A human look at the COVID-19 pandemic

More than a year after the World Health Organization (WHO) declared the COVID-19 pandemic, there is talk of what is known as pandemic fatigue in the world population, in general, and in health personnel, in particular.

This report has been prepared in order to humanize this situation; her interviews were compiled in writing, and her objective is to show, on the one hand, the testimony of a general practitioner from Ecuador, Kathy Díaz, who tells of her experience about how the pandemic was in her country from last year until now, and on the other, give a panoramic view of the situation on a world scale.

Díaz talks, among other things, about how he found a way to adapt to the situation along what this road has been, with all its ups and downs, and how he tried to provide empathy, resilience, calm, training, agility and knowledge even when she herself was trying to fight a disease as unforeseen as it was unknown... a problem that both his patients and his co-workers have also struggled with.

An experience that has had a meaning for all those for whom the victims are not just numbers that add or subtract, but unforgettable faces, suffering and, above all, lives that could have been saved in other circumstances.

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“A year ago we did not know what we were facing. We were a small group of doctors who worked in the Emergency. We did not know how we were going to work, how we were going to provide care to so many patients infected by a virus that was new, and the worst thing was that, in many countries, this disease was being treated experimental.

To this was added the isolation from our families, the protective equipment, the situations of helplessness and pain, the endless work. All this drowned us, and I say drowned because we all felt a pressure in our chest, a lump in our throat; the uncertainty was inexplicable.

At the beginning, we had the necessary protective equipment to take care of ourselves 24 hours a day, we didn't mind getting dehydrated, having a headache, that was the least of it. The fear of infecting ourselves, the fear of bringing the virus into the house, made us tolerate the unbearable heat that wearing them implied.

Many patients died, my hospital became a sentinel just to treat COVID. The health system was saturated to such an extent that we had nowhere to admit a patient; witnessing deaths at the entrance of the hospital, but without being able to do anything; relatives who arrived with their loved ones in their arms, but without vital signs, begging us to save their lives... It was a very painful situation. Caring for patients who did not stop arriving because they needed oxygen, and no longer have even that, is exasperating; companions who were infected and whose presence we lacked; sharing the pain of my partner when he lost his father to COVID in our hospital, and seeing him continue working for the patients, pushed us to move on ”.

Kathy Díaz is a Critical Care resident physician at a hospital in Quito, Ecuador. This health center became a sentinel due to the COVID-19 pandemic. Even though she has been a doctor for eight years, she affirms that she never thought of experiencing such a situation, and that, in reality, most of the world's inhabitants were unprepared for it.

She knows first-hand what this disease means from a physical and mental point of view, a disease that, by the time this report is written to mid-June, she has (according to the monitoring center of the Johns Hopkins University of Medicine, United States) more than 178 million confirmed cases Y more than 3 million 800 thousand deaths worldwide. This, despite the fact that there are more than 2.6 billion vaccines administered, a figure that, although encouraging, did not cover even half of the world's population.

The United States, India and Brazil continue to top the list of countries with the most confirmed cases and deaths, although, according to the WHO, these have decreased in recent days.

With regard to Ecuador, there are more than 445 thousand confirmed cases and more than 21 thousand deaths, among them doctors, nurses and other members of the health centers.

Ecuador, by the way, was a country that made headlines at the beginning of the pandemic (This was declared as such by the WHO in mid-March 2020) due to the number of infections, the collapse of the public health system and the overflow of funeral services. The provinces of Guayas and Pichincha, whose capitals are Guayaquil and Quito, respectively, and which have a greater number of inhabitants throughout the South American country, have been more affected.

And it is that this unforeseen illness put to the test in a resounding and prolonged way the capacity, preparation, preventive culture and resistance of both health systems and health personnel throughout the world. world. Also the mental health of the population (including common prisoners, political prisoners, immigrants and refugees, people with disability, people with previous physical and mental health conditions, children, women and the elderly), in general, and that of healthcare personnel, in particular.

By October 2020, Hans Henri P. Kluge, WHO Regional Director for Europe, said in a press release that European countries were reporting, as expected, an increase in the degree of pandemic fatigue.

Thus, based on data from surveys carried out in countries of the region, it was calculated that said fatigue was, although it depended on each country, of more than 60% in some cases.

Pandemic fatigue is the state of emotional exhaustion, due to the long time that the pandemic has meant, the stress, worries, fear and the constant use of protective measures such as social distancing and confinements.

Pandemic fatigue can therefore affect moods, behaviors, and relationships of people, who could relax about such measures, not to seek reliable information and to not giving importance to the coronavirus, despite the warnings of the risk of outbreaks and the appearance of variants, on the one hand, and the increase in confirmed cases and deaths in some places, on the other.

Also, due to the fact that some people, having already been vaccinated against COVID-19, think that are safe from any contagion, and underestimate said protection measures both for them and for the the rest.

“Remember that getting vaccinated does not prevent,” Kluge warned in a tweet in mid-June, “getting sick or spreading the virus. However, vaccines decrease the chance of getting seriously ill or dying from COVID-19. "

To the consequences of pandemic fatigue We must add both the tiredness of hearing about the new coronavirus and the complaints of opacity or information manipulation in some countries.

The latter aggravates the situation of helplessness, anguish, anger, fear, stress, depression and anxiety that some people may be experiencing in the face of confusion and the lack of real figures; the grief of individuals and families for having lost their relatives or friends, and for not being able to dismiss them through religious ceremonies; unrest and drowning due to the economic crisis, unemployment, evictions, domestic violence, immigration, etc.

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In this sense, Venezuelan health personnel, for example, are going through a dire situation because of not only the COVID-19, but also because of official negligence and the humanitarian crisis, which has been hitting the population for the last years.

A) Yes, the personnel of the public health system, which is not an exception to the crisis, must fight day by day against precariousness and, with it, the lack of basic services, such as, for example, water, electricity, fuel; the lack of supplies and security equipment, low salaries, insecurity, threats or arrests if they report ...

In this way, Médicos Unidos Venezuela indicated, according to the newspaper El Diario, that 651 workers have died since June 16, 2020.

“One year after the first death of a health worker, we continue to demand the same thing: protective equipment, supplies, medicines, security and vaccines is not a lot to ask for ”, they published through a tweet, also in mid- June.

Already in January of this year, the World Medical Association (WMA) published a statement in which specialists made a call for international cooperation to fight the coronavirus together, the collaboration of the world's population to help curb infections and, especially, to be vaccinated, and the need to increase investment in health systems. The work of health personnel was also recognized, despite the risks they have run due to infections.

“Little by little we learned to deal with everything, we had to be strong. New health personnel arrived and we desperately wanted to be hired. We went from being six doctors, per guard, to fifteen, and that was relieving. However, the number of infections increased. The work was such that many times we did not eat, ambulance after ambulance would arrive and ask for oxygen for the patients who were in them, but we did not have; all tanks were occupied with patients sitting in chairs; most of them, unbalanced, waiting for a bed, waiting for someone to die so that that bed could be released.

Not to mention the stories of all the patients we have seen: they have been so sad that just remembering them makes me cry again. Mothers, fathers, siblings, and even entire families admitted to the hospital; Some succeeded and won the battle against this deadly virus, and others lost it. Calling your relatives and having to tell them the death of your loved one is very sad. The screams, the despair of who or who receive the news, is indescribable.

All doctors prepare to make the statement, we breathe deeply, we try not to break our voices, but it is impossible. Many times I have cried with the person who received my call. I am deeply sorry to break that news.

In turn, when we think that nothing could be worse, we began to lack medications for sedation. You can imagine what that is, how exasperating it is to hear the infusion pump indicating that the medicine is running out, rationing the medicines, and not to mention personal protections, which are also beginning to be lacking, so we decided to buy with our money.

Between the month of September and October 2020 we felt a small respite, it seemed that the infections were going down and there was one or another free bed, but it did not last long when they increased again. Now they were younger patients, who were in excellent health at the time, and again we are living the collapse of the health system, lack of beds, lack of psychotropic medications, physical fatigue and mental".

The Government of Ecuador published, for its part, the official page CoronavirusEcuador.com, in which the The population can see, among other aspects, information related to mental health in cases of emergency.

He pointed out that the most common reactions in situations like this, among which are precisely pandemics, are:

• Fear and concern for the safety of both the person and her loved ones.
• Changes in sleep or appetite patterns.
• Changes in mood That is, there may be anguish, insecurity, uncertainty, irritability, powerlessness, anger.
• Worries about the future, trouble concentrating, and repetitive or catastrophic thoughts.
• Physical pain, although without any medical reason that justifies it. Also, palpitations, gastrointestinal complaints, etc.
• Worsening of previous mental health problems.
• Increase in the consumption of tobacco, alcohol and other drugs.

In this way, the prolongation and intensification of a bad state of mind, physical or mental can lead to the appearance or worsening of work problems. Such is the case of stress, Workplace Harassment (also called mobbing) and burnout syndrome (burnout syndrome).

These situations can cause, among other damages, stress, anxiety, depression, post-traumatic stress, deterioration of self-esteem, insecurity, lack of concentration, lack of rest, fear and a greater risk of making mistakes... and health personnel do not escape thereto.

Elizth Pauker, general practitioner and surgeon, with a postgraduate degree in psycho-oncology, and coordinator and founder of the Community of Medical Women of Ecuador, pointed out that different problems that were already creeping into the field of health in that country were evidenced by the pandemic and that this affects the state of mind, physical and mental of the workers of the sector.

“Difficult situations for health personnel emerged throughout the national territory, characterized by a series of limitations for their resolution, aggravating the emergency. In addition to this, persistent job insecurity situations such as a chronic disease suffered by the National System of Health for a long time, evidenced its consequences as an exacerbation of burnout and emotional suffering of women and men. professionals.

The pandemic has been an opportunity to expose the aforementioned conditions, product of the negligence of the authorities or managers, in ignorance of the requirements or demands of the health services to face the emergency sanitary. This time they have won corruption and lack of skill in the administration of health care and human talent in health, the result of which is the death toll, an important lesson in the search to improve the SNS, ”Pauker said.

To this he added that both Guayaquil and Quito were the provinces most affected not only by the number of confirmed cases and deaths, but also by the conditions in which the pandemic. In this sense, young people, as part of the health personnel, have stood out among those affected.

“Guayaquil and Quito have been the cities most affected not only by the number of infected citizens or deaths from SARS-CoV-2, but from the improvised conditions in which the attentions.

The lack of leadership, the limited access to adequate information, the few referral centers and means, the situation of the hospitals, the absence of personal protective equipment (PPE), among others, are the circumstances in which we have exposed ourselves to develop the attentions.

To this we add the lack of emotional resources to manage emotions in periods of crisis on the part of the health professionals, which has fallen on the youngest, who, by force, faced situations for which they were not prepared.

In the case of Quito, incivilities generated frustration and increased distress in health professionals. These acts of irresponsibility of the population confronted the efforts to save the greatest number of lives from health”, He assured.

“Each of the patients we have seen has left a profound mark. Many times with a feeling of helplessness, anguish, pain, that we keep it and that it is a time bomb.

How many times have we witnessed the cry of a colleague and we have not been able to give a comforting hug; How many times have we witnessed the cry of a patient because he misses his loved ones. They have not heard from them for days, lost in time, and the only thing we can offer them in those moments is a video call to their relative, and many times that is the last call; It is beautiful and sad at the same time, we are with emotions on the surface for all the things that we hear that your family member says to the patient and vice versa.

Some patients say goodbye as if that call was the only thing they expected to leave this earthly world; others take strength and fight against this disease. Although they have had everything against them, their progress has been impressive.

But not everything has been bad, because we learned to be more supportive, more empatheticWe are more colleagues, great friends, a great work team, more experienced professionals and many specialties united for patient care.

On the other hand, I have been a doctor for eight years and I never thought I would go through all this. At first, I thought that the pandemic would last a few months, about six months to be exact, but, as the days passed, that option seemed far away.

I started working with all the love, patience and effort that is needed; However, everything I have lived has made me lose hope in people: grandparents who arrive at the hospital without having any idea why they got infected, drowning, begging not to let them die, because their old man would be left alone (referring to his spouse). Some are forgotten by their family, it seemed that they wanted to get rid of them; others, very necessary for their family, are always looking out for them.

I've had so many experiences... I have seen many, many people die; Most of the faces I will never forget. I remember the case of a family who came to the hospital; this was made up of mom, dad and son. All serious, all intubated. The parents passed away. All of us who worked in that area felt sadness.

The young man improved and we were able to remove the tube from his mouth, but in a few hours, the first thing he asked was about his parents. My partner and I looked at each other; I had a lump in my throat, a pressure in my chest. We said to him: 'Rest, you have to recover.'

How to tell him that his parents had died, if before intubation, he had said that he had been the culprit of having infected them. What a great pain I was going to feel!

On the other hand, I learned to operate a mechanical ventilator, which, for me, as a general practitioner, only Intensivists, anesthesiologists, and emergency physicians did it, but the pandemic changed my opinion. I learned to handle critical patients and that was what I liked the most about my profession, but, at the same time, it was what saddened me the most because most seriously ill patients don't win the battle.

To be able to remove the ventilator from a patient and see that he can breathe on his own is the greatest emotion! ”.

Néstor Rubiano, a mental health reference for Doctors Without Borders (MSF), in Mexico, said that pandemic fatigue at this time, in the case particular of global health personnel, will depend on the working conditions in which each one is found and according to each area in which they are find.

“The situation depends a lot on each country or each region. For example, the same is not true in North America, where resources and vaccination rates are higher, than in other places where uncertainty, fear and pain abound. In Mexico, especially, which is where I work, I think there is a fatigue of the staff of the health despite the drop in morbidity and mortality, at least compared to the year previous. I think it is a situation that is related, for example, to working conditions, wages, the shifts they have to do, among other things, ”he said.

He stated - regarding what he recommends for health personnel to protect themselves physically and mentally and, thus, their family and friends - that it is important that they are treated with dignity; recognize her effort through decent contracts; psychosocial support, decent work spaces, supplies, investment in human resources, training, medical programs and diagnostic aids, etc.

On the other hand, Indira Ullauri, clinical psychologist and general manager of Superar Centro Integral de Psicología, Quito, Ecuador, added that she feels admiration for the integrity, drive, discipline and tenacity of Kathy Díaz, who came to her psychological counseling for relief, relief and recovery, and who, being a member of the Ecuadorian health personnel, knows first-hand how important it is to take care of themselves physically and mentally.

“I couldn't help but be moved by Kathy's exhaustion, grief, fear, pain and helplessness. How vulnerable we are, but, at the same time, how potential we are. (…) I admire every Tuesday when Kathy arrives after her turn, without having slept, saving some and broken by others who left. I admire the strength they found as a team, the containment that they offer each other, the smile when she says that they extubated some of her patients, and I am also moved by her tears when she tells the end of many stories ”, he stated.

“At the beginning of the pandemic, I did not see patients coming off the ventilator; however, new scientific studies continue to direct the entire hospital team to try another treatment.

I've cried so many times I have had panic attacks, I had depression, anxiety, all this due to the great emotional burden that exists in a Critical Care area. Have seconds to intubate someone, do CPR, and as I do that, I pray that that patient comes back to life. Some do; others don't. I am often glad, since my intubated patient is responding appropriately, and so I firmly believe that he is going to come out of the respirator, but, to my surprise, upon returning to my shift, I learn that she passed away, that she had multiple she resisted.

Today, a year and two months after being face to face with COVID, I continue to work with love and patience, but physically and emotionally tired. Thank God, I no longer have depression, but anxiety and stress sometimes occur. However, with the help of my psychologist and my co-workers, this becomes more bearable and, most of the time, I know that all members of the work team are like this. Talking for a few minutes and expressing how we felt relieved us a lot ”.

Author: Adriana Ramírez, from the Superar psychology center.