Covid‐19 1 year on: The challenge for low‐middle income countries
Authors: C. Carter; J. Notter
Year: 2021

History has shown that epidemics are a story of inequalities. In early 2020, the World Health Organization (WHO) described the Covid-19 pandemic as a public health emergency of international concern. In many countries, this meant that the demand for critical care services has exceeded availability in terms of workforce, resources and equipment. Since the start of 2021, there has been a significant increase in infections in Africa, with new and different variants of SARS-CoV-2. However, little has been published on the impact of Covid-19 in low-resource settings and the role of critical care nurses and services. This critical commentary is partly based on our reflections as members of a health partnership in Zambia, to capacity build Emergency, Trauma and Critical Care Nursing and also utilises current available evidence. The focus, worldwide, has been on the numbers of cases and numbers requiring critical care services. However, in countries with a limited critical care workforce and resources, it only takes a few cases to overwhelm the health care system. For example, oxygen is classed as an essential drug by the WHO; however, it remains limited in many low-middle income countries' (LMIC) hospital settings. Now, 1 year on since the start of the pandemic, the WHO still identifies access to oxygen in LMIC as limited due to cost, infrastructure and logistical barriers. This is a cause for concern as hospitals that are unable to provide a continuous supply of oxygen or electricity to run oxygen concentrators may result in unnecessary loss of life. Critical care services are an essential, integral service needed for the provision of comprehensive health care systems and should be seen as essential to achieving universal access to health care. However, critics argue that specialist services such as critical care do not necessarily significantly decrease overall mortality; therefore, the development of these services in low-resource settings is unrealistic and instead investment should focus on primary health care projects. Prior to the pandemic, the limited number of emergency, trauma and critical care staff were responding to the “silent epidemic” of rising trauma, communicable and non-communicable disease and the need to provide safe surgery, with little recognition or support. In addition, the reality is that often emergency, trauma and critical care nurses are the only trained specialists within many LMIC hospital settings, due to the limited numbers of doctors. Therefore, they are expected to provide guidance and support across the hospital, as well as deliver critical care nursing. For many countries, the short-, mediumand long-term impacts of Covid-19 have arisen not only from the virus itself but from funding being diverted to provide immediate and essential pandemic services. Sadly, the hard-won reductions in communicable and non-communicable diseases are in danger of being reversed, and we do not know the longer-term impact on an exhausted and over-extended workforce. Then too, in many LMICs, the situation is compounded by the economic damage, which includes a high inflation rate with the rising cost of food and increased unplanned expenditure in terms of illness and funerals causing emotional stress and anxiety. International support through a Health Partnership is one way in which a long-term institutional relationship between countries can aim to improve health care services and systems through the joint sharing of knowledge, skills and experience. Since the start of the pandemic, many health partnerships have had to rapidly move to virtual remote learning and this has determined how we have moved forward as a partnership in terms of project management and activities. Funding organisations see virtual volunteering as a way to engage more professionals to support projects and reduce the need for travel during the pandemic. Nevertheless, it is important to point out that there are several critical limitations to this approach that need to be considered. Virtual teaching may not be fully utilised due to poor internet connectivity and often the majority of students and nurses cannot afford the cost of buying internet bundles, or have smartphones, therefore reducing access to resources. It is important to recognise that, until this situation is redressed, virtual learning will be useful, but cannot totally replace face-to-face learning. In addition, assessing competence via a screen is somewhat challenging. As a Received: 8 April 2021 Accepted: 8 April 2021