Table of Contents  
EDITORIAL
Year : 2020  |  Volume : 7  |  Issue : 4  |  Page : 329-332

Martyred by the microbe


Chief Editor – IJVES, Director – JIVAS, Bengaluru, Karnataka, India

Date of Submission02-Dec-2020
Date of Acceptance02-Dec-2020
Date of Web Publication24-Dec-2020

Correspondence Address:
Kalkunte R Suresh
Chief Editor – IJVES, Director – JIVAS, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0820.304626

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How to cite this article:
Suresh KR. Martyred by the microbe. Indian J Vasc Endovasc Surg 2020;7:329-32

How to cite this URL:
Suresh KR. Martyred by the microbe. Indian J Vasc Endovasc Surg [serial online] 2020 [cited 2021 Jan 23];7:329-32. Available from: https://www.indjvascsurg.org/text.asp?2020/7/4/329/304626



Impact of COVID-19 on the healthcare workers



Bravery is nearly always associated with soldiers who protect us from incursions and invasions of hostile neighbors, especially in India. They selflessly protect the borders; however, the brave hearts battling the invisible microbe, whose domain is the entire world, have no frontiers or lines marking a territory! Healthcare workers (HCWs) across the globe, among others, are fighting a war that has been thrust upon them, sailing into unchartered territory, initially virtually unarmed to stem the onslaught. Many have been martyred – not with just loss of life but with indescribable sufferings. Most of their sacrifices and valor merged together with many such warriors, without any individual recognition.

Although most doctors, if not all, have contributed their might to combat this deadly virus in various degrees, our efforts might pale a bit in comparison to other HCWs, especially the nurses. A touching tribute to their efforts was offered by a senior doctor, who was infected with COVID-19, in an article in Times of India on September 3 titled “… a personal account and a salute to COVID warriors.” I quote from that article, “… As I lay in ICU, I could see the nurses' station …. Many clad in PPEs … one of the nurses walks up to me and performs the required tasks … the fear on the street is missing here …. In contrast, the nurse supports me … why does she wipe my tears when I cough violently? … Why can't she ignore me and stay safe? Doesn't she have a family and fear for them? Doesn't she fear for her own safety? Who will care for her family? Does she really have to risk so much?” Then, the doctor goes on “… When a soldier fights a war, he fears only for his well-being (and of course, his comrades in arms – my add). The enemy bullet does not hit his family…. He is aware if anything happens to him, state will care for his family and is compensated…. he will be spoken as a martyr … across the world, thousands of HCWs have died … only reward they will ever get is prayers from survivors like me … only acclaim would be a thank you … there will be no 21-gun salute for their bravado, no bodies wrapped in tricolor if they die in line of duty. No state honors, no medals, no movies, or books about them. I salute them and I feel the humanity, which we almost chased out of our cities, now exists in their spirit and arms now.” A befitting ode to their ethos, living up to Florence Nightingale – “How very little can be done under the spirit of fear.”

Couple of more media reports which caught my eye – one in early October, “One in three docs are falling to COVID… It states that the case fatality in HCWs was 16.7% as opposed to 1.7% in general population.” Another news report stated, “Seven months on nurses and docs need counseling most.” However, these are from news media and not published reports, but substance is disturbing.

We, at JIVAS, have been stringent about the following protocol and setting up barriers, not just for HCWs but also for reception/administrative staff, who are many a times the first contact for the patients. Many of these who come from long distances already treated at various hospitals. This is true for most vascular departments, since they are so few in India and exposure of a vascular surgeon is likely higher than other super-specialties. Our department, like many, has never stopped functioning; however, so far, we are free from any “endemic” COVID infections.

There are numerous reports about the effects of COVID-19 on HCWs. However, to decipher the data from across the globe and have a meaningful analysis would take months, if not longer, as the pandemic continues to unleash its fury across the world. The frontline workers, including HCWs, will continue to be at risk in the foreseeable future.

Sifting through enormous number of articles, I found couple that would project the true picture, in my opinion. In a multi-authored article, written by experts drawn from many countries – “Infection and mortality of healthcare workers worldwide from COVID-19: A scoping review” by Bandyopadhyay et al.,[1] “Results: A total of 152,888 infections and 1413 deaths were reported. Infections were mainly in women (71.6%) and nurses (38.6%), but deaths were mainly in men (70.8%) and doctors (51.4%). Limited data suggested that general practitioners and mental health nurses were the highest risk specialties for deaths. There were 37.17 deaths reported per 100 infections for healthcare workers aged over 70. Europe had the highest absolute numbers of reported infections (119,628) and deaths (712), but the Eastern Mediterranean region had the highest number of reported deaths per 100 infections.”

They present in Section 3.3.1a – “Number of healthcare workers infected with COVID-19: worldwide: As of May 8, 2020, a total of 152,888 HCWs had been reported to have been infected with COVID-19. This was 3.9% of the total number of 3,912,156 patients with COVID-19 worldwide. A total of 130 countries reported at least one case of HCW infection with COVID-19.”

They continue to collate the data in Section 3.3.1b about number of HCW deaths with COVID-19, worldwide: The total number of reported HCW deaths as of May 8, 2020, was 1413. This was 0.5% of the total number of 270,426 COVID-19 deaths worldwide. This also suggests that for every hundred HCWs who got infected, one died. As of May 8, 2020, 67 countries had reported HCW deaths related to COVID-19.

“Results: A total of 152,888 infections and 1413 deaths were reported. Infections were mainly in women (71.6%) and nurses (38.6%), but deaths were mainly in men (70.8%) and doctors (51.4%). Limited data suggested that general practitioners and mental health nurses were the highest risk specialties for deaths. There were 37.17 deaths reported per 100 infections for healthcare workers aged over 70. Europe had the highest absolute numbers of reported infections (119,628) and deaths (712), but the Eastern Mediterranean region had the highest number of reported deaths per 100 infections (5.7).”

They conclude that “HCW COVID-19 infections and deaths follow that of the general world population. The reasons for gender and specialty differences require further exploration, as do the low rates reported from Africa and India. Although physicians working in certain specialties may be considered high-risk due to exposure to oronasal secretions, the risk to other specialties must not be underestimated. Elderly HCWs may require assigning to less risky settings such as telemedicine or administrative positions. Our pragmatic approach provides general trends and highlights the need for universal guidelines for testing and reporting of infections in HCWs.”

Another review worth reading published in Lancet in September[2] by Nguyen et al. titled “Risk of COVID-19 in front-line health-care workers and general community: A prospective cohort study” – they summarize their findings, “Among 2,035,395 community individuals and 99,795 frontline healthcare workers, we recorded 5545 incident reports of a positive COVID-19 test over 34,435,272 person-days. Compared with the general community, frontline healthcare workers were at increased risk for reporting a positive COVID-19 test (adjusted HR 11.61, 95% CI 10.93–12.33). To account for differences in testing frequency between frontline healthcare workers and the general community and possible selection bias, an inverse probability-weighted model was used to adjust for the likelihood of receiving a COVID-19 test (adjusted HR 3·40, 95% CI 3·37–3·43). Secondary and post hoc analyses suggested adequacy of PPE, clinical setting, and ethnic background were also important factors.”

Recently, MEDSCAPE[3] published the survey conducted on 7414 practicing doctors from several countries titled “Medscape US and International Physicians' COVID-19 experience report: Risk, burnout, loneliness” (September 11, 2020, Leslie Kane Contributor). Responders were from the US, Mexico, Brazil, Portugal, France, Spain, Germany, and the UK. Some of their data are given below:

  • Emergency medicine physicians are more likely to treat COVID patients followed by pulmonologists. 58% of family physicians were treating these patients
  • Significant number of these doctors lacked PPEs
  • 9%–18% had a family member diagnosed with COVID
  • Nearly 50% had significant decline in income
  • Over 60% stated that their burnout was more intense
  • About 44% said that their home environment was more stressed. Further, a large number expressed increasing loneliness
  • 39% never closed their practices and 50% have reopened
  • Heartening to note most physicians had a strong sense of ethics when it came to putting themselves on line for patients in need
  • Touching quotes from physicians in this MEDSCAPE slide show:


    • I realize that I should show how much I love people who mean a lot to me and spend more time with them. I have learned not to complain for any little detail that does not go as I planned
    • I like being a physician and COVID-19 increasing my feeling of duty to patients
    • I feel more proud of career than ever before
    • I have a totally different view of life, death, meaning of life and human behavior.


The above does not do justice to this publication and the readers urged go through above references.

Forbes India published the data on Indian HCWs, updated on October 6, 2020, available online.[4]. They quote Health Ministry as source for these data (I have not personally checked these) titled “Frontline health care workers in the crosshairs of COVID-MEDSCAPE19,” a look at how many HCWs in India have been affected by COVID-19, including the states in which they are the worst affected.





A news channel reported that there are 21 million HCWs in the USA. How many million HCWs are in India? Does the above data reflect infections in HCWs across our country? How does this pandemic affect those who deliver various modes of healthcare at grass root level? This would be a good time to reflect on the efforts of nondoctor HCWs, including nurses, alternative medicine personnel, and those wonderful unrecognized workers (Anganwadi, ASHA, etc.). They are the true frontline workers who helped rid this country of polio, smallpox, etc. In my opinion, we will not be able defeat this disease, especially delivering vaccine when it arrives, without these unsung heroes! Are they exposed to COVID-19 now and how are they affected? It is very likely these are affected in all fronts by thousands, if not more. A somber and sobering thought indeed!

India seems to be “flattening” the curve. However, world over, the curve has spiked again in winter season which has just started. We hope our relatively milder winter offers some protection; however, this myth has already been broken by the huge numbers during warmer months. Our death rate seems mercifully lower than others and hopes that sustains. However, the impact on health resources and economic downturn are staggering – it has made poor poorer and perhaps lowered huge numbers of “middle class” into lower economic strata; many unable to sustain the travails caused COVID and pre-existing diseases. It is our, of all doctors, avowed duty to care for these patients with less target about economic gains. It is sinful to capitalize on the sickness of these patients and hospitals to ignore those who are impoverished, even before, and now affected by COVID. We also know that if there is another spike in India, most of the HCWs will be delivering the care for the patients, in spite of great personal risk of contacting the diseases and possibilities of affecting their friends and families. To paraphrase Sir Winston Churchill:

  • “Let us therefore brace ourselves to our duty, and so bear ourselves that if the COVID and its reign lasts long, the posterity judge us and will say about HCWs – This was their finest hour
  • “Being terrified but going ahead and doing what must be done – that's courage. The one who feels no fear is a fool, and the one who lets fear rule him is a coward.” – Piers Anthony, Castle Roogn.




 
  References Top

1.
Bandyopadhyay S, Baticulon RE, Kadhum M, Alser M, Ojuka DK, Badereddin Y, et al. Infection and mortality of healthcare workers worldwide from COVID-19: A scoping review. MedRxiv (2020.06.04). p. 20119594.  Back to cited text no. 1
    
2.
Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study; Long H Nguyen et al; open access, published 31, 2020 DOI https://doi.org/10.1016/S2468-2667(20)30164.  Back to cited text no. 2
    
3.
Medscape US and International Physicians' COVID-19 Experience Report: Risk, Burnout, Loneliness Leslie Kane, MA | September 11, 2020 | Contributor Information https://www.medscape.com/slideshow/2020-physician-covid-experience-6013151?src=wnl_physrep_200916_COVID_Report_int&uac=290856SJ&impID=256  Back to cited text no. 3
    
4.
Forbes India: Frontline healthcare workers in the crosshairs of COVID19; https://www.forbesindia.com/article/news-by-numbers/frontline-health-care-workers-in-the-crosshairs-of-covid19/63205/1  Back to cited text no. 4
    




 

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