Covid-19 infection and deaths in healthcare workers – who is keeping track?

WE remember the touching scenes of strangers gathering to clap and the dramatic aerial acrobatic salutes to honour healthcare workers (HCW), first responders, military, and other essential personnel. Do you know the extent of their sacrifice?

 

Until recently, the statistics of Covid-19 deaths in many countries did not include occupation. Remembering the fallen heroes and colleagues who lost their lives in the course of Covid-19 duty remains the effort of a few individuals or groups.

HCW deaths/infection by country

In countries across the Asia-Pacific region at least 171 HCW have died and 12,454 infected (June 11).

They include China 34 deaths/3,387 infected (February); Philippines 35 deaths/2,314 infected (majority nurses and physicians); India 34 deaths/1,028 infected; Afghanistan 13 deaths/346 infected; Bangladesh 35 doctor deaths/1,172 doctors tested positive; Pakistan 37 doctor and three paramedic deaths/3,635 infected HCW; Indonesia 38 doctors and 30 nurses have died as of June 23.

According to a British Medical Journal report (June 1), Spain holds the sad record of being the country with the highest number of Covid-19 cases among healthcare professionals. Approximately 50,000 healthcare professionals have been infected, representing 20 per cent of all recorded cases and 70 have died.

The UK reported 272 HCW deaths including doctors, nurses, and midwives, nurse assistants, paramedics, and ambulance staff and hospital porters. Black, Asian and Minority Ethnic are overrepresented in Covid-related HCW deaths. The Office for National Statistics (ONS) recorded 268 social care worker deaths from suspected or confirmed Covid-19 in England and Wales between March 9 and May 25.

No systematic global tracking of Covid-19 HCW infection and deaths

On July 13, Amnesty International (AI) released a report that more than 3,000 health workers are known to have died from COVID-19 in 79 countries worldwide. This figure is likely to be a significant underestimate. ‘Health workers’ refers to everyone involved in the delivery of health and social care in any capacity, including but not limited to doctors, nurses, social care workers, cleaners, ambulance drivers, and facilities staff.

The countries with the highest numbers of health worker deaths thus far, include the USA (507), Russia (545), UK (540 including 262 social care workers), Brazil (351), Mexico (248), Italy (188), Egypt (111), Iran (91), Ecuador (82), and Spain (63).

Serious shortages of PPE 

Serious shortages were reported in nearly all the 63 countries surveyed. A doctor in Mexico City told Amnesty that doctors were spending about 12 per cent of their monthly salaries buying their own personal protective equipment (PPE). The British Medical Association in May, found that 48 per cent of UK doctors had sourced their own PPE or relied on a donation when none was available.

Repercussions for voicing concerns

In Egypt, nine HCW were arbitrarily detained between March and June on vague and overly broad charges of ‘spreading false news’ and ‘terrorism’. They had expressed safety concerns or criticised the government’s handling of the pandemic. Another Egyptian doctor told Amnesty that doctors who spoke out were subjected to threats, interrogation by the National Security Agency, administrative questions and penalties. He said, “Many doctors prefer to pay for their own PPE to avoid this exhausting back and forth. The authorities are forcing doctors to choose between death and jail.”

In the USA, a certified nursing assistant was fired after posting a video on Facebook where she read out a petition calling for more PPE. She said that the staff at the nursing home in Illinois where she worked, were not informed that they were working with Covid-19 patients and had only found out through the media. The nursing home had reported 34 infections and 15 Covid-19 related deaths as of May 29.

In Russia, two doctors, faced retaliation after complaining about the lack of PPE. One has been charged under Russia’s fake news laws and faces a fine of up to RUB100,000 (US$1,443). Another is facing disciplinary proceedings that may result in her dismissal.

Unsafe working conditions

In South Sudan, doctors on the government’s payroll have not received their salaries since February and do not receive welfare packages or medical cover. In Guatemala, at least 46 facilities staff were not paid for the two-and-a-half months they spent working at a Covid-19 hospital.

No additional benefits or compensation

In some countries, there are no additional benefits for health and essential workers in the context of the Covid-19 pandemic, and in other countries benefits exclude certain categories of workers. Amnesty is calling on states to consider Covid-19 an occupational illness and ensure that HCW have access to compensation and other support in case they contract the infection. They must also be included in priority groups for Covid-19 testing.

Stigma and violence

A nurse in Mexico was reportedly drenched with chlorine while walking on the street. In the Philippines, attackers poured bleach in the face of a hospital utility worker.

In Pakistan, Amnesty International has recorded several instances of violence against HCW since April. Hospitals have been vandalised, doctors attacked. One was shot by a member of the Counter Terrorism Force. When hospitals were forced to turn away critical patients due to the shortage of beds, ventilators, and other life-saving equipment, people don’t believe them. Politicians’ claim that hospitals have the necessary resources puts HCW, who have to turn patients away, in danger.

HCW in Malaysia

We must salute our HCW and front-liners under the cool-headed leadership of our director general of Health, whom one netizen-fan wanted to “borrow” when he compared our statistics with his. As of July 9, Malaysia — population 32.7 million, had 8,696 cases and 121 deaths; in contrast to the USA — population 328 million, with 3.24 million cases and 136,000 deaths; UK — population 66.6 million with 288,000 cases and 44,650 deaths; and Italy — population 60.3 million, with 243,000 cases and 34,938 deaths.

On April 23, the director general of Health said that 70 per cent of the then 325 positive cases among HCW were linked to attending wedding receptions and some who had returned from overseas. The infected HCW included 77 medical officers, 66 nurses, 34 graduated medical officers, 23 medical experts, and 21 assistant medical officers. The remaining 104 were involved in other service schemes.

There have been three Malaysian HCW deaths. Only one, a 32 year-old nurse (April 23) was Covid-work related. She had a history of high blood pressure and close contact with a positive patient.

The first HCW fatality was a 48-year-old Malaysian pathologist with no comorbidities, who died March 22 following travel to Turkey, not related to Covid-19 patient care.

As of April 27, 52 HCW in Sarawak tested positive for Covid-19 — 21 were close contacts to positive cases from a church conference. (There have been several more recent cases.)

Recommendations by Amnesty International

Amnesty International calls on all states affected by Covid-19 to:-

Carry out independent public audit into their preparedness for and responses to the pandemic, with a view to better protecting human rights and lives in the event of a future mass disease outbreak.

Review whether the rights of HCW, including the right to just and favourable conditions of work, and the right to freedom of expression — were adequately protected.

Ensure adequate compensation for all health and essential workers who have contracted Covid-19 as a result of work-related activities.

Investigate cases where workers have faced reprisals for raising health and safety concerns.

Provide effective remedy to those who have been unjustly treated including by reinstating workers who have lost their jobs for speaking out.

Personally, I feel that governments owe it to the fallen Covid-19 hero front-liners to ensure their orphans will not lose their future and dreams. There should be a trust or foundation to support them educationally, socially, and emotionally till adulthood. Spouses, dependants, and parents will need support to tide over their loss and grief too.

 

Dr Tan Poh Tin is a public health specialist, paediatrician, retired associate professor, and disaster relief volunteer with a life mission of ‘Doing good, healing all’.

 

 

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