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Since the onset of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes Covid-19, frontline healthcare workers around the world have been at high risk of infection.

As the pandemic ensued, they remained at the frontline, risking their lives to keep us safe, write Dr Patrick Osewe, Chief of Health Sector Group, Asian Development Bank and Dr Kieran Walsh, BMJ Clinical Director.

BMJ in partnership with the Asian Development Bank

Healthcare workers are unsung heroes

And the challenges they face have not gone away.

As Covid-19 continued to paralyze our society, healthcare workers were called to work in overwhelmed health systems. The scale and uncertainty of the public health crisis⎯along with the strain of responding to it⎯ resulted in burnout and exhaustion amongst healthcare workers worldwide.

Over 37 million patients were diagnosed with Covid-19 globally, with approximately 1 081 000 deaths. The countries of Asia have also been severely affected. In India alone, there have been over 7 million confirmed cases and over 100 000 deaths. And at least 7,000 health workers have died around the world after contracting Covid-19.

As the first line of defence in the Covid-19 pandemic, frontline healthcare workers played a critical role in preventing the spread of disease. Under difficult conditions, they were also  responsible for continuing to provide a service for patients with other illnesses.

As the bridge between scientific information and patients, health professionals played a vital role in communicating evidence-based information to patients, carers, and the general public which helped dispel myths and misinformation about the pandemic. It was vital that they received updated, evidence-based and trusted medical information and guidance about the virus. 

From shortages of personal protective equipment to delays in testing, the pandemic exposed the vulnerability and fragility of our health systems. One of the biggest challenges for healthcare workers was working in an uncertain environment with limited knowledge about the virus. Under the best of conditions, it can take up to 17 years for evidence to become routine clinical practice.

The scientific evidence on Covid-19 changed every week for the past nine months and healthcare workers, especially those with little or no prior infectious disease expertise, found it challenging to keep up with the latest guidance in a sea of information, misinformation and disinformation.


The challenge of comorbidities

The World Health Organisation called on all countries to accelerate and fund Covid-19 research to tackle the outbreak, which led to great advances in our knowledge of the virus.

These extended to knowledge of epidemiology, diagnosis, differential diagnosis, investigations, management and prognosis. 

One issue that became clear is that certain groups of patients with Covid-19 will become seriously ill. These are largely patients with comorbidities.

The comorbidities that had the greatest adverse effects were chronic non-communicable diseases (such as hypertension, diabetes, heart disease, and kidney disease). These were found to make the management of the virus more challenging and complex.

With many countries experiencing further waves of infection, there became an urgent need to educate large numbers of healthcare professionals on how to diagnose, manage, and prevent infections. Traditional methods of providing education to healthcare professionals did not work in these new circumstances.

The pace of change of scientific knowledge meant that information on epidemiology, testing and prevention became out of date within days if not weeks.

Digital tools such as evidence-based clinical decision support at the point of care and e-learning were proven means of providing the education needed. They helped health professionals and community health workers manage patients with Covid-19, as well as relevant differential diagnoses, and common comorbidities in real-time, at the point of care.

Health professionals were often guided by their institution or local health authority on which resource to follow, however, there was no guarantee that guidelines are updated regularly. Many also relied on public sources of information; a simple Google search of “Covid-19 resources for healthcare professionals” yields hundreds of options. And of course, this search result varied from country to country. So how did a health professional confidently choose which one to view?  

Coronavirus Information Centre

In response to these many challenges, BMJ in partnership with the Asian Development Bank (ADB) launched a new Coronavirus Information Centre for all healthcare workers in ADB’s 49 member countries in the Asia Pacific region. 

The online Information Centre provided free access to BMJ’s clinical decision support resources via BMJ Best Practice, e-learning modules via BMJ Learning, as well as patient information leaflets and procedural videos.

The Coronavirus Information Centre drew upon BMJ’s experience from the Clinical Decision Support Training Initiative, a pandemic preparedness programme that supported healthcare professionals in the Caucasus, Middle East and South East Asia.

Over 18,000 doctors benefited from the Initiative. BMJ’s resources left a long-term positive impact on health professionals’ knowledge and skills with 95% reporting that BMJ’s resources helped improve patient care.

BMJ also had an impact on strengthening health systems within the countries – through establishing online accredited continuous professional development, integration of e-learning into curricula, and driving healthcare quality improvement initiatives.

In 2018, the Initiative won the Prize for Innovation in Global Security from the Geneva Centre for Security Policy due to positive, and sustainable impact on pandemic preparedness and health systems strengthening. 

We were delighted to put what we had learned from this Initiative into our planning for the Coronavirus Information Centre with ADB.

  • BMJ Best Practice offers continually updated, evidence based and practical guidance for the point of care, giving healthcare professionals immediate answers to their Covid-19 clinical questions without interruption to their workflow.


  • BMJ Learning offers interactive and multimedia learning modules for healthcare professionals. They are essential to patient safety and also the safety of healthcare professionals. 

  • BMJ’s Covid-19 patient information leaflets can be used to help dispel myths about the virus that are being spread by word of mouth and on social media. 

Dr Patrick Osewe, Chief of Health Sector Group, Asian Development Bank provided leadership on policy, technical, and operational matters. In close collaboration with the Sector Committee, and led the application of new and innovative approaches to address priority and emerging health issues in the Asia and Pacific region. 

Prior to his time at ADB, Patrick worked as the World Bank’s Global Lead of Healthy Societies, providing technical and operational guidance to countries, World Bank teams, and the global health community to address public health challenges.

These include strategies for achieving universal health coverage (UHC), combatting the emerging threat of non-communicable diseases, addressing health security as both an economic issue, and as a major challenge to achieving UHC.  

Get in touch

For partnership queries or anything else, please contact us.
Dr Kieran Walsh
BMJ Clinical Director