The SARS-CoV-2 Virus: A Biopsychosocial Hazard for the Anaesthesiologist

Marcelino Murillo Deluque, Sebastian Amaya, Jose Jorge Maya Gomez, Valentina Monsalve, María Paula Pérez Mosquera

marcelmoro04@gmail.com

The SARS-CoV-2 virus is transmitted mainly by aerosols that can be produced when manipulating the airway of an infected patient, which translates to a greater risk of infection by direct contact to which the anaesthesiologist is exposed during surgery (1), through chemical contamination by halogenated anaesthetic residues, which can occur thanks to procedures such as intubation or extubation, and the use of badly positioned laryngeal masks, and circuit leaks (2).

Many common procedures done by anaesthesiologists such as endotracheal intubation and extubation, as well as tracheostomies have been reported to lead to high risk due to aerosol production and exposure. Meanwhile, non-invasive ventilation procedures and the use of a ventilatory mask pose a minor risk (3).

To further emphasize the risk that anaesthesiologists face, one can analyse the following international prospective study conducted in multiple health centres which recruited workers from 17 countries who performed tracheal intubations in patients with suspected or diagnosed COVID-19, with a sample size of 1,718 workers – and found that after 32 days of performing the first intubation 10.7% of the physicians reported being in preventive isolation, hospitalised with symptoms suggestive of infection or were laboratory-confirmed cases of COVID-19 (4).

When evaluating the impact that SARS-CoV-2 has had on health professionals, the psychosocial aspect tends to be neglected; this is essential in the comprehensive analysis of the impact that the new health emergency has had on the health sector in Colombia. In Colombia, as a result of the increase in the need for health personnel, a significantly higher rate of exhaustion has been seen. Likewise, burnout has become increasingly more evident in professionals who work in the first line of care and has been characterised by emotional exhaustion, work inefficiency and depersonalisation (5).

On the other hand, in addition to facing emotional and physical adversities on a daily basis in their work, many anaesthesiologists and intensivists have been victims of threats and attacks by the relatives of their patients who threaten to physically degrade them or their families (6).

Among these threats, cases have been reported ranging from verbal intimidation to particular incidents such as that of a doctor in Atlántico (A department within Colombia) who received a funeral wreath at his home after the death of one of his patients. Similarly, discrimination by the general population towards health professionals has been evidenced in public places such as streets, shopping centres, supermarkets, public transportation and even in their places of residence, under the premise or belief that having contact with a health professional increases the risk of COVID-19 infection (6).

Up to May 13 of this year, 200 incidents were reported worldwide to the international committee of the Red Cross, numbers that continue to increase day by day in Latin America and if not handled properly, may have a psychological and biopsychosocial impact on many medical professionals (6). It is believed that many of these attacks are due to misinformation and misinterpretation that in most cases is disseminated by the media. This problem poses a threat to not only anaesthesiologists and intensivists, but to all health care workers if it is not corrected.

Many media outlets have been the source that perpetuates the stigmatisation of health professionals and will indirectly contribute to the abuse and discrimination of which they are victims; therefore, it is of utmost importance to ensure the clarity of every media article that is released in order to combat the wave of misunderstanding and protect health care workers everywhere.

References

1.  [Journal Article] Galeano CA, Trujillo A. Recomendaciones para el manejo perioperatorio de pacientes con infección o sospecha de infección por COVID19.2020. Disponible en:https://scare.org.co/wp-content/uploads/Recomendaciones-COVID-19.pdf?ut m_source=Masiv&utm_medium=Email&utm_campaign=website
2. [Journal Article] Aparicio Morales Antonio Ismael. Riesgo laboral en Anestesiología ante posible infección por coronavirus. Rev cuba anestesiol reanim [Internet]. 2020 Ago [citado 2020 Ago 26] ; 19( 2 ): e643. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1726-67182020000200 014&lng=es. Epub 20-Mayo-2020.
3. [Journal Article] Cook, T. M., El-Boghdadly, K., McGuire, B., McNarry, A. F., Patel, A., & Higgs, A. (2020). Consensus guidelines for managing the airway in patients with COVID-19. Anaesthesia, 75(6), 785-799. doi:10.1111/anae.15054
4. [Journal Article] El-Boghdadly K, Wong DJN, Owen R, Neuman MD, Pocock S, Carlisle JB, et al. Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study. Anaesthesia. 2020; 10.1111/anae.15170. doi: 10.1111/anae.15170
5. [Journal Article] Udoji MA, Ifeanyi-Pillette IC, Miller TR, Lin DM. Workplace Violence Against Anesthesiologists: We are not Immune to this Patient Safety Threat. International anesthesiology clinics 2019;57(3):123-137.
6. [Journal Article] Taylor Luke. Covid-19 misinformation sparks threats and violence against doctors in Latin America BMJ 2020; 370:m308

Read More of our Monthly newsletter.

Read More of our special newsletter covering our virtual congress.

Visit our COVID-19 Resource Hub for other news and resources.