COVID 19 has taken a heavy toll on healthcare workers in our country. The doctors, nurses and other paramedics who form the backbone of our fight against the ravages of the pandemic are invaluable weapons in this war. Losing them is tantamount to exhausting the fighting machine in favor of the aggressor, which in this case is a deadly virus. According to the WHO director, 1.18,000 health workers have so far died in the line of duty since 2020.

We have so far lost 1,167 doctors in this country since the start of the pandemic last year, 420 of whom have succumbed to the continuing second wave. The stories of senior doctors like Dr KK Aggarwal and Dr Himthani from New Delhi are fresh in our minds. We also remember Dr Vivek Rai who committed suicide, finding him powerless at the Max Hospital in New Delhi to treat very sick patients who could not be admitted for lack of available beds. The highest deaths were reported in Delhi with 100 victims, followed by Bihar (96), Uttar Pradesh (41), Gujarat (31), Andhra Pradesh (26) and Telangana (20) . Jammu and Kashmir has so far reported 9 unfortunate deaths. Unfortunately, only 3% of the 420 doctors lost this year after the vaccine became available had been vaccinated.

These numbers are far higher than any other country, including European states, the United States and the United Kingdom. The total number of reported deaths in those countries was 278 as of May 2020 when COVID peaked in mortality. Italy claimed 122 lives, followed by Iran with 44 medics dead. The figures in the US and UK were much smaller each. Compare our figures of 747 doctors who died in 2020. No deaths of doctors from these countries were reported during the 2^nd wave of COVID. More than half of the doctors who lost their lives in our country were general practitioners. Specialists from different disciplines, including pulmonology, had much lower mortality. The alarming figures for our country are despite the fact that the total number of cases in the United States since the start of the pandemic has been much higher than in India (3.31 crore versus 2.67 crore) with fatalities higher (5.89 misses versus 3.04 misses)

Death in the line of duty is the physician’s ultimate sacrifice. It is made even worse when doctors unknowingly infect their families. The general public may not understand the importance of self-isolation measures in containing the COVID-19 pandemic until a doctor dies fighting the virus. Physician deaths from COVID-19 can vary from country to country due to different public health resources, government policies and controls to enforce quarantine and appropriate Covid behavior. Countries like Singapore, South Korea and Taiwan have taken decisive early action and have had virtually no medical deaths.

Healthcare workers experience considerable mental and physical stress when caring for patients with COVID-19. There have been reports of doctors in the older age groups dying of exhaustion and cardiac decompensation. It is important that hospitals provide mandatory rest, meal breaks and organize shifts to avoid exhaustion, dehydration and malnutrition. Chief physicians with co-morbidities should be considered and not stay on the front line and be held up for tasks other than managing patients who are still COVID positive. During the early periods of the COVID pandemic in 2020, inadequate personal protective equipment (PPE) was often cited as the reason for death, but there is no shortage at this time, but we continue to see these unfortunate events. Appropriate donning and doffing techniques are required. In fact, in hospitals and large facilities, a safety monitor and trained examiner are needed to ensure that proper safety measures are taken to prevent accidental contamination.

In these troubled times, the government and NGOs must come forward and help doctors and other health workers care for their families by providing them with essentials during times of lockdown and maintain an empathetic attitude to keep morale up. Giving them large monetary allocations is also a good step in this direction and has been taken by many state governments.

The most important reason for the striking reductions in general population and health worker mortality in Europe and the United States is the very aggressive and sustained vaccination program of the current year. In the United States, the new Biden government has set a target of reaching 70%, 2^nd dose vaccinations before July 4^e 2021. A number of incentives in the form of lotteries, etc. are also offered. In some states like California, masks are no longer needed as new infections have become rare. Europe plans to open its seaside resorts to tourists due to the scarcity of numbers. A certificate attesting to the completion of the two vaccinations is however compulsory.

We need to speed up our vaccination programs. For healthcare workers, it must become mandatory. Although the covid vaccine has been available since January this year and health workers are given priority, vaccination rates are far from optimal. The overall rate for the country for a single dose is 89% according to the official communication of 22^nd May. In Delhi, the percentage is only 78%. The maximum rate reported is 99% in Chhattisgarh followed by Madhya Pradesh at 93% and Rajasthan at 91%. For Jammu and Kashmir, single dose administration was performed in 81% of cases and for 2 doses only 47%. The vaccine shortage is one of the problems, but the reluctance of doctors continues to be a problem. We need to strengthen this strength as much as possible and make 2 doses of vaccination compulsory for them.

It is a full-fledged war and doctors are the most important weapon we have. It’s a shame we have already lost 1,167 fighting for the lives of COVID victims. The country cannot afford it and it must be stopped at all costs.

Professor Upendra Kaul is a renowned cardiologist, founding director of the Gauri Kaul Foundation. He is the recipient of the Dr BC Roy Award and Padma Shri