As Greece Takes On COVID-19, Healthcare Workers Take The Toll
As Greece all but shuts down due to the spread of the novel coronavirus in Europe, many healthcare workers brace for the worst.
The novel coronavirus, also known as COVID-19, first appeared in Greece on 26 February. As of 6 April, the country of about eleven million people recorded over 1,735 cases of COVID-19.
Mirroring the measures taken by many other countries to combat the virus, Greece subsequently took steps to close down as the number of cases began to rise within its borders. Educational institutions were closed around the country on 13 March, retail and non-essential businesses were closed by 16 March, and by 23 March, the country was on complete lockdown. Currently, residents are only allowed to leave their homes for specific reasons, such as grocery shopping, taking a walk, or going to the bank. When outside, they must carry proper identification along with a transportation certificate (a printed form, note, or SMS) stating their reasons for travel. The government has since arrested hundreds for breaking the newly-established guidelines.
In order to encourage people to travel only when necessary, the Greek government has also launched a promotional MenoumeSpiti (We Stay Home) campaign. The campaign, which has been widely promoted on television and public transportation, provides information about the virus as well as general guidelines that the population should follow to stay safe and healthy. While many have applauded Greece’s generally swift movements to lock down the country, the campaign itself has come under criticism by many, namely for its eleven million euro price tag. Facing criticism from the center-left Syriza and medical professionals alike for the pricey campaign, the government has responded, arguing that it has the responsibility to do everything in its power to protect citizens from the spread of the virus and citizens should stay informed.
Ultimately, frustrations have arisen over MenoumeSpiti because, despite the abundance of money that has been allocated to the campaign, healthcare workers find themselves unprepared to face the virus on many fronts. One major reason for this is the current lack of testing in Greece, which is why some health-care providers feel that the official number does not tell the whole story.
“It’s about the tests. It’s a big problem too — they have [conducted] only 13,200 tests in the last two-and-a-half months: about ninety-four tests per 100,000 people. This is one of the smallest numbers per capita [for testing for the coronavirus] in the world,” argued Dr. Panagiotis Papanikolaou, a neurosurgeon and the general secretary of the National Federation of Greek Doctors, (ΟΕΝΓΕ). “The actual number of cases is much higher than the confirmed number. But if you aren’t testing, you can’t make conclusions about what is happening.”
In addition to the issue of testing, concerns abound as many medical professionals find themselves without the proper equipment, facilities, and even masks and gloves for basic protection.
Frustrated by the inadequate resources provided to them, healthcare workers have started to organize. An open letter to the Committee of Experts of the Greek Ministry of Health about its current approaches to combating the virus, for example, was signed by two-hundred and eighty medical professionals at the end of March posed serious questions including:
“Which scientific approach calls for the banning of outdoor gatherings of more than two people, BUT DOES NOT denounce the continuing of non-essential business operations and industries with dozens of employees crammed in tight spaces without the necessary means of protection?”
“Which scientific approach calls for not conducting mass testing and tracking of the virus amongst the general populations according to the recommendations of the W.H.O.?”
“Which scientific approach calls for the granting of eleven million euros to be given to the media-channel owners for the promotional “Μένουμε σπίτι”/ “We stay home” advertisement campaign and for the doubling of the personnel for private ICU facilities, BUT NOT for the enhancement of public sector health with personnel and equipment?”
While the topics at hand are of the utmost urgency, the problems that have created such a situation have been many years in the making. Ultimately, austerity cuts over the last ten years have had a significant impact on the health system’s ability to prepare for the COVID-19 pandemic in Greece. While there is not enough equipment or personnel, the allocation and distribution of resources within the public and private sectors of the healthcare system have further exacerbated the problem. Such a situation is one that healthcare workers and patients alike will face head-on as the virus continues to spread.
Before the pandemic, austerity cuts meant that the Greek National Health System was already facing systemic shortages of equipment and personnel.
While there are only about 560 ICU beds in Greece, for example, there should be over 2,000, in addition to another 1,500 advanced-care beds with ventilators, according to Dr. Papanikolaou. Such numbers ultimately mean that Greece was already short by over three thousand ventilators before the pandemic, which Dr. Papanikolaou noted are key to saving lives. “The mortality rate [of the coronavirus] has been higher in territories that didn’t have enough respirators. In Wuhan, this was a problem [just] as it is now in Lombardy.” He said to AthensLive. Dr. Panagiotis Papanikolaou is Chief Neurosurgeon at the General Hospital of Nikea-Piraeus, a working-class area in the southern suburbs of Athens next to Piraeus, Greece’s largest port.
Before the pandemic, the National Federation of Greek Doctors was also asking for 8,500 more doctors and 20,000 more nurses to be hired by the government, as many positions were left vacant due to the financial crisis.
While there has been a shortage of medical professionals and equipment, also lacking has been the longer-term training and planning for pandemics that many experts would consider necessary, such as annual pandemic simulations.
“There’s a whole spectrum of preparation [when it comes to pandemic readiness],” said our source, a health systems and policy researcher who wishes to remain anonymous. (Their details are available to AthensLive.) Because of austerity measures taken over the last ten years, however, “the government has not been able to pay for extensive preparation, and many people, especially medical professionals, of course, have left Greece — there’s been a brain drain. There hasn’t been a luxury to prepare.” They added.
The problem is not only about a simple shortage of resources; in Greece, it is also a matter of allocating resources and personnel properly. In fact, Greece has the highest number of doctors per capita in Europe: in 2017, Greece had 607 doctors per 100,000 people. At the same time, while nurses outnumber doctors in most OECD countries, there are almost twice as many doctors as there are nurses in Greece. As a result of such a personnel imbalance (in addition to a lack of family doctors in the country), the situation of primary care in Greece is sorely lacking. Doctors also are not spread evenly across the country; despite the high number of doctors per capita, many islands have faced significant shortages of personnel.
In comparison, Greece also has high numbers of police per capita (492 police officers per 100,000 people, while the EU average is 314 officers) and the highest number of priests per capita in Europe (87.7 priests per 100,000 people).
“It is very bureaucratic how the state buys materials, and it’s very problematic when things are needed quickly,” the researcher explained. He added, furthermore, that “the budget allocations mean that the system cannot move as fast as it needs to… It’s not only an issue of money, it’s also the process of how these people are getting recruited, paid, etc.”
The researcher also emphasized that separations between public and private healthcare providers in Greece mean that the acute decision-making necessary in a time of crisis is not possible.
Such a reality has been in the making for decades. The National Greek Health System itself was only established in the 1980s, where it was first developed in rural areas and eventually spread to urban centers. Because people could still often afford the already existing private care in the cities, private providers remained especially prominent in Greece until the financial crisis, when circumstances made it more difficult to afford. To address the inability to pay for private care during the financial crisis, the public sector had to step up and play a larger role in the Greek healthcare system than it had done previously.
Still, due to the private health sector’s historical prominence in Greece, the public sector is not able to play the role it could — and needs — to play to make decisions quickly in times of crisis.
“Let’s say there is an expenditure of 100 million euros per month and [the system] is fifty-fifty public versus private. When things are equal, things can be coordinated well in an emergency. When sources are fragmented like [they are in Greece], there isn’t a framework that exists to coordinate to make certain decisions in an epidemic. As such, resources are not used as they could be. We have one of the highest rates of doctors in the population in comparison to other EU countries, but they are not distributed well,” the source told AthensLive. At the same time, “we have one of the lowest rates of nurses in Europe and that’s why ICUs can’t work well. This is not about just the operational use of an ICU — we just don’t have the personnel,” the source added.
Unfortunately, it is healthcare workers and patients who now must face the brunt of the system’s shortcomings as the pandemic strikes. Certainly, healthcare providers are putting their physical health on the line as many of them will be in direct contact with patients who have the virus. Some predict that the mental stresses on healthcare workers in such times will also lead to low morale and even many quitting their jobs.
“I’m not optimistic about the health worker’s side. There’s going to be a lot of burnout for them,” the health systems and policies researcher explained. “This will have a backlash on the people who [have to] request services on a daily basis because they have chronic health issues. The people who actually need regular medical care are going to be getting it from people who are burned out.”
“There are going to be these issues with people wanting to quit, and there aren’t resources to support them. You cannot ask someone to work without getting them the proper equipment when you work in such a system that’s already so stressed without backup, you are on your own — and you feel less motivated,” the researcher added.
Despite the tremendous demands being placed on healthcare workers, the government has provided little relief. In fact, health care experts argue national attempts in aiding pandemic efforts thus far have fallen flat or could even exacerbate existing problems.
To address the lack of medical personnel, for example, the Greek government officially put out a call on 23 March for health industry volunteers to combat the virus, including doctors, medical students and staff, psychologists, and retired health scientists. While such an effort is understandable at a time of crisis, medical professionals cite that there are hazards that come with such a decision that may actually worsen matters.
Dr. Papanikolaou pointed out that many prospective volunteers are retirees that are elderly themselves — after all, the retirement age of Greek physicians is sixty-eight — and therefore particularly susceptible to effects of the virus if they were to fall ill.
Dr. Papanikolaou also argued that the government underestimated the skills necessary to volunteer when they made the original call for help. According to Papanikolaou, the training for such work cannot be underestimated — even the training for properly wearing protective equipment alone can take several weeks. With an abbreviated or rushed training, health workers in the system fear that volunteers themselves could fall ill and become a source of transmission.
“The volunteers will all get sick and they will go to their homes. They will all be useless… we need doctors and nurses, and we want them to be paid and compensated for their work,” Dr. Papanikolaou added.
But there are a lot of ethical issues with the government’s call for volunteers. If a volunteer makes a mistake, who is responsible? “It’s a matter of liability,” our anonymous source answered.
In addition to its call for health volunteers, the Mitsotakis government has promised a bonus to all government health workers this Easter, much like the bonus many public servants receive every year for the holiday. In comparison to their already meager paycheck, some argue the bonus of €800 is trivial and “almost mocking,” especially in a system where many Greeks are already paying doctors under the table as an understood acknowledgment of their underpayment.
As Greece continues its lockdown in efforts to avoid the worst, experts hope that the current pandemic will demonstrate the importance of public health in the west, so that efforts to stave off future diseases will be more robust and, hopefully, more successful.
“It’s a matter of priorities. When SARS back in 2003 hit [countries in Asia such as] Vietnam — they changed their priorities and they now do pandemic simulations…that required a change in perception in what public health is,” concluded the anonymous researcher. “This is clearly the responsibility of the state, and now I think there’s an understanding there’s been a huge mistake.”
“We are thinking of our colleagues during this time, in New York City, in Wuhan, in Italy, and elsewhere” Dr. Papanikolaou pointed out and remained optimistic. “We shall work through this together, and we shall overcome.”