The high price paid by healthcare workers

Borzou Daragahi, The Independent

The anguished end of Cemil Tascioglu’s well-lived life came on 1 April. He was a physician who had devoted his life to treating both the patients under his care and the medical students under his tutelage with dignity and compassion. But the respected doctor and beloved scholar died hooked up to machines and alone in an intensive care unit, becoming one of the nearly one million people worldwide killed by the coronavirus pandemic.

He spent his last two weeks intubated and unconscious in the same Istanbul teaching hospital where he had worked much of his life. When the doctor and professor of medicine finally succumbed to Covid-19, no warm hands of his children or loved ones held onto his. None of the students or colleagues that he had trained, nurtured and cultivated over the decades were nearby. He was 68.

“The saddest part was that you could not physically contact him or say anything to him in those final days,” says his son, Irem Tascioglu, 35. “The whole process was a bit too quick. We were talking on the phone and he sounded healthy. Then he got intubated and we were really worried.  They don’t let you into his room. You couldn’t even get near. You could not even go inside the hospital.”

Tascioglu, who contracted coronavirus after treating Turkey’s first confirmed COVID-19 case, was one of thousands and perhaps tens of thousands physicians, nurses and medical personnel to have succumbed to the disease they are on the frontline of  treating.

Of the nearly one million who have died of COVID-19, thousands have been medical workers. The World Health Organisation estimates that 14 per cent of all those infected have been hospital or clinic employees and staff, including ambulance drivers and orderlies, putting a disproportionate burden of the pandemic onto the shoulders of healthcare employees.

Amnesty International reported earlier this month that at least 7,000 healthcare workers have died of COVID-19, though the numbers could be much higher. The International Council of Nurses reported this month said at least 1,000 nurses have died in 44 countries surveyed. Some estimates put the number of medical personnel deaths at 30,000 worldwide.

“These are huge numbers, and behind every of those numbers is the tragedy and loss for an individual family,” says Howard Catton, CEO of the Geneva-based International Council of Nurses. “The fact that countries are not systematically collected data on this is a scandal.”

The journal Medscape has a database naming 1,800 medical workers who have died of the pandemic. Among them are Felicia Ailende, 67, a nurse at a nursing home in southwestern Chicago; Wang Tucheng, a 27-year-old village doctor in China’s Henan province; Gerallt Davies, a 51-year-old paramedic in Swansea; Mohammad Javed, a 55-year-old ear, nose and throat specialist in Peshawar, Pakistan; and Carla de Oliveira Obelar, a 42-year-old neonatal nurse in Rio de Janeiro.

As the pandemic’s toll looks set to surpass one million, it has transformed the medical profession like no other, affecting recruitment and retirement patterns, as well as day-to-day protocols, adding a new and enduring layer of fear and stress to the lives of caregivers.

“Covid has probably changed forever many things in our societies but certainly has changed the delivery of health services,” says Dr Edward Kelley, a senior official at the World Health Organisation, responding to a question from The Independent. “Not just infections, but the stress and the mental health and the new ways of working have forced the medical community to adjust to Covid.”

The human loss is unfathomable. In addition to the grief of those close to the fallen, the wave of premature doctor and nurse deaths means hundreds of years of precious experience and expensive training are lost. Tascioglu, for example, was never referred to by his students or even most colleagues as “doctor.” He was called hocam, which means my coach or mentor, in Turkish, or hakim, which suggests a wise man or judge.

“How he was actually treating patients not like carriers of disease or illness,” says his son, Irem. “He was always asking questions about their life stories. He was well known for his diagnostic skills. All the students were impressed by the way he talked. ‘What do you think is wrong with this patient?’ he would ask . ‘But don’t be too technical. Try not to impose. Try to learn. Try to ask.’”

The threat of death and illness is profoundly impacting the mental health of those medical personnel who soldier on. Many fear contracting the virus at work and bringing it home to more vulnerable relatives, or their own children.

In much of the world being a doctor or nurse in itself never really posed a challenge to one’s health, says Andrew Goddard, a professor of medicine at Royal Darby Hospital and president of the Royal College of Physicians. “This is the first time that doctors are fearing for their lives and health, but also for the health of their families.”

Goddard, a gastroenterologist, described the covid-19 death of a close friend and colleague “as probably the worst point of my professional life.”

Numerous studies have already been sketched out warning that the pandemic was wearing out the medical community, causing an epidemic of Burnout Syndrome, “defined as an excessive and prolonged stress whose main components are emotional fatigue causing energy loss, wear out feeling and fatigue,” which lead to diminished working ability and depression, according to a paper by published a Brazilian medical journal.

Faced with the dangers and stress of the pandemic era, many physicians and nurses have taken early retirements, or simply quit their jobs. In Turkey, between 200 and 300 hundred physicians have either applied to retire or stopped showing up for work, said the head of the doctors association. Tascioglu was set to retire from clinical practice this year, though he was eager to keep teaching.

The shortfall in experienced and well-trained medical personnel will be global. Jordan Search Consultants, an American recruitment firm, predicts an “unprecedented demand for providers unlike what hospitals have ever dealt with before” as a result of Covid-19.

“People are asking, am I prepared to take that level of personal risk and sacrifice?” says Catton. The pandemic has also complicated efforts to quickly train up new physicians. Remote learning means medical students are unable to shadow physicians or work as volunteers at medical facilities and are denied access to laboratories or morgues.

“We’ve seen a dramatic decrease in our ability to train doctors,” says Omar Khorshid, president of the Australian Medical Association, speaking in a telephone interview from Perth. “We’ve been unable to perform exams. We’ve had difficulty performing the selection processes.”

Doctors and nurses across the world have staged protests, demanding better conditions, pay and safety equipment. “Nurses say enough with the clapping and applause,” says Catton. “Get us the personal protective equipment and testing we need.”

But even as it has underscored the healthcare failure of governments, the pandemic has also brought the medical community together across the world like nothing before, as physicians share clinical experiences and researchers race to find treatments and a vaccine — potentially establishing protocols, precautions and treatments that can be applied to the next pandemic to strike the world.