Al jazeera. How can Health Workers fighting the coronavirus pandemic be better protected doctors and nurses around the world are risking their lives to treat the growing number of patients can the enormous mental and physical strain on them be reduced this is inside story. Hello and welcome to the program im homage to him the war against the coronavirus pandemic is being fought in hospitals around the world doctors and nurses are on the front line but the long hours and huge workload are taking their toll hospitals are not only running out of ventilators for patients they cant supply staff with protective gear such as masks and surgical gowns thousands of Health Workers are falling ill the number who have died is growing in spain medical staff account for 15 percent of reported cases and Health Workers in britain in the u. S. Say they cant get tested for the disease because there arent enough screening kits. Some medical staff have even been attacked in india police had to rescue doctors from crowds throwing stones many Health Workers have been sharing their experiences online. Letting out of the quick. That it becomes an emergency workman as this and were getting. The one of the people in the background of the young. Healthy. This is not something thats left a little small all please here this morning and do whatever nothing to prevent this from rome. No matter what is happening in madrid we are completely over float Health Workers are exhausted physically and emotionally because this is awful this is an inferno Critical Care nurse that just finished coaching i was support i just want to get some stuff in for the next 4 hours this no its no thanks to both i just im supposed to stay healthy. And most people who are. Strict because santa looks pretty sick food. You just dont. People like me are going to be looking over see it when youre a yellow is just to open him. All right lets bring in our panel from the u. S. Capitol doctors are headed by you me is professor of medicine and founding director of the rotten institute at the George Washington school of medicine and Health Sciences and from Hong Kong Paul youre chair professor at the department of social work and social Administration University of hong kong welcome to you all john let me start with you just how vulnerable to infection are Health Workers on the front lines right now extremely vulnerable as you can imagine physicians. Nurses social workers even the people that mop the floors and deliver the food are extremely vulnerable depending on what procedures theyre doing they that their risk goes even higher so you can imagine when you have a critically ill patient that needs to go on a respirator the act of actually putting that 2000 the throat aerosolize is all those particles those droplets that are filled with with virus and can scatter and and really make people in stream leave honorable and actually if you notice an italy in france and spain and china as well as in the United States there are many people on the front lines that unfortunately succumbed to cope with 1000 paul could you talk more about some of the other challenges facing medical workers right now around the world one thing it is to be overlooked in this is a hospital setting and on saw. Now they do not allow the visit is having to come into the to visit the patients does it actually you know who create additional work no i think for the Health Workers and also now we are running our mines and also the protective gear as we chose to expose i think a Mental Health look into the commute 1000 john things are so bad now in some parts of the world that medical workers are actually having to to create having to make some of their own protective gear right. Thats correct i was talking to a dear friend whos an Infectious Disease physician up in new york which as you know is the sort of epicenter and hot spot here in the United States she is actually using a garbage bag to protect herself she wipes it down with bleach and between patients she has used this same basket for the past week and finally had to throw it out so yes people are making do but it is really really an untenable situation and it increases the risk to everybody but primarily the clinicians and the Health Care Workers that are providing the much needed care and Critical Care for patients who are really suffering and and also dont forget that the clinicians and the other rest of the team are usually the only contacts with the patients right families cant go visit a. Loved ones cant go visit so you can imagine a patient who is theyre probably disoriented from all the medications that were giving them to just stay sedated on the respirator and youve got somebody with a mask and a garbage bag i mean how horrible is that you can only imagine paul what are some of the ethical dilemmas that medical workers are confronting now due to the Health Care Systems around the world being so stretched. Well dean they they are exposed to this excessive stress as what has sent before theres an isolation i thing theres a fear and panic among the patient in them so not only affecting the physical health and. Mental health as well so i think nowadays. Now they not only have to put one to support and care i mean for the medical of for their physical health but at the same time i think they have to Pay Attention of into the Mental Health of the patients. That is redoubling the low end because the visitors can go in and you know why some sorts of puts i think to do to the patient as well let me ask you the same question because were hearing more and more about really just very difficult ethical choices that you know medical professionals are are having to face now or may have to face soon could you elaborate on that. Sure i mean enormous times not during the pandemic we face ethical dilemmas all the time we take care of people that are perhaps elderly or terminal and we have to have very difficult decisions and discussions with their Family Members you multiply by a 1000000 of a 1000000000 and when equipment is is limited and what we dont have treatments it becomes sort of this this decision of is there going to be a possibility that this individual patient is going to recover right and if theyre older about 80 in particular if they have chronic medical conditions which there are numerous ones which im not going to list because i think it would take the rest of the program to to list them or and the wishes of the individual patient to if we have that abscess living well or if theres a Family Member a durable power of attorney say look if im ever in this situation i do not want to consent you know and a lot of our older patients d we try to encourage them its actually a medicare requirement that we ask about. In general in normal sort of time so the ethics of this are complex but i want to talk about another aspect where ethics are involved sort of outside of the hospital you know when we talk about Health Disparities which is what the right institute does and is dedicated to when you think about lack of food lack of housing lack of transportation lack of education thats actually what makes people much more vulnerable to illness and to catching cold that night scene and so for example at washington d. C. 50 percent of the people in the poor wards ward 7 and 8 to 50 percent have diabetes that is a significant risk factor so when you look at the. Thats in the you know patients and people in these people who are living in the poorest communities where their baseline status is poor are a particular risk paul you wrote an article where you said we need to ensure we are well prepared for what lies ahead that means staying healthy and getting lots of rest while looking out for each other i want to ask you if that is possible right now for medical professionals given professionals given the enormity of this crisis or years studying it is it is difficult but i think. What else can you do and what really can we need to do at the child to stay the optimistic way we tried to have sufficient wrist in thing and everybody i think trying to stay away to to get control of the diseases and not to overload being the host was a system again so i think what i really can see is that at this moment i think everyone have to come to good. Medical help what could they do have the job to do but i think through the olden citizen i think we also have to stay well and stay healthy and not to contest the diseases and otherwise it would just create additional work i think to the already overstretched hospital who have look alright lets look for a moment another aspect of this photos circulating online give us a glimpse of what daily life looks like for those Health Workers weve been speaking about many of them posted selfie showing the toll the fight against the virus is having on them probably the most striking images are of their faces these bruises are caused by wearing protective masks for hours a photo of an exhausted nurse in italy slumped over her keyboard also went viral and emotional pictures of staff reaching the breaking point or being comforted by their colleagues are also being shared Health Workers are discouraging nonessential visitors to hospitals to ease the pressure by staying. At home john let me ask you about this is seeing this these staggering pictures photos that are circulating online of just how exhausted and traumatized these medical workers are is this having an impact. Well of course it is i mean just think of yourself as a human being any parent whos ever taking care of a newborn baby or faced any adversity themselves. I mean when youre not sleeping and i think for a clinicians in particular you know wed like to make sure that people are taking care of to alleviate suffering to cure people when we can but always to provide Compassionate Care and thats not something that we have control over the right. To be added aspect or burden of worrying about your personal health you know im of generation or i took care of people on the front lines during the aids epidemic and there are similarities and differences at that time it was 100 percent what year death 3 of course the rip it see among certain groups in terms of infection or was quite high however what you are seeing is still the fear of actually contracting a hiv was there but through blood borne products and so forth but not through obviously various allies this is a highly contagious infection i have a colleague a medical assistant who is concerned about giving care because she is the primary caretaker for her 73 year old mother and her 93 year old grandmother and i asked her why isnt there anybody else there can help you in the extended family so i know there is a bit so imagine the physical toll of the visible but as dr paul mentioned the Mental Health toll that is not visible that i think is just as important but youre also adding sleep deprivation i can tell you when i was working 120 hours a week during my internship were not eating that well either. Then we know that just our ability to stay focused and sharp when we havent slept is amazing i mean its very very challenging in addition to you youre worried about your kids if you have your family having i have older parents im not able to see them i mean the burdens are many so imagine everybody else is worried about cook at 19 and of Course Community members and the general population is already stressed and worried but all of these burdens and you can only imagine how stressful and difficult this process were talking about stress as were talking about the enormous toll that this is taking on Health Workers across the world from your Vantage Point could this lead to long term posttraumatic stress disorder and other problems for Health Care Workers will you indeed i think give you know hong kong are they going to 03 we have the sinus epidemics at the time being we have to thousands of cases and and and 250 but what happened in doing debt year we actually have we have the historical high number of suicides and then you know community and explicitly among to i think the old and those. Why did kilograms of the when we read at def knox is it just it it is the isolation is this defeat is there and sign he arrives in from the epidemic so i think what we did see is you we can learn something from some of the what we better to do do do with the commit 19 is really time to how to. To to mature to contained oh fear and anxiety and make sure that you even get in the isolation i mean how can we still us how to connect these things connect to people and then you know order to maintain. Mental illness all right so were joined now by a 3rd guest from italy marko jaric kitty is president of the public clinical hospital in milan marco let me ask you 1st and foremost just how bad are things there right now for Health Care Workers. Than everybody in. This situation for the workers now its really hot its really suffering caused and there really a great pressure and. At the moment if luckily we hope it will last like this that detains sion and that did the pressure is a bit. Light and. But but still is still very strong because we are access to emergency its been we have. Fewer person accessing emergency now at the moment but we hope it will last now for the future but we had really really bad time in the last days and weeks marco i was in italy reporting from milan in late february and we were speaking to Health Workers there who were really worried that it could get much worse what are the conditions there whats the reason that it has gotten or the reason that it has gotten as bad as it has gotten. I think we have been after china differ on the line the 1st one to just say so this this virus and. I think we would. We will not. Understood very well how heavy and how difficult this will be and so maybe we reacted not as the same energy we understood we needed after a couple weeks. So i think at the beginning we stoped it was a something very. Easy to control instead it spread it around very very. Quick and fast and so we were not prepared the beginning now after 2 weeks of the for 10 days we have taken the measure and we have. The best condition how to react and how to to point us in front of this john youve been speaking a lot about the impact of this is having on on Family Members of patients i want to ask you more specifically about Family Members of of Health Workers i mean how difficult is it for doctors and nurses and other medical professionals who are grappling with the idea not just they are that they are vulnerable to infection but that they can also be infectious to their loved one especially their spouses and their children. Well thats i mean thats the whole concern i mean what is most important to people in general then your family and your loved ones that is a real issue i can tell you when i start working in my hospital i want to stay in a hotel just so minimize my contact with Family Members i know that other clinicians who can afford to are doing the same and you know about that further kind of worsens the isolation we are social animals how you evolve is to connect with each other and actually scientifically speaking when we connect and when we interact just the mere fact that were interacting increases adopt i mean levels that being of our brains and those are the sort of the feel good neural hormones that circulate and so being isolated and not being able to hug i mean this business of not touching it is really deprivation i mean that is deprivation for a parent who has a child is that actually a infant and to not be able to hold that infant that can have some longer lasting impacts but i think you know one of the at positive aspects if you will of all of this i cannot tell you how many of my patients have reached out and said look were thinking about you we love you please stay safe and healthy i think whats different about this pandemic is the connection between people overall with each other as the clinicians i mean now in new york city every day at 7 oclock people just applaud they go out in or on their balconies and applaud the Health Care Workers and i think thats different and it really speaks to Community Resilience because we have to look at it as as america right and we have to see ourselves as being connected. You you asked a really important question about why italy why the United States why were kind of behind the 8 ball well this underscores the importance of Public HealthPreventative Health as well as knowledge of working interpret freshly whether its social workers you know clinicians nurses doctors looking at the social determinants of health such as food housing etc marco let me ask you on a more personal note how concerned are you how concerned is your family for you and what are the kinds of things youre hearing from colleagues working in the Health Care Profession there. Is a we have we have a very war it. And i completely agree we didnt have vacation made made before because its debt does really. Really tough for a floor operators and from patient to. 2 faced as it did that something new is Something Different isnt it so strong in an a dramatic and so did did the warring get its its completely. Scaling up and i th