Deaths of doctors during the coronavirus pandemic have been haunting the pandemic world . Generally, the elderly and wise people used to say a doctor is second to none other than God. Death of one doctor is not only a death of one doctor, rather it implies one death means equal to deaths of hundred, thousand or a lac people depending upon the availability of one doctor per capita in a particular country. Death of a doctor in general and during the corona virus in particular, has become a serious cause of concern for the human race. There are many reports appearing in the media that doctors are being died due to direct infection by the coronavirus or indirectly by the coronavirus patients. Has the concept of doctor second to God been changing? The doctor who was supposed to bring out the patients from the jaws of death, not able to protect himself. Does it refer to the lack of a medical healthcare system? Perhaps, it raises the alarm and alert of paradoxes and paralysis of the healthcare systems prevalent in the respective countries.
The pandemics have plagued the human race since recorded history. With the transformation of the society from hunting the to settled agrarian communities, the scale and substances of these pandemics had increased exponentially. As the more development took place, the civilized human race had become more vulnerable to such pandemics. The argument can be substantiated taking into account deaths caused by the pandemics. During the last couple of centuries, the human race has been witnessed many pandemics, caused deaths amounts to 5 mil by Antonine Plague, 165-180 AD; 1 mil (Japanese smallpox, 735-737); 30-40 mil (Plague of Justinian, 541-542); 200 mil (Black Death, 1347-1351); 56 mil (New World Smallpox Outbreak, 1520 – onwards); 1 mil (Italian Plague, 1629-1631); 1 mil (Cholera Pandemics 1-6, 1817-1923): 40-50 mil (Spanish Flu, 1918-1919); 25-35 mil (HIV/AIDS, 1981-present) etc. The pandemics like Swine Flu, SAARS, Ebola, MERS and COVID-19 are of recent origin have put the medical and paramedical staff on high alert as well as their increased health risks and their own safety as well.
Coronavirus-19 which originated in Wuhan, Hubei (China) in December, 2019 and within a very short span of time, has entrapped the whole world. China, Italy, Spain, the US, UK, Iran have been among the worst affected countries. The outbreak of the coronavirus pandemic has impacted about 200 countries resulting in more than one lakh deaths and more than one and half million infected cases. In this situation, the role of healthcare professional becomes of prime importance. However, the health professions are becoming vulnerable and deaths of medical and paramedical staff have been taking place, lowering the morale of the health working staff amid the fighting with the Covd-19.
The outbreak of COVID-19 is being equated with war and healthcare staff as frontline fighters and heroes. Taking stock of the situation and realizing the severity and gravity of the same, the current outbreak of COVID-19 has been declared as a Public Health Emergency of International Concern. As a frontline healthcare worker, doctors, nurses and allied staff have been engaged on war footing to take care of the infected patients putting themselves at high level risk of infection and even to the extent of death. How a doctor is being infected, that is the worrisome question for a common man? Is it happening due to the lack of PPE or severity of the virus? But anyway, it is the sadistic part of the story in the backdrop of the Covid-19 that has been taking a heavy toll on the medical fraternity.
The International Health Emergency is becoming more critical at this juncture, when a lot of voices of resistance, criticism have been emerging on part of the medical community. In many countries including the Western ones, doctors and nurses have been putting up their papers for resignations. These healthcare staff have been asked to do their duties without the PPE. Even the nurses reported that the senior doctors are not attending the patients without PPE, rather only the assistant staff have been asked to do the same. Additionally, the doctors and nurses have been working day long and day nights, indirectly impacting their own health as well.
The WHO (Report 2006), had underlined the gravity of the healthcare professional shortage. It stated that there is worldwide lack of 4.3 million healthcare professionals including the doctors, midwives, nurses and support workers. About 36 out of 57 African countries have been facing severe shortage of the healthcare professionals. Even the developed countries like the US, Canada, the UK, Australia, New Zealand, Germany etc have also been facing the severe shortage, citing the reason of international migration including the limited capacity of existing medical institutions. What are the implications in case of shortage of medical and paramedical staff exist in almost all the countries? Shortage of medical and paramedical staff affect the quality of the medical care of the citizens, increased workload directly affecting doctors and indirectly the patients safety; costly healthcare system due to less competition; and ultimately leading to the untimely deaths of the patients even after spending a lot of money as capacity allows.
China was reported as the first country, where the report of doctor’s death due to the corona infection made the main headline in the print and electronic media. Gradually, the doctors and nurses in many countries have died while attending the coronavirus affected patients. As per the report of Newsweek (10 April), more than 200 doctors, nurses and healthcare workers have died combating with the coronavirus across the world including the most affected countries like China, Italy, Spain, US, UK, France, Iran etc. Italy is being an epicenter of the coronavirus deaths, has been standing on the top of death list. About 120 death of doctors and nurses have taken place in Italy; followed by 24 (Indonesia); 19 (UK); 13(China); 12 (Iran); 11(Spain); 5 (France): 02 (US): 1 (Greece); 1(Poland) ; 1 (Pakistan) 2 (India) etc. The most serious situation in this respect is the case of Italy, where more than 100 doctors and 30 nurses and nursing assistants have died due to infection from the coronavirus patients. In the UK, it becomes a double disadvantage when the doctors and nurses have been dying from the Black, Asian and Minority Ethnic (BAME).
At this juncture, it is difficult to say with certainty, the curse of corona how long it will take? How long will it take to reach its peak and how many people would come in its trap? But it’s for sure that most of the governments have knelt down before the monster of corona. Until now, there is upward trends in the deaths due to the corona infection, Starting from a few hundred deaths given the coronavirus, the same has reached to 117,586 and 1,888,975 as confirmed cases. The major paradox is that developed countries come on the top of death list. The US is standing at the top with 22,877 deaths; followed by Italy -20,465; Spain -17,489; France-14,393; UK-11,329; Iran 4,585; Belgium-3,903; China whereas coronavirus is originated, deaths amounted to 3,341.
Generally, it is being argued that the coronavirus has still been under control in the developing countries, which is barely digestible. The rationale of the argument is that the testing of the coronavirus cases has not been carried out at the mass level due to the lack of testing kits. Whereas the developed countries have become hotspot and epicenters of the coronavirus cases due to tests at the major level if not at all mass level. To me, it seems that it is something paradoxical, where health security and the system are being proclaimed as the fundamental rights of the citizens could become hotspot and epicenters over the developing countries where the ratio of doctors per capita is very low as compared to the developed countries.
One more paradox emerges in this critical situation. If neoliberal system is so generous, how the neo/liberal countries, that are the strong advocates of liberal system, have been facing the shortage of basic healthcare PPE systems including the doctors and nurses? Why, even minuscule part of the medical community raising their resistance and criticism for the lack of PPE and why these people have been putting up their papers for resignation, at the time when their services are of prime importance for national/health/personal security?
Most important paradox is increasing the suicidal tendencies among the doctors/nurses/nursing assistants. As per the study of Hawton et. al., (2011), the suicide risk has been increased in certain occupational groups in general and especially in the medical-related professions. The major highlight of the study of Bachmann (2018) underlines the gravity of situation that the female doctors have higher suicide rates than men whereas in common people it is in reverse order. The major causes responsible for doctors/nurses suicides vary but the share common ones such as are patients’ cares, heavy workload, lack of autonomy, work-family conflicts etc.
Deaths of doctors/nurses/nursing assistants simply means, the health care systems of the developed/developing countries have become paralyzed. It is one the noblest professions, and if these people have not only been leaving the services rather many of them putting up their papers for resignation, it raises serious alarms and alerts for the governments to rethink the existing health care systems. The doctors/nurses who are supposed to take care of patients, if they per se have been suffering from suicidal syndromes, how can patients be taken care of?
Therefore, it is suggested that the shortage of the doctors/nurses must be taken care of by the respective governments. These people should be provided with adequate protective equipment. Working loads of doctors/nurses may be set proportionally to maintain the balance between profession and family. Efforts are to be made to set the identical working/services conditions to avoid the team conflict and differences between doctors and nurses.
Of course, moral values may be given an important place in the medical profession curriculum to keep them in high spirit, avoid suicidal syndromes and to promote the concept of selfless service. The important point in this respect is that medical education is to be made cheaper, so that it would be accessible to the marginalized people. One can hope, by taking these steps, paralyzed health system may be revived and the untimely death of doctors along with patients deaths can be made preventable.
*Dr. Bawa Singh is teaching at the Centre for South and Central Asian Studies, School of Global Relations, Central University of Punjab, Bathinda, India.