“Filled with an uneasy calm,” was how a doctor at Delhi’s Ram Manohar Lohia Hospital — which is authorised to treat coronavirus patients — described what his workday is like right now. The situation at his hospital, he said, is under control for now. But the pattern of increase in the number of infected patients in the past week, he said, indicates that there will be a massive rush of COVID-19 patients in the coming days.
“And if that happens immediately or anytime soon, we will be completely overwhelmed,” said Dr Srinivas Rajkumar T, head of the Resident Doctors Association of AIIMS, Delhi. A copy of a page from Kumar’s letter to the superintendent of AIIMS, pointing out that several departments of the hospital were lacking adequate personal protective equipment (PPE), had gone viral on Twitter earlier in the day. Rajkumar told HuffPost India that he had sent the letter to the AIIMS administration a week ago, and “nearly 80%” of the requirements have been fulfilled.
But as a country of 1.3 billion people stares at the very real possibility of community transmission—which will lead to an explosion in the number of cases—government doctors fear that they will soon run out of even basic protective gear, including masks and gloves. Many doctors have begun posting their concerns on social media in an attempt to get attention from the authorities and government.
HuffPost India spoke to doctors in Maharashtra, West Bengal and Delhi to find that their concerns ranged from lack of resources to not being provided adequate training.
RATIONING OF EQUIPMENT
At Nagpur’s Government Medical College and Hospital, a senior doctor told HuffPost India, that they have not been provided a single N95 mask, crucial to treat coronavirus patients. Over the last week, as the number of people infected surged, the hospital has been declared one of the two facilities in Nagpur where coronavirus patients will be treated. The doctor said that emergency tenders have been issued to put the infrastructure in place for patients, but there is no word on PPE for doctors and the support staff.
“We have been given the normal cotton surgical masks and are having to make do with them as of now. There’s a shortage of that too. The people who are actually working closely with patients are always residents and interns and they don’t have enough masks. I have to give the extras I had to them,” the doctor said, adding, despite repeated requests, they have only got ‘blank assurance’ that things will get better.
““We have been given the normal cotton surgical masks and are having to make do with them as of now. There’s a shortage of that too.”
He also added that the hospital doesn’t have a single protective hood cover for the staff, and they need hundreds of them. “When we treat critical care patients, and have to put them on a ventilator or intubate them, we just cannot do that without the hoods. When we have to insert a tube for artificial breathing into someone’s trachea, the patients start coughing and the deposits always land on the doctor and the staff’s faces and head,” he said. While people who wear specs, could be protecting their eyes, treating critically ill patients without a completely covered suit would mean there would be deposits on the staff’s cheeks, head, hair. A mask won’t be enough.
“How will we protect ourselves like this?” he said. GMC has set up a 100-bed isolation ward, and has had three suspected patients who have tested negative at the moment.
A concern echoed by doctors at both AIIMS and Ram Manohar Lohia Hospital in Delhi was that due to an acute shortage in supply of basic personal protective gear such as masks at the moment, hospitals were ‘rationing’ the supplies to departments carefully.
The doctor at RML, who wanted to remain anonymous fearing repercussions, said, “If we see a huge rush of patients soon, like we have seen in the other countries, even doctors will not have enough protection and equipment like masks, let alone support staff,” he explained. The doctor has not been deployed at the section treating coronavirus yet, but his regular duties have been reduced considerably as the hospital prepares to deal with the impending emergency.
AIIMS’s Rajkumar, who said that they were ‘grossly under equipped to handle this’ at the moment, said the lapses were the result of the absence of a centralised decision-making distribution system exclusively dedicated to the coronavirus emergency. He explained that the procurement and distribution of equipment is usually handled by separate departments of the hospital—the ensuing delay and miscommunication meant that the staff at 50-60% of the major departments in AIIMS didn’t have enough protective gear to prevent their staff from getting infected by the virus once they began admitting patients.
“The lapses were the result of the absence of a centralised decision-making distribution system exclusively dedicated to the coronavirus emergency.”
However, he insisted, things are looking up. “We have all the facilities, it’s a matter of sorting out the logistics now,” he said hopefully.
A senior doctor at Calcutta’s SSKM Hospital told HuffPost India that a few days ago, they reviewed the PPE requirement at their department, and requisitioned the N-95 masks, gloves and sanitizers from the government . “The West Bengal government is creating completely different set-ups to deal with COVID-19 patients so that an apex hospital like SSKM can treat other cases,” he said on condition of anonymity.
SSKM Hospital, one of the largest in Kolkata, sees a footfall of at least 800-1,000 people in the outpatients department (OPD) of general medicine, the doctor said, while specialty OPDs treat at least 450-500 patients every day. Junior doctors have to see at least 40-50 patients on an average every day, he said.
While government advisories have been asking people to only visit the facilities meant to treat Coronavirus patients at the moment — SSKM isn’t one of them — there is a high possibility that people showing symptoms of a COVID-19 infection may turn up at the SSKM Hospital. It is located more centrally in Kolkata than the Beliaghata Infectious Diseases Hospital, which is the designated COVID-19 hospital. Have the doctors been taking extra precautions in view of that?
“A separate department called the fever clinic has been set up a couple of days ago in an annexe building of the hospital. People who turn up with fever and symptoms of flu are being referred there. The doctors from general medicine posted there do a preliminary diagnosis and are supposed to refer patients to the designated COVID-19 treatment hospital if required,” the doctor said. He said the doctors had been provided surgical masks, gloves and sanitiser as protection gear but wasn’t aware of any hazmat suits being provided to them.
“It is possible they are exposed to the virus with that much protection, but I am not sure if everyone can be provided with those suits anyway, also in this timeline we are working around,” the doctor said.
“Say, I am in a suit inside the ICU, I am safe. What about the guard outside the ICU, even he would need the same equipment to make sure he is completely safe,”
The doctor at RML said that this was what he feared the most. “When it finally happens (a spike in number of patients), we won’t have the equipment to protect ourselves. We also have families, they fear for our lives too. Also, it’s not just doctors who need special gear right, all the nurses, ward boys, everyone needs them. Say, I am in a suit inside the ICU, I am safe. What about the guard outside the ICU, even he would need the same equipment to make sure he is completely safe,” the doctor said.
Though RML was the first hospital that began handling coronavirus cases in Delhi, including screening of suspected patients, the doctor told HuffPost India that it was only last week that the decision to decongest the OPD exclusively for suspected coronavirus patients and to ease the duties of doctors in other departments was taken. “The decisions were verbally communicated to us,” he said.
At AIIMS too, Rajkumar said, the burns department and parts of the cancer treatment departments were being turned into coronavirus wards at the moment.
Dr Asokan, the secretary general of the Indian Medical Association, however, insisted that the ‘government is moving in the right direction’ and that the shortage in equipment was because of ‘hoarding’. “It (COVID-19) came here quite late, and there is no point blaming the government or the authorities. This is bound to happen, hoarding is human nature and now people who don’t even need them are hoarding masks,” Dr Asokan said.
Asked about the acute shortage of suits and the doctors’ concerns, Dr Asokan said that he felt not everybody in a hospital treating COVID-19 patients needed the gear. “Only the doctors and the staff looking after a patient needs them and the glasses. They are coming in direct touch with the patient, secretions from their body, so they need it the most,” he said.
When repeatedly asked about the doctors’ concerns about the primary screening facilities, Dr Asokan said that it was not necessary that the healthcare professionals doing the preliminary training also needed a suit. “If they are in a big, well-ventilated hall, and allow only one patient in at a time, a mask, gloves and sanitiser should suffice,” Dr Asokan said.
But as anyone who has worked at or even visited a government hospital in India can vouch, these conditions can never work out in reality.
NO TRAINING OF STAFF YET
As the number of people infected by the COVID-19 coronavirus nears the 500 mark in India, marking huge jumps in the past couple of days, another challenge looming on government facilities is the training of staff. The RML doctor pointed out that he will ‘have to brush up on his critical care lessons’ which he practiced many years ago at medical school. Not all doctors and staff regularly treat critically ill patients or patients in ICU, though they have basic training.
“Years of not practicing, like any other skill, makes you rusty, so it is important to hold a hands-on training session for all the staff specifically for this emergency,” he said.
Dr Rajkumar also said that AIIMS has not held a training session for the staff yet, making him apprehensive of the burden on a handful of doctors and support staff if there is a spurt of critically ill patients from the COVID-19 infection.
The doctor at RML also pointed out that the government hospitals needed to do a proper mobilisation drive, addressing post-graduate students—who will be called in to work in these situations—nurses, guards, administrative staff and ward boys.
“No one has prior experience here with something like this. Unless everyone is gathered and mentally prepared for the situation, it is like waiting in the wings during a war, waiting to be called in to work and not knowing what we are in for. People are scared. For example, will we have to move out of our apartments where we live with families if we are treating COVID-19 patients? Where will we live then? There is so much uncertainty,” he said.