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story.lead_photo.caption A man removes his cap as a soldier takes his temperature outside a food market as a preventative measure against the spread of the coronavirus in Caracas, Venezuela, Thursday, March 19, 2020. To enter the market, people are required to get their temperature taken and disinfect their hands. (AP Photo/Ariana Cubillos)

DAKAR, Senegal -- The West African nation of Mali has roughly one ventilator per 1 million people -- 20 in all to help the critically ill with respiratory failure. In Peru, with more than 32 million people, there are about 350 beds in intensive care units.

The coronavirus is now moving into parts of the world that may be the least prepared. Some countries in Africa and Latin America lack the equipment or even trained health workers to respond.

Many of their nations are slamming shut borders and banning large gatherings, but local transmission of the virus has begun.

Containing that spread is the new challenge. Africa has more than 900 confirmed cases and Latin America more than 2,500, but an early response is crucial as fragile health systems could be quickly overwhelmed.

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With such limited resources, experts say identifying cases, tracing and testing are key.

"We have seen how the virus actually accelerates that after a certain ... tipping point. So the best advice for Africa is to prepare for the worst and prepare today," WHO Director-General Tedros Adhanom Ghebreyesus said Wednesday.

"We have different and significant barriers to health care in Africa, which could be a real challenge," said Dr. Ngozi Erondu, a senior research fellow at the Chatham House Center for Global Health Security.

Many countries in sub-Saharan Africa do not have the isolation wards or a large number of health care workers to respond to a surge of covid-19 patients, she said.

Liberia and Burkina Faso have only a few ventilators for their millions of people.

Dr. Bernard Olayo, founder of the Kenya-based Center for Public Health and Development, said most countries in Africa can't afford ventilators. Even if they were provided by other countries, it's not sufficient because of the lack of qualified people to use them.

"It's complex, it's very very complex, because the patients that end up on ventilators require round-the-clock care by larger teams," he said.

Many patients could do well with just oxygen, he said, but close to half of health facilities in African countries don't have reliable oxygen supplies. Oxygen concentrators can be used, but given the frequent electricity cuts in many countries, oxygen generators and pressure cylinders are needed because they can function while power is out.

The WHO regional Africa director, Dr. Matshidiso Moeti, said the lack of ICU facilities and ventilators is one of the biggest challenges facing the continent.

"We have been able to identify importing a field hospital-type of facility that can be set up and equipped with some of the key items needed, such as ventilators," she said. Training has begun in the Republic of Congo and Senegal so health care workers will be ready to operate it, and World Bank funding is being made available, she said.

It's not all grim. Elsie Kanza, head of Africa at the World Economic Forum, said many countries are deploying lessons learned from the Ebola outbreak in West Africa in 2014-16 that killed more than 10,000 people.

The Africa Centers for Disease Control and Prevention was created to respond to that Ebola outbreak. As of Thursday, 43 countries can test for the coronavirus, it said. In addition, Chinese billionaire Jack Ma this week pledged to donate 1.1 million testing kits, 6 million masks and 60,000 protective suits and face shields to share among all African countries.

Meanwhile, Senegal is helping to develop a fast covid-19 test that is expected in June.

But some including Adama Dempster, a human rights advocate in Liberia, warned that support for African nations' efforts might dry up if cases soar.

"It's something that is worrisome because other countries that are so powerful and have the sophistication to deal with things like this are themselves concerned about their own situation," she said.

Africa isn't the only continent worried about what's to come.

Several countries in Latin America are among the least prepared in the world for a pandemic, with health care systems already stretched thin.

Peruvian Minister of Defense Walter Martos told local America TV on Monday that the nation has fewer than 400 respirators available.

Venezuela ranks 176th of 195 nations worldwide in preparedness for a health crisis, according to the Global Health Security Index, a project of the John Hopkins Center for Health Security and the Nuclear Threat Initiative.

The nation's health care system has been crippled by years of economic contraction, political chaos and a humanitarian crisis, with rising infant mortality rates and critical shortages of water and medicine.

Information for this article was contributed by Clarence Roy-Macaulay, Jonathan Paye-Layleh, Babacar Dione, Sam Mednick, Christine Armario and Maria Cheng of The Associated Press.

A Section on 03/21/2020

Print Headline: Fragile targets brace for the virus


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