The Westminster government in England and as a consequence the other jurisdictions of the UK are now pursuing policies that require the population to effectively get used to living with COVID-19. The Secretary of State for Health and Social Care Sajid Javid is on the record as saying that the UK is leading the way in learning to live with the virus “…thus enabling the country to begin to manage the virus like other respiratory infections.” So is Coronavirus like other respiratory Infections? Well, we know it is not, just by looking at the impact that the virus has had on health and social care workers.
The WHO in September 2021 estimated that between 80 000 to 180 000 health and care workers could have died from COVID-19 in the period between January 2020 to May 2021, converging to a medium scenario of 115 500 deaths. This estimate is derived from the 3.45 million COVID-19 related deaths reported to WHO as of May 2021; a number considered to be much lower than the real death toll (which could be 60% or more than this estimate). See the John Hopkins Coronavirus Resource Center figures.
In March 2021, Steve Cockburn, Head of Economic and Social Justice at Amnesty International stated that “For one health worker to die from COVID-19 every 30 minutes is both a tragedy and an injustice. Health workers all over the world have put their lives on the line to try and keep people safe from COVID-19, yet far too many have been left unprotected and paid the ultimate price,”
Unsafe working conditions and a lack of personal protective equipment (PPE) have caused huge problems for health workers worldwide throughout the pandemic, especially in the early phases. Some groups were particularly neglected cleaners, auxiliary staff and social care workers even faced reprisals including dismissal and arrest after demanding PPE and safe working conditions in some countries. In a significant number of countries, the neglect of care workers has been a consistent feature of the pandemic. At least 1,576 nursing home staff have so far died from COVID-19 in the USA. In the UK, 494 social care workers died in 2020, and UK government data shows that those working in nursing homes and community care were more than three times as likely to have died from COVID-19 as the general working population.
Death though is only one outcome. What about Long Covid? There have been many reports from healthcare professionals experiencing mild symptoms during their initial infection with COVID-19 and thereafter a prolonged course of symptoms of fatigue, dyspnoea, joint pain, and chest pain, many of which are characteristic of autoimmune mediated responses. How many healthcare workers are we talking about though who may have Long Covid?
In September 2021 the ONS estimated that the percentage of healthcare workers living in private households with self-reported long COVID of any duration by sex and age group in the UK, for the 4 week period ending 5 September 2021 was as follows
Amongst men it was 2.28% in women it was 3.36% rising to a worrying 4.01% in women over 50.
Their estimates relate to self-reported Long Covid, as experienced by study participants in the ONS Coronavirus infection Survey. Although they were not clinically diagnosed as having Long Covid they were asked to respond to the following questions: “Would you describe yourself as having ‘long COVID’, that is, you are still experiencing symptoms more than 4 weeks after you first had COVID-19, that are not explained by something else?” and, if so: “Does this reduce your ability to carry-out day-to-day activities compared with the time before you had COVID-19?” and “Have you had any of the following symptoms as part of your experience of long COVID? Please include any pre-existing symptoms which long COVID has made worse.” So it is fairly certain that they were experiencing Long Covid at the time.
Again you have to consider this an underestimate, as health professionals have been overwhelmed with the surge in workload posed by the rise in cases and growing demand on the health systems that have limited capacity. Symptoms of chronic fatigue, joint pains and dyspnoea could easily be attributed to the additional workload, or accompanying work related stress. Healthcare workers are likely to be silently suffering while experiencing Long Covid, even while continuing to save lives during this ongoing pandemic. So let’s just say that we are losing around 4% of the health and social care workforce worldwide for some considerable periods, as a consequence of Long Covid. One product of this is that if we are to protect the health and social care workforce, research into the role of repeated exposure in a healthcare delivery setting and/or in the community to COVID-19 needs urgent evaluation. While we know vaccinations are saving lives, we have very little knowledge of the protection they offer to Long Covid should you get infected or re-infected as is occurring now.
There are also the other consequences that are concerning all healthcare organisations currently, as an increasing proportion of the workforce are suffering from burnout, stress, anxiety and fatigue.
So back to my original question. Should we be managing this virus like other respiratory infections. Well clearly not… because if we do the outcome will be more health and social care staff dying and developing Long Covid etc. and they are in short supply worldwide as it is. In October 2021 the WHO and its partners began calling on all Member State governments and stakeholders to strengthen the monitoring and reporting of COVID-19 infections, ill-health and deaths among health and care workers. They should also include disaggregation by age, gender and occupation as a standard procedure, to enable decision makers and scientists to identify and implement mitigation measures that will further reduce the risk of infections and ill-health. As a society we have a moral obligation to protect all of our health and care workers, ensure their rights and provide them with decent work in a safe and enabling practice environment and that includes not exposing them to further risk because of our and our respective governments’ complacency.
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