Sunday, March 7, 2021

‘You can’t forget the hissing noise of oxygen’: 12 months on the coronavirus frontlines

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When sailors return from long journeys at sea, the sensation of being rocked around on the waves lingers long after stepping ashore. For doctors on the coronavirus front line, it’s the tinnitus-like thrum of oxygen support systems which outlasts each shift.

“Ask anybody in this hospital to describe what Covid sounds like and it’s the hissing of high flow oxygen,” Dr Marc Mendelson tells The Telegraph from his office in the infectious diseases department at the Groote Schuur Hospital in Cape Town, South Africa.

“These machines make a hiss, and that stays with you. It’s almost like being on a boat and feeling a bit motion sick. When you leave those wards you can still hear it.”

This weekend marks a year since the World Health Organization designated the spread of the new coronavirus as a global health emergency – the highest warning level under international law. 

The 12 months since that declaration have taken a considerable toll on those on the frontlines in the UK and across the globe. 

“My colleagues are under a huge stress and the mental health impacts of what they’re going through is unimaginable,” says Rashida Ferrand, a professor of international health and member of Zimbabwe’s coronavirus advisory panel.

A patient wearing an oxygen mask is being treated in makeshift emergency units at Steve Biko Academic Hospital in Pretoria, South Africa, A patient wearing an oxygen mask is being treated in makeshift emergency units at Steve Biko Academic Hospital in Pretoria, South Africa, Credit: AP Photo/Themba Hadebe

It was not until the WHO described the accelerating coronavirus outbreak as a “pandemic” in early March that “sheer fear and anxiety” set in, she adds. 

By this point, the virus was wreaking havoc in much of Europe and the United States.

Just because of the state of our fragile health system, that was really my first thought.”

Many of her concerns, despite efforts to prepare for and limit the arrival of Covid-19, came to pass.

Zimbabwe, like much of the world, has struggled in the face of a stream of challenges: adapting existing pandemic plans to a virus that spreads asymptomatically; shortages of personal protective equipment; staff sickness; and unprecedented disruption for the wider health system – to name just a few.

In lower income countries, where resources are already stretched thin, the hurdles have at times felt insurmountable, if familiar.

Undertakers lower the coffin of a Covid-19 victim into a grave at Glen Forest cemetery in Harare, where gravediggers say the rising coronavirus death toll in Zimbabwe is keeping them busy. Undertakers lower the coffin of a Covid-19 victim into a grave at Glen Forest cemetery in Harare, where gravediggers say the rising coronavirus death toll in Zimbabwe is keeping them busy.And it is really hard and stressful and horrible, but that is what South African doctors and the workforce in healthcare professionals are used to, and it sucks. But that’s the reality.”

It is the volume of Covid patients, though, that has put unprecedented pressure on this triaging process. Twelve months in, staff are reporting high levels of post-traumatic stress syndrome, “akin to a wartime situation”, and the weight is always increasing, Dr Mendelson adds.

Few countries have escaped the horrors of Covid-19. Even in Malawi, where just 21,660 cases have officially been confirmed, the healthcare system has struggled.

After experiencing few infections early last year the arrival of 501Y.V2, the more contagious variant first detected in South Africa, has triggered a rapid resurgence.

“Looking at the second wave, it has been an emotional moment… traumatising,” says Edna Nsomba, lead research nurse at the Queen Elizabeth Central Hospital in Blantyre.

“You know, you keep on putting all your effort or your resources into working hard and then you see people still dying.”

But while wealthy countries are hailing a “light at the end of the tunnel” as vaccine roll-out ramps up, many lower income nations see little respite in sight.

Many, including the head of Wellcome Sir Jeremy Farrar, have urged countries to support efforts to distribute jabs equitably – or risk “leaving the virus unchecked in large parts of the world,” leading to more variants emerging.

Cases, deaths and vaccinations, coronavirus world map

But Prof Ferrand says that “[vaccines] are perceived as something that the country will not be able to get in the near future.”

And instead of vaccine hesitancy, social media in Zimbabwe is dominated with theories about miracle treatments, including drugs discounted in clinical trials – like hydroxychloroquine. 

“There is a very rampant market for the prescription and use of drugs that have not had any proven efficacy… which has created additional problems,” says Prof Ferrand.

Since the start of the pandemic elective care has experienced huge delays, says Dr Elias Ortega Chahla, a clinical oncologist at the Roffo Oncology Institute at the University of Buenos Aires.

“The Argentinian Association for Clinical Oncology estimates that per year we diagnose up to 100,000 to 150,000 diagnosis of cancer in our country, ” he says.

“That number has gone dramatically down this year, not because cancer stopped happening in our country, but because people are not getting diagnosed on time.

“I’m not really being overdramatic, I think it’s going to be catastrophic.”

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