Ômicron overloads health facilities and generates a wave of aggression against professionals

In the emergency room of a public hospital in Maceió (AL), doctor Marília Magalhães, 33, and her colleagues have been treating patients with two security guards at the office door. “People kick and knock on the door, scream, threaten the team. Some behave in an animalistic way with exhausted professionals, who have been working non-stop for two years in this pandemic, often with a tripled workload to occupy the space of colleagues who are sick,” she says.

At the Praia dos Ingleses health center, in Florianópolis (SC), nurse Andressa Albrecht, 35, was punched in the eye earlier this month while trying to break up a fight between patients that started because the two doctors at the post interrupted care for a few minutes to try to stabilize a critically ill patient brought in by ambulance.

“At the end of the day, the security guard and I, who was also attacked, had to leave the unit escorted by police. The next day, all four tires of my car were emptied”, he says.

In Rio de Janeiro, capital, nurse Ronaldo, 40, also had to call the Military Police after suffering physical aggression. Verbals have become routine. “People call us bums, say they are the ones who pay our salaries. They arrive when the unit is already closed and want to be tested, they shout, they curse.”

At a UBS in the west of São Paulo, family doctor Lucas Guilherme de Lima, 29, has lost count of the times he has been threatened with death and aggression since the beginning of this year. “The user comes and threatens to catch you at the end of the shift. Usually, it’s the healthy guy [saudável], troublemaker, 20, 30 years old, who wants to get ahead of others and doesn’t accept that other people have more priority.”

With the explosion of cases of omicron and influenza, emergency rooms and health units that were already operating beyond the limit saw the situation worsen even more with the increase in demand and the removal of contaminated employees. In São Paulo, the Municipal Health Department registered until last Thursday (27), 4,707 professionals on leave due to Covid or flu-like illness – triple the number of workers at the beginning of the month (1,585).

The delay in care has generated revolt in the population and increased cases of violence against health professionals. The reports come from all over the country and affect, mainly, doctors and nursing staff of PHC (Primary Health Care) and emergency care.

There are no statistics that measure this current violence, but, according to a recent survey by Coren (Regional Nursing Council of São Paulo), with 252 workers in the sector, 40.9% of professionals report having suffered verbal aggression and another 9.5% have already were victims of physical attacks. The São Paulo Physicians Union is also collecting these data.

“Violence we suffer daily, but now, with this tsunami of the omicron, it has increased a lot. Most users complain about the waiting time, they think that the six-hour wait is the fault of the doctor, the nurse”, says Lima, who has already reached 120 patients in 12 hours of work.

There are also many leaves of absence from colleagues due to burnout, according to nurse Glaycie de Abreu Branco, 41, who works at the same UBS in Lima. “It’s a lot of work overload, few employees for the demand and there’s a general mental exhaustion. It’s two years in this crazy footprint”, she says.

Work overload, the physical and psychological exhaustion of health professionals and structural problems (lack of basic medicines, EPIs, tests, toilet paper, among others) have been repeatedly denounced by the Capital Physicians Union, which has already approved an indication of strike, but the strike was suspended by decision of the São Paulo Court of Justice.

For Branco, who is writing on the topic of violence against nursing, many attacks occur because the population does not understand that health teams have to follow Ministry of Health protocols with criteria and priorities for care in the SUS.

“There are asymptomatic people who want to take a Covid test to travel. Then we try to explain that the SUS cannot afford the test in these situations and then the person gets nervous, curses you and thinks you don’t want to do it”, he says. the nurse.

For Gabriela Lotta, professor of public administration at FGV (Fundação Getulio Vargas), the increase in violence may have several causes, which require different interventions.

She recalls that the population is also exhausted, after two years of the pandemic, and this is reflected in increased anxiety, difficulty in social interaction and other issues that can generate a negative reaction against front-line professionals.

“There are reports from around the world showing how frontline service providers [não só de saúde], because they are the first people we interact with, are suffering the consequences of this long period of distance and having to deal with people with low tolerance and a lot of nervousness.”

But, for experts, it would be possible to minimize this hostility against frontline health professionals if services were better prepared to face these new demands.

According to Michelle Fernandez, a researcher at the Institute of Political Science at UnB (University of Brasília), the signals coming from the United States and Europe that the arrival of the omicron variant in Brazil would overload health services was clear, but was ignored by many managers. .

“For the population, health professionals are the face of the state. People arrive at a health service, take hours to be seen and take it out on those on the front line. Professionals, in turn, are vulnerable if contaminating a lot, overloading themselves to cover sick colleagues.”

According to her, health professionals today go through a process of dehumanization, often unable to eat lunch, go to the bathroom, all in favor of the “proper functioning of the health unit”. “But the proper functioning has to be guaranteed by those who are in the management, thinking about all this dynamics.”

The episode of violence in Florianópolis illustrates this well. The health center at Praia do Ingleses, the largest in the city, normally serves a population of 7,000 people, almost triple its capacity. And at this time of year it is also very popular with tourists.

“We understand, we have empathy for people who spend five hours standing in the sun, but people need to understand that we are not responsible for the lack of organization. Some things were already foreseen, such as the arrival of the micron and the increased flow of tourists”, says nurse Andressa Albrecht.

After the attacks that Albrecht and the security guard suffered, the Municipal Health Department sent more health professionals to help with the care and opened more offices in the health center. “Service has become more agile and users are no longer so aggressive”, says the nurse.

According to Rudi Rocha, director of Ieps (Institute of Studies for Health Policies), it is up to management to take care of security directly and respond effectively, legally and criminally, to offenses and aggressions, but there is also a lack of training for health professionals and other areas that provide support, such as security and warehouse personnel, to deal with these situations of violence.

In addition to the current crisis caused by the omicron, Gabriela Lotta recalls that there is a huge pent-up demand for other care, and health services will have to manage it. “Many people were away from health units for two years, they did not undergo treatments and preventive consultations, and now they have a low tolerance for doing them and waiting for the time and procedures of the services. And this ends up being discounted in the professionals.”

She suggests awareness campaigns trying to make the population aware of the need for greater tolerance given the current overload, as well as technical and psychological support for professionals.

“They have been active for two years, without rest, under a lot of stress, and they need to be able to deal with it and with the possible violent reactions of users. to try to alleviate these problems.”

She says that another cause of violence has been the denialism of part of the population, especially in relation to vaccines. “Anti-vaccinations express their disagreement with health professionals in a violent way. It is more complicated in some areas for community health agents to go to homes alone to convince the population to be vaccinated. It is better for management to create larger groups.”

In a note, the Municipal Health Department of São Paulo says that it has responded to the increase in demand since the beginning of the pandemic, with the delivery of ten hospitals, expanding the number of ICU beds from 507 to more than 1,400, at the height of the pandemic. , in addition to expanding its infirmary beds.

It also says that to meet the demand of citizens who seek health units, the UBSs are treating patients with flu symptoms without the need for prior scheduling and 39 AMAs (Ambulatory Medical Assistance) and Integrated UBSs had their hours extended.

The secretariat emphasizes that, even with the commitment of all professionals, collaboration and understanding of users is essential, mainly, to follow the flow in the service in the equipment.