How do you survive on the front lines of an epidemic?
The world’s health workers taking the brunt of COVID-19.
The last three months seem to have passed in decades after COVID-19, also known as Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) or Coronavirus, has spread to more than 200 countries.
Initially reported in December 2019 in the capital of China's Hubei Province, Wuhan, the aggressive virus has claimed the lives of more than 150,000 people around the globe, with numbers rising by the second.
An epic struggle has ensued for the world's health systems, its soldiers on the frontlines have been the doctors, nurses, and volunteers at health centers.
AL DÍA contacted several doctors in Spain, the United States, and Colombia to share the often-overlooked picture, in part because, in their words, it is simply unimaginable.
While in Spain, the government did not make a move in the face of the advancing coronavirus in neighboring Italy, the health workers began to prepare to avoid the collapse of the sick in the hospitals days before President Pedro Sanchez declared a state of emergency in the country on March 14. This is especially true of the doctors in Madrid, a city that has become the epicenter of this cruel pandemic with more than 49,526 confirmed cases of COVID-19 and 6,726 deaths - according to data from April 15.
Dr. Sandra García Botella, general gastrointestinal surgeon at the Hospital Clínico San Carlos in Madrid and creator of the campaign #Quedateencasa, the first initiative for solidarity for confinement in the country, saw the collapse of the hospitals coming and acted before the politicians.
"I alerted Dr. Salvador Morrales, a prestigious surgeon from Seville, and we organized the surgeons so that the hospital chaos in Madrid would not happen in the rest of Spain," said García Botella, who is procuring, along with other surgeons, medical action documents to address the crisis that has already been requested by the American College of Science.
For the doctor, the lack of foresight and resources have been the main problems.
"There are no teams, they send you to the front without a gun and the nurses and assistants are getting the worst of it," she said. "It is striking that we are the country with the most infected health workers, but we are not going to abandon our patients.
She also says the situation would not have been so chaotic with more protective equipment and testing of all citizens - "they don't even test us," he said - but the confinement "is showing.
Botella warned, however, that the situation in the hospitals is really tough and that health workers will suffer from post-traumatic effects.
"A few weeks ago, one of my nurses broke down in tears on the stairs. It breaks your heart; the patient is alone, dies alone and is buried, while his family waits anxiously at home for a call,” she said.
Botella also stressed the great solidarity among medical professionals.
"I am a surgeon, but if I have to wash patients, I do it, and my husband is a cardiologist and is on the front line as well. But mostly there are senior resident doctors who are younger and are doing a lot of hours so that other older doctors are not exposed and the government has not wanted to give them the title this year so that they can continue working and getting paid as residents and not as specialists. And that's not fair," she said."We are organizing ourselves in spite of the politicians and they are mistreating us like this.”
In spite of everything, the Spanish surgeon is optimistic.
"COVID-19 is going to win the battle by showing its face, which is what I've missed in this government. We are facing up to it," she concluded.
The novel coronavirus isn’t Dr. Arabia Mollette’s first encounter with a pandemic-like virus. When she was a medical exchange student from the U.S. in Cuba at the Latin American School of Medicine, she and her classmates confronted Dengue.
Now, as an emergency room doctor based in the Bronx, New York, Mollette is playing another role in the battle against COVID-19.
When AL DÍA interviewed Dr. Mollette, Europe was still the epicenter of the virus, but a week after, the U.S. vaulted well ahead of the rest of the world in case count.
“If we don’t act quickly, we will be Italy,” she said at the time.
Now, cities like New York are the center of the world’s fight against COVID-19.
On the ground in the city’s emergency rooms, the scene is chaotic, to say the least. Packed hospitals, dwindling or stolen supplies, and overwhelmed doctors were just some of the circumstances described by Mollette.
As one of those overwhelmed doctors, she’s admittedly “frustrated” by the response of the federal government to COVID-19.
“The government failed,” said Mollette. “This came on the scene back in November and we didn’t take it seriously.”
What was once a warning call has turned into a chronic shortage of essential medical supplies across the country.
In Mollette’s case, the hospitals where she operates have had to turn away patients from tests and beds unless they are seriously ill or have COVID-19’s telltale symptoms of dry cough, fever or shortness of breath.
That’s tough in an emergency room.
“I have to prepare myself for everything,” said Mollette.
But Mollette said the responsibility goes beyond appointed leaders — it’s also in the hands of everyday people.
“Everyone is on the frontlines,” she said.
In the place of allocating resources and deciding where to support the supply chain, citizens have a duty to follow the established rules for COVID-19, which vary across the country but include staying home and social distancing.
“We can do better,” said Mollette.
Initially, some members of younger generations thought themselves less susceptible to the serious symptoms of the virus, but a CDC study found that in the early U.S. cases, one in five hospitalizations because of COVID-19 were of someone between 22 and 44 years old.
As for the panic, Mollette understands it, but urged people to “stay home.”
Fredy and Camilo Rodriguez are father and son, one is a nurse and the other is a general practitioner, working at Kennedy Hospital in Bogota, one of the most important hospitals in Colombia’s capital.
The first case of COVID-19 was reported in Colombia on March 6, and they said a week later, changes started in the emergency department. In Colombia, it is usual to have to wait for months to get a routine medical appointment, so the emergency department is often full of people who do not need it. Since the arrival of COVID-19 in Colombia, emergency care has been reduced exclusively to vital emergencies because people are afraid of getting infected.
This, plus the reduction in transit incidents and violence with weapons, and the implementation of virtual consultations, have helped open up the system.
However, although the capacity of the health system has so far held up well, doctors and nurses look with concern to the future. They feel that while the quarantine has helped, it took the national government a long time to impose it and close borders and the foreigners who arrived in the country in early March did not follow the quarantine orders they were requested to follow.
An additional problem is that the quarantine is not being enforced in poorer areas of the capital.
"The measures that need to be taken are more severe because the curve in Colombia has not yet reached its peak," said Camilo. "People have not yet begun to see that this is real and when their acquaintances start to be affected by the disease it will be very late," added Fredy.
In addition, they are concerned about the shortage of biosecurity material, which is leading many health personnel to give up for fear of contagion. They also commented that no additional ventilators have arrived at the hospital where they work, despite the issue’s high profile, and that the biggest difficulty of all is testing.
"In terms of testing, we are very behind, with thousands of tests held back because there is no technical or human capacity to process them. We're a long way from a real number of infections," said Camilo with concern.
What is saddest to Fredy is that health personnel are feeling the rejection from part of the population.
"There are people who are not being allowed to go where they live. They are not getting transportation: there are health workers who are not managing to get to work or are not getting a ride home because the taxis and buses won't stop. We are extreme in our care, people should understand that we are the most capable and careful people there are to prevent them from getting infected from us," said Fredy, hoping that this behavior will change.