EDITORIAL: Challenges of Congenital Heart Disease and the Impact of Covid-19 on Health Workers.

West Afr J Med. 2021 Feb;38(2):105-106. PMID: 33641141

Abstract

It gives me great pleasure to present the February 2021 edition of the West African Journal of Medicine. The articles in this edition, as usual, cuts across numerous fields in Medicine and Surgery making it a compelling read. It also reflects the versatility of our contributors.

I am especially delighted to introduce the editorial on ‘The Challenges of Managing Congenital Heart Diseases in Africa’ by a passionate and astute Paediatric Cardiologist, who has made significant contributions to the advancement of paediatric paediatric cardiac services on the African continent - Professor Samuel Omkhodion.

Morbidity and mortality from congenital heart diseases remains unacceptably high in Africa. While most congenital heart diseases (CHD) are amenable to intervention in developed countries, needless deaths from CHD remain unabated in developing nations. Paediatric cardiovascular healthcare services are capital intensive and require the availability of modern diagnostics facilities, interventional procedures, definitive surgical solutions and matching intensive postoperative care. This editorial is very enlightening and reveals the peculiarities involved in managing congenital heart diseases in resource constrained environments like ours. The article which the editorial focused on, is quite timely and brings to fore the enormous financial burden associated with congenital heart diseases. The study describes the catastrophic effects of the cost of pre-surgical management of CHD on typical Nigerian families.

The challenges of the previous year have been rolled over into this new year and the battle with COVID-19 virus is far from over. The corona virus pandemic is still ravaging, with increased virulence as new strains of the virus are being discovered. The discovery of the UK strain of the COVID-19 virus has made the battle fiercer with increased rate of infectivity, severe infections and increased mortality. Other variants have also emerged including the South African variant and the Brazilian variant making the control of this disease more challenging.¹ The fact remains that mutations may not be susceptible to antibodies induced by currently available vaccines and might not respond to available therapies.²

Health workers globally continue to face the full brunt of this pandemic as they work at the frontline, managing patients infected with this deadly virus. The increasing number of health care workers getting infected with the virus gives cause for concern. Many healthcare workers have succumbed to the virus all over the world. A systematic analysis of health workforce infectivity and care fatality rates shows that Europe had the highest number of infections and deaths with the lowest case fatality rate while the Eastern Mediterranean region had the highest case fatality rate.³ Reports from the United States of America and Mexico revealed that health workers represent ‘one in every seventh case’ of COVID-19 infections. As at mid-last year, data from 37 countries in the Pan American region showed that over 570,000 healthcare workers were infected with the virus and 2,500 died from Covid-19 in North and South America. ^4,5

Africa and India have reported a relatively lower number of infections and deaths.³ However, this is increasing in view of the second wave of the pandemic. Report from the World Health Organization’s Regional Office for Africa showed over 10,000 infections among healthcare workers in Africa, mid-last year. This is only the tip of the iceberg as cases are grossly under reported and there is paucity of data in sub-Saharan Africa. Just two months ago, within a period of a week Nigeria lost 20 doctors to COVID- 19. Recently, some hospitals have lost very senior colleagues. This calls for an increase in preventive and mitigation measures.

Most COVID-19 cases and deaths reported among the health work force were found in the 50–59 age range, while the group aged over 70 years had the highest case fatality rate.³ This is a reflection of the general trend of the disease among the populace. In this edition, a 51-year-old Nigerian frontline health care worker details his terrifying personal experience with the COVID- 19 infection. He experienced all the four phases of the infection. This brings closer home the dire consequences of infectivity with COVID-19 among health care workers. Nigeria is one of the countries with the highest number of health care workers infected by the corona virus in Africa. African countries are currently facing a crisis in the health sector with the exodus of health workers to Western countries resulting in shortage of man-power. Losing healthcare workers to COVID-19 will further compound the current precarious situation.

The government of African nations need to be more proactive in guarantying the safety of health care workers by ensuring increased testing, provision of personal protective equipment, safe working environment for health care workers, provision of prophylactic medications and the establishment of more treatment centers to cater for the increasing number of persons infected by the virus.

There is the need for strict enforcement of the COVID -19 guidelines. Isolation centers should be well equipped and maintained. Risk assessment and stratification should be done. Considerations should be made for the elderly, those with co-morbid conditions and the immunosuppressed amongst the health work force who may be at higher risk of being infected with the COVID-19. Elderly health care workers may be assigned to less risky settings such as telemedicine or administrative positions to reduce exposure. Routine testing and vaccination of health care workers for COVID-19 should be done.

We, as health care practitioners, endure considerable psychological and physical stress in caring for patients. Hence, we cannot afford to be careless. We must protect ourselves, colleagues, patients and families. It is time we all must take heed to the call ‘Physician heal thyself.’ As long as there is still one person infected with COVID-19, we cannot drop our guards.

We commend the efforts of the global health workforce in combating this pandemic and applaud the commitment of researchers who have continued to pursue laudable research in the face of such dire circumstances. We encourage you to keep sending your manuscripts for review and subsequent publication in this highly educative journal. Together, we can survive this pandemic and come out stronger.

REFERENCES

1. https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant.html. Accessed 16/02/2021

1. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/a-new-strain-of-coronavirus-what-you-should-know. Accessed 16/02/2021

1. Bandyopadhyay S, Baticulon RE, Kadhum M, et al. Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review. BMJ Global Health 2020;5:e003097. doi:10.1136/ bmjgh-2020-003097

1. Erdema H., Lucey D.R. Healthcare worker infections and deaths due to COVID-19: A survey from 37 nations and a call for WHO to post national data on their website. International Journal of Infectious Diseases Volume 102, January 01, 2021; 239-241

1. https://www.paho.org/en/news/2-9-2020-covid-19-has-infected-some-570000-health-workers-and-killed-2500-americas-paho. Accessed 16/02/2021

1. https://www.afro.who.int/news/over-10-000-health-workers-africa-infected-covid-19