Let's Talk COVID-19: The road ahead

Avril Benoît:

Welcome and thanks for joining us for the final episode in this summer webinar series, Let's Talk COVID-19. Today we're going to talk about how far we have come in the last six months or so and discuss the challenges and opportunities that lie ahead as we work toward ending the pandemic once and for all. I'm Avril Benoît. I'm the Executive Director of Doctors Without Borders in the US. You might know us from our international name which is Médecins Sans Frontières. And that's why you might hear the acronym MSF come up, that means Doctors Without Borders. I'm really delighted to be with you today.

We'll talk for about 45 minutes or so. And you can ask your questions. We really encourage this as a chance for us to connect with one another. If you're watching on Zoom, the questions can be placed in the Q&A option that you see there. If you're joining on Facebook Live, YouTube Live, or Twitch, you can send your questions through the comments or the chat section that you have. So here we are six months later. Six months since the World Health Organization declared COVID-19 as a global pandemic. And as of today, the latest numbers that we have are that 26 million people have the confirmed positive COVID-19. Over 863,000 deaths worldwide due to the Coronavirus, this novel Coronavirus, and many more losses as health care systems have struggled to cope with the demands and have had to shut down different services and people have had difficulty to get health care. So a lot of impact of this all over the place. You've been following it in the news. We'll take you a little more deeply into the heart of the humanitarian work that we do as a medical organization.

And if you've been tuning in over the course of this whole series, you know that we've touched down on ... we try to go a little deeper each time with specific topics. So we talked about how we're intervening in Latin America, what we're seeing in Yemen, impacts on reproductive health, all these kinds of subtopics can all come together today if you want. If these are the questions that you asked we will answer them. Obviously, we're looking to support all the essential health workers that are facing a staggering challenge. And we're looking also to strengthen the health systems, public health promotion in all kinds of ways that we have to work to combat the pandemic. As you heard even last time we have to combat the misinformation around this particular virus. 

So you've heard from MSF teams who have been working with local health authorities trying to support them, trying to support community groups in the US and around the world to help slow the spread of this disease. And so now, we're ready to talk to you about how we're taking action to ensure that any tests, or treatments, or vaccines for COVID-19 specifically are safe, affordable, and available for all the people who need them. So that's our webinar for today. It's about all of it. So today, we welcome back to familiar faces that you've perhaps seen before in this series. Kate White is a specialist in emergency response and public health for MSF's Emergency Support Department based in Amsterdam. And she's currently the medical technical lead for MSF's COVID-19 pandemic response. So welcome. Nice to see you again, Kate. 

Also joining us, we have Matt Coldiron. A physician, and a medical epidemiologist at Epicentre, which is an epidemiology and research satellite of MSF, of Doctors Without Borders. Nice to see you as well, Matt. So Kate and Matt, maybe you could start. Kate, what's your level of energy after six months of working nonstop on this?

Kate White:

To be really honest, I'm quite tired. It's been a very boring six months. And I think I need a very long holiday, but that won't be happening for a little while yet.

Avril Benoît:

Sorry to hear that. How about you, Matt? How you holding up? 

Matt Coldiron:

I think it's the same. And I think that we've heard these anecdotes all around. Everyone is physically tired, everyone is emotionally and mentally tired. I remember being in lockdown in New York and going and volunteering in the public hospital system and doing my day job with COVID and then things still go on. Just recently in Niger yesterday, we were enrolling a patient in a brand new trial of malaria. Let's not forget that there are still millions of children every year that are getting sick with malaria and it's not stopping because of COVID.

Avril Benoît:

Well, we look forward to throwing some good questions to you. There might be things that have come up before, but again, if you're watching, please put your question in the Q&A function on Zoom. And we have our staff here also responding in the chat if there's something specific that we're not going to address necessarily just because of the volume of questions. So the first question is from Jean posing it on Zoom. I'm wondering if MSF has plans to acquire a COVID-19 vaccine once it's approved. Matt, what do you know about this?

Matt Coldiron:

Well, I think I'll take maybe the first ... the second part of the question which is maybe the first, which is, "When is the vaccine going to be approved or when will different vaccines will be approved?" There are dozens of candidate vaccines right now. And several of them are allowed. Maybe two handfuls are actually in advanced phase trials or the phase three trials, which is usually the sort of the end of the road of the clinical evaluation of the vaccine. Some of the results may be ready soon and maybe before the end of the year even. And then the question is, with which speed the regulatory authorities, like the FDA here in the United States or the European Medicines Agency, will sort of examine all of the evidence and say, "This vaccine is safe and effective." And then sort of put the stamp on it and say, "Yes, people can use it." So that's the first part of it. And I think it's possible that there could be one or maybe two vaccines approved around the end of the year, maybe early next year. And the second part maybe Kate can talk about MSF.

Kate White:

Yeah. Would MSF like to secure some vaccines? Yes. What is the likelihood of that happening within the timeframe that Matt refers to? Probably not very likely. There will be multiple buyers on the market that will want to get their hands on an effective vaccine for their own populations. I think the US, European governments. I know I'm from Australia, and you've already seen many, many countries put in what they see as an intention to order and it's very difficult sometimes for us to compete with that. And also for many of the countries where we work to compete in that market to be able to get the vaccine. I think either way, MSF wants to be involved with how the vaccine gets to the populations that we work with. Whether that's with our own stocks or really working with the health authorities on the ground to make sure that vaccine then gets to the populations that need it.

Avril Benoît:

And if you were both to speculate then, assuming that it starts with not enough vaccine for the whole world, the manufacturing capacity would have to build up and the stocks would have to build up. You've mentioned the richer countries would likely have the means to be able to acquire, hold, hoard even some of the vaccine for their own populations. How much time or what would be the sequence of things for a vaccine that's approved to become available to some of the more difficult countries and countries in crisis who don't have a financial means themselves to place that kind of order with the manufacturers? How will it work? Matt.

Matt Coldiron:

The first rule I've learned with COVID is to never speculate, but since first-

Avril Benoît:

Sorry.

Matt Coldiron:

No, no. Just a joke. But I think optimistically, and this is just my personal feeling based on my reading of the politics of the situation, maybe 2022, maybe. But I think the biggest problem we're having right now is there's so little funding available committed towards stockpiling vaccines for low and middle income countries. I think there's a lot of statements, sort of general statements saying, "Yes, this will be a global public health good, global good. And yes, we will work towards access to all populations," but there hasn't a lot of concrete steps towards actually buying or committing towards buying. So I'm not particularly optimistic that developing countries will be faring as well as some of the richer countries.

Avril Benoît:

Well, we have a hope that with the vaccine, we have the end of the pandemic. And having heard all the complexity of that, and I'm sure there are more questions that will come over the course of the webinar around this, but in the meantime, Francis is asking a question on Facebook. Is it possible to beat COVID-19 or will it always be with us in some form or another like the flu, or SARS, or even Ebola? There was a bit of news around polio which is mostly conquered in most parts of the world where the vaccine programs have worked. And when you have a breakdown, you'll have to catch up again, but is it possible for us to really close the book on COVID-19 specifically, Matt?

Matt Coldiron:
I don't think so. The caveat is we don't know. This is a new disease, we've got eight months of experience, we don't know. I think that the best guess is that it probably will be something that stays with us. And that in some way it will maybe end up looking like the seasonal flu. I think one of the challenges right now is it’s brand new. No one in the world has ever sort of seen it. So people are very, very susceptible. If it circulates for five or 10 years and there's a vaccine, we will sort of as a population be better protected against it. So I don't think that 10 years from now it will cause the dramatic effects that we saw say in New York City in April and that would be my hope. Little by little, it sort of normalizes and stabilizes and becomes a little bit more manageable like we manage with the seasonal flu, which is still obviously a large problem, but we know about it, we know how to deal with it and we have a lot of tools in our toolbox to fight.

Avril Benoît:

Right. And more and more tools will be found presumably. Kate, here's one for you from Luther asking the question on Zoom. What are your greatest equipment, resource, or medical supply needs right now? All health responders in this have communicated initially about the shortage of PPE, but where are we now in terms of that? And have the supply chain issues been resolved or are still impacted by the pandemic?

Kate White:

They're definitely much better than they were at the start of this. And the global supply chain really has opened up in terms of PPE, but what we see now is that there is still a great need in the places that we work. And that need will continue because as sort of Matt has alluded to, it's now how do we treat malaria, how do we treat malnutrition in the context of COVID? Because it's kind of a new normal, so to speak. So all of our forecasts in terms of how much of this equipment we would need have all gone up and now it's about supplying that for the future. And in the past, we would have sort of six months buffer stock on the field, now we've got three months. And so whilst we have stock and it's much better than it was before, there is still a lot of pressure on the global supply chain to push the PPE. And that will continue for the coming year at least.

Avril Benoît:

You've both mentioned malaria and the complexity of that, Kate, can you elaborate a bit more? There's a question from Casey on the Zoom about malaria. How has COVID-19 really impacted MSF's ability to continue with other programs like that?

Kate White:

It's impacted it in terms of HR and supplies, but in a number of ways, it's also had a good impact. I think in terms of malaria, there are many places where we've been able to do sort of prevention strategies that we wouldn't have always, in normal situations, been able to do. So we've done mass drug administrations in a number of locations to help decrease that malaria burden that we knew would come, whilst we were also having to deal with COVID. So that's a great thing, but it has definitely impacted how people access healthcare. People are reluctant to come sometimes to health centers because they see them as places where they get COVID-19. So that is really where we've had to tackle the stigma associated with many of the other things that we deal with on a day-to-day basis.

Avril Benoît:

That's something that you talked about also last time that you joined us on the webinar. This concern that we had that while it was okay to pivot programs and start focusing a little more on COVID-19, we were quite worried about what programs that we were having to slow down or cut. How are things now, Kate, in terms of that? And this is a follow-up question from the last one. Have you had to cut back on some programs to focus on the pandemic response? We know that was the case initially, but is it still the case now?
Kate White:

Luckily in the majority of places that we work, we've been able to if not get completely back to normal, at least program or do activities for those particular components, whether it be maternal and child health or malnutrition in a way that we can still treat patients and still have our patients still have access to health care, but it may not look exactly the same way as it did before. But luckily, it's changed.

Avril Benoît:

Now, Matt. One of the things that you've really been tracking is all the research around this. I mean this is the main focus of your work. How are we doing with treatment options? Speaking to the resource shortage, initially it was, "We need ventilators everywhere to do this intubation." And then it started to be questioned and so forth. How do you see things now?

Matt Coldiron:

I think that there are a few things to say. One is that there has been an incredible amount of research. The sheer volume of research that's being done is incredible. And we went from knowing nothing this time eight months ago to knowing a whole lot. There's still a lot of open questions, but I think objectively you have to take a step back and say, "We have learned a lot amazingly fast." I think there are a few problems. In some places, there are studies that are being planned and resources being plowed into them that are not asking the right question, or not looking at it in the right population, or not sort of ... not with enough collaboration, or maybe in a place where there's not enough disease. I think one of the things that we've learned in the vaccine research is that it's important to run the studies in places where there are lots of cases. The big trial that got a lot of news that had the sort of the biggest result so far happened in the UK. And they were able to do this trial of Dexamethasone and several other treatment options. There were tens of thousands of cases in the UK.

It's really important to do the research there because you have the numbers of cases to be able to get the answers that you want. It doesn't do anyone any good to design a trial that needs 5000 patients if you're only going to expect 200 or 300 to show up in your clinic or your hospital over the next few months. So I think there's a lot that've been done. There have been some great examples of collaborative work and I think that we're seeing more and more that there has also been a lot of waste or at least waste of resource or waste of energy into the studies that are not going to really come to fruition or be as valuable as they could have been. We're doing okay, but we could do better.

Avril Benoît:

Can you give us an example of a kind of research line that was a waste?

Matt Coldiron:

I think that the best things sample is with hydroxychloroquine. And that was for a long time seen as potentially very useful in the treatment of COVID for a lot of reasons. It was easily available, it has sort of a long track record, we know more or less how it works, and there was a supply of it. So it made sense to look into, but it became fairly clear fairly early on that it was not going to be great. And there were still a lot of effort going into some of these trials. And there were hundreds of trials, of small trials of, "We're going to enroll 300 patients in our single hospital and see if hydroxychloroquine works." And the fact is you're never going to answer that question with 300 patients in your single hospital. Sort of the proliferation of studies around that single molecule I think was a waste of resources. I'm not saying it wasn't valuable. People were certainly trying and had their heart in the right place for wanting to do it, but it wasn't as impactful as it could have been had there been a little bit better coordination.

Avril Benoît:

Do you see that kind of coordination for convalescent plasma?

Matt Coldiron:

Not so much. I think there's been a lot of coordination towards getting people convalescent plasma. There's two examples I'll give. One is in the United Kingdom. Again, this trial where they showed that Dexamethasone was an effective treatment for some patients that need oxygen. They've now also been randomizing patients to receive plasma or not. And that's sort of important because then you can really compare people who got plasma and who didn't get plasma and see what their results are. It is an open question whether it works. There was a very large study in the United States and it led to an emergency use authorization by the US FDA. 35,000 people who got plasma. Unfortunately, it was an observational study.  So instead of comparing people who got plasma and who didn't get plasma, they compared it to people who got plasma early versus late. The results suggested they compared to people who got plasma late to people who got plasma early. It did better, which is good but sort of in the absolute, we're not sure compared to people who wouldn't have gotten plasma at all is it okay?

We don't want to withhold treatment for anyone if there could be a benefit, but it takes time and energy to harvest the plasma. So if we're spending all this time, all these resources in doing it and we don't actually 100% know that it works maybe it's the time and the resources that could be better spent elsewhere. Which is not to say one shouldn't take it or one shouldn't get it, but it's ... there's still a lot of questions.

Avril Benoît:

Yeah. Kate, here's one for you from Jamil on Zoom asking about the vaccine. There are people who don't want to get a COVID-19 vaccine once it's released. They won't have confidence for a variety of reasons and maybe good ones because maybe things will be rushed or there's a sense that things are getting hyped and they're not so sure. What would you say to people who have reservations about the development of a vaccine and how much confidence they should have? How should they know that the one they might have access to is okay? 

Kate White:

Great question. Vaccines have to go through a number of different phases of trials. And there's a whole process to seeing how effective they are. So by the time it actually gets to the point where you would have mass distribution and administration, their efficacy is proven, so to speak. However, having said that, there will always be a group of people who don't want to be vaccinated. And you see that with pretty much every vaccine preventable disease. Which is one of the reasons, kind of going back to the first question, I think we will always see COVID-19 around in some way, shape or form even if it's small pockets or it's seasonal because even with the development of an effective vaccine, and even if we were able to mass produce it at a level that we could get coverage of the global population, there will always be people who refuse to have it. I can give all the scientific reasons why it will work and why I should be confident in it, but sometimes that is just not enough for many.

Avril Benoît:

Matt, this is the time of year also where many of us will get the flu vaccine and yet there are large numbers of people who won't. What is the connection then between getting the flu vaccine and the current pandemic?

Matt Coldiron:

The current pandemic has all that more reason to make sure you get your flu shot like you should every year because the flu is seasonal. We know that in the Northern Hemisphere, we'll start seeing it in October, November, December and through the winter months, the opposite in the southern hemisphere, but we don't know yet whether there is that same mark of seasonality with this novel coronavirus. Some people think that there will be. I think it's prudent to plan that there also will. It might not happen. This is sort of going back to what I said we don't know everything yet. We know a lot, but we don't know everything. But at the very least it's prudent to anticipate that things might get worse this winter in the Northern Hemisphere. So all the much more reason to get your flu shot like you do every ... like you should every year.

Avril Benoît:

All right. We're also hearing from Matt on Zoom. Does MSF or Epicentre play a role in sentinel surveillance or EID? Are there other collaborating partners? Who do we work with do have a look at all of this?

Matt Coldiron:

So I can answer briefly and then Kate probably answer too. I think MSF in the field around is collaborating both in our projects where we're supporting issues of health or sort of acting in the community to provide great data. Both feeding into the national system and also looking at our own patients that we're taking care of in a very collaborative way to have a global understanding of as an organization, as an international medical humanitarian organization, can MSF look at sort of how we're doing in taking care of patients in Yemen comparing those to patients in Brazil, comparing those to patients in Mali, for example. And so we've put a lot of effort into that because it's important to understand. It's important for us to look at how we're doing. And I think the biggest benefit of collecting data like that as a physician or as a clinician is to understand, are we doing a good job?

Avril Benoît:

Yeah. And so these EID, Early Infectious Diseases, are there any others that are colliding our way that are likely to make it more complicated to deal with COVID-19, Matt? I see you nodding.

Matt Coldiron:

Yeah. So emerging infectious diseases, there are more and more. Actually, there was a really thoughtful piece by a medical historian and Dr. Fauci that came out last week talking about how pandemics are the new normal. A lot of the diseases that we see that are sort of scary and new like Ebola, or like this novel Coronavirus, or other things like the Nipah virus. One of the things that they have in common is that they have some element of animal ... Animals are in their lifecycle somehow. Whether it's animals are sort of hosts occasionally or whether animals directly transmits to humans. 

And as we see this confluence of deforestation, changing environments, urbanization, humans are being brought more and more into contact with a lot of these animals, and then also in more and more contact with each other. And the confluence of that plus climate change I think is really going to be driving the emergence, putting pressure on the emergence of new diseases. Maybe things that have just been sort of simmering around in the background that have never left one village and one place that we've never seen, but as our behavior changes, then we will be in more and more contact with them. You get on an airplane and you're halfway across the world in 12 hours. So I think it is the new normal. Do I know when the next one? No. Do I know where it's going to come? No. A lot of smart people have a lot of lists and there are some that they're looking at very closely, but we might be up for a new surprise.

Avril Benoît:

I think this one is enough for me right now. One at a time, please. Kate, as somebody who's working very closely with our emergency planning, one of the things you've had to do is pivot, adapt to all these unknowns and especially as we're learning more and more about this disease. Can you tell us a bit more about how far things have come in terms of the innovations and the ways that Médecins Sans Frontière or MSF has been able to adapt especially in the recent months?

Kate White:

Yeah. I think we're lucky in many ways that we're living in a time where also technology is so advanced, that we can do everything from engaging with local universities who have 3D printers to locally 3D print personal protective equipment. Everyone has a smartphone now. Even in the most remote villages in DRC or CAR, the communities that we ... Sorry. Central African Republic, the communities that we work with they have smartphones. So we have things like WhatsApp groups with traditional healers, so that we can work with them and make sure that they can protect themselves, they can refer people who are experiencing severe illnesses, whether that be from COVID-19 or others, and work in a way that we haven't always been pushed to work before. And there are many downsides to something like a pandemic, but what history shows is that these are also the moments where we truly innovate and change the way that we work which has a benefit not only to the now, but to how we do things in the future.

Avril Benoît:

Yeah. It's extraordinary. I suppose there are some things probably that we also tried and didn't work. Care to speak to that?

Kate White:

Yeah. I think there's many things that we tried and it didn't quite work or there were elements of it that worked. I think most of those though are around some of the novels of ... the treatments that came out. When hydroxychloroquine was first the big ticket item in the news, we were one of the first to try and secure some stocks and then it came out that that was not going to be the case. And so we were, "Okay. We're not going to go down that path anymore." Then there are other things. We know we have tried to negotiate and get access to communities. And as a part of that process, we've learned some very interesting things around our regular programming. I know we've also attempted to do some AV materials as a part of sort of teaching communities to sort of empower themselves, but it hasn't always worked. We sometimes do not hit the mark, but overall, I think in general, we've come out winners in many things.

Avril Benoît:

Yeah. It's worth trying the things that we know from experience are so important. And one of the issues that I know has been a major concern of yours, Kate, is how to work with communities. To really work with community partners and to gain that trust. In the early months, we were really comparing it to our experience with Ebola. Finding the commonalities and differences with that. How far have we gotten in terms of building that trust at the ground level and really being partners with the community? Can you maybe give us an example of one that you think is that's the way we should continue to work?

Kate White:

For me, the example that sticks out the most is Nigeria, but we've done it in actually many places. And it's been not just our medical teams, but kind of the whole project really coming together and talking with different members of the community. And so originally, we had this big idea that shielding would work for this population. And so the team went out and they talked with various members in this community. And it was a combination of internally displaced people in this camp setting very close to a host population who was also quite marginalized and disenfranchised in terms of what they were able to access. And so we've always worked across both communities really focusing on the health structures that have been in place. And as the team talked to the community and various members, what came out was that actually for this community, they didn't think that shielding would be the best option for them. And so that was both fascinating, but also for the team quite different. And they learned a lot about this community, both the host community and the displaced population. And they changed actually. They pivoted in terms of what they were going to do. And the wonderful thing that has happened is that they've come back over time to explain what we could do and what we couldn't do. 

There were some things that were not particularly health related, but we were also able to work with other local actors to fulfill those needs. And so now we're six months down the track. They've had these moments three times in that six months. And even our regular programming that we were doing there has changed slightly in terms of how the team goes about it based on this community feedback. And it's something that the entire team has been very positive about and they say, "This is actually how we want to continue to work in the future." And it's built a really good relationship between us, the host population, and the displaced population that's living in the camp site.

Avril Benoît:

Yeah. It's great to know. Thank you for describing that for us. Matt, here's one for you from Jim on Zoom. Countries around the world have taken different approaches to combating the spread of this virus. I remember watching very closely Sweden herd immunity, UK versus New Zealand or all these different approaches and then what happened with Spain. Even a state like Hawaii which seemed to be a model of how to handle things and then it seems less so now. So Jim's answer is what have we learned are the most effective measures in terms of things like masks, border closures, frequent testing, stay-at-home orders, all these things?

Matt Coldiron:

So I think that there's two parts of the question. There's some things that we know that work. So I think the two most important things are sort of masks and hand hygiene. Wash your hands, wear a mask, and avoid being in a small room with a lot of people. Those are sort of the things that we know they work. Now how you translate that into sort of a policy or a strategy, I think different countries have had different ways of playing around the edges with how, do you say 10 people versus 20 people? Do you close the bars or do you have half of the capacity of a restaurant. There's lots of different ways to play with that, but the fundamentals of what works is sort of keeping distance from people, wearing masks, and washing your hands. I think that we have learned a lot of different ways. Governments have learned what works and what doesn't work. 

I think it's also important to remember this is a parallel, a direct parallel of what Kate was just talking about. If we're in an internally displaced persons camp in Nigeria, and we say, "The best way to protect yourselves is to shield the elderly and isolate them from the rest of the community." And the community comes back and says, "No, that's not going to work for us." We adapt our programs. And I think it's the same way in different countries. And different countries have experimented with different policies based on what they think may or may not work or be acceptable in their populations. I think the one thing that's clear is that we can go about things as normal. So in New York City crowded subway cars are not going to be good for anyone. That is unfortunately going to be a problem for figuring out how to sort of reopen schools, to reopen businesses, getting people to work every day. And there aren't going to be easy answers, but some fundamentals are pretty clear at this point.

Avril Benoît:

When you look then at the places in the world that are seeing very dramatic peaks, I'm thinking of India right now and some of the latest numbers from countries like that. How long can they expect it to be so bad? Because that's another thing that seems to have emerged. It's how long you can expect the worst to really grip a local region or a city.

Matt Coldiron:

Again, I don't think that we know 100%, but I think we've had experienced enough in a few places in New York. I'm hate to come back to New York, but that's where I've been living and I've seen it. We had an awful and a catastrophic couple of months. I remember at the beginning, you wouldn't ... you'd walk around and 20% of the people on the street would have a mask on. If you walk around in my neighborhood today, 95% of people are wearing masks all the time. 

So I think as soon as the measures go into place, there are some ... there's usually drastic reductions. The question is, if you're living in sort of an informal settlement in Mumbai where you've got an incredible density of population, are those same measures that we've been able to put in place in Brooklyn going to work there? Are they going to be feasible there? Who's going to buy the masks? Who's going to distribute the masks? Where is there going to be running water for people to wash their hands? And so these sorts of basic things. Like I said, the fundamentals are known. We know the fundamentals and the question is how to implement them. And so I think if Mumbai could do what New York City did, then you could have a very catastrophic peak for six weeks and then maybe climb it down, but if those known countermeasures are not possible then things would go on for a long time. I think we saw that in Brazil where there were few countermeasures put in place for a long time and they just had a very long prolonged outbreak.

Avril Benoît:

Kate, Matt's talking about the informal settlements in urbanized areas like Mumbai. Bridget is asking a question. Oh, sorry. It's Ralph on Zoom asking how COVID-19 has affected what happens in refugee camps. So this was something that we were very worried about for the same reason. So the close proximity of people and the difficulty to have decent services. So he's asking how are the services being carried out with refugee populations around the world?

Kate White:

It's different in so many different places. So if we look at Cox's Bazar in Bangladesh we, and other actors in health authorities, we have been able to continue our programming, it took a lot of concerted effort. And we've also done a massive cloth mask distribution to be able to cover the entire population of what is known as the mega cap. So that's almost a million people. But then, you contrast that to other places. For example, in northeastern Syria, what we've seen is at the beginning we were very worried when COVID-19 hit northeastern Syria that it would get into the displaced persons camps. And it didn't get there straight away because they had various public health measures that were put in place to decrease movements and make sure that it decrease transmission as much as possible, but what we saw over time was that because the case numbers didn't rise dramatically, there was almost this feeling of being safe and the, "Oh, this isn't going to affect us." 

So then they decreased the measures and didn't sustain many at all. And then what we've seen in the last month or so is that those case numbers have risen dramatically. And now we have significant community transmission in some of these displaced population camps. And so I think it's really important that what measures we put in place not only work for communities, but we sustain them because until we either get a vaccine or something happens, this will continue. It's not going to go anywhere. So even though it might seem like there's not so much transmission in the area, as soon as you decrease those measures and make life go back to what it was pre COVID-19, that transmission will go up because most populations are just so mobile these days.

Matt Coldiron:

I would jump in to say, Kate, a vaccine, a few good treatments, and a lot of people are doing these things like masks and hand wash. It's not just a vaccine that's going to solve it, it's sort of ensemble of all of them.

Avril Benoît:

Kate, would it be fair to say that MSF or Doctors Without Borders works in roughly 70 countries around the world. Is every single one of our projects though pretty much prepared if not able a to respond quickly? I know that was a huge push at the beginning to beef up our infection prevention and control measures and so forth and make sure that we had enough PPE for the staff and to make sure that we were ready. Would you say that's still the case now that we are ready pretty much everywhere if not already responding to the pandemic having already arrived?

Kate White:

Yeah. Not only are we either ready to do more or it's almost become our new normal in terms of both treating patients with COVID plus all of the other things that we were doing in many of our locations. And now, we're also at that point where we're saying, "Okay. We need to make sure that we plan for this, for next year, and the year after that." What we call our E-Prep scenario. So emergency preparedness scenarios include this. So what would it look like to do a response to a message influx of refugees in the context of COVID? Do we have all of the things that we would need for that? It's becoming our new normal, so to speak.

Avril Benoît:

That to some extent answers a question from Zoom. How does MSF stay agile to provide care quickly and in so many different places, and contexts? And this will be my last question for you, Kate. It must be pretty overwhelming to think of all the adaptations you have to do, the specificity of the response in different location. How does MSF stay so agile?

Kate White:

With a large number of extraordinary people that work for us across the world, it's not something that's done centrally. Every country, every project location thinks about this and plans for this. And we have thousands of staff worldwide who this is what they do. At certain moments of the year they say, "Okay. What is this going to look like for the next three months? What is it going to look like for the next six months? And how can we continue to respond to malnutrition but where there's community transmission of COVID-19? Or how can we continue to increase our care for malaria, or meningitis or measles or so many other things? It's our extraordinary staff who work in those 70 countries.

Avril Benoît:

And now our final question for you Matt. Every time we do these, and this is the final one in the series, we often have people asking they watch it all, they listen, they're absorbing, they follow the news and they wonder how they can help. What do you tell people? And you're at home in Kentucky if I'm not mistaken. What do you tell people around you in your home community when they say, "Matt, what can we do? How can we help you?"

Kate White:

I think that first thing, and this is a real struggle even in my own family sometimes is that this is a community effort. So to do something starts with protecting those around you. So if you're concerned about wearing a mask or if you're tired of wearing a mask, because we've been wearing a mask for six months, you just need to do it for a little while longer. Because I think the most important thing that you can do to stop COVID is to act yourself, directly for yourself to do the things that you know how to do. I think in terms of other things that you can do to help, if you have COVID, God forbid, be part of a trial of one of the novel therapeutic. If you're in a place where they're doing a trial of a vaccine, that is ... it is a great thing to be able to do. It contributes to our scientific knowledge and altruism towards furthering our knowledge for everyone else. 

And I won't say give MSF money, but there are things that people can do both in volunteering in the field. Volunteering with MSF, but volunteering at home, volunteering with your local shelters or local organizations to help marginalized or vulnerable populations like we do in MSF maybe on the other side of the world or frankly in this pandemic, even at home here in the United States. I guess in the end, I would say just do something and don't say, "Oh, that's not important, or that's just too small." If everyone did something a little bit small, by the time everyone did it, it would actually add up to something large. So I would encourage everyone to make an effort to do something.

Avril Benoît:

Yes. And for those who have supported us and donated money, supported our independent medical humanitarian action, speaking for all of us who are working on COVID-19, we thank you from the bottom of our hearts. We couldn't do it without you. Kate and Matt, always good to see you. And I wish you lots of strength and courage for the month ahead as we continue to do our small part in this global pandemic. Thanks again and do stay healthy.

Matt Coldiron:

Thanks, Avril.

Avril Benoît: I want to thank also those who have joined us. I really appreciate all your questions. All summer long we've been doing this series. This is the last one for now, but we'll come back sometime in the future. We always have webinars on different kinds of topics. And we're open to your suggestions also. Things that you're interested in, people that you'd like to hear from at Doctors Without Borders. If you'd like to contact us, the team that puts these webinars together can be reached by email. The email address is event.rsvp@newyork.msf.org. And as always, you can just go to our website. Our International website is msf.org. The US one is doctorswithoutborders.org. You can also find us of course on Instagram, on Twitter, and on Facebook. That's where we try to inform you where you are. Where you'll find us is all good. So keep an eye on that and keep an eye out for our future webinars. I'm Avril Benoît, signing off. And thank you so much for being with us today. Bye for now.