Mar 9, 2020 - Health

Paul Farmer on the coronavirus: "This is another caregivers' disease"

Photo Illustration: Sarah Grillo/Axios. Photo: Ramin Talaie/Corbis via Getty Images

Paul Farmer, co-founder of Partners in Health, has spent decades treating infectious diseases in impoverished countries like Haiti and Sierra Leone.

What he's saying: The U.S. has lagged in its response to the coronavirus, but Farmer still has confidence in the country's public health agencies as well as the treatments that are available to infected patients.

This interview has been edited for brevity and clarity.

Axios: What's your sense for where we stand, globally, on the coronavirus right now?

PF: I've been struck by the [JAMA report] on 138 patients in Wuhan: 26% of that cohort required intensive care. Is that similar to other cohorts even if we don't know the number in the denominator? If it's a substantial fraction of patients who require intensive care, there are a lot of places in the world where I've worked that don't have an intensive care unit. With the Ebola epidemic, we lacked [intensive care beds] then, and we lack them now.

Axios: In your work, you've routinely talked about the need for "staff, stuff, spaces and systems." Can you explain that in the context of COVID-19?

PF: We're in big trouble where we don't have the staff, stuff, spaces and systems — and that will be a lot of rural regions.

  • Staff: I am worried about how many people require supportive or intensive care. We need more nurses.
  • Stuff: The delays in diagnosis [and tests] probably meant in a place where there could've been ready access to clinical care, patients didn't get it.
  • Space: Even if we don't need ICUs, we need something similar — a place where people can receive supportive care without exposing the health care workers and other caregivers to this new coronavirus.
  • Systems: Infection control is needed, including taking contact and respiratory precautions.

Axios: How would you compare the U.S. response to COVID-19 compared with other areas you've worked in?

PF: I just came from Rwanda. I'm cool with saying the Rwanda response seemed more organized. But at the same time, the resources here are the envy of the world. Even if you make a critique of our lack of a public health system, I don't think you could say our public health institutions would compare unfavorably. The CDC, the NIH — there's no other NIH in the world. The individuals who work in those institutions are pretty impressive.

Axios: There's been quite a bit of panic as COVID-19 becomes more widespread here. How much of it is justified, and how hard is messaging an epidemic like this?

PF: Our public health professionals are really good, and our scientists and researchers are the best in the world. It's nice to be able to say that. And if you are critically ill with this disease, even though we don't have a specific treatment, we do have nonspecific treatments — they're called supportive and clinical care. And these nonspecific treatments are lifesaving.

But it's so confusing right now. People like me — this is my area of expertise — we don't even know what to tell our own friends and family about things like travel, events, their schedules. Even though we're saying, "Don't panic, there's this safety net here," we're also saying, "This is a rapidly evolving situation." We'll find out a hell of a lot more about this virus with more widespread testing, and I believe we will find thousands of cases already in the U.S.

One last thing: Always remember the caregivers. The caregivers need protecting, too, and sometimes the caregivers are going to be family members. This is another caregivers' disease like Ebola. The people most at risk of being exposed are those providing care.

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