Frontline workers on covid-19

The year was 2020 and the month was March. Everyone slept through a peaceful night unaware of something sinister brewing in the store. The following morning, the people of the world woke up not to watch the smiles of their community but the news that a tiny strain of the virus had spread like wildfire. 

Everything was chaotic and a worldwide lockdown was enforced to contain its spread. While struggling to deal with the unknown, people were forced into isolation and fought for survival. While some stood in long queues to collect toilet papers, hoarding groceries; there was a class of professionals who stepped out for their duties despite the unknown nature of the virus. They were our frontline workers.

Frontline Workers of COVID-19

The COVID-19 virus, originated in Wuhan, China in the year 2019, had already caused multiple casualties. By the time the entire world shut down, the number of cases in China and Europe had already reached multiples of thousand. 

India also went under nationwide lockdown to prevent its spread even though it had only reported a few thousand cases. But our frontline workers kept driving and walking towards their workplaces through it all. 

If you may ask what are the frontline workers and who comes under frontline workers – the answer is simple. All professionals who deal directly with the patients of COVID-19 are frontline workers, which majorly includes healthcare staff like doctors, nurses, and sanitation workers.

By definition, frontline workers of COVID-19 are the personnel from the healthcare department (public and private), state and central police organisations, armed forces, home guards, and civil defence volunteers including disaster management volunteers, municipal workers, prison staff, and revenue officials engaged in containment and surveillance activities.

Categories of Essential/ Frontline Workers of COVID-19

• Essential Healthcare Workers

It includes all paid and unpaid people serving in the healthcare industry who have the potential of exposing themselves directly or indirectly to the COVID-19 patients or infectious surface/ material. It also includes people who are not involved in patient care but may potentially expose themselves to infectious agents while working in a healthcare setting.

• Essential Non-Healthcare Workers

It includes professionals who are essential in maintaining critical healthcare infrastructure and continue critical services and functions like:

• Essential workers at the highest risk for work-related exposure to SARS-CoV-2 (Virus that causes COVID-19 disease) as their duties are performed on-site in close proximity to the patients or coworkers of the same line
• Other essential workers not included in all of the above categories

Of all these essential worker categories, healthcare workers who come in direct contact with the patient like doctors, nurses, and sanitation workers remain the most vulnerable. 

While scientists across the world started a global hunt for its cure, doctors and nurses began racing against the virus to save lives.

Understanding the Role of Healthcare Workers During COVID-19

Known as the ‘Warriors of COVID-19’, frontline workers in India faced the wrath of a tiny strain that was mighty as fire. Covering themselves in hazmat suits from head to toe, leaving no space even for the oxygen to enter, they sweat inside all day long while attending patients.

Staying away from their families for days and weeks, trying to save the lives of people was not easy. Even though many people succumbed to the virus, they tried their best to save each life. In this regard, advisories were also issued by the government for COVID appropriate behaviour. 

No one ever thought that touching their face, hugging, openly smiling or even coughing would become illegal one day – all because a tiny molecule became so powerful that it shut the entire world but healthcare workers.

Although WHO declared the outbreak of coronavirus diseases as a pandemic, the world was already seeing its massive ill effects. While WHO closely monitored the situation, the governments teamed up to spread their knowledge base, only frontline workers faced the fury.

The role of healthcare workers during the COVID-19 outbreak became crucial than ever, making them the backbone of every system ever known. Despite the stigma around the virus and abuse the healthcare workers were facing, they continued working in favour of society.

Even after the Prime Minister’s address to the nation and support from most people of the country, nothing was enough to contain COVID-19. India’s women frontline community of healthcare workers (ASHA workers) who were tasked with tracing COVID-19 patients were left defenceless.

ASHA workers walked door to door to note details of people who may have come in contact with the infected person and their travel history, including the ones in home isolation. As fearful as the on-ground situations were, it was not too different from within the hospital walls.

To strengthen preparations for the healthcare workers, higher authorities sat to devise plans necessary for dealing with this nationwide emergency, while reaching out to the people in remote parts of India. ASHA workers helped in tackling on-ground situations.

The knowledge of healthcare workers was largely based on the exposure and effects of the treatment on the COVID-19 disease. While guidelines for the role and responsibilities of healthcare workers were issued by ICMR in India and WHO, tackling misinformation was another task. Self-help and similar community groups stepped forward to help during times of distress.

Social Stigma and Discrimination During COVID-19

As if this public health emergency was not enough, healthcare workers also had to deal with the social stigma and discrimination. In many parts of India, adverse community behaviour was observed. Fear, anxiety, and lack of knowledge of coronavirus led to many perceived notions. Frontline workers in India faced mental health challenges as a consequence of people’s behaviour.

Since the outbreak of novel coronavirus, a negative perception has been formed towards its patients and the ones treating it in the hospitals. While COVID-19 patients were accused of being negligent and contracting the virus, stereotyped as active spreaders, healthcare workers faced it in no different light.

The doctors were also called the carriers of the virus. The social stigma and discrimination grew to such an extent that the director of AIIMS Delhi warned people about the perceived dread of being stigmatised among others leading them to refrain from getting tested. 

A recent survey also suggested that 61% of the Indian population suffered from mental health issues wherein the number of women outweighed men. While the deteriorated mental health for common people was majorly due to the lockdown and isolation, it was no different for doctors and nurses who regularly saw people die in front of their eyes.

A report updated in March 2020 by (IFRC)  International Federation of Red Cross and Red Crescent Societies, WHO, and UNICEF suggested that this social stigma is affecting both prevention and treatment of COVID-19. Further, it has also driven people away from getting screened, tested, and quarantined.

Doctors and nurses faced multiple challenges during the treatment of COVID-19, including the shortage of PPE kits, relevant training, and rest but worst of all their lives to COVID-19. Over 200 doctors succumbed to COVID-19 in only a month since its inception, reported IMA. 75% of these doctors were reported to be of age above 50 years with general practitioners attributing the highest numbers.

2020 was a difficult year for all but mental health took a toll on those treating these patients. Burnout and helplessness were seen as driving forces towards increasing suicide death rates among doctors and healthcare professionals.

A resident doctor in Delhi died by suicide for the same reasons. Another doctor in Gujarat was not allowed to enter the society because of their COVID duties. A group of medical professionals were pelted with stones in an area in Uttar Pradesh because they went to test people and trace COVID.

There are many stories like these that prove how doctors were stigmatised and discriminated against solely based on their professional duties.

However, this all happened during the first wave of COVID-19 in India.

The second wave hitting India in 2021 was even worse. As many as 719 doctors succumbed to COVID-19 while treating their patients for the same disease.

Second Wave of COVID-19 in India

The second wave of coronavirus hit India in March-April 2021. Despite the warnings from medical fraternities, people let their guard down and hence saw the worst in the history of pandemics.

Even though the vaccine production had already started and most healthcare workers were inoculated against the disease, the worst was still not behind. Patients gasped for oxygen and many lost their battles.

The shortage of oxygen and treatment drugs led to an increase in the mortality rate by over 40%. The death rate rose the sharpest among individuals under the age of 45 years. A journal published in the MedRxiv suggested that the overall COVID-19 mortality rate increased to 10.5% in the second wave with the highest number of young patients. 

Not only this but the requirement of ICU was also increased during the second wave of COVID-19 in India increasing the mortality rate from 19.8% in 2020 to 25.1% in 2021. The ones admitted in the ward also saw an increased mortality rate of 3.1% in 2021.

Healthcare professionals attending patients were also left helpless, forcing them to make SOS calls for oxygen. 

While the healthcare system collapsed, India was seeing its darkest times since independence. Commenting on the situation, a doctor from Mumbai serving in the COVID wards said, “We don’t learn from our mistakes at all. The first wave ended and we thought the second would never come.”

She further added, “India doesn’t have to be like this. That is the most heartbreaking thing. That’s why it hurts. Young people shouldn’t have died.”

Chief cremator from Varanasi commented on the situation saying, “Our family has been traditionally involved in managing the crematoriums for many generations. No one has ever seen anything like this. Last year was nothing like 2021. This situation is horrific.”

Battling Mental Health Crisis During COVID-19 in India

The fear of the unknown has always triggered anxiety among people and COVID-19 was no different. Lockdowns, isolations, lack of knowledge, crumbling healthcare infrastructure, everything combined led to an increase in mental health crises in India. Since doctors and nurses were facing it head-on, they were the most affected beside patients. It is only natural to feel anxiety, stress, fatigue, grief, and worry during these trying times.

The risk of getting infected, adequate protection, long working hours, isolation, and separation from families is leading to multiple psychological distresses among healthcare professionals. 

With the increase in mental health crises, the number of help resources has also increased. Many organisations have stepped up their role in serving the community and offering adequate help to overcome challenges related to COVID-19. 

If anyone has a family member working on the frontline, here are some symptoms to diagnose their mental health crisis:

• Poor memory
• Drowsiness
• Change in the ways of communication
• Disrupted routine
• Restlessness or irritability
• Quick mood changes, anger outbursts, or crying spells
• Wish to harm themselves
• Avoiding interactions with family members or friends
• Burnouts
• Sleep disturbance
• Emotional exhaustion
• Reduced appetite
• Decreased sense of accomplishments
• Feeling nervous, anxious, or sad
• Change in patterns of substance consumption (Alcohol/drugs)
• Pre-existing mental health conditions

Health employees working long hours are generally worried about the safety of their families. While help is offered to medical professionals in distress, there is still a lack of them. To combat these issues, private companies have also taken initiatives to support the employees and their families.

Going by the extent of COVID-19 in the country,  the government machinery and resources only seem to fall short. Businesses, philanthropists, and civil societies have all come together in the fight against this deadly disease. 

The addition of resources has only helped frontline workers in India to combat the virus. 

COVID-19 Initiatives by Private Organisations Help Strengthen the Fight

By May 2021, the private sector of India had already allocated ₹5806 crores towards India’s fight against COVID-19.

As unique and unprecedented as the pandemic situation in India is, similar is the response of the private sector. Many organisations have contributed to NGOs, the PM CARES fund, and other state and national funds. The same companies are also covering the medical expenses of their employees and vaccination costs to help strengthen the fight against coronavirus.

The help is also extended to the family members and friends of their loved ones during emergencies. 

Such initiatives from the private sector have, directly and indirectly, helped reduce the burden on the health infrastructure of the country that was seen crumbling during the second wave.

The Final Word

2021 has proved to be the worst year in the history of pandemics for India. While the number of coronavirus cases seems to subside, it is still not the time to let our guard down.

If the cases increase, a similar crisis may potentially arise. There is already a warning issued for the third wave of COVID-19.

Now that we have seen how much chaos and fatalities this strange virus can cause, we must ensure to retain COVID appropriate behaviour and do our part in helping healthcare professionals.

Stay home, stay masked!

Sources:

CSR Box – Live Edition (2021). How Indian Companies are Responding to COVID-19.

https://csrbox.org/how-Indian-companies-responding-COVID19

Financial Times. Benjamin Parkin and Jyotsna Singh in New Delhi, Andrea Rodrigues in Mumbai (MAY 1, 2021). Stories from inside India’s COVID disaster. FT News. 

https://www.ft.com/content/39ad9165-fc31-42ff-86d5-317d32ecfe6d

The Tribune (July 13, 2021). 719 doctors dies of COVID in second wave of pandemic. IMA Study. The Tribune India News.

https://www.tribuneindia.com/news/nation/719-doctors-died-of-covid-in-second-wave-of-pandemic-ima-267324

The Times of India (August 8, 2020). IMA says nearly 200 doctors in India have succumbed to COVID-19 so far, requests PM’s attention. India News.

https://timesofindia.indiatimes.com/india/ima-says-nearly-200-doctors-in-india-have-succumbed-to-covid-19-so-far-requests-pms-attention/articleshow/77430766.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst

The Indian Express (May 17, 2020). 61% of Indians suffering from mental health issues during lockdown. Health News.

https://www.newindianexpress.com/lifestyle/health/2020/may/17/61-indians-suffering-from-mental-health-issues-during-lockdown-survey-2144506.html

Varsha Torgalkar. WMC Women Under Siege (June 9, 2021). India’s women frontline community healthcare workers tracing COVID-19 are left defenseless. WMC Health News.

https://womensmediacenter.com/women-under-siege/indias-women-frontline-community-health-care-workers-tracing-covid-19-are-left-defenseless