Healthcare workers (HCWs) are disproportionately affected by COVID-19 in Egypt:
As frontline workers providing direct health services to COVID confirmed or probable cases, healthcare workers (physicians – nursing – technicians – pharmacists) are much more exposed to COVID-19 than any other sector. While High-income countries (HIC) possess the required resources and take all possible means to ensure the health and safety of medical personnel, provide them with adequate Personal Protective Equipment (PPE), and implement up to date, scientific-based Infection Prevention and Control (IPC) measures, governments in Low and Middle-Income Countries (LMIC) don't have the capacity or the will to do so.
To better understand what is going on in these countries let's have a closer look at the situation in Egypt and use the language of numbers first which is always expressive and truthful.
The Egyptian Ministry of Health reported on Sat. 06/06/20, 32,612 total confirmed cases, and 1,198 deaths. According to the Egyptian Medical Syndicate, there were more than 400 cases and 50 deaths among physicians, which means 4.2% of the total deaths but this percentage grows alarmingly over time due to the growing caseload and health system exhaustion.
On Saturday alone, the ministry reported 32 deaths, including 8 physicians, equivalent to 25% of deaths or a physician every 6 hours.
Looking into those 50 physicians that Egypt lost till now, 14 of them (28%) are high-ranked professors at distinguished universities including 6 (43%) form Al Azhar University (the university that I graduated from).
Sadr Al Abbasiyah Hospital, one of the main quarantine hospitals in Cairo, reported that a large number of medical staff were infected with the Coronavirus as a result of their work in the hospital in light of the lack of preventive medical supplies. The report shows that the number of infections among the nursing staff reached 50 cases, while 10 doctors were confirmed to be infected with the Coronavirus.
In addition to physicians, Egypt has lost more than 10 nurses, 6 lab and radiology technicians, and 14 pharmacists since the beginning of the pandemic.
According to Dr. Kawthar Mahmoud, the president of the Egyptian Nursing workers syndicate, the total number of nursing workers in Egypt is estimated at 300 thousand nurses, including 220 thousand in government hospitals, pointing to the large role that nursing crews play during this stage to counter the Coronavirus. She added that the Coronavirus crisis highlighted the importance of nursing in Egypt as the first line of defense for the health of citizens through their proximity to patients and their provision of 70% of the services provided to them while they are in hospitals.
The numbers of deaths among pharmacist are subject to increase, according to the syndicate, as pharmacists are part of frontline for Coronavirus patients through their presence in their pharmacies all over the country, and their dealings with infected people who visit the pharmacy to get their medication, especially with a large number of infected people dependent for treatment at home.
Looking at these terrifying figures, we find our selves before an important question of WHY? To answer such a complicated question, we need to dive deeper into the Egyptian context and try to discuss it from different angles.
Military syndrome:
Egypt has witnessed a bloody military coup since 2013 and like all countries subject to military coups, all state resources are harnessed to serve the ruling class and their supporters locally and internationally, no matter how this leads to scarcity or lack of basic resources available to the general public. In Egypt, the military regime sends massive shipments of PPE to different countries such as Italy and the USA to win their support with which led to a major shortage in the health sector's stocks.
Weak government:
The health care system in Egypt is headed by the Ministry of Health which is headed by some of the nonspecialized people all their qualifications are that their dedication to serving the ruling regime and having strong ties with it. The health minister herself headed some of the convoys that deliver PPE aids to other countries at the same time that the ministry hospitals are suffering sever shortage of PPE. The parliament also can not revise any decision done by the government or make any step outside the track that the coup draws for it. No one in the ministry or the parliament is seriously caring of the HCWs and the risk they are facing every day.
Discriminatory health system:
In Egypt, there are many completely different and independent health systems. There is a luxurious one which is reserved only for military and police personnel. In this system everything is available and the best IPC measures are applied. Healthcare workers in this system are military staff and the budget of it is huge and confidential, even the parliament has no right to discuss it. On the second level, there is another health system reserved for special sectors like justice. This system is funded by the corresponding ministry which ensures the treatment of its personnel in the best private hospital and pays all expenses. There is another health system which is the private one. this system is formed of some high standard hospitals, which are owned by some businessmen with strong ties to the ruling regime. These hospitals offer extremely expensive services which more than 90% of the population can afford. The least efficient system is the public one where more than 80% of the healthcare worker serves more than 80% of the population. This system is collapsing right now without any serious actions taken to support it.
Heavy workload and poor IPC measures;
In the public health system, physicians work for long hours without breaks. I have one of my friends died last month with a heart attack and another physician lost his eye because of the workload. IPC measures are very poor and there is no unified plan from the ministry to ensure even the WHO minimal standard. Healthcare workers use whatever possible to control the spread of infection within public hospitals and save people's lives, but unfortunately, they couldn't even save their own lives because they receive no real support while working in high-risk environments.
Limited testing;
The Ministry of Health testing protocol for healthcare workers provides that any healthcare worker is not eligible for testing until s/he develops symptoms, which gives high chances for the disease to spread among healthcare workers and increases the possibility of severe outcomes.
Media paradox:
At the beginning of the epidemic, Egyptian public media praised the role of healthcare workers and appreciated what they are doing to keep them in the frontline and encourage them to work even where there is no enough PPE and to link what the healthcare workers do with the military regime and credit their work to the coup record they call them (white army). With the epidemic spread and cases increase, the health system starts to collapse and most of the hospitals run out of PPE while the regime continues to send PPE and other aids to other countries. Healthcare workers found themselves in the middle of the battlefield without any sort of protection and start criticizing the regime and some of them resigned. At that point the public media launched a war against them, calling them traitors and country's enemies which put an extra stress on HCWs and greatly affected their mental health.
Patients' attitude
In Egypt, no single physician can convince the patient with his diagnosis. Commonly, a patient consults at least two or three physicians before he gets convinced of the need to isolate himself. During this conviction journey, every single patient exposes many healthcare workers to a high risk of infection.
Socioeconomic status of HCWs:
The average monthly income of a specialized physician in the public hospitals works 8 hours shift/ 5-6 days a week is about 250$ and the daily peridium a physician can get for working in isolation and quarantine hospitals is 22$ maximum. While a judge, relatively save the working environment, gets 200$ infection allowance, a physician in a public hospital gets 1.2 $. Healthcare workers in Egypt belong to the low to middle-income sectors, they live in small rented apartments in overcrowded neighborhoods, use public transit daily, work in multiple places for long hours, what make them more vulnerable to get infected at any point in their daily routine.
In the end, I hope I have been able to highlight the suffering of HCW in Egypt as one of the low and middle-income countries and I hope this will help draw attention to them as one of the most vulnerable groups and extend all possible support to them in this asymmetric war.
Mohamed Habash is an Egyptian trained physician working with Canadian Red Cross