Facing the Monster in Haiti

Abstract

T h e ne w e ngl a nd jou r na l o f m e dicine n engl j med 383;1 nejm.org July 2, 2020 e4(2) and stigma. We hired 1000 community health agents and are providing education on Covid-19, and our clinics have now seen hundreds of patients seeking Covid-19 testing and care. Grassroots community engagement is essential to gain public trust and combat stigma, and we are scaling up this strategy nationwide. Unlike prior humanitarian crises, when resources and international technical experts were rushed into Haiti, during this one we're on our own. For example, Haiti has 41 centers that could perform Covid-19 testing nationwide using the Cepheid platform, but the U.S. manufacturer is not distributing the tests to Haiti. Consequently , only the Haitian National Laboratory and GHESKIO can perform polymerase-chain-reaction testing, using other platforms. These laboratories are working in unison, sharing resources and technical staff, and Haitian businesses and the Haitian diaspora have provided support for this national effort. Screening and testing algorithms must rapidly adapt to emerging public health needs. We started screening early to detect the anticipated surge. Initially, Haiti tested anyone with symptoms suggestive of Covid-19; 20 tests were run per week, and less than 10% of results were positive. In mid-May, Haiti saw a dramatic upswing in new cases, with 1000 people tested in a week, 70% of whom had positive results (Figure 1). We are now targeting testing to patients with coexisting conditions or atypical presentations, pregnant women, and health care workers. For other patients , we are employing an MSPP clinical case definition that is based on symptoms and radiology results. GHESKIO has two Covid-19 treatment centers in Port-au-Prince. Of 520 GHESKIO patients with confirmed Covid-19, 79 (15.2%) have required hospitalization , 6 (1.2%) have died, and 435 (83.7%) are being monitored at home by cell phone. In-patient care is focused on oxygen therapy, fluid management, and anticoagulation. Hypertension and diabetes medications are available, since patients with these coexisting conditions have the highest risk of hospitalization. Patients with chronic cough and acute deterioration are tested for both tuberculosis and Covid-19. We have diagnosed three patients with coinfection. We have trained approximately 200 clinicians at public and private hospitals in Covid-19 care and have shared video tutorials online. Haiti is susceptible to natural disasters and epidemics. But we are also resilient, creative, and relentless when faced with overwhelming challenges. We have overcome worse, and we will overcome Covid-19. We hope that our suggestions help our colleagues in other low-income countries.