A ‘staggering crisis’

Hailed as heroes by governments, in media and social media and by everyday people, anyone would think that healthcare workers are benefitting from the COVID pandemic. Shockingly, the opposite is true. Far less attention is paid to the factors that undermine global efforts to protect frontline healthcare workers.

At least 7,000 health workers have died around the world after contracting COVID-19, according to new analysis by the prominent rights campaign group Amnesty International.

“For over seven thousand people to die while trying to save others is a crisis on a staggering scale,” said Steve Cockburn, head of Economic and Social Justice at Amnesty International.

The new information is an update to an earlier report released by Amnesty International on July 13. At the time, it found that over 3,000 health workers across 79 countries had died after contracting COVID-19. The latest figures are driven by increasing rates of COVID-19 in several countries, as well as the availability of new data sources.

Amnesty International reports that the countries with the highest estimated numbers of health workers who have died from COVID-19 include Mexico (1,320), USA (1,077) and here in the UK (649). The exact toll of COVID-19 on healthcare workers can only be approximated, according to a recent commentary in “The Lancet,” the highly respected independent, international weekly general medical journal, by Linda McCauley and Rose Hayes. Titled “Taking responsibility for frontline healthcare workers,” it notes a study that found that frontline healthcare workers were at increased risk for reporting a positive COVID-19 test compared with the general community, after adjustment for the likelihood of receiving a COVID-19 test. It also found there is an increased risk for COVID-19 identified among healthcare workers who reported inadequate personal protective equipment (PPE).

This number probably represents a fraction of the true global death toll of healthcare workers because of factors including poor documentation of deaths in some countries (and scant recording of profession), inconsistent definitions of healthcare worker across nations and data obfuscation.

Amnesty International points out that figures for countries may not always be directly comparable due to different methods used to collect data, and definitions of health workers used in different countries and that these figures are likely to be a significant underestimate, due to underreporting by many of the countries included in the analysis.

Nevertheless, as Cockburn puts it: “Many months into the pandemic, health workers are still dying at horrific rates in countries such as Mexico, Brazil and the USA, while the rapid spread of infections in South Africa and India show the need for all states to take action. Every health worker has the right to be safe at work, and it is a scandal that so many are paying the ultimate price. There must be global cooperation to ensure all health workers are provided with adequate protective equipment, so they can continue their vital work without risking their own lives.”

In the United States, Kaiser Health Network in partnership with The Guardian has launched a database of thoroughly researched cases of frontline healthcare workers who have died after testing positive for COVID-19. “Lost on the Frontline” has counted 1,079 US healthcare workers who have died fighting the pandemic – two more than Amnesty – and is investigating the circumstances of their deaths, asking “Did they have to die?”

Of the 167 workers added to the “Lost on the Frontline” database so far, 62 percent were identified as people of color. About one-third – at least 53 – were born outside the USA, and 25 were from the Philippines. At least 52 or 31 percent were reported to have had inadequate PPE.

Healthcare workers in the USA are saying that hospitals, clinics and other healthcare facilities have flouted the simple guidance of public health experts to stay home if you feel sick. Instead, the workers say, they are pressuring workers who contract COVID-19 to return to work sooner than public health standards suggest it’s safe for them, their colleagues or their patients.

Some of these healthcare worker deaths were preventable, according to the “Lost on the Frontline” investigations. They say poor preparation, government missteps and an overburdened healthcare system increased that risk. Inadequate access to testing, a nationwide shortage of protective gear and resistance to social distancing and mask-wearing have forced more patients into overburdened hospitals and driven up the death toll.

It’s not just the US. Seven months into the COVID-19 pandemic, The Lancet article reports many governments around the world have not adequately improved healthcare workers’ access to PPE. This is deeply concerning not only for thousands of Filipino nurses and others working overseas and their families, as well as anyone with the duty of care, but also for anyone who might need healthcare.

Lack of coordination has led to competition rather than cooperation for resources, hoarding, price gouging and unnecessary shortages in some nations, while others have a surplus. This unstable market favors large purchasers and puts small companies and low-income countries at a disadvantage. Although some improvements have been made to major supply chains, some facilities, like nursing homes, continue to face shortages.

One immediate step governments can take is to mandate universal masking. It may seem extraordinary to readers in the Philippines and east Asia, but it is not mandated in all healthcare situations elsewhere in the world. Studies have shown a reduction in COVID-19 cases among healthcare workers after implementation of universal masking. Even more importantly, it would target the pandemic infection rate itself – the underlying reason for all the public health and economic challenges faced by governments around the world.

Secondly, data transparency is essential. Proper methodological approaches to gathering key data like patient and provider demographics, death tolls and PPE supply levels.

Further, national leaders must assume responsibility for frontline healthcare workers’ safety. Governments need to cooperate with other nations to ensure equitable distribution of PPE, according to The Lancet.

Surely this is the least that can be done for front-liners? The health of us all depends on it.