MADRID (NYTIMES) – It has been hard for any healthcare system to fight the coronavirus, but when the doctors and nurses themselves become infected, the situation can rapidly spiral out of control.

Across Western Europe, healthcare professionals have used the language of war to describe a struggle that has left some hospitals on the brink of collapse. In that war, there is no doubt that they are the ones battling on the front lines.

Extraordinary numbers of health workers are catching the virus and getting sick. More than 30 have died in Italy, France and Spain, and thousands of others have had to self-isolate.

Spain stands out as the country facing the severest crisis among its health workers. Out of Spain’s 40,000 confirmed cases, 5,400 – nearly 14 per cent – are medical professionals, the health ministry said on Tuesday (March 24). No other country has reported healthcare staff accounting for a double-digit percentage of total infections.

The thinning ranks of qualified doctors, nurses and other practitioners is adding to the burdens on healthcare systems already groaning under the strain of an expanding epidemic. What’s more, infected workers and their hospitals are increasingly being recognised as vectors for the spread of the virus.

In Brescia province, the centre of Italy’s outbreak, 10 to 15 per cent of doctors and nurses have been infected and put out of commission, according to a doctor there. In France, the public hospital system in Paris has tallied 490 infected staff members, a small but growing proportion of the system’s 100,000 or so employees.

The same dynamics are starting to take hold in countries like Britain and the United States, where the contagion is bearing down but has yet to fully bite.

At the La Paz hospital in Madrid, one of the largest in Spain’s capital, 426 employees – 6 per cent of the medical staff – are isolated at home, after testing positive or showing possible symptoms of the coronavirus, according to internal numbers provided by a labour union that represents doctors in Madrid. At the smaller Igualada hospital in Catalonia, a third of the 1,000 hospital staff has been sent home.

“The virus was already among us when we were really only testing those who came from Wuhan and then from Italy,” said Dr Angela Hernandez Puente, a doctor who is the deputy secretary-general of the doctors’ union. “Some of our doctors unfortunately worked without adequate protection and acted as vectors.”

Medical professionals, of course, are not the only ones afflicted, as Spain, where the number of cases has been doubling every four days, is fast shaping up as Europe’s next epicentre of the contagion. On Tuesday, Spain’s coronavirus toll reached 2,700 dead, the second-highest in Europe after Italy.

In Madrid, the focus of Spain’s outbreak, so many are dying that bodies are being placed in an Olympic-sized ice skating rink that has been converted into an emergency morgue.

The grim situation has left many of Spain’s healthcare professionals overwhelmed and pleading for more equipment, doctors, nurses and ambulance crews have told The New York Times. For those who have been infected, a feeling of powerlessness has sunk in.

“You are used to taking care of others and now you’re being asked to stay home and take care of yourself,” said Dr Marc Arnaiz, a doctor in the internal medicine unit of the Igualada hospital, who tested positive earlier this month. “For most of us this job is a vocation, so it’s shocking and frustrating.”

Dr Arnaiz, 31, said he had likely been infected by a patient. He noticed the first symptoms on March 9, the day his patient was confirmed positive, among the first in the hospital, which has since become one of the worst infection clusters in north-eastern Spain.

While it’s impossible to know how many patients infected doctors and vice versa, the alarming spread within hospitals has forced the government to struggle with a shortage of both professionals and equipment. Last week, the government launched an emergency recruitment plan to add 50,000 health care workers, ranging from medical students to retired doctors.

After employees began complaining openly about the stresses on the system, some Madrid hospitals told their staff not to speak out. Many of those interviewed by The New York Times were not authorised to comment publicly and asked that their full names not be used for fear of retribution.

One, Ms Yolanda, has been a nurse for 30 years, working in a public hospital in Madrid. But earlier this month, as the outbreak worsened in Spain, she said she was moved instead to a makeshift emergency ward, where she had to learn new skills on the job while working without decent protective gear.

“We’ve been put on the front line not only without enough protection, but also sometimes with the stress of a very different work environment,” she said, noting that she had never before handled intubated patients. The nurses in her unit wore face masks and gowns, but they had to reuse them because of a shortage.

“Putting on a face mask again and again is as useless as sticking a piece of paper on your face,” she said.

Last Thursday, Ms Yolanda went home feeling feverish. On Sunday, she tested positive for coronavirus, along with about 30 colleagues. “We have done our best, but some of us sadly became part of the contamination chain,” she said.

Hospital workers’ unions were less hesitant to point fingers.

“When we already knew that the virus was circulating in hospitals, we were still being told that the usage of protective gear should be limited to specific circumstances,” said Mr Juanjo Menendez, the communications director of SATSE Madrid, a nurses’ union. “It’s the kind of basic error that a student learns to avoid in the first year of medical school.”

In Spain, doctors warned that hospitals were now paying the price of the loose measures announced in the early days of the outbreak.

“The lack of protection is everywhere, the improvisation seems to be widespread,” said Dr Antonio Antela, a doctor who coordinates the infectious disease unit at the university hospital of Santiago de Compostela, in north-western Spain. He has been hospitalised for a week after developing pneumonia and testing positive.

“The lesson is: take care of your public health care system, because there will be other epidemics and we ought to be better prepared,” he added in a telephone interview from his hospital bed.

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