It took almost two years, but today, Thursday, June 25, the Ebola epidemic that has been plaguing the Democratic Republic of the Congo (DRC) since 2018 was officially declared over. This outbreak – the second deadliest on record – required a coordinated response by the DRC government, World Health Organization (WHO), UN agencies, humanitarian aid groups, and the private sector. All sectors worked in tandem to save lives by limiting the disease’s spread to neighboring countries and preventing it from turning into a pandemic.
The level of international cooperation required to manage Ebola’s devastating health and socioeconomic impacts suggests a long road ahead to fight COVID-19. Two vaccines against Ebola were approved and deployed during this time, which helped reduce the spread. Even so, the disease persisted stubbornly, preventing the region from officially declaring the outbreak over sooner.
As Dr. Tedros Adhanom Ghebreyesus, Director-General, WHO, noted “We should celebrate this moment, but we must resist complacency. Viruses do not take breaks. Ultimately, the best defense against any outbreak is investing in a stronger health system as the foundation for universal health coverage.”
The world must heed this warning with COVID-19 overwhelming health systems around the world. In just one week (from June 15 to 22), the total number of confirmed COVID-19 cases jumped from 8 million to 9 million. On Sunday, June 21, WHO reported the largest single day increase in cases globally. Notably, Brazil reported nearly 55,000 new cases in a single day – the record for any country so far – and the United States reported more than 36,000. Dr. Tedros cautioned that WHO expects the global case count to hit 10 million within the next week.
Reopening the economy too soon and without proper precautions in place poses dangerous consequences. This week’s edition of Rabin Martin’s COVID-19 Briefing examines the impact of reopening and asks, “When is too early?” How do we navigate the situation safely without backsliding and perpetuating an on-going crisis? Please find our earlier COVID-19 Briefings here.
Global COVID-19 Cases (Johns Hopkins University Center for Systems Science and Engineering)
Reopening: Consequences and Opportunities
As countries work to balance reopening their economies with the imperative to protect public health, decision makers must grapple with their citizens’ best interests. On Monday, June 22, Dr. Tedros said that more than 183,000 new cases were reported globally in 24 hours, representing “easily the most in a single day so far.” Around the world, as countries reopen, we are seeing spikes in cases that recall the first weeks of the pandemic.
Latin America & the Caribbean: Still Accelerating
Latin America and the Caribbean are reporting more than two million confirmed cases of COVID-19. Dr. Carissa Etienne, Director, Pan American Health Organization (PAHO), asserted that despite the recent upturn in cases, the pandemic has not yet peaked in the Americas. “This epidemic is still accelerating in the region. We are not seeing transmission slowing down,” she said. In fact, Dr. Etienne warned that “in the absence of effective treatments or a widely available vaccine, we expect that over the next two years the region of the Americas will experience recurring COVID-19 outbreaks.”
Latin America continues to lead the world in new cases, concentrated heavily in Brazil, which became the second country (along with the U.S.) to report more than 50,000 deaths resulting from COVID-19 as of Tuesday, June 23. Brazilian President Jair Bolsonaro has been criticized for a weak national response that flouts social distancing in favor of a rapid reopening of the economy.
Additionally, with Mexico, Peru, Chile, and others each reporting mass increases in cases, international audiences are watching their responses closely. Public health officials predict up to 70,000 deaths in Chile if stronger actions aren’t taken to contain the virus. In neighboring Argentina, the country has extended its lockdown in Buenos Aires following a resurgence in cases in the area, but it is relaxing restrictions in most other provinces. “We’re doing well because of everything we did, but there is a real possibility that the increase in cases will turn into a problem that is difficult to manage,” said Dr. Ginés González García, Argentina’s health minister.
India: Losing Early Gains
When the first cases of COVID-19 were diagnosed in India in March, the country responded with a strict lockdown that succeeded in limiting spread of the virus that many feared would devastate the nation where 300 million people live in poverty. Concerns around a national swell in cases were warranted, as India’s epidemic has grown to the fourth largest in the world, behind only the U.S., Brazil, and Russia. Prime Minister Narendra Modi began easing the country’s lockdown in early May and new infections spiked soon after, peaking on Wednesday, June 24, as India reported its highest daily rise in new infections: 15,968 new cases.
That same day, cases in Delhi jumped, surpassing Mumbai as the hardest-hit city in the nation. As of Thursday, June 25, at 9:45 am ET, 70,390 cases had been recorded in the city. Delhi’s health system has been strained by the weight of COVID-19 cases. The city’s hospitals – primarily privately run and unaffordable for many Indians – have seen shortages of beds, medical providers, and respiratory interventions like oxygen and ventilators. According to Dr. Sonali Vaid, Quality Improvement Consultant to the WHO Collaborating Centre for Newborn Care, even before the COVID-19 epidemic began, the country’s health system was already pushed near collapse. Experts doubt the health system can handle the current crisis.
Rana Ayyub, The Washington Post
The United States: Contradictions Abound
As all 50 states in the U.S. have reopened their economies to some degree, the consequences are becoming more apparent. The New York Times reports that cases are up by 15 percent in the past two weeks. Florida, South Carolina, Missouri, and other states saw a record number of daily cases since the start of the country’s epidemic. The Washington Post reports that 29 states and U.S. territories reported a higher seven-day average than they did last week: Arizona, California, Colorado, Delaware, Florida, Georgia, Guam, Hawaii, Idaho, Kansas, Kentucky, Michigan, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, Tennessee, Texas, Utah, Washington, West Virginia, Wisconsin, and Wyoming.
Peter Hotez, Dean for the National School of Tropical Medicine, Baylor College of Medicine
The response from U.S. leadership remains fragmented. In past weeks, President Trump and others in his administration have claimed that the rise in cases is due to more testing, not increased transmission – a claim that has since been discounted by experts. On Monday, June 22, Dr. Deborah Birx, Coordinator of the White House Coronavirus Task Force, countered the President, calling for more testing to stay ahead of the virus: “It’s not going to work as a signal if we’re not expanding tests,” she said.
On Monday, June 22, Dr. Michael Ryan, Executive Director, WHO Health Emergencies Programme, said that increased testing was not the cause behind the surge in global cases: “We do not believe that this is a testing phenomenon,” he said. “Clearly, hospital admissions are also rising in a number of countries, deaths are also rising, and they are not due to increased testing.”
The United States: Examining the Response
As the U.S. faces one of its worst weeks since the early days of the pandemic, the U.S. House of Representatives is interrogating the nation’s response. On Tuesday, June 23, Dr. Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases (NIAID); Dr. Robert Redfield, Director, U.S. Centers for Disease Control and Prevention (CDC); Dr. Stephen Hahn, Commissioner, U.S. Food and Drug Administration (FDA); and Admiral Brett Giroir, Assistant Secretary for Public Health, U.S. Department of Health and Human Services, testified before the House Energy and Commerce Committee on the status of the epidemic. All four speakers expressed great concern and described a much more desperate situation than President Trump and Vice President Pence have communicated in recent weeks. Although the President last week claimed the epidemic is “going to fade away,” Dr. Fauci offered a harsher prediction: “The virus is not going to disappear.”
Robert Redfield, Director, U.S. CDC
Dr. Fauci cautioned that talk of a second wave is inappropriate as the nation has yet to control the first wave. Rather, the U.S. is reaching levels similar to those at the height of the crisis that worried experts about health system collapse. Dr. Fauci issued a warning that “the next couple of weeks are going to be critical in our ability to address those [surges] that we’re seeing in Florida, in Texas, in Arizona, and in other states.” He called on Americans to heed social distancing advice.
Admiral Giroir, whom the Trump administration designated as the “testing czar” in March, argued against the President’s calls to slow down testing saying, “We want to do more testing and of higher quality.” Expansive testing and contact tracing has long been considered a crucial strategy in fighting the spread of infectious diseases like COVID-19.
Insights on Global Health Security
On Wednesday, June 24, Rabin Martin, as the Secretariat for the Private Sector Roundtable for Global Health Security (PSRT), hosted a thirteenth webinar in a series on the latest health impacts of COVID-19. The call featured Dr. Joy St. John, Executive Director, Caribbean Public Health Agency (CARPHA), who discussed the dynamics of the region’s epidemic.
Dr. St. John described the current state of the COVID-19 response in the Caribbean and CARPHA’s role in mitigating the health and economic impact given the growing number of cases, now estimated at more than 45,000. She emphasized that the Caribbean region– comprising 33 countries – has taken a coordinated response informed by a strong health security perspective.
In tackling COVID-19, CARPHA is focused specifically on global health security, with an emphasis on resource mobilization, advice to non-health sectors, coordination of the public health response, and risk communication – especially important given rampant misinformation and “fake news” about the coronavirus.
The major challenges to the response in the region have included procuring essential medical supplies (test kits, personal protective equipment, ventilators, etc.), inadequate surveillance data, and economic shocks to the tourism and agricultural industries, in particular.
The tourism industry – the lifeblood for the region at an estimated 14 percent of the economy – has been hard hit. Cruises and flights, intra-regional tourism, and broader tourism have all been stopped or sharply reduced. Dr. St. John noted, “Safe tourism isn’t just from the traveler perspective, but also the workers’ perspective.” She added that they are exploring a certification for businesses to demonstrate that they are safe to open for tourism – the Caribbean Travel Health Assurance Stamp.
The agricultural sector has also suffered due to the lack of tourism, the shift in consumption patterns to more non-perishable goods, and overall reduction in trade.
In addition to a scale-up in communications, CARPHA has developed protocols for testing, water, sanitation and hygiene, and food service. CARPHA also established an expert advisory group of clinicians to advise on clinical management of COVID-19, identifying the need to train hospital lab technologists, develop specific surveillance for children, create mental health services, and determine participation in WHO’s Solidarity Trial to help find an effective treatment for COVID-19.
In terms of private sector engagement, Dr. St. John reported that companies collaborated with labor unions and the government to manage the damage to the tourism industry in a coordinated way. In addition, the private sector has been critical in helping ensure business continuity, including addressing the challenge of internet bandwidth and supporting new models that promote both telework and e-learning. “The private sector stepped in to help define the new normal” and developed products to adapt to the lockdown.
She closed by noting that the global community should not be talking about COVID-19 as if it is a crisis in isolation. Given that it is hurricane and rainy season now, there is potential for a rise in vector-borne diseases. With severe weather events on top of COVID-19, Dr. St. John underscored the importance of coordination with the security sector – “Health security isn’t trying to minimize the illness; it’s about making sure that people are safe from these threats.”
From the Experts
“The pandemic shows us how vulnerable Europe is.”
Angela Merkel, Chancellor, Germany
Thursday, June 18
“The world is learning the hard way that health is not a luxury item; it’s the cornerstone of security, stability, and prosperity. Now more than ever, all countries must make universal health coverage a priority.”
Tedros Adhanom Ghebreyesus, Director-General, WHO
Monday, June 22
“Science and data – not politics – [have] and will always guide our decision-making, including our work related to vaccines.”
Stephen Hahn, Commissioner, FDA
Tuesday, June 23
“Communication is critical to the response to this pandemic. People are literally dying because they are getting bad information.”
Robert Skinner, Senior Special Advisor,
United Nations’ COVID-19 Communications Response
Tuesday, June 23
“We’re very concerned about what’s happening [in regard to women’s and children’s health] – particularly in sub-Saharan Africa. Many of the countries we work in are fragile and so, by definition, already have very challenging situations when it comes to health service delivery. [COVID-19] is making things worse.”
Monique Vledder, Global Financing Facility Practice Manager, World Bank
Wednesday, June 24
Reports from International Governments and Bodies
- WHO COVID-19 Information and Guidance
- WHO Situation Reports, June 15, June 16, June 17
- CDC Coronavirus Resource Page
- COVID-19 Health Systems Response Monitor
- NCD Alliance COVID resources relevant to NCDs
Funding and Policy Trackers
- International Monetary Fund Policy Tracker
- Kaiser Family Foundation Coronavirus Policy Tracker
- U.S. Chamber of Commerce Foundation Corporate Aid Tracker
- Devex Interactive Funding Tracker
Resource Pages and Market Research Literature
- JAMA Resource Center
- The Lancet COVID-19 Resource Centre
- 2019 Novel Coronavirus Research Compendium (NCRC)
- National Academy of Medicine COVID-19 News and Resources
- WIPO COVID-19 IP Policy Tracker
- The COVID Tracking Project
- PharmaIntelligence: Coronavirus – What will the Impact Be?
- Health Affairs Resource Center
- STAT News COVID-19 Tracker
- International Association of National Public Health Institutes COVID-19 Resources
- Primary Health Care Performance Initiative Forum
- U.S. Global Leadership Coalition COVID-19 Issue Briefs
- Prevent Epidemics Weekly Science Review
What We’re Reading
- The COVID-19 Catastrophe; COVID-19: The Pandemic That Never Should Have Happened: Review – Mark Honigsbaum, The Guardian
- Where The Women Aren’t: On Coronavirus Task Forces – Malaka Gharib, NPR
- The UN’s COVID-19 Response Team Is Calling For A New Era Of Collaborations With The Private Sector (And Kindness) – Serena Oppenheim, Forbes
- Coronavirus Researchers Are Dismantling Science’s Ivory Tower—One Study at a Time – Maimuna Majumder, WIRED
- Why COVID-19 Kills Nearly Twice as Many Men as Women – Paul Nuki, The Telegraph
- Let the Learning Begin — a WHO Open-Access Platform Could Transform COVID-19 Response -Lawrence Gostin and Eric Friedman, Devex
- Many Medical Decision Tools Disadvantage Black Patients – Gina Kolata, The New York Times
- Coronavirus Racial Disparities Are Worse Than We Thought – Caitlin Owens, Axios
- Potential Impacts of Delaying “Non-Essential” Reproductive Health Care – Gabriela Weigel, Alina Salganicoff, and Usha Ranji, Kaiser Family Foundation
- ‘Heroes, Right?’: Anthony Almojera, on Being a New York City Paramedic and the Injustices of COVID-19 – Anthony Almojera as told to Eli Saslow, The Washington Post
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About Rabin Martin
Rabin Martin is a global health strategy firm working at the intersection of private sector capabilities and unmet public health needs. Rooted in our mission to improve health for underserved populations, we design strategies, programs and partnerships that both deliver public health impact and drive business results. We leverage our deep knowledge and networks across a wide range of geographies and health areas to develop tailored solutions for every client engagement. We have helped many clients create bold global health initiatives and innovative multi-sector partnerships. Our specific areas of expertise include infectious disease and vaccines, non-communicable diseases, rare diseases, maternal and child health, and universal health coverage. Our clients and partners include multinational health care companies, multilateral institutions, government agencies, large foundations and leading NGOs. Rabin Martin is part of the Omnicom Public Relations Group.
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