Published By: Build Health International

David Walton Published in American Journal of Tropical Medicine and Hygiene on Facilities-Level COVID Approach

BHI Co-Founder David Walton was published in the American Journal of Tropical Medicine and Hygiene, sharing BHI’s COVID ward designs and lessons learned in Haiti from BHI’s COVID reponse. Read the full report here

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Several low- and middle-income countries have slowed transmission of COVID-19 through rapid implementation of physical distancing policies; public health investment in testing, tracing, and isolating; and the mobilization of existing health workers.13 However, COVID-19 cases continue to increase in countries with fragile health systems, and lack of testing capacity and clinical capacities to care for ill patients may become barriers to providing effective care.4 Haiti, a country in which we have both worked as clinicians for over a decade, puts these needs in sharp relief.5 At the time of this writing, PCR-confirmed cases of COVID-19 in Haiti are rapidly escalating, and they likely represent only a fraction of actual cases—the only two laboratories in the country with the ability to perform SARS-CoV-2 reverse transcription-PCR (RT-PCR) being overwhelmed with requests.6,7 Other diagnostic modalities, such as the SARS-CoV-2 GeneXpert test, remain difficult to access, and rapid immunoassays have thus far proven to have limited or no utility for patient care.8,9 Modeling by Cornell University and Oxford University projects up to 430,000 people in Haiti might require hospitalization, which would require more than 9,000 additional hospital beds10; however, fewer than 300 hospital beds are currently available for COVID-19 patients.11 Hospitals are already beginning to report an inability to deal with the significant influx of patients. Lack of access to hospital beds, let alone critical care beds, will likely continue to be a major bottleneck to the care of patients. Haiti offers one example, but other countries have experienced similar challenges with vulnerable populations, often leveraging unique solutions to add additional bed capacity for COVID-19 patients.12,13

In March, the WHO released guidelines on the establishment of treatment centers for severe acute respiratory infections.14 The document is a thorough and welcome guide, created as a response to the COVID-19 pandemic, but the infrastructure solutions proposed are likely to be out of reach for large portions of the global population living where health budgets are woefully inadequate to ensure safe delivery of health services in the midst of this pandemic. We have argued for more than a decade for additional health system investment as an approach to delivering global health equity; however, in Haiti, the immediate gap between available hospital beds and the projected need for COVID-19 hospitalizations seems insurmountable. Any chance at caring for vast quantities of patients sick with respiratory illness will require a simple but effective model that can be implemented by local teams with limited equipment, resources, and testing capacity.

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Read the full report here.