Social issues among the medical professionals during COVID-19 pandemic: An Indian Scenario

doi:10.21203/rs.3.rs-3863620/v1

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Research Article

Social issues among the medical professionals during COVID-19 pandemic: An Indian Scenario

https://doi.org/10.21203/rs.3.rs-3863620/v1

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Background

Corona virus pandemic was a global pandemic due to Corona virus which resulted social and economic disruption around the world and medical professionals were not an exception.

Methodology & study population

Descriptive Cross-sectional questionnaire-based survey was conducted among the medical professionals in India to find out the social issues faced during COVID pandemic.

Results

Medical professionals faced isolation, harassment denial of accommodation (38.89%) and untoward incidents (26.68%). Pandemic affected the income for majority and they also faced expenditure in the form of investment in health insurance schemes. Bio medical waste management was fairly good and medical professionals were aware of the biomedical waste management guidelines. Majority (87.63%) were aware of the guidelines regarding Pandemic related biomedical waste management and 67.74% were trained in biomedical waste management rules which exist in the country.

Conclusion

Pandemic raised social issues among medical professionals in the form of stigma, violence, decline in revenue, increased insurance expenditure. Guidelines and training were obtained for majority of medical professionals regarding biomedical waste management.

COVID pandemic

Stigma

Financial health

health insurance

Bio medical waste

Violence against medical professionals

Corona virus disease (COVID-19) is an infectious disease caused by a newly identified virus. In December 2019 Wuhan Municipal commission in China reported a cluster of pneumonia cases in Wuhan of Hubei province ⁽¹⁾. A virus was eventually identified as the causative agent and initially called as 2019 novel Corona virus. On 11 February 2020, this virus was officially named “the Severe Acute Respiratory Syndrome Coronavirus-2” by the International Committee on Taxonomy of Viruses. The disease caused by this agent was named COVID-19 by the World Health organization (WHO) where CO stands for corona, VI for virus, D for Disease and 19 for the year 2019⁽²⁾. The disease started human to human transmission and was spreading beyond Wuhan and China.

Because of the spread of the disease around the world, the World Health Organization designated this disease on 30 January 2020 as Public health emergency of international concern. On 11 March 2020, World Health Organization declared COVID-19 a “pandemic” ⁽³⁾.

First case of India was reported from Thrissur a district of Kerala state on 30 January 2020. By first week of March 2020 few states started reporting their first cases in quick succession. In the days to follow, cases have been reported in large numbers. Virulent virus has affected all sectors of life. To control the spread of pandemic along with many other public health measures, a country wide lockdown was announced by the government of India from 25 March 2020 onwards ⁽⁴⁾. Even though it was initially for a period of 21 days, lockdown was extended to 31 May 2020 ⁽⁵⁾. As on 31 May 2020 a total of 182143 confirmed cases and 5164 deaths were reported ⁽⁶⁾.Covid-19 cases started dropping since September 2020. From a peak of around 90000 cases per day in September 2020 number of cases fell below 20,000 in January and February 2021 ⁽⁷⁾. Cases started rising and exploded since early March 2021. As on 22 May 2021 India’s cumulative COVID-19 case count became 2, 65, 15,789 with 2, 98,849 deaths ⁽⁸⁾.

Being in a humanitarian profession, it is the duty of medical professionals to take care of the patient. But there is always an inherent risk to the personal health while treating a case of covid-19. A medical professional treating a case of Covid-19 or working in a hospital where COVID cases are treated always carries a risk of spreading the disease to the member of his family or society. Because of this threat of spread, the medical professionals are facing a sort of exclusion from the family or society ⁽⁹⁾. Social stigma in this context means medical professionals who are dealing with highly contagious infection are discriminated and socially isolated since they have a link with infection. This can have a negative effect on their work ⁽¹⁰⁾. Both in developed and developing countries physical and mental harassment of health care workers were also reported during the pandemic. Health care workers faced isolation, harassment denial of accommodation and transportation ^{(11, 12, 13)}.

Health care services were substantially reduced for non COVID ailments. Planned hospitalization, elective surgeries and follow up treatments have been reduced or stopped, which in turn interrupted the private health care sector. This has affected the financial health of medical professionals ⁽¹⁴⁾.

A steep increase in COVID care expenditure in private health sector has compelled the people including medical professional to buy a health insurance policy or to enhance the sum insured ⁽¹⁵⁾.

The violence against doctors which exists in the country for the past few decades ⁽¹⁶⁾ has been amplified by the pandemic ⁽¹⁷⁾. The recent surge in violence against medical professionals is a social challenge they face. Medical professional is subjected to ostracisation by the society on the presumption that they carry and spread disease ⁽¹⁸⁾ from the place they work.

Medical professionals have a role in disposal of biomedical waste in a scientific manner. Covid-19 related biomedical waste in the country has increased, which is recent social concern for the medical professional and health care sector ⁽¹⁹⁾.

Objectives

To find out the social issues faced by the medical professionals in India during covid-19 pandemic.

Scope of the study:

Identifying the areas of social challenges and introducing socially acceptable administrative measures, so as to ensure an effective approach for the healthcare professionals to improve the outcome.

Data collection instrument: The method used to collect and gather information was Questionnaire. The Questionnaire of the study was original.

Construction process:

English was chosen as the medium of questionnaire since it was a nation-wide survey among medical professionals.

A flow chart was designed (Fig-1) in such a way that the questionnaire includes

Fig: 1: Questionnaire design

A pre-test was performed among 30 medical professionals in the institution where the author belongs to.

Study design

Descriptive Cross-sectional questionnaire-based survey.

Study setting

Health care institutions in India where COVID patients were treated including public and private sector.

Targeted population

Registered Medical Practitioners in India involved in COVID management.

Study Sample: To get a statistically significant result, the biostatiscian in our host institution has fixed a minimum sample size required of 384, considering the dropouts and confidence interval. But in the present study, 558 Registered Medical Practitioners, who were involved in COVID care and management throughout India participated.

Inclusion criteria

Registered Medical Practitioners in modern medicine involved in COVID management in India.

Exclusion criteria

Registered Medical Practitioners who were not involved in COVID management and practitioners of alternative system of Medicine.

Duration of the study

One year (2022)

Approval:

Prior approval was taken from the institutional ethical committee for conducting the study.

Data Collection:

Data collected using a questionnaire via Google forms. Registered medical practitioners who were practising in India participated in the study by filling the forms through the link after providing the informed consent

Questionnaire: attached

Study was conducted during the year 2022 among 558 medical professionals in India. Out of the 558 medical professionals 393(70.43%) were males and 165 (29.57%) were females (Table-1). 87 (15.59%) medical professionals participated in the study belongs to public sector while 411(73.66%) from private sector. Medical professionals involved in private practise only were 60(10.75%). Speciality wise distribution of medical professionals is shown in Table: 2

Number and gender of medical professionals (Table 1 )
	No:	%
Males	393	70.43
Females	165	29.57
Total	558

Speciality wise distribution of medical professionals (Table-2 )
	No:	%
General practitioners	87	15.59
Broad speciality-Medical	237	42.47
Broad speciality-Surgical	135	24.20
Super speciality	99	17.74
Total	558

Social stigma:

Out of the 558 Medical professionals, 217 participants (38.89%) faced some kind of avoidance by members of the family or society.

Knowing the threat of spreading the disease to members of family or society 159(28.49%) medical professionals shifted to solitary accommodation and 363 (65.05%) did not shift to any such solitary accommodation but have taken precaution by way of seclusion. 36 medical professionals (6.46%) used the facility at the institution where they worked.

Financial health and pandemic:

Pandemic affected 410 medical professionals (73.48%) financially while 148 (26.52%) were not affected. 330 medical professionals (59.14%) opined that financial status of institutions where they were working was affected during pandemic. This resulted in the form of job loss, leave without pay and pay cut.(Table-3)

Table-3 Financial effect of pandemic
	NO	%
Job loss	15	4.55
Leave without pay	33	10.00
Pay cut	282	85.45

Among the 327 medical professional doing private practise, 60 (18.35%) stopped their practise during the pandemic and 267(81.65%) were affected by drastic reduction in their income.

Violence against medical professionals:

While performing or engaging in duty related to COVID-19 care 150 medical professionals (26.88%) were subjected to untoward incidents from the public. Incidences were in the form of physical violence, verbal abuse and commotion. 408 medical professions(73.12%) participated in the study were not subjected to any of such untoward incidences. 9 out of 150 participants lodged complaints against such incidences to legal authority. Government of India amended the epidemic disease act during the pandemic to protect the health care workers and health care institutions. 336 medical professionals (60.22%) participated in the study were aware of this act and its amendment while 222(39.78%) were not aware of such regulations.

Health insurance:

Prior to COVID pandemic, 396 medical professionals (70.97%) who participated in the study had health insurance coverage while 162(29.03%) did not have any insurance coverage. Out of the 396 who had health insurance coverage 180(45.45%) have enhanced the sum assured during the pandemic period. Out of the 162 medical professionals who did not have health insurance 151 participants (93.21%) purchased new health insurance policy seeing COVID 19 treatment expenditure

Biomedical waste management during pandemic:

489 participants (87.63%) stated that the health care institutions where they work have proper procedure for handling, segregation and disposal of biomedical waste related to COVID-19 care, while 12 of them (2.15%) stated that their institutions did not have such facility. 57 medical professionals (10.22%) were not aware of such facilities in institutions where they work.

Guidelines were published by the health authority of the country regarding biomedical waste management in relation to COVID care and 489 participants (87.63%) in this study were aware of such guidelines while 69 (12.37%) were not aware. 378 medical professionals (67.74%) participated in the study were trained in safe management of biomedical waste management as per existing rules at that time while 180(32.26%) were not trained.

Duty of care and social stigma:

Among the medical professionals who were involved in COVID care management, 38.89% participants faced some kind of avoidance by members of the family or society.

Knowing the threat of spreading the disease to members of family or society 159 medical professionals shifted to solitary accommodation and 363 did not shift to any such solitary accommodation but have taken precaution by way of seclusion. 36 medical professionals used the facility at the institution where they worked.

This suggests that a good number of medical professionals in this study experienced COVID-19 related stigmatization.

In India stigma against infection is an ever existing problem and reported many cases where doctors and other health care workers are avoided by the society for the fear of being getting infected ⁽²⁰⁾. A study conducted in India among 120 health care workers during 2020 showed that severe level of stigma was experienced by 68(56.6%) participants while 52 participants experienced mild to moderate stigma ⁽²¹⁾. In a similar kind of study conducted in Egypt among 509 physicians, 159 physicians (31.2%) reported that they have experienced severe stigma ⁽²²⁾. A review of infectious diseases stated that HCWs felt greater stigmatization than the general population and experienced more avoidance behaviours from the community ⁽²³⁾.

In Madhya Pradesh a state in India, doctors were attacked by a group of people while they had gone to collect samples from suspected COVID patients. Incident happened purely because of the COVID related stigmatization exhibited by the public ⁽²⁴⁾.

Fear and anxiety among public against a pandemic can be prevented or reduced through health education. This can be in the form of interaction with experts, newsletters and pamphlets ^{(25, 26)}. Harassment to medical professionals can be prevented to some extent in this way.

Financial health and pandemic:

One of the goals of this study was to examine the financial impacts the pandemic has had on primary care clinicians and practices.

Pandemic affected 73.48% medical professionals financially while 26.52% were not affected. 330 medical professionals opined that financial status of institutions where they were working was affected during pandemic. This resulted in the form of job loss, leave without pay and pay cut. Among the medical professional doing private practise, 18.35% stopped their practise during the pandemic and 81.65% were affected by drastic reduction in their income.

The American Medical Association conducted a survey among physicians during July and August 2022 to study the financial impacts. Among 3500 physicians participated in this study, 81% of physicians said their income was lower than pre pandemic and average drop of income was 32% ⁽²⁷⁾.

Survey conducted by The American Academy of Family Physicians National Research Network and the Robert Graham Centre reported that low patient visits directly resulted in decreased revenues, which in turn, impacted staffing decisions and fuelled telehealth implementation ⁽²⁸⁾.

COVID outbreak, lock down and various restrictions resulted huge decline of revenue in various countries across the world. The international health system including health system in India suffered a huge burden due to this pandemic. The private health sector in India was not an exception ⁽²⁹⁾.

There was a steep fall in the number of patients visiting the hospitals. With an aim to reduce the infection, doctors postponed elective procedures and follow up cases. Paediatric patients visiting hospitals were reduced drastically. All these factors lead to reduction in the income of hospitals and doctors. Eventually this affected the health care professionals by way of job loss, salary cut, and salary deferment. Some hospitals asked their health care workers including doctors to take leave with loss of pay. Doctors, health care workers and administrative staff of many hospitals were volunteered to take pay cuts considering the existence of their establishments ⁽³⁰⁾.

Violence against medical professionals:

Assault on health care workers have been happening for a long time in India and this has been amplified by pandemic. COVID designated hospitals, quarantine centres and even residence of health workers were the targets for violence ⁽³¹⁾. Government of India amended and the epidemic disease act of 1897 by an ordinance and promulgated the amendment with effect from April 20, 2022.Amended act provides provisions for protection for health care workers combatting epidemic diseases such as COVID-19. Even with the act in existence 26.88% medical professionals in the present study were subjected to untoward incidents from the public in the form of physical violence, verbal abuse and commotion. 60.22% medical professionals participated in the study were aware of epidemic disease act and its 2022 amendment. Even though the government acted by strict compliance, such response to the crisis alone does not appear to boost the morale of medical staff or represent a solution. People need to know that the hospitals are places of healing and rehabilitation and that doctors are important for the health and well-being of the society. The change must come from people themselves.

Health insurance and Covid-19:

Health care system in India includes both Public and private health-care service providers. Private healthcare in India gives timely treatment and gives personalized attention to patients. But all this comes with a price to pay. Healthcare facilities in the private sector are much more expensive than those in the public sector. Private health care system in India includes individual practitioners, small hospitals, medium hospitals and large super speciality hospitals. In India during the year 2012, 61% in urban areas had chosen the private sector over the public and in rural areas nearly 69 per cent had selected private sector ⁽³²⁾.

The problem with private health care providers are (1) concentrated in urban India, providing secondary and tertiary care services and (2) They are expensive and not accessible to common men.

To make private health care system accessible to common men one of the initiatives started by the government is health insurance scheme. Currently medical insurance is provided through several private insurance companies and four public general insurance companies. A recent survey conducted in Asia-Pacific region during the year 2020 regarding purchase of new health insurance policies was found that India stands second position in this region ⁽³³⁾.

The concept here in India was that a health insurance with 7 to 10 lakhs INR sum assured is sufficient to take care of the health needs of the whole family. But Covid-19 pandemic has changed this concept as fourteen days treatment of a single member of family itself costs 5 to 7 lakhs INR ⁽³⁴⁾. During Covid pandemic both buyers of health insurance policies and people investing higher sum insured have increased ⁽³⁵⁾. A 30% increase in purchase of online health insurance schemes was reported in India while offline purchase reported a fall ⁽³⁶⁾.

Biomedical waste management during pandemic:

An observational cross sectional study conducted in 2019 among health care workers in India showed that 54% of them have not received any training in handling and disposal of biomedical waste.43% of participants had knowledge about categorization about biomedical waste and its disposal in relevant colour coded bags.72% are aware of existence of a biomedical waste management rule in the country ⁽³⁷⁾. A cross sectional study was carried out using questionnaire as the study tool among the health care professionals in a tertiary care teaching hospital. The study demonstrated gaps in the knowledge amongst all the cadres of the study respondents. The knowledge in relation to BMW Management including the hospital BMW protocols was more desirable among doctors, but practical facets were better in nurses and the lab technicians ⁽³⁸⁾.

Both studies were conducted much before COVID-19 pandemic. But a cross sectional survey conducted during COVID-19 pandemic in India, appropriate biomedical waste management practises were observed among 68.7% medical professionals⁽³⁹⁾. A similar study to assess the knowledge, practice attitude and factors affecting knowledge on biomedical waste management among health care workers while taking care of patients with COVID-19, showed that 43.2% had an excellent knowledge ⁽⁴⁰⁾.

Present study showed that 489 participants (87.63%) were aware of COVID related biomedical waste management guidelines while 69 (12.37%) were not aware.

In this pandemic situation, BioMedical Waste management is extremely important to consider as HCWs being frontline workers in the COVID-19 crisis have been facing a greater risk of contamination due to their direct contact with patients and specimens. Accordingly, HCWs must have adequate knowledge regarding the proper handling of BMW, prevention of infection, and prevention of transmission of diseases.

Good number of medical professionals in this study experienced COVID-19 related stigmatization and harassment. This can be prevented to some extent by health education in the form of interaction with experts, newsletters and pamphlets.

COVID outbreak, lock down and related restrictions resulted huge decline of revenue in private health sector and this has affected medical professionals too.

COVID-19 pandemic had led to significant change in health insurance by way of investing in insurance schemes for the financial protection of families of medical professionals.

COVID19 period has brought violence against doctors and the existing Epidemic disease act was amended to curb such violence and the medical professional are aware of such amended act.

Strict implementation of biomedical waste (management and handling) rules is the need of hour. Comprehensive training programs about BMW management including-segregation, in-house transportation, storage of waste in colour bins and final disposal for treatment, etc., for all hospital staff is highly recommended especially during any pandemic to prevent infection transmission.

Ethics approval and consent to participate

The study was approved by the institutional ethical committee, Jubilee Mission Medical College & research Institute, Thrissur, Kerala, India (IEC: 61/21/IEC/JMMC&RI). Informed consent was obtained from all the participants prior to participation in the study.

Consent for publication

Not applicable

Availability of data and material

The datasets used and analysed during the current study available from the corresponding author on reasonable request.

Declaration of competing interest

Authors have no conflicts of interest to declare

Funding

This research received no external funding.

Authors Contributions:

PK drafted the manuscript and contributed to the study concept, study analysis and interpretation of data. RD, ID and RN revised the manuscript and contributed to the interpretation of data. All the authors have approved the final article.

Acknowledgement

None

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No competing interests reported.

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You are reading this latest preprint version

Social issues among the medical professionals during COVID-19 pandemic: An Indian Scenario

Status:

Version 1

Abstract

Figures

Introduction

Objectives

Scope of the study:

Methodology

Construction process:

Approval:

Data Collection:

Results

Social stigma:

Financial health and pandemic:

Violence against medical professionals:

Health insurance:

Biomedical waste management during pandemic:

Discussion

Duty of care and social stigma:

Financial health and pandemic:

Violence against medical professionals:

Health insurance and Covid-19:

Biomedical waste management during pandemic:

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1