200 Needless Deaths

Kompas/AGUS SUSANTO

A mobile fruit seller passes in front of the mural thanks to health workers in Kampung Rawa Pasung RW 022, Kota Baru Village, West Bekasi District, Bekasi City, West Java, on Wednesday (22/7/2020).

The angel of death has been working harder than ever in 2020. An excess of 850,000 deaths has been recorded during the Covid-19 pandemic, on top of the 56 million deaths expected in a “normal” year.

Among this figure were 3,000 health workers who lost their lives to Covid-19 as of mid-July 2020, according to Amnesty International. Indonesia alone has lost 200 health workers to the disease through 1 Sept. 2020.

The Eijkman-Oxford Clinical Research Unit (EOCRU) has recorded the deaths of 102 doctors (51 percent), 76 nurses (38 percent), 10 midwives (5 percent), 7 dentists (3.5 percent), and 5 radiographers, pharmacists and laboratory analysts (2.5 percent). Deaths between June and August were more than double the figure in the first three months of the Covid-19 pandemic.

Scattered data

In the 183 days since Indonesia recorded its first cases in March 2020, the government has not released the number of health workers who contracted Covid-19. We have used references in the media and on social media to compile our data. For example, Kompas reported on 31 Aug. that 350 health workers had tested positive for Covid-19, while an online media outlet reported on the same date that 200 health workers in Aceh, or 10 percent, had tested positive for Covid-19.

The Covid-19 health crisis has had no small impact on health workers. The Brazilian Health Minister stated that 83,000 health workers had contracted Covid-19 and that more than 350 had died of the disease. The Mexican Health Minister admitted that 24 percent of all Covid-19 cases had occurred among health workers, including nurses (41 percent), doctors (37 percent), other medical personnel (19 percent), lab technicians (2 percent), and dentists (1 percent). The Argentine and Ukrainian health ministers also announced publicly that health workers accounted for 14-18 percent of all Covid-19 cases in their countries.

About 50 percent of all health workers are on the island of Java, the epicenter of the Indonesian outbreak (59 percent of all cases).

Health workers are one of the most vulnerable groups to Covid-19. The 2019 Indonesian Health Profile estimated that Indonesia had 220,000 physicians, 345,000 nurses and 210,000 midwives in Indonesia. About 50 percent of all health workers are on the island of Java, the epicenter of the Indonesian outbreak (59 percent of all cases).

Covid-19 laboratories have tested nearly 1.3 million people, but the percentage of health workers who have been tested in each province is unknown. The percentage of health workers among the 180,000 confirmed cases also remains unknown.

Also read: The Messages behind the Public Ambiguity

Indonesian health authorities must certainly be maintaining a separate database on its nearly 780,000 health workers. They have access to contact tracing and individual test results. In having access to both databases, it will not be difficult to integrate the data using either the personal identity number or employee number as the key parameter. The resulting database would be a valuable source of data in understanding the pandemic’s impact on health workers.

Serious investigation

The dynamics between Covid-19 transmission and mortality among health workers is not fully understood. Health workers are exposed to the disease both inside and outside health facilities. Indoor exposure may occur through contact with patients, other healthcare professionals, or anyone working at a health facility. Meanwhile, exposure outside health facilities may occur through contact with family members and during travel or other activities.

We will enter the second semester of the pandemic, which may not be any better. Health workers need a full set of PPE, from hazmat suits to headgear, to masks, towels, gloves, boots, and goggles. Several organizations are investigating the availability of PPE for health workers.

Amnesty International (July 2020) collected data from January to June in 63 countries and found that respondents from nearly all countries highlighted a shortage of PPE as a major issue. The May 2020 International Public Services Survey on healthcare unions in 62 countries found that only 23.8 percent of the surveyed unions said their members had received complete sets of PPE.

Meanwhile, the International Trade Union Confederation survey in April found that 51 percent of surveyed countries reported limited supplies of PPE. National Nurses United of the United States surveyed nearly 23,000 nurses in April and found that 87 percent of all respondents had reused disposable respirators or masks.

Also read: The Continuing Struggle of Recovered Covid-19 Patients

Indonesia has also experienced a shortage of PPE. At the start of the epidemic in the country, hospitals competed to obtain the more expensive N95 respirators for health workers who were in direct contact with Covid-19 patients. Some health workers purchased their own PPE or created makeshift protective gear from trash bags and raincoats.

In August, the Covid-19 Management Task Force distributed 4.8 million PPE and 23.5 million surgical masks. The availability of PPE must be maintained because of concerns that a large proportion of infected people have not been detected, the growing number of cases, and uncertainty about when the health crisis will end.

KOMPAS/RONY ARIYANTO NUGROHO

The medical staff who carried out the Covid-19 Polymerase Chain Reaction (PCR) test around the Pasar Kebon Kembang area, Bogor City, carried out their greetings of enthusiasm before being assigned, on Friday (8/5/2020).

Health workers have a constitutional right to raise issue about life-threatening situations, for example, when they do not have an adequate supply of PPE, high stress from long working hours, and physical and mental exhaustion. Local authorities should not push back for fear that this might worsen the image of the government’s efforts to control Covid-19 transmission in the regions.

Appreciating Their sacrifice

During the first semester of the pandemic, authorities and the public alike failed to hail the sacrifices health workers made. At the start of the pandemic, authorities denied the scale of the crisis and neglected to provide the highest quality PPE. Its various policies to restrict community movement have been unsuccessful because they are not followed up with strict sanctions for violations. The reopening of offices, industrial and economic activities and transportation facilities in June was quickly followed by an increase in new cases.

They need more positive energy to support them in the war against Covid-19.

There is no need for a resurgence of stigma and violence against health workers. It is also natural that health workers have security and legal protection at health facilities to minimize the potential for physical assault. The public needs to refrain from commenting negatively on these frontline fighters. They need more positive energy to support them in the war against Covid-19.

Also read: Protect Oneself and the Surroundings

Disobedience towards the rules on wearing masks, maintaining physical distance, and avoiding crowds has contributed to the increase in Covid-19 cases. On some occasions, people have lied about their symptoms and their travel history, families have used force in claiming the bodies of relatives who died of Covid-19, and mobs have attacked health workers. All simply prove their indifference to the sacrifice that health workers are making.

The rising numbers of confirmed cases and hospitalizations have only added to their burdens of contract tracing and providing long-term care.

Acting as if Covid-19 has been brought under control by referring to the higher recovery rate is self-deception. The plan to reopen schools, movie theaters and entertainment venues to encourage travel is a recipe for a new wave of infections.

Also read: Six Months Against COVID-19

Expecting that people will adhere to the health protocol on their own is premature. Willpower, honesty and extraordinary measures are an absolute necessity in the second semester of the pandemic.

ARSIP PRIBADI

Iqbal Elyasar

qqqIqbal Elyazar, Scientific Collaboration Manager, LaporCOVID-19; Member, Indonesian Young Scientist Forum