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Protect our healthcare workers

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1324 (Published 02 April 2020) Cite this as: BMJ 2020;369:m1324

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Rapid Response:

The plight of Health Care Workers in India duding COVID-19 pandemic

Dear Editor,
Although the Health Care Workers (HCW) is at the forefront in the battle of COVID-19 pandemic, they are facing several challenges in delivering their duties. The plights of HCW in India (and perhaps across the world) can be described in five main subheadings:
A) Shortages of Personal Protective Equipments
Most health care facilities in India are facing shortages of personal protective equipments (PPE), including face masks, gowns, and respirators. Either the hospitals do not have these available in adequate numbers or they cannot afford to purchase the PPEs. In these extraordinary times, the health care providers must adapt and be flexible so that HCWs continue to safeguard themselves, their colleagues, their families, and their patients in this crisis. As the virus spreads, it is of increasing importance that HCW and other members of our communities protect themselves. The concept of viral load demands it. It is nearly impossible to tell who has been infected with COVID-19 until he or she is displaying symptoms.
B) Long working hours
It is becoming apparent from the reports from across the world that the long duty hours of the HCW is a major risk factor for them to acquire infection and hence it is mandatory they work in shorter shifts, based on a strict rota.

C) Violence against HCW
It is highly disturbing and demoralizing to see the HCW on duty are facing violence against them from some irresponsible public, within the hospitals and in the community surveillance work. It damages and dampen the work of HCW and may ultimately affect the health care of the public.

D) Increased risk of infection
The reports are coming in from across the world that several HCW are getting infected or dying due to COVID-19. In Spain, HCW have accounted for at least 14% of total Covid-19 cases. The hospitals and isolation centres are getting overloaded, essential medical equipments are scarce and the doctors and nursing staff are stretched thin. The high viral load in hospital settings may make healthcare workers particularly susceptible to the disease (1). The implications of infection in HCW are serious and many folds:
i) They can spread the infection to the colleagues, family members, friends and the patients.
ii) India already has a grave shortage of HCW. An increase numbers in cases seem inevitable. This will require all the available human resources, but if doctors and nurses get infected on a large scale, the opposite will happen. They will need to be quarantined and treated, depleting resources.
iii) There would be a direct blow to the morale of the medical fraternity. There are already reports of doctors and nurses contemplating mass resignations, which authorities are in no position to accept. While this may seem irresponsible, it is important to recognize that they are individuals, with anxieties and fears, families, and want to survive. India cannot afford its HCW to be low on motivation at a time when it needs them at their best. (2)

E) Social and Family impacts

Indeed the Medicine is a humanitarian profession, and the HCW have a duty to care for the sick. By willingly entering into this profession, they have implicitly agreed to accept the risks involved in it. However, they need to balance their obligations as professionals with their duties to their family members too. The risk to personal health from the coronavirus is alarming enough, but the risk of infecting their families because of exposure on the job is for unjustified and not acceptable. The HCW have also been facing a sort of ‘ostracisation’ by the society. Several HCW have been asked to vacate their rented accommodation on the presumption that they may carry and spread this disease from their place of work (hospitals) to the society.

It is becoming apparent that some HCW have already started rebelling during this COVID-19 pandemic, due to the direct impact of the various factors mentioned above. If it becomes rampant, it would be a disaster, because people are in urgent need of care. Social order relies on reciprocity. Imposing outsize burdens on one group without sacrifice from others is unfair. Doctors and nurses and other HCW may be heroes in this pandemic, but we will not be martyrs (3). It is important for the public, health care administrator and politicians to realize that the HCW are the ones holding the line against Covid-19 and they need to be fully supported in this time of crisis. The Government of India has taken some laudable steps like imposing severe punitive actions on people who are violent against the HCW, by providing Rs 5 million insurance cover and asking the manufacturers in India to do mass production of the PPEs. As this point of time HCW really need these equipments, which are extreme short supply. There are reports that doctors are having to use with substandard PPEs which some have compared to raincoats – akin to sending soldiers into war with misfiring guns (1). If we are to win the battle against coronavirus, the country needs to support and provide resources for its doctors and other HCW just as it would support its soldiers in a war.

Reference:
1. Soldiers in whitecoats: Doctors and nurses need support and proper equipment to fight the Covid-19 war. The Times of India. 2nd April 2020. https://timesofindia.indiatimes.com/blogs/toi-editorials/soldiers-in-whi...
2. Help the health workers, now (Editorial). Hindustan Times. 2nd April 2020. https://www.hindustantimes.com/editorials/help-the-health-workers-now-ht...
3. Jauhar S. In a Pandemic, Do Doctors Still Have a Duty to Treat? New York Times. 2nd April 2020. https://www.nytimes.com/2020/04/02/opinion/coronavirus-doctors-duty.html

Competing interests: No competing interests

04 April 2020
RAJU VAISHYA
Consultant Orthopaedic Surgeon
Abhishek Vaish
Indraprastha Apollo Hospitals, New Delhi, INDIA
Sarita Vihar, New Delhi