Health

Health Care Workers Hit Hard by the Coronavirus Pandemic

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Dr. Sheetal Khedkar Rao, 42, an internist in suburban Chicago, cannot pinpoint the exact time she decided to last hang her stethoscope. There was the chaos and confusion of spring when a nationwide shortage of N95 masks forced them to screen patients wearing a surgical mask, fears that they could bring the coronavirus home to their family, and vexing public disregard for the Wearing masks and social distancing that was reinforced by the White House.

However, recent blows included a 30 percent wage cut to offset a decline in patients seeking primary care and a realization that she needed to spend more time at home after her kids 10 and 11 switched to distance learning.

“Everyone says doctors are heroes and put us on a pedestal, but we also have children and aging parents to worry about,” said Dr. Rao, who left her practice in October. “After a while, the emotional strain and moral harm become too much to bear.”

Doctors, paramedics and nurses have been hailed as Covid warriors on the forefront of America, but the days when people applauded workers outside of hospitals and on the streets of the city are over.

Now, a year after the pandemic began, with emergency rooms jammed again, scarce vaccines, and contagious variants of the virus that could spark a new wave of infections, the country’s medical workers feel burned out and ignored.

Last year there has been the psychological trauma of overworked ICUs being forced into rationing, the overwhelming guilt for nurses who unknowingly infected patients or family members, and the struggles of medical staff who survived Covid-19 but are still limping from that Fatigue and the brain fog that affect your ability to work.

Researchers say the pandemic’s toll on the country’s health care workers will continue long after the coronavirus is tamed. For now, the impact can be measured in part by an increase in early retirement and the desperation of community hospitals that are struggling to hire enough workers to keep their emergency rooms up and running.

“Everyone wants to talk about vaccines, vaccines and vaccines, but for our members all they want to talk about is manpower, manpower, manpower,” said Alan Morgan, executive director of the National Rural Health Association. “Right now our hospitals and our workers are being crushed.”

Some health professionals are calling for national efforts to track the psychological wellbeing of medical professionals, much like the federal health program that monitors workers who responded to the 9/11 terrorist attacks.

“We have a great obligation to people who are risking their lives for the nation,” said Dr. Victor J. Dzau, President of the National Academy of Medicine.

Celia Nieto, 44, an ICU nurse in Las Vegas, said many Americans had little appreciation of the hardships they and their colleagues face every day. There’s the physical exhaustion of lifting and twisting a patient’s stomach so they can breathe easier, the endless clutter of adjusting ventilators and pain relievers, and the emotional fear of telling relatives she doesn’t have the time to help them FaceTime Your loved ones.

“It feels like we’re failing when we’re actually working with what we have and we don’t have enough,” she said. “We feel pretty helpless and it’s a real violation of our psyche.”

Dr. Donald Pathman, a researcher at the University of North Carolina at Chapel Hill, said he was impressed with the early results of a study he conducted on the impact of the pandemic on clinicians in poor communities. Many of the 2,000 medical, dental, and mental health professionals who have responded to the survey so far are disaffected.

“There are a lot of personal trauma,” said Dr. Pathman. “Many people have been affected by their experiences during the pandemic and they will try to abandon their practices.”

In interviews, doctors who recently quit the field or are considering early retirement said the pandemic had exacerbated frustrations caused by shifts in the health care business that often resulted in them having to work longer hours, without receiving higher compensation.

In a survey published in September by the online Medscape site, two-thirds of American doctors said they had experienced severe burnout during the pandemic. A similar percentage reported a drop in income. A quarter of those surveyed said they had left the medical field due to their experience with Covid.

Another Physicians Foundation poll found that 8 percent of doctors in the U.S. had closed their offices during the pandemic, which is 16,000 fewer private practices.

Updated

Apr. 4, 2021 at 1:46 AM ET

Dr. Erica Bial, a suburban Boston pain specialist who barely survived Covid-19 last spring, said she was feeling increasingly drained.

“We put on our masks and come to work every day because we don’t have the luxury of working from home in pajamas, but the apathy and boredom that grips society makes our job just ungrateful,” said Dr. Bial, working full time despite struggling with the lingering effects of her illness. “It’s so demoralizing.”

The staff shortage was particularly acute in nursing homes and long-term care facilities. They already had problems keeping employees before the pandemic, but many now face an existential shortage of skilled workers. According to a study published last week by the bipartisan US PIRG Education Fund, more than 20 percent of the country’s 15,000 nursing homes reported severe shortages of care workers in December, up from 17 percent in May, a sharp jump over such a short period of time.

As more health workers fall sick or quit, those who stay in the workplace have to work harder and the quality of care inevitably suffers, said Dr. Michael L. Barnett, Assistant Professor at Harvard TH Chan School of Public Health who served as an advisor on the study.

“It’s a recipe for a workforce breakdown,” he said.

So far, the federal government has shown little interest in tackling what Dr. Dzau described by the National Academy of Medicine in the New England Journal of Medicine as a “parallel pandemic” of mental trauma among health workers.

He and other experts say the government should first make a concerted effort to accurately count infections and deaths among medical professionals.

There is no comprehensive federal government count of worker deaths. More than 3,300 nurses, doctors, social workers and physical therapists have died of Covid-19 since March, according to a tally by Kaiser Health News and The Guardian.

Experts say the death toll is most likely far higher. The Centers for Disease Control and Prevention count 1,332 deaths among medical personnel. This is noteworthy in that its sister agency, the Centers for Medicare and Medicaid Services, lists roughly the same number of deaths only among nursing home workers – a small fraction of those employed by the country’s hospitals, health clinics, and private practices.

A number of studies suggest that medical professionals accounted for 10 to 20 percent of all coronavirus cases in the first few months of the pandemic, despite making up about 4 percent of the population.

Christopher R. Friese, a researcher at the University of Michigan, said the government’s failure to track down health care workers has most likely contributed to many unnecessary deaths. Without detailed, comprehensive data, the federal health authorities are limited in their ability to identify patterns and develop interventions.

“The number of health care worker deaths in this country is staggering, but as shocking and terrifying as they are, we shouldn’t be surprised with some very basic tools for dealing with the crisis on the shelf,” said Dr. Friezes. Who runs the School’s Center for Improving Patient and Population Health?

A spokeswoman for the CDC, Jasmine Reed, acknowledged the limitations of her coronavirus case data, noting that the agency relies on reports from state health officials and these can vary by state. At least a dozen states don’t even participate in the CDC’s reporting process, she said.

Many medical workers who have survived Covid-19 face more immediate challenges. Dr. Bial, the Boston pain specialist, is still plagued by fatigue and lung dysfunction.

“The day before I got sick, I could easily walk eight to ten miles,” said Dr. Bial, 45, who started a Facebook group remembering doctors lost to Covid. “Now I’m going for a quick walk and my heart is pounding. I wonder if these effects could be permanent. “

Dr. Andrew T. Chan, a professor at Harvard Medical School and a gastroenterologist at Massachusetts General Hospital who has been researching the disproportionate burden on health care workers from the pandemic, said his preliminary research indicated that long-distance medical drivers have greater health problems than the total population. In part, this is because they are often exposed to increased levels of virus, which can lead to more severe illness.

Another factor, he said, is that increasing staff shortages in much of the country are causing many Covid survivors to return to work before they have fully recovered.

Healthcare workers “are likely to be at higher risk for long-term complications,” said Dr. Chan. “Covid could affect our health system for years by not only depleting our workforce but also affecting survivors’ ability to do their jobs.”

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Robert Dunfee