EHS-COVID (53) Q1: How has COVID-19 affected the delivery of essential health services? (3) Deaths of frontline health workers

16 November, 2020

Thank you Neil for fostering, on behalf of HIFA and WHO, such important and helpful discussions at the HIFA Forum.

In regard to the question of how has COVID-19 affected the delivery of essential health services (Q1), I would like to share with you the enormous death toll COVID-19 has taken from health personnel in Honduras, Central America, and specifically from physicians working in the public and private sectors, some as general practitioners and some with specialization. This loss of human talent affects directly the provision of essential health services and has produced a lot of suffering among the health personnel, their families, and the society in general.

Since March 10, when Honduras reported the first COVID-19 cases, up to October 31st, 61 physicians have passed away. Not all of them due to COVID-19 but all of them and their families affected by the general situation of confinement, limited circulation, closed outpatient clinics, and overwhelmed public and private hospitals, with shortage of medical equipment and supplies to treat complicated cases and limited Intensive Care Unit beds availability. Among these 61 physicians 20 were specialized physicians, including specialties such as epidemiology, obstetrics and gynecology, pediatrics, psychiatry, public health, and urology; some of them less than 40 years old. Very sad indeed.

On October 22, 2020, the Honduras Medical College paid tribute to deceased physicians and those currently on the front line of care. A description of this tribute and a also a commemoration as an article was recently published in the Revista Médica Hondureña (Alger J, Mejía F, Mejía M. Tributo a los médicos hondureños fallecidos durante la pandemia de COVID-19, octubre 2020. Revista Médica Hondureña 2020; 88 (Suplemento 1): 45-48), which is available at the following link:

https://revistamedicahondurena.hn/assets/Uploads/Vol88-S1-2020-26.pdf

Here some extracts from the paper:

'In Honduras, health personnel have also suffered these consequences [COVID-19 pandemic] and as of October 2020 the Honduran Medical College has reported the death of 61 physicians during the pandemic [Table 1].

'The first cases of COVID-19 [in Honduras] were reported on 10 March 2020. As of 26 October, 93,214 cases and 2,623 deaths had been reported. The estimated 263 deaths per million Hondurans is similar to that reported on the same date by Canada (264) and higher than reported by Costa Rica (257), Dominican Republic (204), Guatemala (203) and El Salvador (147); all of them with a number of laboratory tests carried out per million inhabitants ranging from 1.02 to 11.45 times more than the number carried out in Honduras. These data of death by COVID-19 in Honduras, the highest in Central America and the Dominican Republic, after Panama (608), could be explained by some of the characteristics of the country that have already been described in other epidemics such as dengue in 2019 and which stand out for their relevance in the current context of the COVID-19 pandemic.

'Honduras faces social and health determinants that require urgent and comprehensive care. Social determinants include poverty and inequality (Gini index of 0.52), insufficient education, mass migration, crime, high homicide rates and drug trafficking. Health determinants include disorganized population growth, unplanned urbanization, insufficient access to safe water, limited access to deteriorated and insufficient health infrastructure, and the ecological consequences of climate change. It adds to the negative effects of governance and failed health policies, the privatization of the health system and corruption, with the diversion of millionaire public funds as a widespread government practice and the consequent weakening of major health and education programmes. And yet, despite obvious and pressing needs, Honduras' military spending has steadily increased since 2010. All these characteristics of the country have become enhancing elements of the impact of the pandemic on health but also on society at large and the economy, and its negative effects in the medium and long term are under development throughout the region.'

Looking forward to the continuation of the discussions.

Jackeline

HIFA profile: Jackeline Alger works in the Parasitology Service, Department of Clinical Laboratories, Hospital Escuela Universitario, and at the Faculty of Medical Sciences, Universidad Nacional Autonoma de Honduras, Tegucigalpa, Honduras. She is a Country Representative for HIFA and CHIFA and is the 2-time holder of HIFA Country Representative of the Year Award 2015 and 2018. http://www.hifa.org/people/country-representatives/map

http://www.hifa.org/support/members/jackeline

Email: jackelinealger AT gmail.com