Lessons for a pandemic, from those who’ve experienced one

Nurses and doctors in Médecins Sans Frontières have long experience fighting epidemics around the world. They are now sharing advice for Canadians preparing for one. There is no room for wishful thinking, they say. One must prepare for the worst-case scenario, while doing everything we can to avoid it. We must be mentally and organizationally prepared to deal with the conditions that are rocking Italy and Spain:

1. As much as possible, set up medical facilities dedicated only to COVID-19 patients: either stand-alone structures or a separate hospital within a hospital. It is tempting to try to manage COVID-19 cases within existing structures. This might work where case numbers are low. But when the numbers become overwhelming, chaos will take over and foster cross-contamination. There needs to be a dedicated COVID-19 area and a non-COVID-19 area with no interchange of staff or patients between the two. By separating patients, and by having separate staff, one can significantly decrease the risk of medical facilities becoming centres of amplification. Dedicated staff may also reduce the volume of personal protection equipment (PPE) required as staff will not go from one COVID-19-positive patient to a non-COVID-19 patient.

2. Our health-care workers are our best and last line of defense in a pandemic. For their sake and ours, we need to protect their physical and mental health. We need to make sure that our medical staff will always have the right PPE available at all times. There should be guidelines prepared to guide health providers with the complex and harrowing decision-making they will face, should it become necessary to do so. We also need to help health-care workers protect and take care of their families. Should medical staff stay away from their loved ones? If medical staff are infected by COVID-19, where should they be hospitalized? Can health-care workers and their families count on being fully supported if they fall gravely ill? The mental pressure and anguish faced by health-care workers in a pandemic is unimaginably high. They must have access to psychological counselling and support.

3. We must ensure that critical care to non-COVID-19 patients is maintained. During the height of the crisis, COVID-19 could get all the attention and monopolize all available resources. We have to make absolutely sure that highly treatable and preventable medical conditions do not become lethal. We should not create a second-rate status for non-COVID-19 patients with acute needs.