcare personnel who are the first line of response against the disease. Responding to epidemics and assisting vulnerable populations in crises is something MSF has done over many decades globally. In the next few weeks, we will also potentially support the Bihar state health authorities in the direct management of patients through facility decongestion preparedness.”

     -Dr. Prince Mathew, Country Director, Doctors Without Borders, India.
Until next time continue washing your hands and practising safe social distancing!
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