Labor Impact of SARS-COV-2 pandemic on Argentinian rheumatologists

The novel coronavirus SARS2-COV-2 has precipitated the present outbreak of COVID-19 and the worldwide spread has had a strong impact on the general population and on healthcare workers (1). The objective of the present study was to describe the current work conditions and the impact of the COVID-19 outbreak on Argentinian rheumatologists. 

A voluntary survey, delivered by email, was carried out by members of the Argentinian Society of Rheumatology (SAR), during the mandatory preventive isolation established in Argentina by the national government (since March 18th, 2020). A 27-item survey was designed and developed by the authors. After a brief explanation, the physicians were invited to complete an anonymous online closed survey.  For descriptive statistics, the Mann-Whitney or T-test were used for continuous variables and Fisher’s exact test or Chi2 for categorical ones. A p value< 0.05 was considered significant. The database was analyzed with STATA 14.

This observational study was approved by an institutional ethics committee and was conducted in accordance with the current Helsinki declaration, the resolution 1480/11 of the local Health Ministry, and local regulations applicable to this type of study.

One thousand and forty-four physicians registered in SAR were invited. Responses were collected from April 22nd to May 22nd, 2020, (days: 34-64  of quarantine). For the analysis, only those that presented complete data were used amounting to 272 surveys. More than half of the subjects were women (65.59%) with a median age of 44 years (IQR 38-52) and 9.68% were trainees. Most of the rheumatologists (85.03%) live in big cities (over 100,000 h). Only 17 rheumatologists (6.09%) work exclusively in the public sector.

In total, 96% of the physicians had virtual contact with patients, mainly by WhatsApp (78.8%). The most frequent reason for consultation was the prescription of medication (81.8%) and although 90% (IQR 70-100) were able to obtain medications in digital format. More than half      (52.7%) required a new virtual contact with their physicians for the same reason. Physicians received payment for only 5% (RIC 0-40) of a large number of virtual consultations.      The physicians reported, on average of 65% (IQR 50-80) was the decrease in their monthly income.

Ninety-five rheumatologists (34%) reported some kind of change in their work functions, and 30% were assigned to COVID-19 patient care. A similar proportion saw a decrease in their workload, which was unilaterally decided by their employer. Nine of the rheumatologists lost at least one job in this period. Only 57.66% reported having adequate personal protective equipment (PPE). Table 1 shows detailed data from the physicians and the responses to the survey.

About 40% of the population of the country lives in the metropolitan area of Buenos Aires  (AMBA), which concentrates the largest number of cases of patients with SARS2-COV-2 infection (at the time of conducting the survey and writing this report). Table 2 shows the differences between AMBA and the rest of Argentina.

We consider that the response percentage was low, and knowing that the heterogeneous Argentine health system, it is difficult to extrapolate to other Latin American countries, this being a weakness of the study. On the other hand, the differentiation in AMBA and the rest of Argentina is a strength, because we consider that they are the areas where there are the greatest differences in labour supply and development of the pandemic.

It is possible that the economic impact of the Pandemic by the novel SARS-Co V-2 has been more profound in emerging countries, as is the case of several countries in Latin America (2).

The lack of safe and effective systems to provide virtual consultations means that rheumatology patients,  from all other specialities and even in primary health care, have been unable to continue with the adequate follow-up of their chronic diseases (3). Many times, physicians have to use their personal devices (cell phone, computer) to maintain contact with their patients and reduce the negative impact that can be caused by the discontinuation of consultation and treatment and to give emotional support during the pandemic (4).

The quality of work and poor payment of physicians in Argentina appears to deeply deteriorate at the moment, and as it has been reported, there is a lack of adequate PPE to perform activities related to the pandemic (5).