“Nobody knew anything, it was all new. I confess that I despaired. I tried to deal with the fear any way I could, to keep working”. This is the account of 55 year old nursing technician Márcia de Assis, which portrays a feeling shared by thousands of health professionals in Brazil, who became the main instruments in the fight against a lethal and until then, unknown virus, almost overnight. Caring for patients infected with a respiratory disease for which no protocols were in place, administering medications amid a sea of uncertainties, facing a collapse in the healthcare system, being overloaded with work while facing an imminent risk of contamination, and frequently notifying family members about the deaths of loved ones is unprecedented. This has been the routine of those at the forefront of the fight against the coronavirus in Brazil for about a year. However, even though the expression “front line” has been widely repeated and heard, it does not make an important point clear: most professionals who are in direct contact with covid-19 patients are women. The largest sector in Brazil’s health industry, nursing, is largely made up of women, who account for 85% of professionals. Data from the Federal Nursing Council (Cofen) shows that, nurses, nursing technicians and assistants, are the ones mostly face to face with the virus. “Most of our patients are in breathing tubes. We bathe them, check on them every 2 hours, give them medication all the time, change their laying position because they are bedridden. This contact we have with the patient is direct, over 12 hours of work", says Márcia de Assis, a nursing technician at the Covid-ICU ward of the University of Campinas’ Hospital das Clínicas. "It’s an absurd burden. To go into a room, and have to pay attention to everything. It’s very exhausting, physically and emotionally", she adds. In order to be able to enter an Intensive Care Unit (ICU), it takes five to ten minutes just to deal with the security measures. The hardship experienced at the beginning of the pandemic was eased as more information about the virus became available, and prevention and care protocols were consolidated. The mother of a child with disabilities, Assis says that her main fear, also felt by other professionals, is bringing covid-19 into her home and contaminating family members. A scenario she had never imagined facing during her 27 years in the field. Exerting all her efforts to meet the demands of her job, on a professional and personal level, she explains that solidarity is essential during this time of crisis. "There are many women who face fear, leave their children, their family at home, to care for patients, for people they don't even know", she says. The first to be vaccinated The novel coronavirus pandemic also marked the life trajectory of Mônica Calazans, the first person vaccinated against covid-19 in Brazil. A nurse at the Instituto de Infectologia Emílio Ribas, she received the Coronavac, produced by Brazil’s Butatan Institute, on January 17th, as soon as the National Health Surveillance Agency (Anvisa) approved the emergency use of the innoculation. A black woman who is diabetic and suffers from hypertension, the nurse with decades of experience made headlines all over the country, when she asked the population not to be afraid of receiving the vaccine and to trust science. “I feel extremely proud because my profession has been recognized. It is symbolic, but the most important thing is that I am Brazilian, I fight for science and I really wanted this [pandemic] to end. This message speaks loudest at that moment”, says Mônica, who is 54 years old.
The nursing professional exalts the uphill battle faced by women in nursing. Many, like her, who also work at the Emergency Care Unit (UPA) in the São Mateus neighborhood, on the outskirts of the city of São Paulo, have to reconcile two jobs and still handle household chores. “It’s a rush. Twelve hours on call in both places. On the front lines, the ladies are killing it, we work tirelessly", says the nurse. "We are unfolding. Most have two jobs. It is not even a double shift, it’s a triple shift. In addition to two jobs, there is the household, husband, son, and parents to take care of". Calazans affirms that the pandemic has also reinforced her life lessons and explained how the humanization of care is essential in the midst of a pandemic. “Being humane, having solidarity and providing shelter. When the patient comes to you with covid symptoms or covid positive, they come seeking shelter. To feel safe. This is what we have to give them. This humanization has become more acute in me”. Victims of contagion Health professionals are in the priority group for immunization against covid-19 in Brazil, precisely because they are essential workers who labor in high-risk environments.
According to epidemiological bulletin No. 44, published by the Ministry of Health at the end of 2020, from the first to the last epidemiological week of the pandemic last year, 442,285 cases of covid-19 were confirmed among health professionals. About 148 thousand of these infections occurred among nursing technicians and assistants, 33.5% of the figure. More than 67 thousand nurses were infected (15.2% of the total) and 48 thousand positive diagnoses were registered among doctors (11%).
About 22 thousand community health workers also tested positive (5.1%) and more than 17 thousand receptionists in healthcare units were infected. The nursing segment once again stands out as the most affected by the virus among the 452 deaths registered among health professionals until the last week of 2020, corresponding to 33.3% of deaths in the healthcare industry.
More than half (53.8%) of health professionals who died as a result of the respiratory disease, considering all its segments, were women. Some elements account for the fact that nursing assistants and technicians are those most commonly infected with covid. They are the majority of health professionals and also occupy the most precarious positions, with the lowest remuneration. In addition to these factors, there is still a lag in the availability of Personal Protective Equipment (PPEs), something that widely occurred at the beginning of the pandemic, further exposing these workers. According to Alva Helena de Almeida, a retired nurse, who has masters in Public Health and doctorate in Health Sciences, the coronavirus showed the chronic precariousness that nursing professionals are a victim of.
This is because health services operate with an undersized nursing staff, who face a “naturalized burden”. She also explains that the health sector has shown a trend of having a more female workforce in recent decades. “They are the women at the reception, in the laboratories, operating the x-ray machines, working as community health agents, nurses, an absolute majority being women. The occupational structure of the healthcare industry health is based on a certain logic of exploitation of the female workforce”, details Almeida. “If it were not for insufficient wages, the absolute majority of women would not be led to seek a second job. If the conditions were not so bad, we would not have this high number of sick leaves, illness and death among these professionals", she points out. "Look at how during this pandemic little has changed. Few are the places and municipalities that are hiring nurses. The situation was already deficient, it is a painful moment, it scars us a lot".
Edited by: Leandro Melito