Aydogdu ALF.Violence and discrimination against healthcare workers in times of new coronavirus. J. nurs. health. 2020;10(n.esp.):e20104006

https://periodicos.ufpel.edu.br/ojs2/index.php/enfermagem/article/view/18666/11520

Update ARTICLE

Violence and discrimination against healthcare workers in times of new coronavirus

Violência e discriminação contra profissionais de saúde em tempos de novo coronavírus

Violencia y discriminación contra personales de salud en tiempos de nuevo coronavirus

Aydogdu, Ana Luiza Ferreira[1]

ABSTRACT

Objective: to reflect about the increase in violence and discrimination against healthcare workers due to the new coronavirus pandemic. Method: theoretical reflection based on reading, analyzing and interpreting news, scientific articles and reports on violence and discrimination to healthcare workers who combat the novel coronavirus. Results: as it is a new disease, there are still many uncertainties around it which can lead to violence and prejudice. That’s exactly what happened when the population mistakenly began to see the healthcare worker as a spreader of diseases. International organizations call on governments around the world to take action to protect health teams that have become victims of violence and discrimination. Conclusions: hospital administrators and governments need to create measures to stop these aggressions and discrimination.

Descriptors: Coronavirus; Pandemics; Violence; Health personnel; Communicable diseases

RESUMO

Objetivo: refletir sobre o aumento da violência e da discriminação deferidas aos profissionais de saúde em razão da pandemia do novo coronavírus. Método: reflexão teórica baseada na leitura, análise e interpretação de reportagens, artigos científicos e relatórios sobre violência e discriminação aos profissionais que atuam no combate ao novo coronavírus. Resultados: por ser uma doença nova, ainda existem muitas incertezas a seu respeito, o que pode levar ao surgimento de violência e  preconceito aos profissionais de saúde. Foi justamente o que aconteceu, quando a população erroneamente começou a ver o profissional de saúde como um disseminador de doenças. Organizações internacionais pedem que governantes de todo mundo tomem providências, procurando proteger as equipes de saúde de se tornarem vítimas de violência e discriminação. Conclusões: administradores hospitalares e governantes precisam criar medidas, visando impedir que essas agressões e discriminações ocorram.

Descritores: Coronavirus; Pandemias; Violência; Pessoal de saúde; Doenças transmissíveis

RESUMEN

Objetivo: reflexionar sobre el aumento de la violencia y la discriminación contra los personales de salud debido a la pandemia de nuevo coronavirus. Método: reflexión teórica basada en la lectura, análisis e interpretación de noticias, artículos científicos e informes sobre violencia y discriminación a profesionales que trabajan para combatir el nuevo coronavirus. Resultados: como se trata de una enfermedad nueva, todavía hay muchas incertidumbres al respecto, lo que puede conducir a la aparición de violencia y prejuicios. Esto es exactamente lo que sucedió cuando la población comenzó a ver por error al personal de salud como un difusor de enfermedades. Las organizaciones internacionales hacen un llamado a los gobiernos de todo el mundo para que tomen medidas para proteger a los equipos de salud de violencia y discriminación. Conclusiones: los administradores de hospitales y los gobernantes deben crear medidas para evitar estas agresiones y discriminaciones.

Descriptores: Coronavirus; Pandemias; Violencia; Personal de salud; Enfermedades transmisibles

INTRODUCTION

It was in December 2019, when the government of China informed the World Health Organization (WHO) about an outbreak of pneumonia in the city of Wuhan¹ that the world began to undergo transformations. In March 2020, WHO reported that it was a pandemic of new coronavirus (SARS-CoV-2).² On April 21, the total number of cases worldwide accounted for 2,492,963, while 171,152 people had died, due to the disease.³ At the same time, in Brazil there were 43,079 cases and 2,741 deaths.⁴ Following the WHO recommendations to prevent the spread of the disease, governments of several countries established social isolation,⁵ in some places in more rigid ways, in others not so much.^6-7

However, for healthcare workers there is no possibility of isolation, quite the opposite, they are the ones who are on the frontline against COVID-19, at great risk of becoming infected,⁸ suffering with the lack of Personal Protective Equipment (PPE)⁹ and also suffering due to their use.¹⁰ As if all of those problems were not enough, violence and discrimination against healthcare workers increased since the pandemic emerged.^8,11-13 There are approximately 59 million health personnel worldwide.¹⁴ Health facilities in Brazil employ about 3.5 million workers.^15-16 Most of them are currently combating COVID-19. Unfortunately, healthcare workers are being seen by the population not as a solution to solve the pandemic, but as a focus of disease contamination.⁸

Health personnel, who had already been suffering from acts of violence in the workplace,¹⁷ also became victims of extramural aggressions after the emergence of COVID-19.^8,12 It is possible through news, internet and social media to have access to information about violence and discrimination against healthcare works. The aggressions can be verbal and even physical.^18-21 Acts of discrimination and humiliation range from insults to expulsion from public transport^22-23 and hotels.²⁴ This kind of occurrences have been observed in several countries such as Turkey, Mexico, Philippines, United States of America, India, United Kingdom and Brazil.^18-20,25-28 Organizations are concerned about the situation and ask the authorities to have no tolerance for verbal, physical and psychological violence against health personnel.^8,11,29-30 Laws have been changed, aiming to punish more effectively those who attack healthcare workers.^11,31 The main reason for the aggressions and discrimination is the fear of contracting COVID-19, but there are also other reasons for them to occur.

The purpose of this article is to reflect about increase in violence and discrimination against healthcare workers due to the COVID-19 pandemic.

METHOD

It is a theoretical reflection based on reading, analysis and interpretation of reports, scientific articles and news about violence and discrimination against professionals who are fighting against SARS-CoV-2.

The bibliographic material was collected between April and the first week of May 2020. The search for reports on violence and discrimination against health personnel, who combat SARS-CoV-2 around the world was carried out through from Google, using keywords like “Health care professionals” AND “Violence” AND “Discrimination” AND “Coronavirus” OR “COVID-19”.

The selection of scientific articles and other official documents were made through Google Scholar using the same descriptors above mentioned. Consultations were also carried out on the websites of councils and associations of healthcare workers and international organizations in order to access reports about the subject. There were discussed studies that addressed the theme of violence and discrimination against health professionals who work to combat COVID19.

RESULTS AND DISCUSSION

The fear of the unknown, in this case SARS-CoV-2, brings reactions that are often meaningless, such as attacking those who should be exalted for doing a so high-risk job, such as caring for patients with COVID-19. Generally, the aggressions against health personnel are for fear of contagion.

However, they can be committed for other reasons. There is aggression because the patient considers himself infected and does not accept the negative diagnosis,³² there is also aggression on the part of a patient who receives a suspicious diagnosis and does not accept it.³³ There are cases in which healthcare workers are attacked by family members who wish to visit relatives hospitalized and are prohibited due to the risk of contamination.³⁴

Around the world, an increase in the occurrence of verbal, physical and psychological aggressions against healthcare workers has been reported. Professionals are attacked inside and outside their workplaces. Professionals, who should be proud of what they do in such a tragic moment, are actually afraid to be recognized on the streets.

Healthcare workers were already victims of many threats, hostilities and aggressions even before the COVID-19 pandemic. They felt apprehensive at work. Health institutions are identified as places where acts of violence against employees occur most. Such actions may come from patients, patients’ family members or even from coworkers.^35-39 According to WHO, from 8% to 38% of health personnel worldwide are victims of physical violence at some point in their professional lives.⁴⁰ Authorities from some countries felt the need to change laws regarding to aggression against healthcare workers, speeding up trials and increasing punishments.^31,41

Violence and discrimination against health personnel increased in many countries due to COVID-19 pandemic. At a moment when the population should be focused on fighting the disease, they turn against healthcare workers, who feel increasingly persecuted by the shadow of violence and discrimination, which is now also pursuing them outside the workplace.^11-12 Due to all that, healthcare workers are more depressed and anxious.^42-43

Just as the use of physical force is a type of violence, acts with a high risk of causing deprivation, psychological damage or inappropriate development are also agressions.⁴⁴ There is a lack of PPE at health institutions of several countries,⁹ which can bring irremediable physical and psychological consequences for those who work in such places. The lack of PPE is also institutional and governmental violence against health personnel.

During a pandemic caused by a virus that spreads so quickly, the professional needs to be physically and mentally healthy so as not to be contaminated, not spread the disease and also take care of those who are already sick. To stay healthy when working at a health facility, which in normal times is already a stressful environment and which, in the midst of an epidemic, is in danger of becoming a chaos, can be very difficult, especially if the professionals feel that their lives are threatened in the workplace as well as outside it. It is necessary to keep in mind that the aggressor's stress level is also high, as it is driven by fear and lack of knowledge.

When healthcare workers develop psychosocial problems, in addition to being exposed to the risks arising from their own profession, there is also a decrease in the quality of the care provided by them, what threatens patients’ lives.^38-40,45

When healthcare workers are attacked, population is not aware that is actually attacking those who will be the only ones to be by its side in the event of a hospitalization. Social media, news and internet that so well inform about acts of violence can also be used to report that healthcare workers are precisely the most suitable people to help the population in preventing and combating COVID-19. It is vital to recall that health personnel take necessary measures, preventing the spread of the disease and should in no way be harassed and accused of spreading diseases.

Countries will not be able to control the pandemic without healthcare workers.⁴⁶ Measures are being taken by institutions around the world to increase the motivation of health personnel and also to reduce the occurrence of verbal, physical and psychological aggressions against them. After the emergence of the COVID-19 pandemic, in face of the increase of violence against health professionals, laws are being changed.¹¹ WHO asks that professionals also take care of their mental health and immediately report to their superiors in case of danger of any kind.^12,47

In Brazil, healthcare workers are attacked even during a silent act in memory of colleagues, who lost their lives fighting against COVID-19.⁴⁸ Brazilian authorities and health institutions administrators also need to make efforts to inform the population correctly and protect health personnel, so that they can do their best in a situation as difficult as the one we are going through.⁴⁹

FINAL CONSIDERATIONS

COVID-19 is a very serious threat to Brazil and to the world. It is vital that the population worldwide has the same objective and follows preventive measures correctly for the pandemic to be controlled. Healthcare workers have very important roles in this battle, and they must be protected and not attacked. In face of the current situation that points to an increase in discrimination and violence against health personnel, institutions and authorities must develop measures to prevent such acts. The following points seem to be of paramount importance:

1. To create a phone number to which healthcare workers can call in case of violence and discrimination;

 2. To revise the penal code so that acts of aggression and discrimination against health personnel can be penalized immediately and more strictly;

3. To provide psychosocial assistance to those professionals who are victims of violence and/or discrimination;

4. To increase security in health institutions, so that employees feel more secure in the workplace;

5. To ensure that healthcare workers are not attacked or discriminated on the streets or on public transport;

6. To inform the population about the transmission of COVID-19, describing that healthcare workers are specialists, that well know the disease and preventive measures;

7. To make the population become an ally of health personnel, recognizing their value and supporting them in such a difficult time as the one we are going through;

8. To take political measures to make healthcare workers feel safe and supported by the government.

It is hoped that this article will raise awareness among the authorities about the situation that healthcare workers are going through. When planning strategies aimed to control the COVID-19 pandemic, they should also create strategies to protect healthcare workers against violence and discrimination, making the population aware of the importance of those professionals. To protect the general population, healthcare teams must be specially protected, since they are fundamental to the control of the pandemic.

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Submission date: 28/04/2020

Acceptance date: 06/05/2020

Publication date: 07/05/2020