Health promotion and protection of health care workers during COVID-19 Pandemic:
World Health Organization declared COVID-19 as a pandemic on 11th March 2020. It is the greatest pandemic experienced in over a century, and has impacted physical, mental, and social aspects of our lives. It has challenged our abilities of self-control and tolerance inone way or the other. A huge manforce has been deployed from all fields to combat & contain the pandemic situation. Those in the fore front and at highest risk of getting infected are from the field of Health (Medical, Paramedical & supporting staff), Police department and other staff involved in essential services (food industry, transportation, etc.). These are the people who have to work hard during these challenging times against all odds, controlling their own apprehensions and fear. This takes a toll on their mental health and has consequences on their physical efficiency and productivity.
To share some of the first hand experiences of performing COVID duties during this pandemic with you, let me begin by stating that five staff members including four doctors from the Department of Community Medicine, Santosh Medical College, Ghaziabad were posted for COVID isolation ward duty at one time or other in the past three months, namely:
The primary ethical conundrum experienced by all of us (including all health workers) remains as to how one should balance one’s ethical duty of taking care of the patients against the concern of contracting the disease. Moreover, there lingers a substantial risk of transmitting the disease to one’s family members. This concern was of paramount importance to most medical health professionals as some of them have young children and/or elderly parents at home, who are considered more vulnerable to get infected with COVID-19. The limited availability of Personal protective equipment (PPE), inequitable distribution of available drugs and sanitizers, andconstantly changing recommendations on use of PPE especially face masks, played a major role in accentuating the paranoia associated with the disease.
Another common dilemma faced by health care workers is how to balance their own physical and mental healthcare needs against the call of the duty. For instance, in most cases the healthcare workers are overworked and may not be feeling well. Sometimes they may even be having some mild symptoms and theymight have been exposed to the infection. In such a scenario they have to decide whether to open up about their issues and face some discrimination at workplace or continue to work thereby risking the health of co-workers till they get tested positive for COVID-19.At the same time staying in Active & Passive quarantine & being discriminated by the neighbours after duties was a great challenge.
A common predicament experienced by some healthcare workers posted in ICU setting is regarding the triage of critically ill patients. Deciding whether a critical patient with slim chance of recovery and survival should be given ventilatory support, or to another patient who had better chances of survival, was an ethical dilemma.Triaging of patients when resources are not adequately available creates stress, frustration, and ethical dilemma atthe time of emergency&decision making for the team leader.
The hardship experienced & described above are just a few out of the many tough scenarios faced everyday by the health workers at any health care facility and these eventually take a heavy toll on them, which often leads to clouding of judgement, increased medical errors or a risk of burnout among health care professionals.
Some suggestions to deal with the above situations to promote the health of the workers may be:
Institutes must inform their Plans,Policies, and Standard Operating Procedures (SOP) to all their staff and heath care workers.
Ample availability of patient care equipment,crystal clear risk stratification protocols must be in place and communicated clearly& in time. All the health care workers must be briefed frequently about any change in policies and rational use of Personal protective equipment.
Work shifts should not be more than 4-6 hours per day to prevent any burnout or medical errors.Prompt testing and results along with adequate isolation facilities for all healthcare workers should be made available without discrimination.
Pre-counselling session before starting duty in the COVID ward can help reduce anxiety and help clarify any safety concerns.
A COVID support cell can be set up in every institution. A mental health care professional can be appointed to be available for crisis counselling in case a health worker is feeling overwhelmed.
Extraordinary times call for extraordinary actions. Keeping the workforce motivated by ensuring that they are free of any mental, physical & financial stress during this hard time with COVID duties, facilitates the healthcare workers to attend to their duties in high spirits & at full potential. It is hoped that the suggestions furnished herein, would assist institutions and team leaders in providing the best possible working conditions for their staff and healthcare workers, along with motivating healthcare workers to do their best.