Throughout this pandemic, we have seen that no one is safe from COVID-19. It’s all around us, and what’s worst of all is we cannot see it which makes everyone a target. Because this is transmitted through direct contact with respiratory droplets or through touching contaminated surfaces, occupations where there are communal spaces and close communal contact are more likely to see cases. As expected, healthcare settings are one of the most affected workplaces due to the high volume of patients infected with COVID-19. In order to protect the workers from the patients, personal protective equipment (PPE) is utilized. However even with these measures being put in place, we are still seeing a disproportionate amount of healthcare workers reporting cases of COVID-19, ranging from 14-35% around the world, even though this group makes up only 3% of the global population. This suggests that even with the stringent hygiene measures that are being put in place, the PPE that they are using is not providing adequate protection, and therefore negatively affecting the workforce’s ability to provide care.
Prior to the outbreak of COVID-19, there was already a huge shortage of healthcare workers globally which is estimated to be around 7.2 million people. In the US alone, there are as many as 1.2 million vacancies that need to be filled. With COVID-19 entering healthcare facilities and hospitalization numbers pushing critical resources and staffing to the brink, this further exacerbates the effects felt of these shortages. On top of this, the people that are needed to care for patients are contracting COVID-19. Those staff are then taken away from their work, and because of the lengthy duration of symptoms and effect of the disease, there can be significant periods of time before they are able to return to work. The impact of all of this brings to the surface some significant short and long term issues for an already fragile healthcare system.
With healthcare worker numbers falling short of the demand for patient care, their workloads are increased as they try to keep up. For nurses and doctors, this means they have less time with each patient, and less staff that are able to attend to their needs. This results in a reduced quality of care that they are able to provide and this is difficult to deal with in this profession. Because of the highly contagious nature of the disease and the need for staff on the frontline, working conditions are made difficult, resulting in long shifts without normal break times and days off to regain their strength. This means the healthcare workers are operating under incredibly high levels of fatigue, stress and anxiety, taking a heavy toll on their mental wellbeing.
Who’s at risk?
In aged care facilities, the residents are in the highest risk bracket for COVID-19. With underlying health issues and an already compromised immune system, these factors make this group of people susceptible to the effects of the disease. Despite only making up 5.7% of all cases in the US, this group accounts for nearly 40% of the reported deaths. Staff need to be in extremely close contact with residents to bath, dress, feed and provide medical care which makes transmission in these environments a common occurrence. Many staff and other residents may be unaware that they are infected due to the long incubation periods of the disease, and with some people remaining asymptomatic throughout, this makes it even harder to contain and trace. PPE, such as surgical masks and safety glasses are being utilized in these settings, but do not guarantee protection, which makes both residents and staff incredibly vulnerable.
One of the most devastating impacts that shortages of healthcare workers have is on the people needing treatment for things outside of COVID-19. Because resources are pushed to their brink and the highly infectious virus is present in these facilities, in an effort to reduce the spread and treat the excessive numbers of cases, those that are needing non-COVID-19 related treatment are put on the back burner. Elective surgeries such as knee and hip replacements are being deferred as these are not considered life-threatening, although patients may be in excruciating pain. Where emergency treatment is needed for things like heart attacks, if a hospital is filled to the brink, the patient cannot be treated in that facility and so this backlog of COVID related patients is risking the lives of others. In addition to this, treatment of noncommunicable diseases like cancer, diabetes and coronary artery disease are being disrupted with vital screening and treatments not occurring. This also raises issues around the diagnosis of other diseases that may have significant consequences for these groups of people and can result in compromised quality of living or even death.
The way forward
The people in healthcare roles are highly skilled, and depending on the qualification, it can take between 3-8 years to become qualified in their particular field. It is simply not feasible to fill these vacancies and meet the demand that is currently needed, so it is of the utmost importance to ensure those that are on the frontline are being protected in every way possible to ensure theirs and their patients’ safety. When hazards cannot be engineered out of work environments or reduced through administrative measures, then PPE is the most logical form of protection for the worker. Healthcare facilities throughout the US have been turning to alternative forms of PPE, with the biggest shift being to powered air purifying respirators (PAPRs). These offer a far higher level of respiratory protection through filtration that is able to prevent COVID-19 from entering the respiratory system in addition to protecting all exposed areas such as the eyes, mouth and nose. Through using PAPRs, healthcare facilities such as the Freeman Health System in Missouri have reported zero staff cases of COVID-19.
It is clear that the battle on the frontline is going to continue for some time until the virus plateaus and vaccines are reliable, and readily accessible. However, until then, the health system as a whole is at threat and at the heart of it, it is absolutely crucial that healthcare workers are able to go to their place of work and come home each day, COVID-19 free. Through reassessing the PPE being utilized, this is one simple way that can have a huge impact towards protecting and saving millions of lives.
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