Since the start of the COVID-19 pandemic, thousands of doctors worldwide have contracted the coronavirus – about 3,400 medical workers in China, and nearly 12,700 in Italy where at least 94 doctors and 26 nurses have died as of April 7. People in the healthcare sector are at risk due to constant contact with the infected and exhaustion after many hours of work. Hromadske spoke with Ukrainian doctors and volunteers in Czechia, Germany, Spain and the U.S. about their work during the pandemic.
“You get scared of helplessness”
Roman Glushchenko, a doctor in Zaragoza, Spain
Initially, experienced infectious disease specialists and epidemiologists who have experience of more than one epidemic in Africa had been reassuring that there is no threat, that Spain has one of the best healthcare systems in the world. But the opponent was underestimated.
They understood that the situation was serious only when the outbreak had swept Italy. When the March 8 demonstrations were held in Spain, epidemiologists said that quarantine should be introduced immediately and the medical system must be prepared for a large workload. Later, we realized that we had lost the moment – the infected were already spreading the virus being unaware of that. On March 14, a state of emergency was declared in Spain.
Potentially vulnerable groups of population have been determined rapidly based on experience of past epidemics – for example, SARS and avian influenza affected the heart. Recently, there have also been other symptoms – dry eyes, dizziness, and loss of smell. When the epidemic started, the priority was to define the bigger picture, so many details were not noticed by the doctors. But it is also important to understand that viruses mutate and adapt, and the virus that is now spreading in Europe is different from the one that has spread in China.
At first, there was even a lack of masks – people were sewing them by hand. In the early days, many medical professionals became infected. Scheduled surgeries and consultations were canceled, and within 2-3 weeks doctors working from home, such as urologists, were engaged in duty and work in the infectious wards. When even this wasn’t enough, senior medical students were brought in. Many of my acquaintances got infected. Sometimes doctors who have mild symptoms are not even tested because there will be nobody to work.
Generally, we understood that the best healthcare system is the one that has people who – whatever happens – are saving lives every time, working without the proper resources, respect and pay for work which actually cannot be properly appreciated. Maybe if these points were to be prioritized, it would be possible to prevent, rather than resolve, the problems.
We expect a peak in morbidity at the end of April – about 270,000 hospitalized. There are 200,000 beds in the country. The numbers are jaw-dropping and this is a key factor that people who need help can't get it. Due to the overload of the system, patients with stroke, heart attack or cancer have to be left behind because people do not understand that now it is necessary to stay home.
Blood turns cold when you see the expo center and seven hotels in Madrid being converted to hospitals because of the lack of beds, and the ice arenas into morgues. And when you see an elderly asking to find a socket to say goodbye to relatives, just in case, or 25-year-old men who have their lungs full of pus in a matter of hours, you become scared due to helplessness and understanding that it was possible to prevent the situation.
Family and loved ones are the best support for doctors and patients alike. Daily applause from the balconies and words of support on social media are extremely motivating. Despite the lack of time, psychology webinars about burnout are organized, topics like social distancing, excess information, and loneliness are also touched on.
A month ago, I was explaining the threat of coronavirus to my friends in Kyiv. They suggested I write an article and tell in simple terms about possible consequences, and subsequently – launch a Telegram channel to distribute important information. I am still surprised by the phrases like "there is no virus, this is information terrorism." But I understand that this is due to a lack of information – and it motivates me to write further, though there is no time at all.
And I am very glad when people stay home and promote safety measures. They very much facilitate the work of doctors and protect themselves. Everyone saves the world differently – some in the hospital and some on the couch in their pajamas.
“The modern history of mankind has not seen such figures”
Hryhoriy Lapshyn, surgeon at the University Clinic of Lübeck, Germany
The situation is a bit surreal: there are almost no patients and doctors in the hospital, we have not been doing planned surgeries for two weeks. About 80% of doctors are now home – resting and awaiting their turn. We only operate and treat patients who need immediate help.
The clinic isn’t the only place missing people – the streets are empty too. Everyone stays home. Authorities only allow to visits to pharmacies, hospitals and supermarkets. Running and exercising alone is also allowed.
READ MORE: Ukrainian Medics to Help out in Italy
Recently, Chancellor Angela Merkel stressed that the situation is very serious and there has not been a time since World War II when the country would need more solidarity than it does now. Mortality rate from coronavirus in Germany is 0.5% (data as of March 27; 1.9% as of April 7 – ed.). At the same time, in Italy about 600-800 people die daily, which is an almost 10% mortality rate (12.6% as of April 8 – ed.). In Europe, the average mortality rate for coronavirus is 6% (data as of March 27 – ed.). This is because of the elderly. The average age of those infected in Germany is 45 years and 81 years of those who died.
The Robert Koch Institute estimates that 60-70% of Germany's population will get infected. The peak is expected in May-June. 83 million people live in Germany, so 70% is about 50 million. The mortality rate in the country is increasing, and according to the most optimistic estimates, 1% of those infected will die – 500,000. The modern history of mankind has not seen such figures.
About 160,000 tests a week are done In Germany. Those who have had contacts with patients, who have symptoms and those working in hospitals are being tested. Only patients in serious condition are hospitalized, and the rest are placed in self-quarantine for two weeks.
This approach to testing is one reason behind the fact Germany has many infected but a low mortality rate. The way to solve the problem is to buy time. That’s why they have introduced such testing mode – to identify and isolate the infected quickly. The second step is to protect people at risk. The third, and very important, is to improve the healthcare system rapidly. People would get sick anyway because the coronavirus is very contagious.
“At first, we laughed about it but now it isn’t so funny”
Mykola Poberezhnyi, student of the Faculty of Medicine, Charles University of Prague, volunteer at Hořovice Hospital, Czechia
When the state of emergency was introduced in Czechia, the universities quarantined, so at first we just stayed home. There were few patients, no one knew what was happening. And then the number of infected began to increase, so doctors began to work several shifts in a row. The medical faculties offered students’ assistance. Later, the ministries in charge joined the initiative.
Volunteers were asked to choose a hospital from a list of those who had agreed to get help from students. At first there were few such establishments, and now there are many of them all over the country.
There is work of various degrees of difficulty. The easiest thing to do is look after the children of the doctors while they are at work. The most difficult is to work in infectious wards. Students are well paid – 150 CZK (almost $6 – ed.) per hour. This is the largest sum that a Czech student can expect.
I work in a small hospital 40 kilometers from Prague. It did not have an infectious ward, but now the medical system is on the verge, so we opened it at the neurology ward. We can choose a shift – morning, evening or night, which last from 6 to 11 hours. My two longest shifts lasted 13 hours.
Our hospital is sealed, there is one entrance and exit. At the entrance, there are three temporary tents where I work. The first one is where the students work. We interview patients and decide whether to admit them to hospital. In the second tent, children are examined separately and the third tent is for those who are suspected of carrying coronavirus infected and who must be isolated. We have thermometers, plenty of disinfectants, masks and protective suits – this is in short supply across the country, but the hospital provides us.
We decide whether to let the patient go further based on a questionnaire – whether the individual was in self-quarantine after returning from dangerous regions and whether there are any symptoms of COVID-19. If at least one question is answered in the affirmative, we do not let the person enter the hospital. Patients who do not require a serious examination go home, and those who need treatment go to the isolation tent where a doctor works with them.
There can be 1,000 people during a shift, you need to be on your feet all the time. My job is to do everything for patients: run to the hospital for prescription or a note, take patients in a wheelchair. It is exhausting. We admit about 10 people with COVID-19 symptoms every day. People in Czechia usually stay home if they have coronavirus symptoms.
We have signed contracts until mid-April but are already getting offers to continue working. In my hospital the infectious ward is being expanded, volunteers will be required – so I will probably work there.
Mykola Poberezhnyi, student at the Faculty of Medicine at Charles University in Prague, volunteer at Hořovice Hospital, Czechia. Photo from personal archive provided to hromadske
Vasyl Dolog, student at the Faculty of Medicine at Charles University in Prague, volunteer at FNKV, Czechia
In the winter, we did not take the situation seriously. The pandemic seemed very distant, we even joked about the coronavirus. Personally, I thought China just had a bad healthcare system. At the beginning of March my friends went to Italy. There were already quite many cases of the disease, but we still laughed about it. And then the first infected were confirmed in the Czech Republic. It slowly reached 100, and then very quickly to 200. When it reached 500, it wasn’t funny anymore.
Students organized themselves when there were 150 patients in the country. I saw the questionnaire and decided to sign up, just in case. I thought that being on that list would be a plus for karma. My friends and I were sure that they would not send us to any hospital, so we asked not to be at the end of the list. Now they are sending everyone and are recruiting more.
Initially, I worked at a hygienic station. For instance, people who had a connecting flight leaving from an Italian airport and did not know what to do were calling us. Then I went to work in the hospital in the therapy ward. Half of the ward’s staff was quarantined because it turned out that they had been working with a patient with COVID-19. I was a paramedic, but I did everything that was needed: I looked after patients, helped doctors put on protective suits, mixed medicines.
Three days later I was transferred to the infectious ward. But in a few days it turned out that there was another COVID-19 patient in the therapy ward. The doctors were quarantined and I went there again to help. And after a fortnight, we had another coronavirus patient diagnosed. It turned out that I was working with this patient without protective gear. So now I'm also at home for a 14-day quarantine. After these cases, in regular wards, doctors work in respirators and protective face shields, and only one patient can be in a room.
Doctors and students who are sent for quarantine are not tested. There are very few tests in the country, even patients wait for them for several days. After two weeks of self-quarantine, I will be tested and return to work in the same infectious ward.
Our department was not overloaded while I was working, but even the simplest action required efforts – you had to put on a suit and a respirator, disinfect and then vice versa. It took longer than working with patients themselves.
We had patients with coronavirus suspicion, and those who received a positive PCR test were sent to one of four hospitals in Prague. All the beds were already taken there, so the "positive" patients will stay with us. The Czech health system will be able to accommodate 15,000 patients, and there are already 3,000 infected in the country (5,033 as of April 8 – ed.).
"Yes, it will happen, but not to me"
Ivanka Nebor, ENT doctor at a research position at Cincinnati Hospital, USA
Before the outbreak in the U.S., we were quietly discussing the virus, quarantine seemed to be a commonplace thing. The doctors were a little concerned, but nothing serious was happening. That all changed three weeks ago. Restaurants, subways, and stores in Washington and New York were already closing. And in California, people still were going to the beach. Now California is also under lockdown.
The hospital changed the work schedule, created online systems for hourly workers. The doctors were divided into two groups which are shifting every fortnight. In our hospital, one ward was reformatted for the needs of patients with coronavirus. But any reformatting means big money, so for now, we're watching New York and Washington.
Planned surgeries and examinations are postponed until May-July. They expect that by that time the epidemic will subside. It is a complicated process that affects doctors’ financial situation. But when quarantine is over, they will be extremely overloaded with work. Patients are understanding with regard to the changes.
Ivanka Nebor, ENT doctor in research position at Cincinnati Hospital, USA. Photo from personal archive provided to hromadske
I live in a mid-sized city in Ohio, where there are relatively few cases of the disease yet. There is no developed network of public transport and crowds like in big cities, so the infection does not spread that fast. The restaurants, cafes, and entertainment facilities are already closed. Only supermarkets and pharmacies remain open. Everyone reassures themselves, "Yes, it will happen, but not to me. Learning from Italy’s experience, they are trying to prevent the outbreak.
This is how “one-story America” works but big cities are more difficult to control. No one is surprised that New York has become the epicenter – many people from Europe and China have returned. When Trump announced the closure of the borders, doctors said it was too late. But everything happened so quickly that I still can't grasp that half the world is quarantined now.
The medical system in the U.S. is complex, it is based on insurance, which covers emergency cases too. People who do not have it still receive medical care – for example, through the Medicare system. It is in the public interest to cure everyone.
The hospitals in the U.S. had disinfectants and antiseptics everywhere in every ward even before the outbreak. Usually, there are no knobs on the doors – you have to push them. At first, we were even taught to wash our hands properly. Now we are following the new instructions: for example, you cannot take a purse to the hospital and you cannot take anything home from the hospital, even a pen. You are also advised to bring packed food and your own cup from home, and to greet your family home only after your clothes are in the laundry room and you have taken a shower.
Together with [Ukrainian education platform] Prometheus, our INgenius platform has prepared an online course on coronavirus – about the spread, prevention, and treatment. Young people need to understand that a mild illness and faster recovery does not mean that people from vulnerable groups should be put at risk.
For all the latest updates on the coronavirus in Ukraine, follow this link.