Coronavirus Disease: 4 Million Cases Worldwide and the Importance of Multidisciplinary Health Care Teams During the Pandemic

Dear Editor:

On May 12, 2020—International Nurses Day—4 million cases of coronavirus disease (COVID-19) were recorded, with a total of 292,000 deaths worldwide. Brazil, at that point, recorded a total of approximately 178,000 cases and 12,404 deaths caused by the disease. At that period in time, Brazil appeared in the seventh position regarding number of cases, sixth in number of deaths, and second in number of active and serious cases (N = 8,318), with a low number of real-time polymerase chain reaction (RT-PCR) examinations per million inhabitants (N = 3,459).^{1 , 2}

During the COVID-19 pandemic, a multidisciplinary health care team (nurses, biologists, nutritionists, physiotherapists, medical doctors, pharmacists, and psychologists), working exhaustive and continuous hours, is acting intensively to promote a better outcome for all patients with COVID-19, mainly those in intensive care units. Health professionals take all the steps involved in the treatment of patients with COVID-19, after the diagnosis by RT-PCR, by providing medical support during ventilatory maneuvers as well as psychological support to the patients and their relatives, mainly in cases of deaths. The multidisciplinary health care team should be better recognized for its actions during and after the COVID-19 pandemic.

Several countries around the world, including Brazil, have acknowledged multidisciplinary health care teams for their heroism during the COVID-19 pandemic, which is a stressful time. However, in Brazil, there have been some isolated cases of aggression toward health professionals, arising mainly from differences over political opinions, fear of contamination by contact with health professionals, fear of the spread of the disease by professionals who work directly with patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), credibility of pharmacological treatments still undergoing efficacy tests, ignorance of the seriousness of the COVID-19 pandemic worldwide, and disagreement over ideologies linked to political issues. For example, an episode of aggression toward nurses occurred during a silent protest on Labor Day (celebrated in May in Brazil) regarding the number of deaths from COVID-19, and this episode was linked to political issues.

In many countries or regions worldwide, multidisciplinary health care teams are under intense stress as they work continuously to deal with the high number of patients with COVID-19 and the need to optimize the number of RT-PCRs and number of beds in intensive care units; moreover, these professionals are dealing with a high number of deaths of patients, health professional colleagues, and, perhaps, relatives. In some cases, health professionals are isolated from their familiar environments to avoid the contamination of their relatives by SARS-CoV-2, mainly if the relatives are older or present with comorbidities, both groups recognized as “at risk” for the disease. The COVID-19 pandemic is a challenge to health professionals, and the community should recognize their heroism and the importance of all members of multidisciplinary health care teams.

On May 18, 2020, the International Council of Nurses reported a total of 360 deaths of nurses caused by COVID-19.³ On May 20, 2020, Brazil’s Conselho Federal de Enfermagem (Federal Nursing Council) declared a total of 138 deaths (111 confirmed cases and 27 suspicious cases) of nurses caused by COVID-19, representing 138/360 (38.33%) of all deaths of nurses by COVID-19 disease. Brazil, on May 20, 2020, had 15,923 cases of nurses with COVID-19 (4,825 cases confirmed by RT-PCR), with a case fatality rate of 2.3% using only the confirmed cases as the parameters. In all states and the Federal District, there were nurses who had been infected by SARS-CoV-2 virus. Female nurses represented 84.77% of the cases and 62.32% of the deaths. Moreover, the range of infections by age was as follows: age 20 to 30 years: 2,938 cases (5 deaths); age 31 to 40 years: 6,849 cases (29 deaths); age 41 to 50 years: 24,456 cases (38 deaths); age 51 to 60 years: 1,485 cases (35 deaths); age 61 to 70 years: 201 cases (25 deaths); and age 71 to 80 years: 22 cases (6 deaths).⁴ In Brazil, at some referral centers, health professionals have poor access to the personal protection equipment they need when treating patients with COVID-19. In addition, our data demonstrated the need to optimize the diagnosis by RT-PCR, including that for health professionals; for example, many nurses are treated as suspicious COVID-19 cases owing to the lack of an RT-PCR diagnosis. COVID-19 has caused a high number of deaths worldwide, including the deaths of health professionals. The loss of these professionals can result in more deaths because of the difficulty of providing treatment to all patients with COVID-19, mainly in places where the contagion rate is as high as it is in Brazil, and many health professionals are needed to optimize treatment.

Multidisciplinary health care teams are responsible for keeping patients alive, mainly in severe cases of COVID-19, including millions of people worldwide. As declared by Marson,⁵ “We miss that global hug;” however, we need to thank our health professionals for giving us the opportunity to dream about that global hug after the pandemic.—Camila Vantini Capasso Palamim, MS, researcher , Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds and Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, São Paulo, Brazil, ORCIDidentifier: http://orcid.org/0000-0001-6825-1154 ; and Fernando Augusto Lima Marson, PhD, professor, Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds and Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, São Paulo, Brazil, ORCIDidentifier: http://orcid.org/0000-0003-4955-4234 ; E-mail: fernandolimamarson@hotmail.com and fernando.marson@usf.edu.br