UNAMCAM-UNAM

  • Report 134. In total job insecurity, health workers face the Covid-19 pandemic in Mexico.

    Published the Friday 16 in April of 2021 1:52 am CAM No comment

    Content:

    1. 1. The dual character of the current crisis of world capitalism

    1.1. Global and regional context of infections and deaths due to the Covid-19 pandemic

    1.2. Impact on health workers due to the Covid-19 pandemic

    1.3. The vulnerability of health workers in Mexico to the Covid-19 pandemic

    1.4. Factors that have contributed to the spread of the pandemic in Mexico

    1. 2. Aspects about the precariousness processes of health workers

    2.1. Purchasing power of the tabulating salary of IMSS workers

    2.2. Working conditions of health workers during the pandemic

    • Characteristics of health workers in the public sector
    • Activities of health workers in the public sector
    • Forms of hiring health workers in the public sector
    • Characteristics of health workers in the private sector
    • Activities of health workers in the private sector
    • Forms of contracting health workers in the private sector
    • Health personnel to attend to hospital capacity due to the pandemic and general illnesses at all levels in the public and private sectors
    • Perception of salary and benefits in the public and private sector
    • COVID bonus
    • Covid-19 contagion among health personnel in the public and private sector
    • Support to health workers in the public sector in case of Covid-19 contagion
    • Deaths of health workers in the public and private sectors and compensation
    • Increase in working hours, a day or a week, from the Covid-19 pandemic and its impact on remuneration by form of hiring and workplace
    • Inputs and protection instruments received by health workers in the public and private sectors by form of contract
    • Inputs and protection instruments received by health workers in the public and private sectors for their activities and workplaces
    • Periodicity of the delivery of protection supplies
    • Possibility of contagion of Covid-19 against working conditions by workplace in the public and private sectors
    • The role of the union facing the needs of health workers during the pandemic by form of hiring
    • Psychological ailments resulting from work stress during the pandemic by type of hiring
    • Employer support to health workers to treat the psychological consequences of the pandemic by means of hiring
    1. 3. Impact of the pandemic on the mental health of health workers

    2. Statistical Annex

    3. Sources

    4. Footnotes

     

     

    1. 1. The dual character of the current crisis of world capitalism

    The current course of the global economic crisis that we are experiencing combined with the worsening of the health crisis due to Covid-19 has economic aspects, social and political that must be analyzed with special attention, to allow us to verify the ways in which governments and big capital, They have agreed on the way in which they have decided to face these conflicts that inhibit the accumulation of capital worldwide..

    Initially, It is important to highlight that the character of the current Covid-19 pandemic has different meanings and dimensions with respect to the pandemics previously experienced by humanity. It, explained largely first, for global interconnection, regional, and local, established in the eighties as a requirement to make possible the mobility of capital from the fragmentation of production processes towards new markets; and second, due to the high speed with which fully globalized and interconnected markets operate in distribution, the circulation and consumption of any type of merchandise, obviously including the labor force.

    This situation has translated during the Covid-19 pandemic into a very high rate of spread of the virus worldwide, no country was able to close its borders to prevent the spread as this measure would undermine capital accumulation processes. Thus, we think that it is not enough to locate the problem as part of the neoliberal phase, despite the fact that during this time the institutions of the welfare state were dismantled and destroyed, Therefore it is, an underlying problem, that has exposed the capitalist system itself and its logic of reproduction in which the pro-life discourse is stripped bare and I know that profit is put before life.

    Initially in the research report we will talk about the trend in the growth of the world economy, The same that has been distinguished during the last six decades by a process of decline in the rates of capital accumulation on a world scale, deepened especially during the neoliberal phase, This process is reflected in the real growth rates of the Gross Domestic Product (henceforth GDP), recorded below 5% annual.

    We will use in this part of the analysis the economic indicator of GDP, that historically accounts for the trend behavior on the growth of world capital accumulation, Therefore, we present historical data for this indicator through the real annual growth rate of the GDP of 1961 to the 2020, period that encompasses both the welfare state phase and the current neoliberal state.

    In the following graph, we can infer that from 1976 With the exhaustion of the so-called import substitution model, growth rates in capital accumulation are sustained below the 5% annual, and that in particular it is during the neoliberal phase where a rhythm has been averaged in the real growth rates of 2,64%, also, During this phase, a greater presence of economic crises is observed with a greater level of devastation for the world economy; the iconic dates of these economic crises are 1982, 1987, 1994, 2000, 2008 and the one that is currently brewing.

    Graphic 1.

     

    Towards the end of 2019 occurs not only the beginning of what later the 11 March of 2020 would be declared by the World Health Organization (hereinafter WHO) as a Covid-19 pandemic, It would also translate as the turning point for a deteriorated process of capital accumulation as a consequence of the demands and domination of finance capital over industrial capital through the process of financialization.. In other words, the health emergency has also represented the element that managed to dislocate the world economy as a whole, deepening the economic and social effects for the working class.

    About, the International Monetary Fund (hereinafter IMF) presented in April of 2020[1] in its World Economic Outlook report a forecast of world GDP growth for that year, estimating a figure of -3.0%; which in short already represented in itself a much more severe contraction than the one that could be observed during the world financial crisis of the 2008.

    The same IMF regionally estimated real GDP growth rates for the 2020, on the one hand, in the heading of imperialist economies, as is the case of the Euro Zone when forecasting a GDP of -7.50%, In this area, the cases of Italy with -9.10%, Spain with -8.0%, France with -7.20, Germany with -7.0% and from the United Kingdom with -6.50%; in the same region of the imperialist economies, but outside of this area is Canada with -6.20, United States with -5,90%.

    On the other hand, the same IMF estimated for the economies of the periphery that are integrated by the economies of Asia, with the case of India with 1.90% and from China with 1.20% and, also in Europe with Russia with -5.50%.

    Continuing with the economies in the periphery is the region of Latin America and the Caribbean. The IMF projected for this area a real GDP growth rate of -5.20%, highlighting the case of two countries, considering that they would be more economically affected, on the one hand, Mexico meets with -8.5% and, on the other Brazil with -5.30%.

    In the following graph, It is appreciated for Mexico that, during the last 38 years of the neoliberal phase, trend growth in the capitalist accumulation process has registered a real GDP growth rate of 2% (see graph 2).

    Graphic 2

    In the case of the Latin American region, ECLAC estimated at the beginning of the Covid-19 pandemic a growth for the region of 1,3%, after the ravages of the health emergency, he rectified the data, estimating that GDP would fall - in the best of cases- a 1,8%, These ECLAC estimates were based on the assessment that world trade will decline spatially, reducing production volumes and operations worldwide, causing as a consequence that unemployment worsens more and more.

    In that sense, the World Trade Organization (OMC) made mention of the deterioration in the volume of exports and imports of millions of merchandise in the international market, UNCTAD Director Pamela Coke-Hamilton, emphasized that the Chinese economy was facing a much more complex and worse scenario than the one experienced during the financial crisis in 2008, because there were data obtained in the official indicator of China, the Purchasing Managers Index (SMEs), which registered that the activity of the factories was totally contracted.

    However, it was not a new situation, since these deteriorations in the commercial exchange on a world scale were already on the horizon since 2019, since the volume of world trade in goods had fallen by 0,4%, due, primarily, to the trade barriers implemented at the beginning of 2018. In consecuense, for 2020 the contraction of world trade deepened as the Covid-19 pandemic progressed, causing many companies to return to the system nearshoring, known as the process of outsourcing the work activity of a company through subcontracting with other companies in a relatively close country. This system implies the relocation of capital from the management of supply chains and manufacturing, so confidence in global suppliers was drastically affected.

    However, in the midst of this dual process due to the slowdown in the economy and the Covid-19 pandemic, The big capitals did not miss this extraordinary opportunity to test in every inch of the labor markets a series of mechanisms that allow them to increase their profits.; first, through the State with the implementation of methods of repression and control of the working population; and second, in shaping future rates to define the magnitudes of labor force exploitation, which means a transfer of the costs of the crisis to the working classes, by implementing the mechanisms that allow large capitals to counteract the trend decline in world capitalist accumulation, like telecommuting, and that they are expressing themselves with greater job insecurity in order to reduce the costs of the workforce, which has meant lower nominal wages for formal workers due to the increase in unemployment, instability in hiring forms, decrease in the levels of consumption of goods wages of the working class, suspension of various employment rights such as overtime pay, profit sharing, the aguinaldo, etc., vital elements in terms of work as a form of protection against the Covid-19 pandemic of the working class worldwide, in other words, millions of workers have had to deal in their workplaces with the possibility of becoming infected and / or dying, a clear example of this situation is experienced by workers in the health sector, who for practically a year have worked in their work centers to treat Covid-19 patients and who have constantly denounced the deplorable working conditions in which they have had to do so and that throughout the investigation report we will analyze.

     

    1.1. Global and regional context of infections and deaths due to the Covid-19 pandemic

    The health emergency is declared worldwide on 11 March by the World Health Organization (WHO), practically a year and according to a follow-up of 221 countries conducted by worldometer, we find the following figures at 24 March of the current year on cases confirmed by Covid-19 which amount to 125,429,834 cases and, With respect to deaths from this disease, 2,756,742 cases; while the government of Mexico for the same date recognizes 2,208,755 of confirmed infections to be located in place number 13 worldwide and with respect to the deceased, the number of 199,627 to be the 3rd place in the world[2], (see graphs 3 and 4).

    Graphic 3

    Graphic 4.

    In the following graph we can review the fatality rate at 23 March or the current year in a comparison between 14 countries, with world average of 2.2%; Mexico is the country with the highest fatality rate with 9.4%, in other words, 1 of each 14 deaths from Covid-19 in the world, he is mexican.

    Graphic 5.

    It is worth mentioning that in Mexico the 13 March preventive measures due to the Covid-19 pandemic, However, It is not until the 23 March when the government recognized the epidemic locally according to the statement published in the Official Gazette of the Federation of 1 April of the 2020. Emphasizing that by then contagions and deaths were already registered.

     

    1.2. Impact on health workers due to the Covid-19 pandemic

    On the other hand, placing in particular the analysis on the world of health workers according to a study by Amnesty International published in September, Mexico is placed in the second place of infections with 130,950 while the United States with 144,799. However, In the area of ​​deaths in Mexico, the fatality rate for health personnel was 1.36%, to rank first globally with 1,790 deceased at 19 October according to the figure offered by the Ministry of Health, (see table 1).

    Picture 1.

    Of the 19 October to the 24 March have passed 146 days with respect to the figures mentioned in the table 1 in relation to the cases of infected and deceased health personnel. In this period of time, the numbers of infected health workers confirmed by Covid-19 in Mexico have increased in 99,644 cases, to have a daily average of 682 cases; in the line of health personnel who died from Covid-19 in this same period of time, they have increased by 1,806 cases, to have a daily average of 12 deceased.

     

    1.3. The vulnerability of health workers in Mexico to the Covid-19 pandemic

    In the following graph we can see that when 15 February 2021 the Mexican government has recognized a total of 230,594[3] positive infections by Covid-19 in health workers. About this figure, When conducting a more detailed analysis from the reports on infections in health professionals presented by the Ministry of Health, we find the following: As of November, there is an increasing rate in infections, i.e., of the 23 to the 30 November are recognized 6,334 cases, to average per day 791 cases; the next critical period in contagions is from 4 to the 11 in January of 2021 with 7,351 cases, to average per day 918 cases, and immediately from 12 to the 18 January with 8,512 cases to increase the average to 1,064 cases per day; of the 18 to the 25 January with 8,975 cases, to reach the maximum average of 1,122 infections per day, to the 8 February, according to data recognized by the government, infections have decreased to 388 cases per day; of the 8 February to 15 February with 2,617 cases to average per day 374 contagion; of the 15 February to 21 February with 1,683 cases, for a daily average of 280 cases; of the 21 February to 1 of March, with 1,576 contagion, to average per day 175 contagion; of the 1 March to 15 of March, with 2,437 cases, to record an average per day of 162 contagion. (see graphic 6).

    Graphic 6

    According to the figures recognized by the Ministry of Health regarding health workers who have unfortunately died from Covid-19, the number rises to 3,596 cases to 15 March of 2021 (see graphic 9). When conducting an analysis based on the reports on infections in professionals presented by the government, We can note that the most serious periods when presenting the highest rates of deaths of health workers, from del 9 to the 16 August with 91 cases, to average 11 deaths per day; of the 5 to the 19 October with 144 cases, to average 10 cases per day; of the 23 to the 30 November to register 78 cases and average per day 10 cases; of the 7 to the 14 December for a total of 80 cases, to have on average 10 deaths per day; but undoubtedly the period with the highest mortality rate occurs first of the 4 to the 11 January of the 2021 with 110 cases, to achieve an average of 14 deaths per day and, of the 12 to the 18 January with 107 cases, to average 13 cases per day; of the 19 to the 25 January there was 167 cases, to have an average per day of 21 deceased; of the 26 from january to 1 February are presented 142 cases, to average daily 18 deaths, and from 2 to the 8 February were 141 cases, to stay in 18 daily deaths; of the 9 February to 15 February, were recorded on average per day 123 deceased; of the 16 February to 21 February, the daily average number of deaths was 12; of the 22 February to 1 of March, are observed on average 12 deceased per day; of the 2 March to 15 of March, the daily average was 9 deceased. In summary, the trend observed during the pandemic to 15 March is that 1 of each 55 Mexicans who died from Covid-19 were a health worker.

    Graphic 7

    In the particular case of health workers, this situation has been expressed in that of the 230,594 positive cases for Covid-19 to 15 of March, the 33.48%, i.e., 77,202 be patient with 1 or more comorbidities[4]such as obesity, hypertension, diabetes, smoking, asthma, EPOC, chronic renal insufficiency, cardiovascular disease, immunosuppression, VIH, and that you have paid the 3,596 deaths recorded for the same date.

    The foregoing must be linked to the situation that exists in the working conditions at the national level for health personnel, because in view of the insufficiency of health personnel it has been impossible to rotate it, with everything and that during the first months of the Covid-19 pandemic only hired 44 thousand 247 doctors and nurses, 3 thousand 675 specialist doctors, 7 thousand 194 general practitioners, 1 thousand 502 specialist nurses, 18 thousand 664 general nurses and 13 thousand 212 health workers, by the way, all under the contractual figure of eventual, i.e., only during the pandemic will they provide their services to the health sector; the same Secretary of Health admitted that they work with a deficit of 300 thousand health workers.[1]

     

    1.4. Factors that have contributed to the spread of the pandemic in Mexico

    The situation in Mexico in the face of the economic crisis and the Covid-19 pandemic, place much of the working population in a very difficult and vulnerable situation, It has been said that a key element for a serious and complicated patient positive for Covid-19 to get ahead has to do with their health in general, and in a scenario in which the vast majority have comorbidities such as obesity, hypertension, diabetes, Cancer, VIH, makes handling very complicated, Before which we cannot ignore the following reflection related to the income and nutrition of the Mexican population that we will address in the following three aspects; first, it is just during neoliberalism in which the working class has seen its income greatly affected, of 1982 to the 2019 there is a loss of purchasing power of the salary of -87.41%, reducing consumption to only 22% of what makes up a Recommended Food Basket (on CAR) composed of 40 staple foods[5]; the second, the quality and frequency of the food consumed daily by Mexican families, for example, Substitute goods have appeared that have displaced the consumption of meat for sausages, which has generated many problems in the health of the population; the third aspect, the heyday of fast food based on the time workers have to spend to work to buy a CAR, in 1982 with 1 minimum wage you could buy almost three food baskets, so it was enough to work 2 hours and 42 minutes of a working day of 8 hours, for 2017 with 1 minimum wage could only buy the 32.62% of a food basket, so the workers were forced to work 24 hours with 31 minutes, which is humanly impossible, then what millions of families had to incorporate two or three family members to work, in 2019 although there is an improvement, the trend is maintained, with a minimum wage you can consume the 37.20% of a food basket, workers require work 21 hours with 30 minutes, (see table 2); Therefore, those times when families had time to cook are part of the anecdote of the working class, and of course it has had devastating consequences on the health of the working classes.

    In addition to the poor nutritional conditions that favor the appearance of physical diseases, there are conditions of social disadvantage that promote contagion by Covid-19, we mean overcrowding cases, i.e., the chain of propagation of the pandemic is directly linked by poverty in Mexico.

    According to the studies carried out by the Medical College and the University of Chile, in which it was evaluated that one of the causes of contagion, it has to do with housing precariousness, registering a probability of 9.6% to become a suspected case or be diagnosed with Covid-19. Above all, when the time of living with an infected person is very long during the day and night, which is even more complicated when considering that there are many inhabitants in the house.

    In the particular case of Mexico for the 2018, existed 28.7% overcrowded homes (9.8 million homes), i.e., 50.7 millions of people live in these conditions (41% of the total population) (INEGI, 2018).

    Overcrowding facilitates the spread of Covid-19, between family members or co-workers, even more so if it is a closed place, little ventilated, no access to water or sanitation. In Mexico, Habitat for humanity[6] (2020) funded a study on this topic, highlighting that:

    1. On individuals infected by Covid-19. People who live in municipalities with high levels of overcrowding have a higher probability of death from Covid-19.
    2. Overcrowding is associated with higher fatality even among people who have access to medical care.

    Not only in Mexico, according to the Organization for Economic Cooperation and Development (OECD, 2020) Preliminary data for France and the UK show that crowded living conditions and densely populated environments were associated with higher rates of Covid-19 infection.

    In United States, Emeruwa et al. (2020) found that pregnant women living in crowded neighborhoods in New York are more likely to be infected with Covid-19. The probability of contagion for women living in neighborhoods with more inhabitants per household is 23.9% on average, compared to 9% for women living in areas with fewer inhabitants per household.

    In the United Kingdom, Niedzwiedz et al. (2020) studied the incidence of socioeconomic deprivation in confirmed COVID-19 cases. The deprivation index includes overcrowding. The authors found that living in an area with high levels of deprivation increases 2.1 times the risk of infection. On the other hand, Soltan et. to the. (2020) analyzed the effect of housing conditions on the health outcomes of COVID-19 patients in the Birmingham area. The study shows that hospitalized patients who resided in areas with higher barriers to housing, including overcrowding, have 2.2 times more likely to reach intensive care than those with lower rates of deprivation (Habitat for humanity, 2020, p.9).

    There are interesting findings in the study of sociodemographic variables and infections, as in Brown and Ravallion (2020), who postulate that countries with more economic inequality and greater poverty have high infection rates. (Chin ae al., 2020) find that living in conditions of poverty and extreme poverty makes social groups more vulnerable, thereby increasing the risk of spread and death from COVID-19, therefore, social disparities are one of the main factors that considerably increase the risk of exposure to SARS-CoV-2 (Williams, 2020).

    On the other hand, A key element for the analysis of trends observed in contagion and fatality rates in Mexico has to do with testing to detect Covid-19 in order to detect cases of asymptomatic people and even false negatives.

    According to the results of a survey conducted by the National Institute of Public Health, there are approximately 31 million Mexicans who were in contact with SARS-Co V-2, but they never developed symptoms suggesting possible contagion, so they were undoubtedly cases of asymptomatic people[7], They continued in contact with many people and unknowingly made possible a greater spread of the pandemic.

    From our point of view, the magnitude and rate of spread of the pandemic has to do with testing for Covid-19. In the case of Mexico, it is one of the countries that make up the OECD where fewer Covid-19 tests have been carried out since the beginning of the pandemic., As we can see in the following graph to the month of August of the 2020.

    Graphic 8

    For the 27 March of 2021, when making a comparison between 20 Latin American and North American countries, It can be seen that Mexico is one of the countries in which fewer tests are carried out for the detection of Covid-19 for each 1000 population, especially to detect asymptomatic cases.

    Graphic 9

    With the arrival to the presidency of the United States of Joe Baiden, the 21 January, the US strategy to contain the Covid-19 pandemic was redefined through ten executive orders contained in the document "National Strategy for the response to COVID-19 and preparedness for pandemics", that in the first point manifests: "Accelerate the manufacturing and delivery of supplies (KN95 masks and test kits), in addition to diagnosing, treat and vaccinate coronavirus cases. At the time of delivery, preference will be given to the most affected communities "[8]; implementing as a key factor increasing testing for the detection of Covid-19 to break the chain of infections.

    In Mexico, It is well known that a policy to manage the pandemic has been implemented since the beginning of the pandemic, the calls to stay at home, and in fact the null closure of the borders, are undoubtedly the nature of the current government that has decided to completely transfer the responsibility for the pandemic to the population.

    Also, throughout the debate on the figures presented by the current federal government and state governments regarding the deaths from Covid-19 that occurred in Mexico, takes special importance again, from the mentions made on 27 January by the National Institute of Statistics and Geography (INEGI), agency that initially mentions that between the months of January and August they were reported for the 2019 a total of 488,333 deaths, while for him 2020 were historically recorded 673,260 deceased, reason why an excess of deaths is being registered in 2020 of 184,917 cases, i.e., 37.9% plus, in other words, If the trend between the months of January and August of 2011 to 2019 there has been an increase that goes from 1 to the 6%, situation that drastically changes in 2020 with the pandemic. In the same way, It is mentioned by INEGI that in a preliminary way between the months of January and August of 2020 there is a record of 108,658 deaths as a result of Covid-19, while the Ministry of Health for the same period only confirmed 75,017 cases, so there is a difference from 44.8. In addition to the above, there is the daily report that is presented by the Health Administration and by the federal government and, that to 31 of August 2020 published the cumulative figure of 64,414 people killed by Covid-19, data found 68.6% below the estimate made by INEGI[9].

    Then, We present two interviews conducted by the UNAM Center for Multidisciplinary Analysis, with Dr.. Arturo Erdely Ruíz and Dr Miguel Sánchez Alemán, on the handling of figures during the Covid-19 pandemic and the sentinel model implemented by the Ministry of Health in Mexico.

    Interview conducted by Dr. Arturo Erdely Ruíz.[10]

    The questions are basically two:

    1. Critical opinion on the use of the sentinel model for monitoring the pandemic in Mexico.
    2. On the controversy about the factor that would act as a multiple to obtain an accurate estimate of the number of people infected by covid-19.

    He does not question the sentinel model, but the way they were using the model results, since the policy they would implement to face the pandemic depended on them.

    In no country is it possible to confirm the possibility of contagion, because there will be those who get sick and do not report or do not get tested.

    In Mexico, the government was clear that they would measure less than what would actually happen. For this reason, decided to infer the size of the infected people based on a representative sample. The controversy develops in how the number of confirmed people who showed up is related. There is an epidemiological calendar, and the results presented by the 8 April, were made with the closure of the epidemiological week 13, and that week spanned from 22 to the 28 of March, the problem is that they compared that number with the confirmed cases at 28 April. In this sense, there is a data inconsistency, and the debate was consolidated with this incongruity.

    The worrying thing that the estimate was not adequate was and is fundamental because from these data the conditions to face the pandemic would be established, reason why the information should not be underestimated.

    About the survey we carry out at CAM

    The end of a first epidemic wave occurs when the 95% of the total number of cases estimated, it turns out that the estimated amount is unknown, then an estimate would have to be made and projected on a trend, He proposes up to a million cases, as seen in the following graph.

    The end of the first epidemic wave could be in January, according to the information above, and if from this level of infected decreases, it will be possible to speak of a second wave, but if it does not tend to decrease, it would be the same wave, but with diverse peaks, with different magnitudes, as in the American case.

    It is essential to evaluate the way in which this situation was faced for future problems, and to prevent lives from being lost.

    An element that highlights Arturo Erdely, is the remarkable learning that health personnel have developed along the way. However, us in the CAM, we would see it as a bigger problem, because the responsibility for a public problem is transferred to the workers and in that battle, they get sick or lose their lives, and despite the fact that the staff learning has managed to avoid losing more lives, they are not recognized, and their working conditions do not seem to improve, In this sense, the reproach to the government could be structured in terms of the resources they disburse for the life and health of the population., while in other mega projects they do not skimp on the expense. For this reason, the issue of defense of life is political.

    On the data and contagions in the field of health workers.

    Arturo Erdely, mentions that it is a protection level problem, as well as the lack of specialists. Both topics are not minor and they are not new, some stem from government neglect. Specific, one of the problems is long term, product of inattention to the education of physicians and their training. Another is short term, This could be taken care of in a better way and it was neglected, having severe consequences for the workers in this sector.

    Another issue involved is related to the creation of the vaccine, and political disputes involving their nationalities, another future topic is added, regarding the national vaccination campaign, and the way in which it will be distributed and how that also implies resources and availability of information.

    Interview with Dr Miguel Sánchez Alemán[11].

    Sentinel model considerations.

    In the words of Dr. Miguel Sánchez German, the sentinel model is very good conceptually, i.e., it is basically constituted by surveys, so its design is characterized by not making samples from all over the country, if not that only considers some clinics in the sample.

    In that sense, is that the sentinel model does work, but as long as you proceed well. So that, for Dr. Miguel Sanchez, It is important to emphasize that one of the mistakes that are usually made during the implementation of this model has to do with the notion that one has when talking about health personnel, because normally you think about the doctor and the nurse, However, implies a larger universe of health personnel, such is the case of the personnel who have been relegated in the construction of this imaginary as chemists, the statistics, epidemiologists, the computer personnel and that finally they are the ones who carry a lot of weight of the sentinel model. For such a situation, Dr.. Sánchez Alemán considers that this situation happened to the government during the start of the Covid-19 pandemic, since not taking them into account led to the collapse of the model by not considering hiring this type of staff, since it is this staff who bears all the weight to apply this model well, in other words, the sentinel model system in the week 7 and 8 having started the epidemic it just collapsed, since on the one hand it was impossible to capture tens of thousands of surveys that are made, That is why it was only during four or five weeks that they gave us data on the pandemic and then they disappeared for the simple fact of having collapsed as a result of the lack of infrastructure and personnel.; on the other hand, Also during the initial implementation of the model, the government thought a lot about the clinical part but did not consider at all towards that part of surveillance..

    On the other hand, regarding the methodology on whether the calculation should be by 8 the by 23, comments Dr.. Sánchez German, than multiplication by 8 never existed and that it was a misunderstanding caused by misapp and information, since the sentinel model had 15 days late, Thus, multiplication by 23 It was given with respect to two weeks delay. In consecuense, what the government tried to do and was very poorly understood by the media consisted of looking for a factor from today's week, but with the data from ago 15 days.

    Regarding the issue of positive cases due to Covid-19 among health personnel in hospitals, tells us that, for him, the number of infections among health workers far exceeds the 20% which is talked about, Well this 20% corresponds to cases confirmed by PCR test that tells us if we are infected today, and that contrast with serological tests based on the examination of antibodies and that allow us to know who has already been infected, therefore, there is a high probability of asymptomatic personnel who were not detected. Hence, when serological tests begin on a regular basis to detect contagions, the number of health personnel infected by Covid-19 could reach up to 30 o 40 % No problem.

    Something similar happens when we talk about the accounting of cases of suspects and those confirmed by Covid-19, emphasizing that a confirmed case is one that has a positive PCR test, while, a suspected case is a case that meets certain clinical characteristics, However, there is no clear criterion on which patient can or cannot pass the test, and this criterion can be passed from a doctor, a nurse or even a policeman working at the entrance control of the health institution; So what, under this assumption, yes there are more cases than reported. However, tells us that this situation should be reviewed with caution and case by case depending on the state of the republic, since each entity behaves differently depending on the guidelines it decides to apply, because it makes the distinction that the 50% of the hospitals correspond to the IMSS (federalized body) and the 50% correspond to the states.

    He carefully points out that there is an external factor that determines the level of contagion depending on the work carried out in the hospital, because for laboratory personnel there has always been a very strict care protocol (gloves, masks, safety glasses) and that - despite the fact that he has been trying to change for a long time- doctors and nurses have not been trained under these safety measures.

    Structurally speaking, this is a problem both of physical deficiencies for the safety of the personnel and of the lack of training and that is carried out even from professional education, this despite the existence of biosafety committees in health institutions.

    Dr. Miguel was asked about his opinion about whether we are prepared for a COVID-19 outbreak in Mexico. To which he replied:

    I agree with other media such as networks that there is no regrowth, Well, that implies that there was a decrease in the cases to figures close to zero and that has not happened or it has been very slow.. I think it can be given, but I don't think it's higher than past peaks, to speak of a regrowth would imply going down and stabilizing and then going up to figures that exceed past figures, situation that can be given, but I don't think the situation is going to be worse than what has already happened because I think all the Covid hospitals will remain, However, if there are two major problems that can complicate the picture, first, is that we have not treated other types of diseases in the general population for six months, and in addition to the above, let us remember that there could be combined cases of influenza and Covid; and the second, due to the exhaustion of health personnel.

    In the case of PCR tests with a positive result, there is the contact follow-up protocol, when they have been in contact with a confirmed positive for more than 10 minutes in a closed environment, but it is still very random to find an asymptomatic positive; that is why these are recommended when they come with symptoms. Regarding false negatives, tells us that a PCR test comes out positive between the day 4 and 10 of the disease and that can produce false negatives. The serological test tells us if a person was infected or not (regardless of symptoms) However, since it works through antibodies this is only correct up to two weeks later (time it takes for antibodies to appear).

     

    1. 2. Aspects about the precariousness processes of health workers

    As with the global economic crisis, the Covid-19 pandemic exacerbated and accelerated processes and trends that were already present in the precariousness of the working conditions of health workers. Since the 1970s and 1980s with the advent of neoliberalism, workers around the world have faced a war against their working and living conditions that manifests itself in different scales and intensities., as part of this war are the continuous macroeconomic adjustments that aim to make working conditions more precarious through different mechanisms such as wage containment, the increase in working hours or the suspension or elimination of benefits and labor rights. Throughout this war against the world of work, the working conditions of health professionals have not been exempt from precariousness.

    In Mexico, for decades, demographic change, product of population aging, and the recrudescence of chronic-degenerative diseases have put strong pressure on the National Health System, added to this, the quest to provide universal access to health care for the entire population has made the employment conditions of health workers increasingly critical, who have faced low wages for several decades, long working hours, irregular and temporary hiring and absence of unions that truly defend their labor and human rights.

    To explain the current precariousness of health workers in Mexico it is necessary to go back to the year 2003 when Congress approved the reforms to the General Health Law that made possible the establishment of the Social Protection System in Health (SPSS). The SPSS would aim to provide the non-eligible population with public health insurance, To carry this out, public spending was increased for the construction of new infrastructure and the modernization of medical equipment and instruments., as well as the hiring of more health professionals, However, the hiring took place in conditions that were quite adverse for the workers because most of them were temporary. The eventual hiring is divided into two: structure, which corresponds to the Middle and Senior Managers, and fee, the latter being the main method of hiring health workers, lasting five and a half months and without access to employment benefits.

    In 2007 The regularization process begins with the reform of the Law on the Social Security and Services Institute for State Workers, which would propose incorporating workers hired for fees into the benefits of said law, As of this reform, the National Union of Workers of the Ministry of Health (SNTSA), known for being a charro union, Negotiation begins to modify the modality of hiring workers financed with SPSS funds. It should be mentioned that the regularization of workers was subject to the relationship they had with the SNTSA, i.e., only the SNTSA decides who could be regularized.

    Regarding this process, Article, "Labor regularization of health workers paid with resources from the Seguro Popular in Mexico", notes that, “An initial agreement within the National Commission for the Regulation of the Hiring of Human Resources in the Federal Entities (CNRCRHEF) was that the duration of the contracts would be extended from five to twelve months with automatic renewal. Salaries would be updated based on the corresponding tabulator and benefits such as social security would be included., aguinaldo, retirement, pension, holidays, vacation cousin, although in less quantity and proportion than those established by the Federal Law of Workers in the Service of the State and more limited in comparison with those contained in the General Conditions of Work (the bureaucratic modality of a collective bargaining agreement). In addition, the SNTSA would have the right to receive the payment of the union dues for each regularized worker as well as to participate in the selection of the individuals to "regularize" ".

    Since the regularization process began, he has faced various problems, initially the National Commission for Social Protection in Health (CNPSS) requested in the National Commission for the Regulation of the Hiring of Human Resources in the Federal Entities (CNRCRHEF) that the regularization will be limited only to the staff of doctors and nurses, although later the regularization was extended to other workers who also directly cared for patients, However, there are still a large number of health workers who are not regularized.

    The problem of basification of health workers extended to the current administration headed by President Andrés Manuel López Obrador. The federal government promised at the beginning of the six-year term to regularize all health workers with basifications. In the delivery of support Production for Well-being in Huetamo, Michoacán held on 8 February's 2019, Andrés Manuel López Obrador spoke on the matter:

    Do you know what happens in health? There are no doctors in the health centers, in hospitals, there are no medicines. What they call Seguro Popular, nor is it safe, nor is it popular.

    Or are there medicines here, in Huetamo?

    Do you know how many health workers are hired temporarily or for fees in the country?? 80 thousand workers.

    There are those who have up to ten, 15, 20 years working as eventual, what do we have to do? We are going to basify them, Health sector workers will also be regularized.

    But the same, it's not for tomorrow, no. Let's see who is older first, what has been the performance and who is going to play this year, who next, like this until the government ends, but I'm going to basify all health workers, it is my commitment (López Obrador, 08 February's 2019)

    Given the apparent willingness of the Federal Government to basify health workers to regularize their employment situation, in march of 2019 the SNTSA, led by Marco Antonio García Ayala, met with authorities of the Ministry of Health, including its holder, Jorge Alcocer Varela, to start the regularization process. Likewise, the leader of the National Front of Health Workers, Antonio Sanchez Arriaga, manifested itself in July of the same year to demand job security for 95 one thousand health workers across the country who were not entitled to their retirement. The negotiation between the Federal Government and the different unions in the health sector did not necessarily imply progress, since these unions are widely known among workers for not representing their interests and defending them, leaving many workers who criticize the action of the unions outside the basifications.

    Now well, The precarious employment that predominates in the health sector is not only expressed in the temporary hiring of active health workers without rights or benefits, but also, in the enormous deficit of health professionals that has been recognized for years. In 2019 the Secretary of Health, Jorge Alcocer Varela, warned that they needed 123 a thousand general practitioners and 72 thousand experts, for may 2020, already in phase 3 due to the accelerated growth of the epidemic in Mexico, The Secretary of Health highlighted the deficit, pointing out that 200 thousand health professionals, only taking into account doctors, general practitioners and specialists, since the deficit of nurses was 300 thousand (López Obrador, TO. M., s/f).

    Likewise, the Undersecretary of Prevention and Health Promotion, Hugo López-Gatell Ramírez, the 11 July of 2020, noted that, according to studies by the Organization for Economic Cooperation and Development and the World Bank, it was concluded that in Mexico there is “a lack of 240,000 elements", that includes doctors, nurses and social workers (López-Gatell Ramírez, H, 11 July of 2020).

    With the arrival of the Covid-19 pandemic, and in the face of the enormous deficit of health personnel, different calls were launched to employ specialists in the care of COVID-19, coming to hire 77 thousand temporary workers, highlighting the hiring of anesthesiologists, infectologists, inhaler therapists, neumologists, pulmonary and intensivist physiotherapists, emergency room specialists and specialist nurses (González, J., 01 in January of 2021).

    However, the hiring of health workers who would face the pandemic were carried out in complete irregularity and job insecurity, well in the best of cases, they only had social security, some benefits and labor rights while their contracts were in force, which must renew every three months or even every fifteen days.

    Under this context of absolute precariousness, it should be taken into account that, many of these workers who agreed to work under these conditions, were unemployed or in informal employment before the health emergency, so having at least one guaranteed salary during the pandemic, it was a benefit for them. However, before the exponential acceleration of infections, the panorama made this situation more complicated, which in itself was already adverse, while the working conditions of health workers only deteriorated further and made it clear that the Mexican National Health System, practically, was and is unable to overcome the health emergency.

    In that sense, The COVID-19 pandemic found the Mexican National Health System under a precarious labor regime and with a serious deficit of health professionals, Therefore, thousands of health workers with low wages were mobilized to attend the health emergency, null benefits, no social security and no labor rights. Precarious working conditions made health workers more vulnerable to the ravages of the pandemic, situation that was even pointed out by the Undersecretary of Prevention and Health Promotion, Hugo Lopez-Gatell, at the press conference of 24 of May 2020:

    We had commented before COVID that in the National Health System as a whole there were about 98 one thousand health workers in precarious hiring conditions, this means that they were hired for fees, for a year, by two, for three, For five, for seven, there were people who were for more than 18 years hired for fees, 98 a thousand people and some even 18 years throughout the National Health System, this means, the 32 state health secretariats, the 32 state health services, which is where this hiring regime mostly exists.

    This, as we mentioned at the time and I say it again, clearly it is against the law, contrary to the Federal Labor Law and is, In addition, contrary to fundamental principles of labor and social justice because obviously, people who are hired that way are being put at a great disadvantage (López-Gatell, 24 may of 2020).

    It does not stop calling attention that even the health authorities recognize that the current working conditions are contrary to the Federal Labor Law and a labor and social injustice when it is the same government that promotes this labor regime for all health workers who deal with the pandemic daily.

     

    2.1. Purchasing power of the tabulating salary of IMSS workers

    Health workers have not been exempt from the process of wage insecurity that has occurred during the last four decades of the neoliberal phase in Mexico, the impoverishment by income is presented through the indicator of the purchasing power of the tabular salary for the case of six categories of work that appear in the Collective Labor Contract of the workers of the Mexican Institute of Social Security (IMSS).

    It is noteworthy that, methodologically to calculate the purchasing power of the tabular salary, two aspects are required: first, consider the Food Basket Recommended (CAR) applied by the Center for Multidisciplinary Analysis of UNAM[12], and the second aspect, It is necessary to calculate the unit of the tabular salary of IMSS workers. The analysis of the purchasing power of the tabular salary of a worker in the IMSS does not consider the part related to benefits.

    The increases to the tabular salary of IMSS workers agreed in the salary review agreements for the 2020 by Arturo Olivares Secretary General of the National Union of Social Security Workers (SNTSS) and by the general director of the IMSS Zoé Robledo, are a true reflection of the so-called wage policy adopted by the current government, perpetuating the precarious wage of health workers, with which it is paid to continue generating the necessary conditions for neoliberalism to enjoy good health in Mexico. Undoubtedly, increases to the minimum wage for 2018 what happened with 16%, for 2019 what happened with 20% and from 16% for the 2021 have not had any kind of positive influence on the increases to the tabular salary of IMSS workers, i.e., that in the more than two years of the current government there are global increases in IMSS workers that are not greater than 6%, for example, in 2018 in the government of Enrique Peña Nieto, the increase to the tabular salary was 3.05% and 2.05% to benefits, for an overall increase in 5.10%; for the 2019 with the government of Andrés Manuel López Obrador, the increase to the tabular salary was 3.05% and 2.10% in benefits, to have an overall increase in 5.15%; for the 2020 the increase to the tabular salary was 3.35% and 1.80% in benefits, for a global salary of 5.15%; the 2021 the global increase was 5.70%, divided in 3.60% to the tabular salary and 2.10% in benefits. In this way, after tributes and medals made by the government of the 4T to health personnel and after more than 10 months of working in extremely precarious working conditions, that although they are the product of the inheritance of the dictatorship of the Institutional Revolutionary Party (PRI) for more than 70 years and that from 2000 It was alternating with the extreme right with the access to power of the National Action Party and today from MORENA it continues on the road under a face of republican austerity to make more efficient public resources charged to the living and working conditions of the health workers.

    Then, We present the analysis of the purchasing power of the tabular salary in six contractual categories of IMSS workers.

     

    Administrative Services Assistant Worker. For the period of 1982 to the 2019, a cumulative loss of purchasing power of the tabular wage of 85.22%, in other words, in 1982 this worker had a monthly tabular salary of $9.98 weights[13], while the monthly price of a CAR was $3.69 weights[14], so with his monthly salary he could buy a basket and he had left over $6.29 weights, Or if all your salary is spent on the purchase of the CAR, it could have the equivalent of 2 baskets and the 70% of one more, in this way it only required work 2 hours with 57 minutes of a working day of 8 hours to generate the salary equivalent to the price of a CAR. After 37 years of neoliberalism and regressive wage policies that were established with the famous wage caps of no more than 5% direct salary and that was observed in the vast majority of years, is that there are the following consequences: for the same category of worker for the 2019 records a monthly tabular salary of $ 3,309.98 weights, while the monthly price of the CAR is $ 8,279.70 weights, so now you can only buy the 39.98 % a car, Unlike 1982 I could buy almost three CARS, now he has no money left over from his salary, if not, what do you need? $4,969.72 pesos to be able to buy the CAR monthly, in this way, the worker is forced to increase the work time necessary to 20 hours with 1 minute to generate the salary equivalent to the price of 1 CAR as can be seen in the picture 3, and this considering that it could be done in the same workplace, but if it is not the case, you will have to do it many times, providing their services in other work centers in worse working conditions or combining it with the informal economy to try to survive, and that throughout the pandemic their purchasing condition has worsened due to Covid-19 due to the lack of resources for the adequate and quality supply of Personal Protective Equipment, who have had to buy them on their own to try to guarantee their health and avoid contagion and / or death as much as possible.

    Picture 3.

     

    General Nursing Assistant Worker. During the period of 1982 to the 2019, there is an accumulated loss of purchasing power of the tabular wage of -83.50%, i.e., the monthly tabular salary of this worker in 1982 was of $14.44 weights[15] and, the monthly price of a CAR was $3.69 weights[16], so with the monthly salary he could buy a basket and he had $10.75 weights, but if all his salary was allocated to the purchase of the CAR, he could acquire 3 baskets and the 64% of one more, so in 1982 only required work 2 hours with 11 minutes of a working day of 8 hours to generate the tabular salary to be able to buy a CAR. For the 2019, for the same category of worker, a monthly tabular salary of $ 4974.38 weights, while the monthly price of the CAR is $ 8,279.70 weights, in such a way that now you can only acquire the 60.08 % a car, in other words you need $ 3,305.32 pesos to be able to buy the CAR monthly, which is reflected in the necessary work time that is of 13 hours with 18 minutes that the worker must perform to try to generate the equivalent salary to buy only 1 CAR, see the picture 4.

    Picture 4.

     

    General Nurse Worker. During the period of 1982 to the 2019, there is an accumulated loss of purchasing power of the tabular wage of -86 %, i.e., the monthly tabular salary of this worker in 1982 was of $ 19.13 weights[17], while the monthly price of a CAR was $3.69 weights[18], so with the monthly salary he could buy a basket and he had $ 15.44 weights, or also if in an exercise with all his salary he used it in the purchase of the CAR he could acquire 5 baskets and 18 % of one more, so in 1982 it only requires work 1 time with 32 minutes of a working day of 8 hours to generate the tabular salary to be able to buy a CAR. On the other hand, for the 2019, for the same category of worker the monthly tabular salary is $ 6,010.54 weights, while the monthly price of the CAR is $ 8,279.70 weights, to need $2,269.16 weights, in such a way that now you can only acquire the 72.59 % a car, for this reason these workers have to work 11 hours with 1 minute to generate the salary to buy a CAR, see the picture 5.

    Picture 5.

     

    Laboratory Worker. In the period of 1982 to the 2019, there is an accumulated loss of purchasing power of the tabular wage of -87.28 %, i.e., the monthly tabular salary of this worker in 1982 was of $ 23.63 weights[19], while the monthly price of a CAR was $3.69 weights[20], so with the monthly salary he could buy a basket and he had $ 19.64 weights, or also if in an exercise with all his salary he used it in the purchase of the CAR he could acquire 6 baskets and 40 % of one more, so in 1982 it only requires work 1 time with 15 minutes of a working day of 8 hours to generate the tabular salary to be able to buy a CAR. On the other hand, for the 2019, for the same category of worker the monthly tabular salary is $ 6,745.50 weights, while the monthly price of the CAR is $ 8,279.70 weights, doing you need $ 1,534.20 pesos to buy only 1 CAR, in such a way that now you can only acquire the 81.47 % a car, for this reason these workers have to work 9 hours with 48 minutes to generate the salary to buy a CAR, see the picture 6.

    Picture 6.

     

    Family Medical Worker. For the period of 1982 to the 2019, there is a cumulative loss of purchasing power of the tabular wage of -88.27 %, i.e., the monthly tabular salary of this worker in 1982 was of $39.74 weights[21], while the monthly price of a CAR was $3.69 weights[22], so with the monthly salary he could buy a basket and he had $ 36.05 weights, or also if in an exercise with all his salary he used it in the purchase of the CAR he could acquire 10 baskets and 76 % of one more, so in 1982 it only requires work 44 minutes of a working day of 8 hours to generate the tabular salary to be able to buy a CAR. However, for the 2019, for the same category of worker, a monthly tabular salary of $ 10,459.20 weights, while the monthly price of the CAR is $ 8,925.52 weights, for what they would need $ 2,179.50 weights, in such a way that now you can only acquire 1 CAR and the 26% of one more, the loss of purchasing power of the monthly tabular salary that has had in 37 years, make this worker have to work 6 hours with 20 minutes to generate the salary to buy a CAR, see the picture 7.

    Picture 7.

     

    Radiologist Technician Worker. In the period of 1982 to the 2019, there is a cumulative loss of purchasing power of the tabular wage of -86.65 %, i.e., the monthly tabular salary of this worker in 1982 was of $21.41 weights[23], while the monthly price of a CAR was $3.69 weights[24], so with the monthly salary he could buy a basket and he had $ 17.72 weights, or also if in an exercise with all his salary he used it in the purchase of the CAR he could acquire 5 baskets and 80 % of one more, so in 1982 it only requires work 1 time with 22 minutes of a working day of 8 hours to generate the tabular salary to be able to buy a CAR. However, for the 2019, for the same category of worker the monthly tabular salary is $ 6,412.94 weights, while the monthly price of the CAR is $ 8,279.70 weights, in such a way that now you can only acquire the 77.45% a car, in such a way that this worker has to work 10 hours with 19 minutes, so now they would need $1,866.76 pesos to generate the salary to buy a CAR, see the picture 8.

    Picture 8.

     

    2.2. Working conditions of health workers during the pandemic

    Information presented in the Investigation Report 133: Results of the Questionnaire on the working conditions of health workers in Mexico during the Covid-19 pandemic, of the multidisciplinary Analysis Center (CAM) UNAM, has shown the adverse labor outlook faced by health workers in Mexico. Although the results have not constituted a probability sampling, the voice of the workers in the sector who answered the questionnaire[25] It is still a benchmark on working conditions in the health sector. Indeed, the results have been very illustrative of job insecurity.

    In this section, the results of the applied questionnaire are retaken with the intention of emphasizing the following aspects, from the workplace and the forms of hiring: Labor journeys, wages and benefits, protection and work supplies, risk of contagion by Covid-19 and capacity of attention of the health sector.

    Characteristics of health workers in the public sector

    The public sector health personnel who answered the questionnaire have specific characteristics: most of them work as a nurse (general nurse, nursing assistant, head nurse and specialist nurse) and doctor (medical specialist, general practitioner and family physician); the vast majority work in hybrid hospitals, hospitals converted to 100% for Covid-19 care, specialty hospitals and health centers, Likewise, work in institutions such as the Health Sector, Mexican Social Security Institute (IMSS), Institute of Social Security and Services for State Workers (ISSSTE) and Institute of Health of the State of Mexico (NAME). (See concentrate 1 of the statistical annex)

    Activities of health workers in the public sector

    About the activities they carry out, the 82.57% of emergency physicians, the 78.26% of family doctors, the 69.06% of general practitioners and half of residents (R1-R8) evaluated COVID patients. Regarding the management of patients with Covid-19, more than 90% of orderlies and ambulance operators, more than 80% of internists, intensivists and emergency physicians, more than 70% of anesthesiologists and inhalotherapists, half of the residents (R1-R8) and more than half of general nurses and nursing assistants; indicated that they carried out this activity. (See concentrate 2 of the statistical annex)

    In addition to the management of patients with Covid-19, between the 50% and 70% of general practitioners, Family members and emergency physicians indicated that they also cared for general consultation patients, Meanwhile he 49.91% of specialty doctors, the 45.87% of emergency physicians, the 67.96% of internists and the 76% of inhalotherapists were dedicated, also, to hospitalization. Half of the general nurses and floor head nurses, and approximately the 40% of the nursing assistants reported, also, perform this last activity. (See concentrate 2 of the statistical annex)

    According to the previous data on the activities carried out by health personnel according to their occupation in the public sector, It is observed that most of this is dedicated to facing the Covid-19 pandemic and carrying out their daily work activities; this would probably be evident given the results of the questionnaire, However, it is not a minor data, especially knowing the labor outlook of the health sector.

    Forms of hiring health workers in the public sector

    Regarding the forms of contracting, more than 70% of specialist doctors, internists and intensivists, and more of 80% of emergency physicians and family physicians, indicated that they were hired from Base, as well as more than half of general nurses, nursing assistants, head nurses and specialist nurses. An important case is that of residents (R1-R8), since although they are also managing and evaluating patients with Covid-19, the 22.95% replied that they had no contract, while half indicate that they are hired in other ways[26] not mentioned in the questionnaire. (See concentrate 3 of the statistical annex)

    Characteristics of health workers in the private sector

    Then, we will address the responses of healthcare workers working in the private sector, because, although they represent only the 8.7% of the total workplaces in the questionnaire, These help describe the big picture of their working conditions and how they are coping with the pandemic, Since, As it was mentioned already, not only public sector health workers face the pandemic and not only they are subjected to job insecurity.

    As in the public sector, In the private sector, most of the health workers who answered the questionnaire work as nurses (general and floor manager) o doctors (general, specialist), most of them work in hospital chains and private clinics. The 40% of nurses work in private clinics and the 44.21% in hospital chains, while half of the head nurses work in the first and second 42.11% in the second. Regarding general practitioners, the 46.48% works in offices outside of a private hospital or clinic and almost 20% in private clinics; in the case of specialist doctors, almost the 30% works in private clinics, a 20% in hospital chains and other 20% in offices within a hospital or private clinic. (See concentrate 1 of the statistical annex)

    Activities of health workers in the private sector

    On the activities carried out by health workers in the private sector, it should be emphasized that, regarding the assessment of patients with Covid-19, less than 30% of the total indicate that they carry out this activity, even so, half of the inhalotherapists and the 100% of family doctors indicate that they carry out this activity. Regarding the management of patients with Covid-19, the 40% of workers indicated to carry out this activity, among these, more than half of the general nurses stand out, floor nurses, nursing assistants and the 80% of specialist nurses. In the same way, half of emergency physicians, more than half of surgeons, the 75% of radiological technicians and 100% of inhalotherapists indicated that they also perform this activity. (See concentrate 2 of the statistical annex)

    Half of the specialist doctors, of inhalotherapists, of nursing assistants, and more than half of family doctors and surgeons; perform general consultation patient management activities. In the case of hospitalization, 50.53% of general nurses, half of internists, of radiology technicians, of social workers and anesthesiologists, and more of 60 and 80% of surgeons and inhalotherapists, respectively, perform this activity. (See concentrate 2 of the statistical annex)

    Forms of contracting health workers in the private sector

    Unlike the public sector, In the private sector, the second most chosen form of hiring was work for fees. Although the most frequent form of hiring was that of Base, only half of the general nurses, and 10% of nursing assistants, enjoy this form of contracting, at the same time, 26.76% of general practitioners and 14.29% of specialist doctors are hired under this figure; in this same area are approximately the 80% of inhalotherapists, of the floor managers nurses, specialist nurses and radiology technicians. At work for fees, is it so 21.13% of the general media, 44.64% of specialist doctors, 40% of intensivists, 50% of internists and 75% of emergency physicians (the 25% remaining is contracted only during the pandemic). Those who had no contract despite being the 14.29% of the total, highlighted in the case of general practitioners, specialists and family. For casual work, stand out 60% of nursing assistants (apart from what 30% of them are hired only during the pandemic), the intensivists (40%) and the residents (50%). (See concentrate 3 of the statistical annex)

    Health personnel to attend to hospital capacity due to the pandemic and general illnesses at all levels in the public and private sectors

    As it mentioned above, it is evident that even in the pandemic, the health sector, both public and private, should continue to see general consultation patients; This situation would not be a major problem if there were enough personnel to meet the demand for health in the country and if the working conditions of these workers were not precarious, in this sense, the 80.61% of the public sector workers who responded to the questionnaire consider that there is not enough staff to attend to the hospital capacity due to the pandemic and general illnesses at all levels, they think the same, more than 80% of people working in hybrid hospitals, hospitals converted to 100% for Covid-19 care, IMSS Bienestar and in specialty hospitals. In the private sector, 65.50% of workers consider that there is not enough staff (especially the 78.51% of those who work in hospital chains). (See concentrate 4 of the statistical annex)

    The simple fact that there are not enough health personnel translates into a greater workload for health personnel as time passes. This situation was beginning to show, as we will see next, at the time the questionnaire was raised.

    Perception of salary and benefits in the public and private sector

    Table 1.

    The 87.39% of all workers in both sectors, public and private, point out that salaries and benefits are not enough compared to what is happening during the Covid-19 pandemic; the 88.01 and 80.86% of public and private sector workers, respectively, consider the same. There is no significant difference in these results according to the form of hiring in these workplaces, since both the grassroots workers and the eventual, those who work for fees, those hired during the pandemic and those who do not have a contract or who are under other contracting figures, they think the same way: wages and benefits are not enough.

    Table 2.

    In the public sector, the results were very similar to the general trend, highlights that, the 91.67 and the 94.87% of those hired for fees and those who do not have a contract, respectively, consider wages and benefits insufficient.

    Retrieving open question 47.a of the applied questionnaire, The aspects that public sector workers mentioned in order to consider their salaries and benefits insufficient in the face of what is happening are the following: lack of professionalization, increased working hours and work intensity, almost nil benefits in case of illness and being the only support for their families.

    The absence of professionalization, refers to the fact that workers consider that they are not awarded wages according to their level of specialization and that, despite having the latter, this is not a guarantee of accessing a base contract (convenient for the employment benefits to which they would have access). About working hours, mention that they have not only increased, but have become more intensive due to lack of personnel, causing that in some cases they cannot eat, drink water or go to the bathroom. Regarding sickness benefits, including the Covid bonus, mention that these are not granted to all workers but only counts for some categories and forms of hiring, even so they are evaluating and treating sick patients for Covid-19 (this point will be detailed later).

    Added to this panorama, we must emphasize that the 53.98% from the workers, they mentioned having other jobs, from working in another health establishment or carrying out another type of commercial activity. Situation consequent to wage insecurity and decrease in purchasing power of workers.

    However, what we are interested in pointing out is that, one of the daily ways to increase the monthly income of workers, consists of carrying out guards, substitutions or extra shifts. This guard system[27], consists of extending the working day for other 8 work hours. Situation that throughout the pandemic has represented a series of problems related to corruption practices and preferential treatment. The pay of the guard varies if it is morning, evening ($800) or night ($1,400), as well as the profession, degree of specialization and health facility, both for the same tab, as if it is from the public or private sector[28].

    For the salary issue, It is convenient to remember the results previously presented on the loss of purchasing power of IMSS workers as a reference, in addition to taking into account the answers to open question 47.a[29] of the questionnaire, because the workers mention that their salary payments are not enough to their degree of specialization and to the pressing needs during the pandemic, since many of them have had to allocate part of their salaries to obtain protective equipment, either because the inputs are insufficient or because they are of poor quality, or have had to pay for their medical care when they have fallen ill with Covid-19 (especially casual workers).

    Table 3.

    A different situation arises in the private sector, Since the 20% of workers with other forms of hiring other than those indicated in the questionnaire consider their benefits and salary sufficient.

    COVID bonus

    At the press conference of the Daily report on coronavirus COVID-19 in Mexico of the 04 in January of 2021, the director of Medical Benefits of the IMSS, Victor Hugo Borja Aburto, presented an update on the COVID bonus for IMSS workers, In this regard, he commented the following:

    What is this COVID bonus?

    It is an economic recognition that is granted to medical and non-medical personnel who work in specific areas of COVID, that is directly related and that you could have a risk of infection because you are exposed to the virus, i.e., who is directly in the front row caring for COVID patients, this is awarded a 20 percent of bonus, It is similar to the bonus that is awarded for infectiousness and that is found in our collective labor contract, the IMSS.

    Who is it for?

    To all these categories of workers, all these categories of workers have to do or may be related to the care of COVID patients, doctors, nurses, inhaloterapeutas, laboratory workers, chemicals, radiologist technicians, camilleros, cleaning and hygiene staff, ambulance staff, food handler, medical assistants, social workers, pharmacy staff, stomatologists, histo / cytechnologists and all those categories that are in direct attention.

    If there is any other category that is in direct care, the director of the hospital reports it and some other category that is entering to care for COVID patients can be authorized, this includes interns and residents as well.

    This was authorized on 16 March of 2020 by the IMSS Technical Council, started at 13 April and to date a payment has been granted, payment to 161 thousand 807 workers in COVID care. The total amount ministered in this concept has been three thousand 132 million pesos.

    For the attention of complaints or requests from staff for the attention of the COVID voucher, you have this email. To date, six thousand have been received 156 emails and five thousand have been attended 769 requests, and they are in process 387 of this.

    Five percent of the requests have been from, this continue.

    In what we have had some problem is in the authorization of the people who initially enter the care of COVID patients since the payroll in the IMSS is paid in advance.

    Non-conformities can be classified in other approaches not related to the COVID bond. Workers who request retroactivity because they received their bonus and want the term to be extended, They must explain from what moment and the director of the unit can justify that it is paid retroactively and because they consider that they are entitled to payment.

    This right to payment is done for the investigation and it must be personnel who are directly treating COVID patients. (Borja Aburto, 04 in January of 2021).

    To the precarious salary and null labor benefits is added the fact that the COVID bonus, Compensation for frontline healthcare workers in caring for Covid patients promised by the government since the start of the Covid-19 pandemic, has not really reached all the workers who have fought the pandemic, despite what the IMSS Director of Medical Benefits reports, because the workers point out that the COVID voucher was delivered only to ISSSTE and IMSS personnel but only to certain categories and grassroots workers.

    Staff hired only during the pandemic or who have been working for years for fees and in workplaces such as clinics rarely received it.. The workers at the same time denounce that the COVID bonus was distributed among the unions, officials and friends of delegates or among base workers who have preferential treatment to have more facilities to stay at home and receive the covid bonus and other incentives. Then, We present the testimony of an intensivist nurse from the ISSSTE that recapitulates the working conditions faced by health workers who are on the front line caring for Covid patients, including payment of the COVID bonus:

    “[…] In the health sector, the guards are also in $1,000 weights that of 12 hours and $600 the of 8 hours approximately. But here what is being handled, is that there are COVID contracts. So these actual COVID contracts, Well, if they are from $30,000 pesos per month, less taxes. So really, these personnel who are entering with this type of contracts at this time, Well, if they are more or less paid.

    What if he is hitting us is that we do not have the necessary equipment, we are buying it on our own. And so the COVID bonus, well it was nothing more than $3,000 weights, which is approximately what, because the staff is spending for all inputs, all your material, of robes, overoles, googles, face mask.

    And really as for the team, Yes there are, or if there is, The trailers with the necessary equipment have arrived, Yes there are, but for example gowns or overalls as they are of poor quality, they are very skinny, the masks as well. But if they have given us, in other words, the truth is that right now if they give us KN-95, they give us googles and they give us hats, limit, boots, everything. But what i say, some if they are of poor quality, then you have to invest […]

    Another thing that is hitting us a lot is that approximately the 50% of the personnel is in safekeeping, i.e., are those who have a chronic disease and are not working. So the staff that we stay, we are overworked. If in intensive care, we received from 1 to 2 patients, Well, right now we are receiving 3, then it is also fatigue, that our vacations have been suspended, payments, holidays, everything, we have no right to anything, to nothing, we have no rest. Then, Well, if it is staff exhaustion. Because some owe us vacations from last year and there is not even when, because the staff keep getting infected and they keep leaving. So the staff that we stay is the one that if we already ask for a corner " [SIC.] (Testimony of an intensivist nurse of the ISSSTE, 27 in January of 2021).

     

    Covid-19 contagion among health personnel in the public and private sector

    Table 4.

    No less important are the benefits granted for COVID-19 infections in the workplace, since according to the results of the questionnaire, in 24.04 % of all workplaces have been infected between 1 and 5 people, in 27.91% places have been infected between 11 and 15 workers and in 24.46% more than 20. In public sector workplaces, the intervals with the highest number of infections were 1 to 5 people, 6-10 people and more than 20 people. In hybrid hospitals 220 responses indicated that 10 people had caught, 166 they pointed to 20 people, 121 to 15, 11 to 30, and there were even responses indicating more than 100 cases (just to mention a few); a similar situation was seen in the converted hospitals 100% for Covid-19 care and in specialty hospitals. Cases of contagion among health workers are plausible in pandemic conditions, adding up, In addition, limited access to and quality of protection supplies, as well as insufficient wages; in this scenario at least there should be adequate benefits, However, This is not like this.

    Support to health workers in the public sector in case of Covid-19 contagion

    In hybrid hospitals, predominant workplace in questionnaire responses, the 10% of the responses express that when workers have had to retire due to complications derived from COVID-19 infection, they do not receive support. Less than half of the responses indicate that workers in hybrid hospitals have these supports: medical assistance (48.49%), hospitalization (39.50%) and medications (36.33%). Less than a tenth of the responses state that this workplace has: pension (1.89%), retirement (1.51%) and compensation (2.47%). Only one benefit: disability, It is a support that more than half of the responses say they count in hybrid hospitals (69.71%). In the hospitals converted to 100% for Covid-19 care, a tenth of the people who say they work there express that their workplaces do not support them; less than half of these express having these supports: hospitalization (39.86%) and medications (33.80%). And less than a tenth of workers say they have a pension (1.28%), retirement (0.70%) and compensation (1.40%). As in the case of hybrid hospitals, disability, It is a support that more than half of the workers in that workplace enjoy (66.32%), they also enjoy this same proportion of medical assistance (52.91%). A similar trend exists in other public sector workplaces, With the exception of compensation and disability, which according to the responses to the questionnaire were more awarded in the IMSS welfare (10% and 72.50% respectively). (See concentrate 5 of the statistical annex)

    It is important to see that some forms of hiring other than a base do not enjoy any other benefit than disability and that disabilities for both base workers and those hired under other forms, they are insufficient; most health workers only had maximum disability 15 days and also, most of them were not typified by COVID-19; it goes without saying that 15 days to recover from COVID-19 are insufficient, more for health workers who have to work hard, for longer, without adequate remuneration and without sufficient protective equipment.

    Deaths of health workers in the public and private sectors and compensation

    In the case of the deaths of workers due to the coronavirus, in seven out of ten public sector workplaces at least one worker has died from coronavirus (in 588 places they talk about 1 death, in 423 places of 3 deaths and 173 of 10, just to mention a few figures); In the private sector, in three out of every ten workplaces a person has died from Covid-19 infection. However, Less than one-tenth of health workers received compensation, and most workers did not know whether the compensation awarded to the family of the deceased health worker was sufficient, at least almost half of the responses indicated that it was insufficient (46.09% in the public sector and 54.70% in the private sector), this situation was similar for those eventually hired.

    Increase in working hours, a day or a week, from the Covid-19 pandemic and its impact on remuneration by form of hiring and workplace

    Table 5.

    Due to the activities carried out in the health sector, it is expected that working hours will increase, Thus, in a third of the workplaces, it is reported that working hours have increased and 80% of workers by workplace indicate that they have not received any remuneration for that extra time (bonds, overtime payments, etc.). On the other hand, not only the days have increased, but they have also become more intensive due to the demand for health and the lack of personnel (a deficit of health personnel and also that some workers in the sector have stopped working because they are part of the vulnerable population). (See concentrate 6 and 7 of the statistical annex)

    Table 6.

    In the public sector, in three out of ten workplaces, working hours are considered to have increased, especially in health centers, clinics, IMSS wellness, hybrid hospitals and specialty hospitals; on the other hand, in the private sector in five of each 10 workplaces an increase in working time is perceived, especially in hospital chains and medical laboratories. (See concentrate 6 of the statistical annex)

    Table 7.

    This increased working time, it has not been translated in most of the cases in adequate remuneration, well the 80% of public sector workers and 70% from the private sector, mentions that their salaries have not increased as a result of this increase in time worked. (See concentrate 7 of the statistical annex)

    Inputs and protection instruments received by health workers in the public and private sectors by form of contract

    Table 8.

    In public sector workplaces, the 62.99% of workers mention that the inputs they receive are insufficient for their protection; the 23.76% points out that sometimes they are enough; and the 13.25% says if they are enough. The only variability of responses in the health sector, It obeys the form of "hired only for the pandemic" with a slightly higher percentage (17.65%) compared to the rest of the answers, considering that they do receive sufficient inputs and instruments for their protection.

    Table 9.

    Responses from private sector workplaces indicate that the 38.54% of workers consider that these inputs are insufficient for their protection, the 35.04% considers that they are enough and the 26.42% that only sometimes. In the case of private sector workplaces, it should be noted that, the 45.33% of workers hired for fees, mostly consider that, the inputs and instruments for their protection are sufficient. (See concentrate 8 of the statistical annex)

    Inputs and protection instruments received by health workers in the public and private sectors for their activities and workplaces

    For health sector workers to carry out activities related to the assessment and management of patients with Covid-19, It is necessary that they have the appropriate material for their protection regardless of their form of contracting, However, this is not so completely.

    First, on protection supplies, just to mention some materials, more than 60% and less than 70% of workers who value Covid-19 patients, do not have N95 face shields and watertight goggles; more than half do not have simple masks, two-layer and three-layer masks; although more than half if it has liquid to sanitize, surgical gloves, limit, KN95 mask, antibacterial gel and face shields, the fact that most of the workers qualify as normal is very noticeable (41.70%) and bad (33.08%) the quality of the inputs and instruments provided by the work centers. In the case of those who are dedicated to the management of Covid-19 patients, between the 50% and 65% of workers do not have N95 face shields, liquid to sanitize, simple masks, three-layer mask, Tyvek coveralls and watertight goggles, so too 60% of these it does have KN95 masks and masks, more than 80% has robes, surgical gloves, antibacterial gel and bilayer mask. (See concentrate 9 of the statistical annex)

    In second place, on protection supplies, by public sector workplace, in the case of hybrid hospitals, more than half of the workers state that they do not have N95 face shields (66.47%), airtight googles (65.11%), liquid to sanitize (63.47%), three-layer mask (57.93%), overoles tykev (73.64%) and more than half declare having antibacterial gel (81.65%), grimace (55.24%) and KN95 face shield (56.57%). It is very important to mention that the responses by workplace are very emphatic in pointing out that, some inputs are only granted to those who are in the covid area and whose inputs are limited to the extent that workers have to acquire them with their income; a similar situation is described for the case of the IMSS welfare. About the hospitals converted to 100% for Covid-19 care, more than half of the workers who work in these places, indicate that they do not have N95 face shields (59.67%), airtight googles (55.83%), liquid to sanitize (60.14%), overoles bonds (65.15%), three-layer mask (57.93%); more than half say they do have KN95 masks (56.57%), gel antibacterial (83.57%), grimace (59.67%) and surgical boots (57.46%); the situation of the hospitals converted to 100% for Covid-19 care shows that, even though more workers have basic supplies compared to hybrid hospital workers, not enough material for protection and safety in these workplaces, This conclusion coincides with the assessment of the health workers themselves. (See concentrate 9 of the statistical annex)

    Periodicity of the delivery of protection supplies

    Despite the fact that protection supplies in the workplace are delivered to workers every week, daily and every time they ask (See concentrate 10 of the statistical annex), half of the responses from the public sector state that inputs are not sufficient; because, as already explained, not all inputs are given to workers or they are limited, a situation that leads many to have to acquire by their own means the acquisition of much necessary material for their protection (1,285 people reported spending from between $1 and $1,000 monthly pesos for the purchase of supplies, while 746 they said spend between $1,001 and $2,000 pesos for the same purpose), which undoubtedly undermines your already insufficient income.

    One could argue the reasons why this situation is presented like this, on the one hand, the budget granted to the health sector to treat the pandemic, for the other, the management of this budget and the control of protection supplies by health institutions.

    Regarding this last reason, it should be noted that, the handling of protection supplies is not immediately handed over to the personnel who require it, but this, go through a registration process, accounting and administration on behalf of the receiving establishment. However, instead of surrendering immediately, on many occasions the inputs are kept in "safekeeping" or are stored to gradually dose the delivery of the material. Is so, at the institutional level, it is indicated that supplies have been delivered or there is no record of shortages, but, at the operational level, inputs were not delivered to workers who require them. In that sense, the incongruity between the "official data" or institutional and the perception of health workers could be explained.

    Whatever the reasons, In this context, the situation of health workers is very unfavorable and it is clear what they themselves say: protection supplies are not enough, even in those institutions where most workers should have them.

    Possibility of contagion of Covid-19 against working conditions by workplace in the public and private sectors

    Table 10.

    Facing the pandemic with the aforementioned conditions is not an easy task, this is reaffirmed by health workers, at least the 40% of them consider very likely to be infected with Covid-19, while another 40% considers it probable; especially in the public sector, where more than half of the workers who reported working at IMSS welfare consider it very likely to be infected, followed by hybrid health centers and hospitals. Something similar is observed in the private sector, except only the 30% of workers consider it very likely to be infected, especially in medical laboratories and private clinics. (See concentrate 11 of the statistical annex)

    Table 11.

    Both open question 19.[30] of the questionnaire as what we have exposed so far, indicate that workers consider it very probable and probable to become infected due to: the lack of protection inputs and the quality of these, the lack of personnel and the saturation of the health units (especially hospitals), the lack of adequate facilities and the lack of adequate protocols for the management of Covid-19 patients.

    The role of the union facing the needs of health workers during the pandemic by form of hiring

    Added to these adverse conditions is the fact that unions have not really intervened in favor of health workers, since as we mentioned before, for political interests they have only given the basification, regularization or formalization of its most ‘loyal’ workers; further aggravating the outlook in the context of the pandemic.

    However, for the 73.44% of grassroots workers the union has been irregular in defending labor rights or has been absent. Regarding the 29.45% of workers hired only during the pandemic and at 45.80% of workers who do not have a contract, there is simply no union. (See concentrate 12 of the statistical annex)

    Psychological ailments resulting from work stress during the pandemic by type of hiring

    Table 12.

    These lethal conditions, translate directly into workers' perception of psychological ailments, product of work stress throughout the pandemic. The 72.27% of total staff responses, affirms the presence of psychological ailments, without significant differences between the perception of the public sector (73.22%) and the private sector (62.26%). In the following section of this research report, develops and deepens more on the psychological impact of the pandemic on health workers. (See concentrate 13 of the statistical annex)

    Employer support to health workers to treat the psychological consequences of the pandemic by means of hiring

    Table 13.

    Is so, a huge concern emerges, given that it is not only the existence of the psychological ailments resulting from the pandemic, otherwise, from their relationship to the existence of some support from the employer to treat these conditions and their consequences. The 55.87% replied that these supports do not exist, the 29.46% he said yes and he 14.67% that i didn't know. According to the forms of contracting and by sector, it should be noted that, private sector workers under the forms of “hired only for the pandemic” (60%) and they do not have a contract (67.92%), were the most significant responses, stating that there are no supports to treat the psychological sequelae. Situation that leaves them helpless for prompt attention to the psychological effects of the pandemic. (See concentrate 14 of the statistical annex)

     

     

    1. 3. Impact of the pandemic on the mental health of health workers

    This section will analyze the impact of the economic crisis and the pandemic on the mental health of workers in the sector.

    As Claire Goodwin-Fee and Ellen Waldren have mentioned, organization therapists Frontline19 in the United Kingdom, the effects on the psyche of frontline workers in the face of the pandemic have progressively reduced their mental health (BBC, 19 in January of 2021).

    After long 10 months of the global health crisis, health personnel have fewer and fewer resources[31] and energy to withstand the situation they live day by day in their work centers. It is enough to review the series of journalistic articles around the world on suicides in health personnel in the middle of the 2020, who not only collapsed with the amount of work and work stress derived from this condition, but, many of them decided to end their life. Example of it, are the cases in Italy of nurses Daniela Trezzi and Silvia Luchetta (Algañaraz, 25 of March, 2020), or the case of María del Carmen Galeana, Guerrero state nurse, Mexico, who took his own life after catching the SARS-CoV-2 virus (Contreras Flowers, 01 of June, 2020).

    In Claire Goodwin-Fee's opinion, the worst is still coming: "I'm waiting for the headline that says: "The doctor committed suicide because of the pandemic". It will happen. If not today, it will be soon because they are devastated and they want people to know it " (BBC, 19 from January 2021, s/p).

    Even though the mental health of health personnel has been deteriorating and has in many cases reached the breaking point, this trend -as well as job insecurity- it had been intensifying since the eighties globally.

    This increased depression, has become a repeated call for prompt detection and treatment of mental health (Calderón Narváez, G. 1981). However, the World Health Organization itself (2013), has recognized the various challenges to face this daunting task.

    In the current context of pandemic, the effects on the mental health of the population have not only exacerbated the risk factors for suffering from a disorder and psychological repercussions, but also, increase the risk of suicide. The most worrying thing is that, the Pan American Health Organization (from now on OPS) warned that we are far from knowing the real effects and sequelae for the general population (OPS, 2020). However, health personnel, you are facing a more unfavorable and worrying situation.

    It should be noted that, before the pandemic, the mental health of health personnel, it was already a problem detected and “related to stress, exhaustion from workload ". Only in the UK, "305 nurses have taken their own lives in the last seven years" (The confidential, 29/04/2019).

    The variety of studies on the problems related to the mental health of health personnel, have been mainly linked to the high level of work stress, as well as long working hours -for example the guard system-. Health personnel, unlike other labor sectors, works days between 8 And till 72 hours in a row, many times without rest, no food and water intake. (Zamora Echegollen, 2017).

    The effects of these days, in addition to manifesting itself in a series of physical repercussions such as hormonal alterations, digestive, cardiovascular (Smith-Coggins, and. to the., 1997; Moore-Ede, and Richardson, 1985) and chronic venous insufficiency (IVC) (Astudillo, P., and. to the., 2016; Vazquez-Hernandez, I. and Acevedo-Peña, 2016). A number of psychological effects have also been reported, as a significant decrease in the psychocognitive and psychomotor response of the staff (Costa, 2015; Hamui-Sutton, et to the., 2013); substance addictive disorders and mental disorders such as anxiety, depression and anguish (Otero Dorrego, Huerta Waiter and Duro Perales, 2008; Cruz Robazzi, 2010); and a high incidence and prevalence of syndrome Burnout (Díaz Bambula and Gómez, 2016).

    Is so, syndrome burnout, has been defined as a response to work stress, involving emotional exhaustion, detachment, depersonalization and a feeling of ineffectiveness at work. This syndrome, It is more prevalent in workers in the service or customer service area, caregivers of other people, of the educational field, and mainly in health personnel (Maslach, Shovel, y head, 2001).

    Now well, stress, it is a biological reaction, psychological and social -biopsychosocial-, of a person in a situation that is identified as threatening and whose magnitude exceeds their own resources of coping and that can endanger their well-being (Naranjo Pareira, 2009).

    In the stress response, a series of processes will be presented. First, the person performs a cognitive assessment -processes the information- of the event, evaluating whether this situation can cause harm or not; in second place, it is estimated whether it is possible to face the situation to prevent the damage or not. From this assessment, a series of physiological and biochemical reactions will be triggered that prepare the body to react to the event (Rodriguez Marin, 2001; Naranjo Pareira, 2009).

    However, a constant stress response, has extremely harmful effects on the body, mainly due to: the constant secretion of adrenaline; increased corticosteroids and catecholamines; the increase in epinephrine levels; and allostatic loading can lead to decreased immunity, related to the inability to cut cortisol secretion in the body (Rodriguez Marin, 2001; Duval, González and Rabia, 2010).

    This physiology, causes physical damage such as: growth of the adrenal cortex, shrinkage of the lymphatic glands, ulceration of the stomach and duodenum, elevation of lipids and blood pressure, decreased immunity and hormonal elevation. And in the psychological and emotional sphere, effects such as: sleep disturbances, irritability, tiredness, anxiety, nervousness and depression (Rodriguez Marin, 2001; Barreto da Costa, and. to the., 2011).

    In the case of work stress, "The increasing pressure in the work environment can cause the physical and / or mental saturation of the worker, generating various consequences that not only affect health, but also their closest environment since it generates an imbalance between work and personal matters " (Federal Government-IMSS, 2021).

    This means that, the person's main source of stress is their job. Research that has focused on work-related stress and syndrome burnout, have determined that, “[e]l work done excessively, represented by high hourly load, multiple jobs, Double or triple shifts are elements that can favor mental / mental health offenses in health workers ” (Cruz Robazzi, and. to the., 2010, p. 60).

    However, even though these investigations have pointed out the primary role of working conditions in the harmful effects on the health of health personnel, mostly stay at an organizational level of the problem. I.e., work appears as a factor related to their organizational level, functional and / or structural, leaving aside the processes of worker exploitation. In addition, who does not even wonder why they need to work more and in these conditions.

    In that sense, even when there is a biological basis for the diseases, as well as environmental factors (and the interaction between the subject-biology-environment), work will be the central category in the analysis of the work-health relationship (Rodríguez Ajenjo and Flores Vázquez, 1979).

    For this reason, at this time it emerges as a central category of analysis in the study of the work-health relationship., the work process itself, since it is around it where all the elements mentioned above are organized and where any aspect of the capitalist mode of production can be objectified. (both political, economic or ideological) indispensable in the study of the causality of health-disease. In these terms, highlights the importance of the work process as an organizer of social relations and life not only of workers within [of the health facility] but outside of [he], as well as the living conditions of both them and their families and, in consecuense, of his health-illness […] For this reason, it is necessary to link the health problem with the form of extraction of surplus value, consequently of the exploitation of the labor force, and relate it to the different forms of attrition in the workforce, both objective elements of the work process […]” (Rodríguez Ajenjo and Flores Vázquez, 1979, p. 7).

    In this way, it becomes necessary to analyze the precarious conditions of health personnel, which since before the pandemic were unimaginable, but that in the current context, they have intensified and deepened.

    As the responses of the Questionnaire on the working conditions of health workers in Mexico during the Covid-19 pandemic, of the multidisciplinary Analysis Center (CAM) UNAM, [Graphic 23], 3,841[32] people identified a series of health sequelae of co-workers who have recovered from SARS-CoV-2 complications. It is highlighted that, the highest percentages, are attributed to anxiety (69.47%), post traumatic stress (50.92%), depression (48.58%), insomnia (41.51%), Respiratory distress syndrome (36.37%), pulmonary fibrosis (26.09%), chronic hypoxemia (16.95%) and others not specified (4.54%). As you can see, psychological complications are the sequelae with the highest percentages.

    Graphic 23

    In the same line, a considerable proportion (66%) of the workplaces reported in the questionnaire, the staff, indicates having knowledge of deceased colleagues. The number of companions they have seen perish, especially in the public sector, contributes to increasing the health workers' feeling of being faced with a threat.

    Added to this is the fact that the compensation awarded in the event of death is in many cases insufficient. [Graphic 26], both for the staff working in those places in general (46.45%), as for those eventually hired as a result of the pandemic [Graphic 27] (42.91%); at the same time, the fact that some families of deceased health workers do not have support from their employers contributes to increasing the number of factors that trigger stress reactions in medical personnel.

    Graphic 26

     

    Graphic 27.

    So that, It is well known that these stressful situations contribute to generating an unfavorable perception of their mental health among health workers, for which in 72.3% of the places registered in the questionnaire, the staff say they experience some psychological illness as a result of work stress during the pandemic [Graphic 41]. According to the stress approaches, this negative perception, becomes a contributor to increased stress at work.

    Graphic 41.

    The perception of health personnel about, whether or not the inputs they receive for their protection are sufficient, becomes a significant perception for worker stress levels. In other words, to the extent that workers feel at greater risk -and that it is a real risk of infection-, will impact cognitive assessments of the stressor, which in this case would be the virus.

    In that sense, responses provided by staff, they point out that, the 60.9% considers that these supplies for personal protection, they are insufficient, the 24% that only sometimes are enough and the 15.1% what if they are enough. These figures necessarily imply that, at least the 60% of workers feel permanently at risk of contagion.

    It should be noted that, risk perception is independent of whether these inputs are effective or not, what is important is the psychophysiological response to the stressor, This is, if the person feels at risk, which implies that it enters a constant state of alert that triggers the segregation of neurochemicals to respond to the threat.

    As already mentioned before, risks have harmful impacts on physical health, but also for mental health. This becomes a high risk situation in every way. First, the body suffers the negative effects of the stress response constantly. Also, long working hours and precarious conditions increase this response, in addition to not allowing adequate rest for the body, thus increasing the chances of tissue damage and getting sick.

    I.e., by contextualizing the precariousness of working conditions directly in the decrease in purchasing power of workers, consumption of poorly nutritious foods (supra op. cit.), plus the characteristics of the working hours, the context in which these workers live on a daily basis is more clearly visible; and that throughout the health contingency, this, has deepened and intensified alarmingly.

    In second place, we have the affective dimensions to face disease and death without rest, that detonate a range of discomforts, psychic suffering and various problems in the different spheres of the worker's life. Product of discomfort at work, ties with his family, friends, coworkers, and of course with patients and their primary caregivers are directly affected (Emmer and Schejter, 2014; Silva de los Ríos, 2016).

    As has been pointed out by various testimonies from workers throughout the pandemic, It has not only been tried to "keep working", but to see thousands of patients die over and over again. As Adriana Ramírez said, kidney nutritionist doctor, of the Hospital "GEA" González: "I'm sick of seeing dead, you have to sigh, so as not to break in front of the patients. Otherwise you cannot survive " [SIC.] (AJ + Spanish, 2020).

    In addition to this constant situation in hospital life, along the 2020 health personnel suffered countless direct attacks, since throwing chlorine at them, hits (Rodriguez, 07 April, 2020), kidnappings (Cruz, 09 April of 2020) and even deny them access to their homes (Drafting Aristegui Noticias, 09 April of 2020).

    I am currently a nurse at Hospital de San Francisco, Nayarit; today I feared for my integrity when they denied me access to the town where Lo de Marcos currently lives… It has been heard that the people of the towns are setting up sanitary fences to prohibit access to ‘tourists’, but in this case I was also denied, just for being health personnel (Testimony of Karina Cancino, Drafting Aristegui Noticias, 09 April of 2020).

    In sum, health personnel face a triple threat, being exposed and vulnerable to the situation inside and outside the hospital, and on the other side, remain concerned about the health of their patients, as narrated by Mari Carmen Medina González, doctor at the General Hospital of Soledad de Graciano Sánchez in San Luis Potosí:

    Yes, We see it on the news that it is something alarming and very scary, but we try to tell them that the patient is fine, is in a hospital, let's try it, convey that peace of mind that we want to help, we want to make a patient improve and the family to stay calm, that is not condemned to death, nor that the whole family is going to die, but it is very difficult for people to take this as another disease, it does impact a lot emotionally (Pacheco, 30 October of 2020).

    Is so, as the testimonials show, journalistic notes and in the opinion of experts in the field of mental health, it is necessary to give timely attention to workers. Situation that is problematic according to what is indicated by the questionnaire, where the 55.9% of workers consider that there is no support from employers, to face the psychological consequences of the pandemic. The 29.5% It says yes, and the 14.7% does not know.

    Under this context, the importance of grassroots hiring comes into play, since if the worker is not formally hired, or is it for fees, will not be able to access the provision of psychological care. Which it's, It will leave them unprotected and at the mercy of the possibility of being treated privately or through the instances and programs that have been generated to provide psychological care for the general population., or even to not attend.

    It should be noted that, during the months of confinement, a series of programs for mental health care have been set up, as the "Patient and Family Support Program" -PAPyF-, through the Federal Government's mental health brigade[33]; programs to positions public and private universities such as the National Autonomous University of Mexico[34], Autonomous University of Metropolitana[35], the Iberoamerican[36], the Anahuac[37], among others.

    However, The question remains as to whether these programs will be sufficient to provide psychological care? Not just for the general public, but for the specialized care of workers who are in the first line of care of the pandemic: doctors, nurses, social workers, the same psychologists, laboratory workers, chemicals, Maintenance and cleaning staff.

    Even though the qualification of these centers in attention to mental health, the underlying problem continues to be the precariousness of staff work. Because if they are not hired according to the law, cannot access minimal health care. Forcing them, in the best case, to go to these free centers, but, just as the workers have bought their minimum supplies of personal protection for the pandemic, we might suspect that they will have to pay for private care.

    In that sense, the urgency falls on the regularization of hiring and the improvement of working conditions.

     

    Statistical Annex

    Concentrated 1

     

     

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    Footnotes:

    [1] IMF. World Economic Outlook Report. April 2020.

    On the internet: https://www.imf.org/es/Publications/WEO/Issues/2020/04/14/weo-april-2020

    [2] HTTPS://www.worldometers.info/coronavirus/

    [3] https://www.gob.mx/cms/uploads/attachment/file/623396/PERSONALDESALUD_15.03.21.pdf

    [4] Health Secretary. Covid-19, health personnel, 11 January of the 2021. In Internet: https://www.gob.mx/cms/uploads/attachment/file/606115/COVID-19_Personal_de_Salud_2021.01.11.pdf

    [5] The recommended food basket (CAR) It was designed by Dr. Abelardo Avila Curiel of the Instituto Nacional de Nutrición Salvador Zubirán, is formed by 40 food, excluding expenses that require preparation, Neither the payment of rent in housing, transport, dress, footwear, toilet staff and many other goods and services that fall within the consumption of a family, It is only in relation to the cost of basic food. The CAR is a weighted basket, use and daily consumption, to a Mexican family of 4 people (2 adults, a / young man and a / child) where nutritional aspects are taken into account, of diet, of tradition and habits cultural.

    [6] https://www.habitat.org/lac-es/newsroom/2020/impacto-en-59-millones-de-personas

    [7] Aristegui News. “31 million Mexicans already had Covid-19, but most were asymptomatic: survey". 17 December 2020. On the internet: https://aristeguinoticias.com/1712/mexico/31-millones-de-mexicanos-ya-tuvieron-covid-19-pero-la-mayoria-fue-asintomatico-encuesta/

    [8] HTTPS://accesolatino.org/noticias/estrategia-para-la-respuesta-al-covid-19-de-biden-prioriza-a-los-latinos/

    [9] The Economist, INEGI registers 44.8% more deaths from Covid-19. 23 in January of 2021. On the internet: https://www.eleconomista.com.mx/politica/INEGI-registra-44.8-mas-fallecimientos-por-Covid-19-20210127-0158.html

    [10] The doctor. Arturo Erdely Ruíz, is Actuary, with Master's and Doctorate in Sciences (Math), UNAM (´área: Statistic and probability), is Level 1 in the National System of Researchers of CONACYT, has 18 years of experience in research activities, and with 22 years of teaching experience at the university level.

    [11] Dr Miguel Sánchez Alemán, by profession is QFB, researcher in epidemiology at the Institute of Public Health. Line of research: infectious diseases, epidemiology and statistics of infectious diseases; Researcher in Medical Sciences "D" at the National Institute of Public Health (INSP).

    [12] Which has as a reference a universe of forty goods wages in food, that were recommended in the daily diet for each Mexican family, It is made up of four members - two adults, a young man and a child-, Dr.. Abelardo Ávila Curiel researcher at the Salvador Zubirán National Institute of Nutrition.

    [13] The figure is presented by converting to new pesos.

    [14] The figure is presented by converting to new pesos.

    [15] The figure is presented by converting to new pesos.

    [16] The figure is presented by converting to new pesos.

    [17] The figure is presented by converting to new pesos.

    [18] The figure is presented by converting to new pesos.

    [19] The figure is presented by converting to new pesos.

    [20] The figure is presented by converting to new pesos.

    [21] The figure is presented by converting to new pesos.

    [22] The figure is presented by converting to new pesos.

    [23] The figure is presented by converting to new pesos.

    [24] The figure is presented by converting to new pesos.

    [25] The questionnaire on the working conditions of health workers in Mexico during the Covid-19 pandemic was raised through the website of the UNAM Multidisciplinary Analysis Center (cam.economia.unam.mx) between the 7 and the 17 August of 2020

    [26] Residences in Mexico are regulated by the Interinstitutional Commission for Health Human Resources Training -CIFRHS-, body that works together with other establishments, among them, the Secretary of Finance and Public Credit. So that, in this case, hiring is regulated between the health establishment where the residence is carried out, the CIFRHS and the Ministry of Finance. For this reason, in the strict sense, are not hired by the hospital or clinic where they work.

    [27]The ABCD guard system consists of the following: day "A" corresponds to a day of 8 hours; day "B", to an extended day of 16 hours; day "C" to 8 hours that are added to the day of 16 hours of the previous day, giving a total of a day of 36 hours between days B and C; and finally, the day D", corresponds to the rest day. Not all hospitals apply this system, in many the ABC system is preserved, This is, no day of rest.

    [28] For example, IMSS nursing staff receives from among $800 to $1,000 by night watch.

    [29] Open question asking why, from the answer to the question 47. Do you think that the salary and benefits you receive in this workplace are sufficient in the face of what is happening due to the pandemic?

    [30] Open question asking why, from the answer to the question 19. Faced with the working conditions in which you work, how likely do you think you get Covid-19??

    [31] We refer to materials of various kinds, among them, material resources, for example personal protection supplies for work, and also, to the symbolic resources of the workers, This is, psychic in nature, emotional, affective, personal, etc.

    [32] To the total number of people who answered the question 23 (4,006), they subtracted 165 responses indicating "no" complication.

    [33] HTTPS://www.gob.mx/salud/iner/acciones-y-programas/programa-de-apoyo-a-pacientes-y-familiares

    [34] HTTPS://www.vozprosaludmental.org.mx/directorio-emergencia-covid19

    [35] HTTPS://lineauam.uam.mx/index.htm

    [36] HTTPS://ibero.mx/prensa/egresados-ofrecen-apoyo-psicologico-gratuito-afectados-de-estres-por-covid

    [37] HTTPS://www.anahuac.mx/puebla/covid-19/apoyo-psicologico-linea


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