Africa cannot afford to lose doctors to COVID-19

It’s been over 13 weeks since the world first heard of the coronavirus. Africa is now witnessing South Africa deal with this overwhelming disease. The news that health staff are dying due to COVID-19 is a pressing concern.

In Zambia, a case of the disease being transmitted locally was recorded on 25 March. It is mandatory that staff at all health centres have adequate personal protection. However, the reality on the ground is different.

A check on 30 March showed that staff, including medical doctors at the Adult University Teaching Hospitals, Zambia’s tertiary referral centre had not been adequately provided with personal protective equipment (PPE). It has since been made available after the various representing bodies aired the concerns of the healthcare workers.

Many healthcare staff across the country are still working with the “do it yourself” protection gear because PPE needs to be rationed, due to a global shortage. With cases of community transmission in our midst, it is standard healthcare policy for healthcare staff in the frontline to be protected. Many healthcare workers are concerned that if one doctor, nurse or cleaner becomes infected, they will transmit the virus to everyone seeking healthcare. This is happening around the globe.

Africa does not have the financial muscle that European countries can fall back on to fight COVID-19 and provide the necessary bailouts. Over 100 doctors and nurses have died fighting coronavirus across the world. In Africa, Gita Ramjee, a Ugandan-South African scientist and researcher in HIV prevention, died on 31 March. The question now is how many healthcare staff is Africa going to lose to COVID-19?

Africa cannot afford to lose healthcare staff to COVID-19

Since the first two cases recorded in Zambia, the message has moved from: “It is just a common cold”; to “We have not yet recorded a community transmission”; to “We have it under control”.

The World Health Organization estimates a projected shortfall of 18 million health workers by 2030, mostly in low and lower-middle income countries. However, countries at all levels of socioeconomic development face, to varying degrees, difficulties in the education, employment, deployment, retention, and performance of their healthcare workforce.

As a Zambian medical doctor, in my practice so far, I have already made the hard decision of who gets to live and who gets to die based on resources and their chances of survival. Seeing and hearing first-hand accounts of the same from doctors in developed countries is not a surprise for many health workers in Africa.

For health staff in developed countries, such as Italy and US, it took their healthcare systems to be strained to the limit before they had to make these kind of decisions. Due to the burden on the health sector caused by COVID-19, they do not have enough resources or healthcare staff to meet the demands of sick people and so they are choosing who is more likely to live and who will die.

That is something we have been grappling with even before COVID-19. In developing African countries decisions of life and death are already being made on a daily basis in standard healthcare, due to lack of resources. Here the narrative is often: “There is nothing much we can do”; versus “We did everything in our ability to save this life”.

Zambia’s healthcare system is already overburdened, with one doctor for every 10,000 people. After a few years of practice – and going above and beyond their means to try and save lives – healthcare workers are conditioned to come to terms with the reality of lives lost due to lack of resources.

Before COVID-19, statistics show that over 40% of WHO Member States have less than 10 medical doctors per 10,000 population; 26% have less than 3. Healthcare workers are distributed unevenly across the globe. Countries with the lowest relative need have the highest numbers of healthcare workers, while those with the greatest burden of disease must make do with a much smaller healthcare workforce. Africa suffers more than 22% of the global burden of disease but has access to only 3% of healthcare workers, and less than 1% of the world’s financial resources.

What if any of the healthcare staff died of COVID-19. This will be a shock to the whole healthcare system as it will leave a huge vacuum in service delivery. Conversations with doctors in Lusaka, Zambia’s capital, suggested they all believed that the healthcare system needs a lot more support before it is ready for COVID-19.

“I am not worried if I will die, what I am worried about is: not knowing what to do with a patient,” said an emergency doctor, as she wondered how we will manage with the already limited resources if the cases pile up.

Many doctors say: “COVID-19 is not an emergency when it’s been in our midst for the past three months now.” This demonstrates the need for a plan of how Africa should prepare for the COVID-19 pandemic. The question is whether African healthcare systems should invest in intensive care units (ICU) and ventilators, or should we focus on our already strained healthcare system with high levels of deaths from diseases such as HIV-AIDS, tuberculosis, malaria and malnutrition.

There is a need to revise and implement appropriate and effective interventions to promote healthy living, and prevent and control disease. During the height of the Ebola epidemic in Sierra Leone in 2014, treatment beds prevented an estimated 57,000 infections and about 40,000 deaths. But due to a lack of capacity in many hospitals, patients with other diseases couldn't get the treatment they needed, causing more than 10,000 deaths.

A resident surgeon said: “In Italy, a nurse describes COVID-19 as a war scene and health staff are the frontline. Well, turns out we are the only line in Africa. We are already grappling as a developing country and the sad reality is, the other diseases are not on strike." A resident paediatrician added: “We do not even have the privilege to get ready for COVID-19, as blood banks run dry and schools are closed and other deaths are happening as we speak. God help us all.”

Another doctor said: “I am battling the COVID-19 anxiety, as I know what may hit us. I spent a decade in training to be a medical doctor. My family invested not just financially but also human capital to get me where I am today. My parents say that I signed up to heal and save lives, not risk my life in the process.”

In my role as the Zambia medical associations public health chair, I have been raising awareness through different channels – on the radio, TV, and through personal outreach – for the past two weeks. Here in Lusaka, it’s clear that many citizens don’t want to know because of a lack of understanding. When you live surrounded by poor health outcomes due to HIV, tuberculosis and malnutrition that have been around for so long, why would you listen to someone telling you about an invisible threat called COVID-19? This applies to the many in middle to low socioeconomic class who have a hand-to-mouth lifestyle.

The question is, why are health workers in the frontline not speaking out about all these concerns and challenges? A shared perspective among many is that COVID-19 is a common enemy. If African healthcare staff speak out against the calm and reassuring, “We have it under control” message, it brews panic which will lead to more harm than good.

Another issue is, due to the many socioeconomic challenges, Africans are highly critical of government. The audiences that do follow the media do not believe what the leaders are saying. It’s a challenge because the government needs everyone to fight this together. The mistrust and lack of hope is a concern. This fight will only be fought if we all join hands with the government. Media houses are working on bringing their audiences round, to listen to the government and recognize COVID-19 as a threat.

Having highlighted the weak and overburdened health systems in Africa, the question is how we will cope with COVID-19. Zambia, like most African countries, continues to be overwhelmed by emerging and re-emerging infectious diseases.

Evidence suggests engaging all stakeholders in preventing and controlling these and other diseases is the way to go. The community needs to be engaged at all levels in order to mitigate the high burden of many preventable diseases.

With COVID-19, we speak of protecting the vulnerable. One could argue that the healthcare staff of Africa and the world are a rare commodity and need to be protected, in light of the already limited healthcare workforce. The lack of PPE for healthcare staff on the frontline should be an urgent priority. Take care of us by providing adequate PPE, as this will help us better cope with patient care.

Thank you for the recognition of all frontlines with #ClapForOurCarers. We appreciate it but what we require from you all is to help frontline staff get adequate personal protective gear. For now, we don't want claps or hero salutes, we need a steady continued supply of PPE.