Mandy Wiener | Covid-19: We have to ensure the safety and sanity of doctors on the frontlines

A health professional holds a swab test for the coronavirus at a drive through testing site outside the Lancet Laboratories facilities in Johannesburg. (Marco Longari, AFP)
A health professional holds a swab test for the coronavirus at a drive through testing site outside the Lancet Laboratories facilities in Johannesburg. (Marco Longari, AFP)

Beyond the physical well-being of our medical staff, we also need to worry about how they are going to get through the next few weeks as cases are expected to surge, writes Mandy Wiener.

Over the past few days, a hashtag has begun trending in the United States as doctors in New York in particular find themselves overrun by patients suffering and dying from Coronavirus.  

#WhereisthePPE show doctors and nurses on the frontline using black rubbish bags, patient gowns, bandanas and pretty much anything else they can MacGyver together to make themselves Personal Protective Equipment to ensure they don’t catch the virus themselves.

The shortage of PPE in the US has become a massive concern. There are simply not enough medical masks and protective equipment for everyone.  

The more health care workers there are that contract the virus, the more capacity drops which makes it so much harder to #flattenthecurve as we have all been trying to do.  

In Italy, worst hit by the pandemic, 61 doctors have died from the virus.  

Medical workers have largely been left to deal with the outbreak without adequate supplies of PPE,  reportedly only equipped with masks, scrubs, gloves and hairnets.

The President of the medical association there said doctors were being sent to "war unarmed".

"The dead do not make a noise. Yet, the names of our dead friends, our colleagues, put here in black and white, make a deafening noise," said Filippo Anelli. 

Fortunately in South Africa, we have had the benefit of learning from those countries that have been worse hit ahead of us. Time is the greatest commodity of all when fighting a pandemic of this scale.

Our government knows full well that we need PPE and lots of it.  

READ | Coronavirus: SA healthcare staff concerned over 'intermittent' supply of masks

The National Treasury has moved to purchase masks and other essential supplies on an emergency basis.

It issued an instruction note last week, telling accounting officers how the procurement of hundreds of thousands of masks, gloves, face shields, protective suits and a range of other medical equipment should be undertaken. 

On Monday, the Solidary Fund announced by President Ramaphosa last week, reported that it has raised over R500 million from corporates, government and individuals who have donated their own money.

The fund has made R100 million available as working capital to urgently fund the purchase of critical medical supplies to protect health workers. R52 million of this will go towards purchasing five million surgical masks.

Officials are scrambling to get supplies but this is a global problem and the difficulty is going to be with international suppliers and importing through closed borders.

We are already hearing from doctors in both public and private hospitals dealing with Covid-19 patients, that they are beginning to worry about PPE running out.

A panicked public has been stealing, stashing and misusing masks and gloves.

In some instances, cleaners have misused them. Medical professionals I know have been posting about how they’re using file dividers to make face screens. They’ve posted pictures of the one mask they have been reusing every day for an entire week. 

Many have bought their own PPE at exorbitant inflated prices.

While anecdotally the situation on the ground is ominous, the Gauteng Health Department’s Kwara Kekana says that for now there is enough PPE.

"We are continuously procuring to ensure that facilities, where needed, they get. We have been receiving stock of PPE and sending to facilities. There is a global shortage of certain items that we are working around the clock to source."

Management seem to be comfortable with the current stock situation but the doctors are not. They fear imminent shortages. That means their lives will be in danger.  

In the Western Cape, provincial health minister Nomafrench Mbombo is appealing to the public not to waste PPE and to ensure it gets to where it is needed most.  

"Wearing a mask or gloves when going to the supermarket or pharmacy to buy essentials, is ineffective, unnecessary, and will not protect you from the coronavirus.

"In fact, it spreads the virus faster because it makes you a carrier from one person to another, it also gives false security that you don’t need to wash or sanitise your hands. Personal protective equipment (PPE) is a scarce commodity and should be used appropriately and by the appropriate people. If you are not ill and not in close contact with someone who has coronavirus, you do not need to wear a mask or gloves."

On Monday, Business for SA’s Public Health Workgroup also issued a call to all companies, especially those in lockdown, to urgently divert their stocks of PPE for use in the national healthcare sector.

"The PPE is critically needed to protect frontline doctors and healthcare workers, and to keep them healthy in their fight against the pandemic," said the organisation. 

But beyond the physical well-being of our medical staff, we also need to worry about how they are going to get through the next few weeks as cases are expected to surge.

We hope they won’t and the lockdown will be effective, but an increase in numbers is inevitable.  

Writing in the New York Times this week, Jennifer Senior commented that we shouldn’t underestimate the moral anguish of making life and death calls, like deciding who gets a ventilator.   

"This is the moment to pray for the psychological welfare of our health care professionals. In the months ahead, many will witness unimaginable scenes of suffering and death, modern Pietàs without Marys, in which victims are escorted into hospitals by their loved ones and left to die alone.

"I fear these doctors and nurses and other first responders will burn out. I fear they will suffer from post-traumatic stress. And with the prospect of triage on the horizon, I fear they will soon be handed a devil's kit of choices no healer should ever have to make. It’s a recipe for moral injury."

Doctors I know are already making immense sacrifices, leaving their families behind, to treat the most vulnerable in hospitals. It’s going to get harder and harder for them.  

We have to ensure that those at the frontlines in this silent war are cared for as well, as they are caring for the rest of society.  

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