Virus stretches limits of strained public health systems


BANGKOK (AP) — The virus outbreak that began in China and has spread to more than 20 countries is stretching already-strained public health systems in Asia and beyond, raising questions over whether everyone can get equal access to treatment.

Authorities in Wuhan, the city at the center of the outbreak, have been ordered to confine people suspected of having the illness in “quarantine camps” reminiscent of makeshift hospitals seen a century ago during the outbreak of Spanish flu.

The hundreds of cots lined up side by side in such facilities illustrate the Everest-sized difficulties of isolating and treating thousands of patients at a time. So do scenes of people begging for treatment and being turned away from hospitals inundated with patients.

Rong Qin, who lives with her newborn son and 3-year-old daughter, mother, father and husband in a two-bedroom apartment in Wuhan, appealed for help in a post on Weibo, a Chinese microblog, saying she and her father were infected and she was worried for the rest of the family.

“I was told that even if we have confirmation of infection from the hospital we have to wait for beds. As far as I know, there are already many people queuing up for help,” she said.

The problems most evident in Wuhan are a worrying specter for health officials in many other places, as the numbers of people infected has surpassed 40,000 with more than 1,000 dead. Officials are trying to reassure the public, while moving to ensure adequate supplies of drugs and other medical necessities.

Several countries outside China that have big caseloads, such as Japan, France and the U.S., have relatively ample resources for isolating and treating patients. Lower-income countries like Nepal, Sri Lanka and Cambodia have reported one case each.

At a meeting of the World Health Organization in Geneva last week, delegates from various countries including Sudan and Bangladesh sought reassurances of support for their overburdened public health networks.

A representative from Sudan said it had managed to create an isolation ward using local resources. But since the country is already battling six other major disease outbreaks and also facing international sanctions, it’s short about $2 million of the funds it needs.

Scott Pendergast, the WHO’s director for Health Emergencies Strategy, said the estimated cost for beefing up the capacity of public health systems to respond to the virus could amount to $675 million in February-April, not including research or the economic impacts of travel restrictions and other measures. The extra cost of handling just 10 imported cases was estimated at $1.5 million, he said.

“It’s an estimated response cost that will have to be augmented by bottom-up planning at the country level together with partners,” Pendergast said.

“All countries are at risk and need to prepare for (the newly identified coronavirus). Partners will prioritize countries with weak health systems and significant gaps in preparedness capacity for technical and operational support,” says the draft WHO plan for handling the outbreak.

In Thailand, which has confirmed 32 cases of the virus, health officials are visiting the contacts of known infected people one-by-one to follow the potential spread of the virus. New cases have continued to emerge in the tropical holiday destination and hub for medical tourism.

“Our Thailand system is one of the best in the world,” Thanarak Plipat, deputy director-general of the Health Ministry’s Disease Control Department, said recently. But he added, “No country is prepared for a global pandemic.”

Most people in China have at least rudimentary access to health care. The country has a tradition of community clinics dating to the days of “barefoot doctors.” But few have coverage for catastrophic illness.

In Wuhan, three big facilities have been converted into makeshift hospitals, providing 3,800 beds for patients with mild symptoms of the virus. The city plans to convert more facilities into hospitals for emergency treatment and examinations, state television reported. Two new hospitals, one with 1,000 beds and the other with 1,500, were also quickly built.

The People’s Liberation Army deployed 1,400 doctors, nurses and other personnel to help staff the hospitals in the industrial hub, whose hospitals have been inundated while the city’s transport links were cut off to contain the spread of the disease.

Even within China, communities have vastly varying capacities to cope with pandemics. Overall, China’s spending on health care is relatively high for a developing country, at $400 per person according to WHO data. That compares with $78 in Cambodia and $34 in Bangladesh.

Access to basic public health care in China is also relatively high, at least as measured by WHO statistics, with 76% of people able to get the care they need without financial hardship. In most wealthy countries, that measure is equal to or more than 80%.

Wealthy Chinese , especially those with connections, often can access VIP departments in public and military hospitals, or expensive, international-style clinics that cater to foreigners. But most people have to take their chances by lining up, often for hours at a time even in normal times, at overcrowded public hospitals.

That’s typical for many developing countries around Asia and elsewhere.

Indonesia, whose annual per capita spending on health care is only one sixth of China’s and about half that of Thailand, is considering building a facility on a deserted island dedicated to monitoring and quarantining coronavirus patients, and in the future, those affected by other epidemic illnesses, said Mohammad Mahfud MD, the coordinating security affairs minister.

“We are still looking for the exact place for it. But we have thousands of vacant islands,” Mahfud said.

Officials have confined 237 Indonesians and one U.S. citizen from Wuhan for observation at a military base on Natuna island.

The country has no confirmed cases of the coronavirus yet, but intends to hold a workshop to train medical staff to be better prepared, said Windra Waworuntu, the health ministry’s director general of infectious diseases.

WHO was sending masks, gloves and respirators and almost 18,000 isolation gowns to 24 countries needing support. To speed up diagnoses, 250,000 test kits are being sent to more than 70 laboratories. The need was most acute in Africa, where most countries do not have the capacity to run such tests.

WHO Director-General Tedros Adhanom Ghebreyesus urged more cooperation between public and private health sectors in developing tests, treatments and vaccines, saying that even wealthier countries are not reporting cases quickly enough.

Thanarak, the Thai health ministry official, said his country is bracing for what could be a global pandemic, but hoping it won’t be.

“It doesn’t have to be like Wuhan,” he said. “Are we good enough? We will see.”

“I believe we have the capability to handle it.”


Associated Press writer Edna Tarigan in Jakarta, Indonesia, contributed to this report.