Citation: Rahim KA, Lassi ZS. The growing challenges of covid-19 for frontline workers in health facilities of Pakistan. J Clin Images Med Case Rep. 2021; 2(2): 1059.

Case Report

The declaration of COVID-19 as a pandemic on March 11, 2020, marked a life-changing disaster. In one-year people have started living a new normal, however, healthcare setups are still struggling to fight against coronavirus. On 26 Feb 2020, Pakistan confirmed its first case of the coronavirus when a student tested positive upon returning from Iran. As of 14 March 2021, there are over 602,000 COVID-19 cases, and almost 13,500 deaths have been confirmed [1]. Noncompliance with Standard Operating Procedures (SOP) followed by the lack of resources in public hospitals, is making the situation worse. Private hospitals are far better at providing quality care, but in the present time, even they have reached the maximum of their capacities in accommodating patients suffering from COVID-19.

It is not novel to hear about the absenteeism in and shortage of frontline workers particularly nurses because of increasing workload and deficiency of resources for decades [2]. However, the increased influx of patients suffering from COVID-19 especially in the tertiary care setups has put a huge burden on the healthcare system across Pakistan. While frontline workers are more focused on managing and caring for patients with COVID-19, their burnout and deteriorating health have completely been overlooked.

It has been established that Severe Acute Respiratory Syndrome (SARS) is a viral respiratory illness caused by the coronavirus and is spread by close person-to-person contact via droplets produced by an infected person who coughs or sneezes. Health authorities such as the Centre for Disease Control, and Prevention (CDC) and World Health Organization (WHO) have strictly advised all frontline workers to take necessary precautions to shield themselves from droplets and other body fluids of infected patients and contaminated surfaces by using Personal Protective Equipment (PPE) [3]. The scarcity of PPEs in hospitals during this pandemic is the primary reason for frontline workers’ burnout. PPEs are mostly not available, however, when it is available, frontline workers are forced to reuse them especially the face mask (N-95) for many days posing more risk to their safety [4]. This is striking anxiety and fear amongst frontline workers considering themselves on a “Suicide Mission”, and is the main reason for their absenteeism to work [5]. No evidence supports that the scarcity has been resolved. Besides, there is a shortage of COVID-19 trained nurses particularly those who are assigned to care for patients with severe COVID-19 who require ventilation support [6]. The anxiety of dealing with patients on mechanical ventilation is also giving rise to physical and psychological fatigue, exhaustion, and breakdown. Overwhelmed and struggling hospitals and health care facilities, during this pandemic, are not offering psychological support [6] and quarantine space to frontline workers who are increasingly threatened for the health of their own and other family members; and hence many frontline workers have resigned [7]. Though the cases of COVID-19 are now declining, the anxiety and fear persist in nurses; the frontline worker still complains of psychological distress and dissatisfaction with their job in Pakistan [8].

The government of Pakistan has started vaccinated the frontline workers against the COVID-19 virus for free in the majority of the hospitals; the vaccine will be given to all the frontline workers twice with a gap of nearly 1-2 weeks in between [9]. According to the recent report published in February 2021, there were nearly 150,000 healthcare workers who have received their first shot of vaccine in February. Besides, the second phase of vaccine rollout is to target seniors over 65 years which could help in flattening the COVID-19 curve and deaths in the population [10]. This would also be promising in declining hospital admissions and burden.

Though the initiation of the COVID-19 vaccine is a great initiative taken by the government of Pakistan, it does not mask the psychological suffering and burnout amongst healthcare professionals. It is very important to remember that frontline workers are health security warriors against coronavirus, and the government should take some immediate actions to protect them. The availability of PPEs in such amplification points is a must. Secondly, they deserve a pay raise and should be rewarded with incentives and given a hazard allowance. Third, they should be appropriately trained to care for COVID-19 cases. Health institutions and hospitals should also take measures in making policies for frontline workers who are facing this unprecedented circumstance and pressure during the COVID-19 pandemic.

References

1. COVID-19 Live Dashboard - Pakistan [Internet]. Google Data Studio. 2021.
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3. Modes of transmission of virus causing COVID-19: Implications for IPC precaution recommendations. 2020.
4. Chughtai AA, Khan W. Use of personal protective equipment to protect against respiratory infections in Pakistan: A systematic review. J Infect Public Health. 2020; 13: 385–390.
5. Doctors without armour [Internet]. Himal Southasian. 2020.
6. Ali S, Noreen S, Farooq I, Bugshan A, Vohra F. Risk Assessment of Healthcare Workers at the Frontline against COVID-19. Pak J Med Sci. 2020.
7. How Health Care Workers Avoid Bringing Covid-19 Home. Wired. 2020.
8. Mahmood QK, Jafree SR, Jalil A, Nadir SMH, Fischer F. Anxiety amongst physicians during COVID-19: Cross-sectional study in Pakistan. BMC Public Health. 2021; 21: 118.
9. Registrations for COVID-19 vaccine now open to Pakistan’s frontline healthcare workers [Internet]. Arab News PK. 2021.
10. Pakistan: 150,000 health workers get COVID-19 vaccine. 2021.