THERE IS LITTLE doubt that the Covid-19 outbreak has produced considerable inner apprehension, which has been ramped up considerably in recent days.
It’s not quite ‘going over the top’ but like most of my healthcare colleagues, I have accepted it’s most likely a case of ‘when not if‘ we get it ourselves.
Healthcare workers are used to outbreaks such as ‘flu’, but large-scale outbreaks of more serious infectious diseases such as measles and polio are largely a thing of the past.
‘Flu’ itself is nasty and carries significant mortality rates but this virus has upped the ante, as well as the anxiety levels, among healthcare workers. We are in the firing line of risk when it comes to contracting Covid-19.
Worry for patients
We’re worried first and foremost in these situations for patients. Our main focus is the number of seriously ill people who will now almost certainly start appearing into the health system and unfortunately may die.
People are worried about the system and its ability to cope.
As a geriatrician, this is a particular personal annual concern at ‘flu’ season. Older people are most severely affected by such outbreaks and ironically are often seen as the ‘nuisance winter crisis’ to our health service, rather than the reason we have such a service in the first place.
You never really hear of the 30-something motorbike accident with pelvic fracture being discharged to ‘transitional care’ as a ‘bed-blocker’ do you? Or the case of a hopeless 50-something not being considered for intensive care?
The ‘just beneath the surface’ ageism we see at times like this – embodied in the narrative of ‘well, mortality from this is mainly in older people’ - is frustrating.
It’s as if we don’t have people in their eighties and nineties who deserve the same shot at intensive medical management as younger people. Remember this when you’re older.
Worry for healthcare workers
At the back of many healthcare workers’ minds is the personal worry of ‘how sick will I get if I get it?’ or ‘What about bringing it home?’
This is a major concern for any household home to two healthcare workers.
True, the evidence shows that personal protective equipment significantly reduces healthcare workers’ chance of contracting Covid-19, and hand washing is naturally important – but we can’t be gowned, goggled and face-masked all day.
In an environment where there are lots of ill people and their visitors touching lots of surfaces, not to mention the time-honoured tradition of patients coughing in your face as you examine them, it is a fact that many of us healthcare workers in hospitals and GP surgeries will fall ill.
What then for the exposed healthcare worker? Self-isolation after exposure is a logical step to prevent onward spread, but if this extends to too many workers within the system then we have a significant problem.
The normal healthcare needs of the nation continue on with or without Covid-19.
The exposed may need to stay working with some extra precautions as the situation unfolds. Doctors, in particular, tend to pride themselves in their self-perceived well-tested immune system, and in such situations many will be banking on that idea as they deal with patients.
Healthcare workers are not invincible
But many healthcare workers, like the rest of humanity, have underlying conditions that put them at special risk. Healthcare workers accounted for 20% of the total death toll from the more serious SARS virus outbreak in Canada.
‘What about home?’ This is often a voiced concern, about bringing ‘something’ home, especially where healthcare workers have children with underlying conditions, or are looking after older relatives.
This is a genuine worry for many, and while healthcare workers accept both the personal risk and duties of their job in such outbreaks, most are concerned about exposing others, mostly their families, to that risk.
We don’t have the basics right
It will surprise many people to know that most hospitals in Ireland do not have proper showering facilities or changes of clothes for their staff coming in and out of work, nor is it a mandatory requirement.
Being fortunate enough to experience working in a proper production environment myself, where showering and changing, both in and out of work, was a condition of employment and expected practice, I have always found the hospital situation in Ireland a curious ‘exception’ – an environment where there is no environmental contamination stewardship of employees.
This is not the case in other countries.
The other difference between a working environment where there is contamination risk and Irish hospitals is the approach to visitors.
Don’t get me wrong – sick people need and benefit from the visits of family and friends. And indeed, as a specialist in stroke and older people’s healthcare, we often need that such engagement to help with aspects of care and recovery.
However, there must be publicly agreed and accepted regulations around this. People seem to often feel hospitals are open public spaces and can be agnostic about visiting times.
Evidence shows that in many communities or hospital disease outbreaks, infection rates drop when hospital visiting is restricted. Remember, a hospital is a hospital and not a train station.
The way in which our hospitals treat their staff, and how the visiting public treats their hospitals in Ireland, need a cultural change. The Covid-19 outbreak may be the catalyst for that change.
Professor Rónán Collins MD FRCP (Lond) FRCPI FESO is a Consultant Physician in Geriatric and Stroke Medicine at Tallaght Hospital. Follow him @ronancollins7.
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