Globally, the unprecedented coronavirus pandemic is demanding equally unprecedented and dedicated care from healthcare staff. That means with no previous knowledge to tackle disease on such a large scale, the authorities are facing much more than a World War-like situation.

Authorities are seeking expert consensus and issuing advisories to healthcare staff as well as to the public. Guidelines are being issued to staff working in hospitals designated for Covid patients as well as in Primary Health Centres (PHC). The structure created by the Central Health Ministry and State Health Ministries involves Tertiary Care Hospitals, District Health Office, District Hospitals or Medical Colleges, Community Health Centres at taluka level, and PHCs.

The PHCs are considered as first line care, as the name itself suggests, and each provides health care to up to 30,000 people all over India. They include ASHA (Accredited Social Health Activist) workers. ASHA workers are considered grassroot-level workers and generally are from the same community. The designated Covid hospitals include wards and Intensive Care Units, which are colour coded depending on the treatment need. As per directives of the Health Department, staff members of every PHC visit houses for surveillance and decide whom to test or whom to quarantine. This depends greatly on the cooperation of the general public who by law are obliged to do so.

Recent incidents of violence towards healthcare staff whilst performing surveillance could undermine confidence and affect the relationship of PHC with the community. Due to lockdown and restricted transport, some ASHA workers and community nurses are having to manage by walking in mid-day in hot summer. There is less chance of getting a break from duty, due to the workload involved, and high chance of being asked to work extra hours. The risk of getting infected with the virus is high for the community staff as they are frequently coming in contact with potential patients, even before testing.

There have been reports of landlords asking doctors and nurses to vacate, and also of neighbourhood Housing Associations placing restrictions on them, fearing spread of infection. An added stress is that their family members are also at high risk of acquiring the virus due to contact at home. Working continuously wearing disposable Personal Protection Equipment (PPE) inside wards is challenging, particularly in the hot summer without air conditioning. This could cause excessive sweating with a need to drink water frequently.

But they try to avoid eating and drinking water and also avoid use of rest rooms during their 6-8 hour duties, so as to not waste expensive PPE; not to leave the ward unattended and also to reduce the chance of infection during changing. A physician colleague with firsthand experience said their team gradually learnt to resolve problems that they faced and cope by having regular team meetings. Some members including male staff started using urology pads or diapers so as to avoid using rest rooms. Using PPE with all the discomfort it entails with little prior experience of doing so, and working in isolation and spending time in quarantined areas with fear of infection are all very stressful.

Staff working in the wards or Intensive Care Units (ICU) treating Covid patients are at higher risk of infection. Deaths of frontline healthcare staff due to Covid infection acquired whilst treating patients have been reported in many countries and have been repeatedly mentioned in news bulletins. This could add stress to the treating healthcare staff, and they are having to convince their apprehensive family members to let them work. It has been thought that sudden increased viral load along with possible fatigue due to workload with less rest could be factors causing death, but the real cause is not known as of now.

Staff members work for one to two weeks followed by 14 days of quarantine depending on their local protocol. If their test on approximately the twelfth day is negative in quarantine, then some of them get up to a week off and get to meet their family including children. The experience is totally new as these were never part of work during their medical or nursing training. In designated Covid hospitals, working with the PPE on itself requires physical and mental effort. In addition to all the difficulties experienced whilst performing duties, reports of the exponential spread of the virus and increasing number of Covid-related deaths can cause exhaustion, loss of motivation and optimism.

Seeing no future or break from this work cycle, some healthcare staff could be assailed by thoughts of death. Since the experience may be psychologically traumatic, some may experience post-traumatic stress. Suitable supporting systems must be put in place based on feedback from staff members who have already completed a few rounds of Covid hospital duty. The morale, confidence and motivation of healthcare members must be maintained. We do not want these dedicated staff members to experience burnout as there seems a long way to go.

Staff require mentoring from those with experience and support from their supervising authority and family members to carry on. Members of public also have a duty to adhere to all the directives of local authorities keeping in mind the risks being taken by these frontline warriors.

(The writer is a Consultant Psychiatrist and Supervising Clinician at Health Heal Home Healthcare services, Bangalore)