Global health, coronavirus and cancer

19 Mar 2020
Global health, coronavirus and cancer

Professor D Cristina Stefan


Adjunct Associate Professor SingHealth Duke-NUS Global Health Institute (SDGHI), Duke-NUS Medical School, Singapore

I write about global health, global cancer, women, mentorship and leadership and anything else which is relevant to me and to the world.

The outbreak of coronavirus disease (COVID-19) is of international concern. The world is facing another crisis after the SARS, Ebola, H1N1 and Zika viruses. The World Health Organization (WHO) has officially declared the outbreak a pandemic and results for Google searches related to this virus now exceed three billion, more than any other disease or virus described in the literature. The number of countries declaring new cases of COVID-19 continues to increase, together with the number of patients and associated fatalities.

Despite the fact that that the epicentre of the pandemic has now moved to Europe, according to WHO, the world is expecting that a large population will acquire the infection in Africa too. For now, Europe is waking up slowly but surely to the reality of this modern contagion and more governments are trying to stop the havoc with all sorts of plans of closing borders, airports, schools and everything else except pharmacies and stores, which are overwhelmed by the excessive demands of scared and confused populations.

Amidst the real challenges that we are experiencing, and which affect almost the entire world, a moment of reckoning of the preparedness to respond to an outbreak of this scale is meaningful.

The response to COVID-19 draws attention once again to the level of adequacy of health systems. We saw the construction of hospitals in China quasi overnight.  In contrast, a surprisingly delayed response has been seen in the USA and lately in Europe, which initially failed to estimate the magnitude of the situation and to plan accordingly. Eastern Europe, where there is chronic underspending on healthcare capacity and where a significant section of the population might not adopt the behavioural changes required to restrict the pandemic, might need financial assistance and expertise coming from the rest of the EU.

Health authorities in Africa are on high alert for the virus; given the continent's extensive trade and transport links with Asia and with the rest of the world, the coronavirus was expected and indeed it has arrived. The capacity to screen, isolate, and treat patients and perform contact tracing is being built under the leadership of the Africa Centers for Disease Control and Prevention and WHO.

Globalisation, including, among other things, the widespread adoption of new lifestyles, migration of the workforce, spreading of new technologies with potential for harm (e.g. mobile phones, genetic manipulation) tourism and trade on an unprecedented scale, and large floods of refugees, has the potential to globalise diseases too. Coordinated, informed, expert responses to global diseases will be necessary much more often in the future. However, at the moment, global health research and formation of specialists in that domain are remaining in the early stages of development. The coronavirus pandemic which is present at the moment and affecting hundreds of thousands of people, with millions in quarantine, is highlighting again the need for expertise and structured scientific knowledge in public and global health.

New global health threats are looming in the meantime, soon to be added to the list released by WHO in 2019. The list includes at present: air pollution and climate change, noncommunicable diseases, the threat of a global influenza pandemic, fragile and vulnerable settings, such as regions affected by drought and conflict, antimicrobial resistance, Ebola and high-threat pathogens, weak primary care, vaccine hesitancy, dengue and HIV.

Despite the acknowledgment of noncommunicable diseases as being part of the list, there is still limited concern for containing the tragic effects of the predicted tsunami-like growth of cancer incidence. The scary statistics published by IARC, predicting that 1 in 6 or 1 in 7 people will have cancer in their lifetime - and some of the figures were even more alarming such as 1 in 3 – had little effect, if any. In many developing countries, the cancer survival rate remains low or very low.
The COVID-19 pandemic is revealing once again the complexity of healthcare and the value of passion and dedication for success when fighting disease. It is also pushing our innovative, creative approach to cancer patients, to hitherto unknown or less expected dimensions. Startups have now created platforms where patients can consult oncologists or other specialists online, without leaving their homes. Some of the startups are now offering delivery of treatments at home for cancer patients with low immunity due to chemotherapy, to reduce the risk of exposure to infections by keeping them at home. Simulation computerised programs have been created, where medical students and interns take calls in virtual call centres and screen patients. For specialists, international platforms have been organised, to discuss complex cases. 

This event has revealed that pandemic preparedness must be a permanent item on the global health agenda and that we need more global health experts.  More importantly, it has shown that the solidarity and empathy shown by the regular shouting of “stay strong” from the balconies of millions of Chinese sequestrated in their apartments or, more recently, by the singing in groups resonating from Italian blocks of flats in Milan will always unite us in the face of adversity.