If I Fail, He Dies

The world is wrestling with the second wave of the Covid-19 pandemic. Coronavirus cases are on the rise and so is the number of doctors, nurses, and paramedics- collectively called Frontline Health Workers (FLHWs), becoming infected. In Pakistan, more than 12,800 FLHWs have contracted the infection so far, and 113 have sacrificed their lives in the line of duty.

The enormity and complexity of the situation may further increase with reports of a new strain of SARS-CoV-2 from different countries. The most widely reported is the one from several authorities in the U.K. The new variant, believed to be more transmissible than the original strain, resulted in a massive lockdown in the U.K. around the Christmas days, which the authorities have extended till mid-February 2021.

Continuation of the pandemic and addition of new and more transmissible variants means a further increase in the number of Covid-19 cases along with a likely increase of infection among the health workers providing care to the patients. The situation demands a sincere understanding and responsibility that each one of us must fulfill. People need to adopt protection to save their own life as well as the life of their dear ones. Not only that, but they must also practice this protection for those health workers, who risk their lives to attend to Covid-19 patients, every day.

This mutual need of caring for each other is not new. “If I fail, he dies” was an important and powerful expression of the shared value of caring for each other in 1918 during the overlapping devastation of World War I and the Spanish Flu. The war claimed 16 million lives while the number of deaths because of the pandemic was estimated at 50-100 million including both the civilians as well as the soldiers.

The poster message “If I fail, he dies” by the Red Cross was widely used to display the power of mutual respect and care. If a health worker fails, the patient who in those days was mostly a soldier would die. At the same time, if a soldier fails, many people would die at the hands of the enemy.

Pakistan too launched a campaign with the same spirit during May-June of 2020, when the country was experiencing its first peak of Covid-19 outbreak. WeCare was a message of mutual care and respect between FLHWs and the community. Health workers caring for people and the people reciprocating by adopting preventive behaviors to protect themselves.

The community’s caring for FLHWs is still relevant as the total number of Covid-19 cases and the number of health workers falling prey to the disease have a direct relationship with each other. On 15th April 2020, there were about 6000 Covid-19 cases in the country; out of them, 152 were health workers who had contracted the disease while being on duty, two of them embracing death. In May, the number of Covid-19 cases escalated and the health system also became overwhelmed. Nearly 2000 FLHWs contracted the infection during six weeks, while 19 lost their life.

In the months of June-July during which, 6000-7000 cases of Covid-19 were reported each day among the public, the health fraternity was also devastated. These two months saw a total of 4563 health workers becoming sick with 56 losing their life to this virus. The months of September and October brought some respite, but the numbers started rising again from early November. The past six weeks have seen another 3350 health workers becoming sick, with 26 embracing death.

Several reasons explain the relationship between a high number of Covid-19 cases amid the general population and the cases among health workers. For example, the role of mental stress and anxiety that Covid-19 health workers have widely faced has been frequently discussed in the context of the pandemic. One of the consequences of this stress is a decreased level of immunity that predisposes to contracting viral infections like Covid-19. The health workers dealing with Covid-19 patients are consistently exposed to stress, likely to have decreased levels of immunity and higher chances of becoming infected.

In the early months of the pandemic, a WHO expert said “the real point of entry for coronavirus is a busy emergency room.” He was referring to the possible high number of virus particles in the hospital settings. Recently, several research studies have also reported that one of the factors on which the outcome of Covid-19 patient depends, is the amount of virus (viral load) they carry.

Patients carrying a bigger viral load are more likely to face complications and death, compared to those who have less number of viruses in their body, and would emerge relatively unscathed. Hospitals, where Covid-19 patients are treated, are known for being a hub for virus load, hence bringing higher chances for health workers to contract the disease and face grave outcomes. Frequent, prolonged, and close contact with Covid-19 patients also makes health workers more vulnerable to contracting the disease.

It is ironic that throughout the world, while millions of people are under the caution “stay home, stay safe”, hundreds of thousands of health workers are expected to do the opposite. They have been going to hospitals, clinics, laboratories, and old people’s homes to perform their duties. After all, who would treat the patients under intensive care, attend them in the outdoor clinics, perform tests, and provide hospice to the elderly at their place?

Important to realize is that the number of health workers getting infected, or succumbing to the disease is just one part of the perplexing story. There is much more than what meets the eye. There are effects on the physical health that these workers face and even more, the mental agony that they and their families endure.

Imagine a doctor or a nurse who has an old mother or father at home. If that doctor or the nurse goes to work, they save the lives of the people but bring disease and death to the elderly at home. If they stay at home for the sake of their parents or grandparents, they violate their oath which is to protect and save human lives.

For a common man, it is hard to imagine the agony, the pain, and the suffering of these health workers. However, what is easy to imagine is saving these health workers from anguish, disease, and death. How? By protecting ourselves from the disease. By practicing simple acts: wearing a mask, washing hands, keeping a safe distance, keeping our house airy, and avoiding crowds. None of these is difficult at all. So let’s practice the advised behaviors without failure. Because if we fail, someone dies.

The writer is a health and risk communication scientist and advises ministry of health.

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