In Kazakhstan and Kyrgyzstan, about a quarter of those infected with Covid-19 are health care workers. They complain on social networks that they were left to fight the epidemic without being provided with personal protective equipment. As a result, many of them became carriers of the virus themselves, traveling around the country as part of mobile teams. At the same time, the authorities often accuse the doctors themselves of being infected.
On March 23, 48-year-old Anara Zhunusova, an assistant epidemiologist at the Bishkek Center for State Sanitary and Epidemiological Surveillance, was on duty: “When I came home for lunch, I immediately felt weakness, lack of energy, and loss of appetite. The next day my temperature rose to 39 degrees and I began to have severe body aches. I thought I had the flu and called for an ambulance, but they told me they only respond to sick children and instructed me to seek help at my home. Ana’s first test for the virus was negative, and only the second confirmed the presence of an infection. She was admitted to the hospital six days later in critical condition; she stayed in the Infectious Diseases Hospital for a total of 17 days, six of which were spent in intensive care. “Out of overwhelming depression, I didn’t even have tears to cry out all the pain and insult I was experiencing. We, the epidemiologists of Bishkek, were among the first to go to the hotspots and identify the first cases of coronavirus in the city. We filled out questionnaires, talked to patients, and conducted rapid tests,” Anara says. At the State Sanitary and Epidemiological Surveillance Center where Anara worked, 51 of her colleagues later fell ill. Anara says they initially did not have enough personal protective equipment, but there was no time to think about it.
Movement between settlements in Kyrgyzstan is prohibited. By then, the virus was actively spreading throughout the country, and authorities were desperately trying to track down contacts of the infected by sending doctors to test people at home. Anara is one of more than 190 health care workers in Kyrgyzstan who have contracted Covid-19, representing more than a quarter of all coronavirus cases in the country. According to the World Health Organization, the total number of infected healthcare workers worldwide is approximately 16%. Data vary from country to country depending on the extent of testing.
We explain quickly, simply, and clearly what happened, why it matters, and what will happen next. The number of offers should remain: episodes. End of story: Podcast Advertising.
The reason for the rapid spread of the virus among doctors, experts say, is a lack of staff and personal protective equipment. Regional hospitals in Kyrgyzstan often lack infectious disease specialists and epidemiologists. “Epidemiologists work as part of mobile brigades: they go out on calls, visit surveillance centers, personally inspect and monitor the work of clinics and hospitals,” explains Bermet Baryktabasova, an evidence-based medicine expert involved in developing clinical standards. “It turns out that an epidemiologist or infectious disease specialist works in different areas and visits several facilities in one day, and then returns home at the end of the day. As a result, they may be spreading the infection.” Once a year, the Sanitary and Epidemiological Service conducts drills and inspections, but this is not enough to prepare for a pandemic, says Gulnara (name changed at her request), a 54-year-old doctor-therapist who has been working in a mobile brigade since the beginning of the pandemic.
Not all health care workers who visited people at home could afford a protective suit. We have been informed that there are people in our area who are at risk and have been placed under home quarantine, and they have been instructed to go and take tests, take temperatures, and check to see if they are violating the isolation conditions. “At the time, we only had one anti-plague suit for the entire hospital, so we did not divide it up and just went in with ordinary surgical masks, gloves, and a cloth on our heads. I guess we were lucky that everyone I checked was not infected,” says Gulnara. “We have repeated the biggest mistake of all healthcare systems in countries where the spread of infection started with healthcare workers,” says Baryktabasova.
Kyrgyzstan began preparing for the pandemic in January. After the WHO declared a pandemic, Kyrgyzstan and neighboring Kazakhstan restricted mass gatherings, banned mass prayers, and closed schools and universities, followed soon after by border closures. The first cases of Covid-19 in Kyrgyzstan were recorded among passengers returning from a pilgrimage to Saudi Arabia, who were immediately placed in home quarantine upon their return. It turned out that one of them had violated the quarantine by organizing a traditional aja-toy (a festival in honor of a pilgrimage) to which he invited about 150 people. Osh, the country’s second largest city, has become a hotspot for coronavirus infection. When cases were detected in Bishkek, the country’s largest cities declared a state of emergency and imposed a curfew, prohibiting residents from moving between settlements and going outside unless absolutely necessary. Nearly 300 mobile medical teams were organized throughout the country and sent to infection hotspots throughout the country. “Colleagues from our district were infected by an epidemiologist from a mobile brigade who had contact with a person with Covid-19 and then went on a trip. The virus spreads very quickly, so some doctors who were in the brigade and even their relatives got sick,” says Dr. Gulnara.
Physicians who perform tests on people and provide primary care were most at risk. Previously, the suits had been supplied by the hospitals themselves. After the coronavirus outbreak, they were sent to infection hotspots in the southern part of the Republic. According to Hans Kluge, Regional Director of the WHO Regional Office for Europe, the situation has been exacerbated by the closure of borders with neighboring China, the main source of imports of medical equipment, including masks and suits. In Kyrgyzstan, for example, the price of surgical masks increased sixfold during the pandemic.
“The lack of personal protective equipment has become a global problem. It is important to remember that in many developing countries, the health sector was underfunded even before the pandemic. So the way doctors are dealing with the outbreak is nothing short of heroic. This is especially true in primary health care facilities, where doctors are under pressure and working in difficult conditions,” says Kluge.
Later, humanitarian aid began to arrive in Kyrgyzstan, including from the WHO and the United States, which included protective suits. The government then resumed the production of masks and suits in Kyrgyzstan. However, the opportunity to protect the first doctors who encountered the epidemic was missed.
“When the first cases of infection occurred, the doctors were told to fend for themselves, and the medical staff began to search for and purchase personal protective equipment on their own. The first suits were of poor quality – they were homemade or made by craftsmen,” says Bermek Bariktabasova.
Forced to take risks without protective gear, some doctors have taken to social media to share photos and videos of the horrific conditions in which they work. The most popular tweet was that of a young doctor, Bektur Apyshev, who photographed the surgical mask he was given and wrote that “a fly could pass through it, let alone Covid-19”. He later tweeted that he had been summoned to a meeting with management.
Tweets in which Apyshev complained about personal protective equipment were later deleted. As a result, his account was temporarily deleted and a video of him apologizing for allegedly misrepresenting information about protective equipment for doctors appeared on the Internet. Following the incident, Kyrgyz users began expressing their support for doctors speaking out about poor working conditions using the hashtag #BekTur, which translates from Kyrgyz as “stand strong” or “insist.” The BBC was unable to reach Apyshev. His case drew world media attention to the issue and was debated in the country’s parliament. Several lawmakers drafted amendments to protect health workers in emergencies and limit pressure on them.
Meanwhile, the Kyrgyz Prosecutor General’s Office, in response to a parliamentary inquiry about the role of special services in cases of public apologies by doctors like Apyshev, stated that “the authors of the videos made their public apologies voluntarily. Other doctors have posted videos on social media of themselves commuting to work on overcrowded buses, violating sanitary norms, getting stuck at checkpoints, or riding bicycles from one village to another to get to work. The Ministry of Health responded to these complaints by saying that doctors often become infected through improper use of protective suits or through contact with infected people outside of work.
The statement by Deputy Prime Minister Kubatbek Boronov, who accused an employee of the Osh Children’s Infectious Diseases Hospital of infecting colleagues, caused a strong reaction. According to him, she visited a neighbor who was on a pilgrimage and continued to work. Later, the hospital staff wrote a letter expressing outrage at Boronov’s words, stating that their colleague had been infected while working with Covid-19 patients. The deputy prime minister later apologized, but other high-ranking officials have made similar statements. In particular, in response to a request for comment on the cases of infection among healthcare workers, Health Minister Sabirzhan Abdikarimov stated that “apparently, the rules for the use of personal protective equipment and precautions during its use, putting on and, especially, taking off have been violated”. The same position was taken by the Ministry of Health in neighboring Kazakhstan, where more than a quarter of the infected are also doctors. The local Ministry of Health also attributed the mass infection to the violation of epidemiological norms by the doctors themselves.
The worst situation was at the Central City Clinical Hospital (ЦГКБ) in Almaty, where more than 360 employees were infected with the coronavirus – more than half of all cases in the city by the end of April. The chief sanitary doctor of Almaty also accused the health workers of neglecting safety measures, while the hospital staff called it slander. “Who, if not medical personnel, knows best about the danger of coronavirus infection and the need to take precautions,” the statement reads. “We are trained, fully equipped with personal protective equipment (PPE – BBC), we change masks up to 10 times per shift, the emergency services work in protective suits, despite the lack of instructions. There is a pandemic in the world, a huge number of infected medical workers, so what does management, health professionals and the lack of precautions have to do with it?” The hospital’s chief physician left his post after the incident, and the hospital is closed for quarantine. The Department of Quality Control and Safety of Goods and Services of Kazakhstan is conducting an investigation into the causes of the mass infection. The city’s chief sanitary doctor has also resigned.
Kyrgyzstan’s capital, Bishkek, is under a state of emergency and curfew. After the Almaty hospital incident, the Ministry of Health required all doctors to be tested for coronavirus and divided all hospitals into “dirty” zones (rooms where staff come into contact with infected people and changing rooms) and “clean” zones (all other areas). There is no talk of such measures in Kyrgyzstan yet.
“Kazakhstan is a pioneer in testing all health workers, even those without symptoms. That is why they have such high infection rates among doctors,” says Hans Kluge, WHO representative. “Unfortunately, not all countries have the resources and capacity to test doctors on a large scale, otherwise the average global rate would probably be much higher”.
In both countries, health workers received financial bonuses during the pandemic. However, some doctors in Kazakhstan and Kyrgyzstan complained that they did not receive the money. Authorities have also promised compensation to infected medical workers – but both Kazakh and Kyrgyz authorities say they will look at each case individually to determine exactly how the worker contracted the coronavirus.