Firstly, the nursing profession is undervalued publicly whilst being heavily feminized and racialized, employing predominantly women and particularly black women in nursing roles that require less formal education. In this context, gender and racial inequalities are produced and reproduced within the SUS both among those who deliver healthcare and those who receive it. This happened after the impeachment of former president Dilma Rousseff, a left-wing politician, and led to a major political context of political disputes and budget constraints concerning public policies ( Vieira et al. Recent neoliberal reforms in Brazil, particularly from 2016 onwards, withdrew investments in the national health system (Sistema Único de Saúde ), weakened national policy coordination, and diminished the level of “universal” coverage in primary healthcare ( Magalhães 2016 Morosini, Fonseca, and Lima 2018). This has to be considered in the context of gendered and racialized historical legacies on Brazilian health system. As a result of these challenges, globally we have seen a significant increase in healthcare worker burnout, mental health concerns, and stress, as they are on the frontlines of responding to the crisis ( Feinstein et al.
Simultaneously, there have been increasing reports of violence against healthcare workers during COVID-19 pandemic ( Devi 2020).
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Furthermore, many healthcare workers have changed their own domestic arrangements to be able to perform their professional role, with some choosing to move out of their houses to protect their family members or having to rearrange childcare provision to enable them to work when schools and childcare locations were forced to close ( Billings et al. For many healthcare workers this included working in infectious disease control and intensive care units for the first time. This has been compounded by the additional working hours created by the pandemic and increasing caseloads for healthcare workers.
This includes poor working conditions, having to wear PPE all day, with many comparing such practice as working in a sauna and with physical scarring on their faces ( Loibner et al. Not only have healthcare workers been disproportionately exposed to infection by COVID-19, but they have also borne the brunt of the additional labor associated with caring for patients during the pandemic ( Liu et al. This reality has been reflected in the number of confirmed cases and deaths amongst healthcare workers (Lapolla, Mingoli, and Regen 2020): estimated to be over 7,000 reported cases by September 2020 ( Amnesty International 2020), but as the world continues into the second, third, or fourth wave of COVID-19, this number is certainly much higher.
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In doing so, this has disproportionately exposed them to increased risk of infection with COVID-19, particularly in locations where there has been no access to adequate personal protective equipment (PPE) or necessary training in how to safely use it ( Zhang et al. Physicians, nursing staff, community healthcare workers (CHWs), and beyond have all been on the frontline of responding to the COVID-19 crisis ( Adams and Walls 2020). One key group which has been disproportionately infected and affected are healthcare workers.
As witnessed during H1N1, Ebola, and Zika outbreaks, and now experienced by the global population during the Coronavirus disease-19 (COVID-19) pandemic, socioeconomic factors, race, geographical location, and gender all create different pathways of vulnerability to infection, and similarly create differential secondary impacts from the interventions introduced to mitigate the virus’s spread ( Harman 2016 Smith 2019 Wenham 2021). Health emergencies differentially affect groups across societies ( Ginette Azcona et al.
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