Howrah: A densely populated district that is home to major industrial clusters, Howrah has emerged as the second epicentre of Covid-19 in West Bengal after Kolkata.
Since 5 May, the number of containment zones in Howrah has gone up to 113 from 72.
There have been 571 confirmed Covid-19 cases in the district, of which 370 are active infections (the number is 1,311 and 673, respectively, in Kolkata).
To make matters worse, diagnosis is plagued by delays, with the district hosting no testing facilities of its own. And the ramifications haunt not just Covid patients but also those suffering from other diseases such as cancer.
The state government cites Howrah’s demography — its clusters of residents packed into pockets — and the returning migrants to explain its Covid burden.
While the government claims efforts are underway to address the gaps in health facilities, those on the ground continue to suffer. Patients find treatment delayed by late diagnosis, and doctors and healthcare staff walk the corridors of hospitals without masks.
Amid all this, many ambulance providers are learnt to have halted services over risk of infection, forcing patients to hire rickshaws for trips to hospitals.
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Kolkata’s twin
Known as the twin district of Kolkata, Howrah is located less than 20 km from the West Bengal capital, connected by the iconic British-era Howrah bridge.
Home to the state secretariat Nabanna, Howrah is also a major industrial centre. According to the 2011 census, the district had a population of 49 lakh, and a density of 3,000 people per square kilometre.
Over the past few days, hundreds of migrants have been returning to the district from cities around India.
Rajib Banerjee, a minister in Mamata Banerjee’s cabinet and Trinamool Congress leader in-charge of Howrah, said there are complications in the district primarily because of its demography.
“There is a huge migrant population that resides in the district. Then, almost all industry clusters — gems and jewellery, garments, paints, foundry, food parks — are located here,” he added.
The district administration has been hard at work trying to keep its Covid burden in check, ensuring the supply of essentials across containment areas through municipal corporation food trucks and other vehicles.
Even so, the health infrastructure in Howrah, where 32 coronavirus patients had died until Sunday, is struggling to cope with the Covid challenge. Around 370 active cases, with an average daily addition of 30 to 40 patients, have put pressure on the six Covid-19 hospitals that together have 96 critical care unit beds and 12 high-dependency unit ones (those between an ICU and a general ward in the hierarchy of criticality), according to government documents accessed by The Print.
Of the six Covid hospitals, two are Level-IV, to treat patients with acute symptoms, and two are Level-III hospitals. There is one each of Level-II and Level-I facilities, the latter meant to cater to mild cases, as part of a tiered system put in place for the judicious use of medical facilities.
Three of these hospitals are private facilities enlisted by the government to address the demands of the pandemic.
However, a major hiccup in the district’s Covid response is the absence of local testing labs. Reports for Covid samples have been taking an average of five days to come in, doctors and patients say, against the standard norm of 24 hours.
The delay in results is proving a challenging prospect for families. At a Level-IV Covid facility, Mohammed Salim said he has been waiting for the Covid results of his brother, a cancer patient, for four days.
His brother is supposed to undergo chemotherapy but the hospital will not admit any patient until they have a “Covid-free certificate”. “We gave been waiting for test reports for over four days now,” he said.
At Satyabala ID Hospital, a state-owned facility now designated a Level-III hospital, 70-year-old Chandi Oraon’s family said he has had fever and respiratory problems — both identified as coronavirus symptoms — for a week.
His respiratory problems, the family claimed, have intensified but treatment remains elusive because his test results have been pending for five days and counting.
“This is the third time I have brought my father to the hospital. He has been suffering from fever and respiratory trouble for over a week,” said Chandi’s daughter Asha, 40. “The first time, doctors prescribed medicines, sent us back. Then, he was tested and we are still awaiting the reports for over five days now,” she added.
“We have brought him back to the hospital since he has developed serious respiratory issues and has high fever.”
A state health department official told ThePrint that samples collected in Howrah are sent to Kolkata labs, mostly those run by the state government. The official, however, did not reveal the name of these labs for “security reasons”.
Minister Banerjee said the state government is trying to upgrade its healthcare infrastructure. “In terms of health infrastructure, we are trying to bolster the arrangements. We have requisitioned some private hospitals and new additions are being made everyday. Attempts are on to set up a testing lab here,” he told ThePrint.
In a bid to step up testing, the Howrah Municipal Corporation has set up six temporary kiosks to collect samples, but a senior civic official admitted the process is taking time.
“We have capacity to test 300 to 400 samples, but we are sending at least double that number daily. This process is taking time,” the official added.
Asked about complaints of patients like Chandi, who have been kept waiting, hospital authorities say they are going by government guidelines and protocol.
According to state health department officials, the protocol suggests all patients do not need hospitalisation. Unless there is a severe comorbidity, home treatment has been been allowed in some asymptomatic and mildly symptomatic cases.
“Treatment protocols say that asymptomatic patients or mildly symptomatic ones can stay at home if they do not have comorbidity,” said a Bengal health department official. “The huge inflow of influenza and severe acute respiratory illness (SARI) patients is clearly a run on the hospitals. So, at times, doctors do not suggest admission. But it varies from hospital to hospital,” the official added.
Shortage of ambulances
Another problem stalking the local healthcare response is the shortage of ambulances at the service of coronavirus patients.
Most service providers, government and private, have refused to ply ambulances, say patients and doctors, since “the vehicles are not designed for infectious diseases”, and they do not want to put drivers at risk of infection.
Calls made to the state health department for ambulances have not helped either, say patients, with most “occupied” or “busy”.
Asha brought her father to the hospital — a distance of 10 km from their home — in a cycle-rickshaw. Mohammad Zubair, the rickshaw-puller, said he has been ferrying three-to-five such passengers every day, which earns him around Rs 200/day.
The aforementioned state government official said they are trying to address ambulance shortage too. “We are giving special incentives to the operators and trying to rope in more ambulances,” the official said.
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‘Returning migrants making situation worse’
A senior doctor at the Howrah District General Hospital — a non-Covid state-run facility, the largest in the district — said infection rates in Howrah hospitals are very high. The high number of returning migrants is making the situation worse, the doctor added.
“Hundreds of patients come in every day with influenza-like symptoms. We have to get reports fast to determine whether it’s a Covid case or not. If not the report, there should be an alert system from the lab to some doctors,” the doctor said.
According to the doctor, 11 of his colleagues at the Howrah District General Hospital have contracted Covid-19, with over 100 of its “200-250 health staffers quarantined”.
Hospital superintendent Narayan Chattopadhyay had tested positive for Covid-19 too, but he has since recovered and is now back at work.
However, more than one hospital has reported a shortage of crucial personal protective equipment (PPE), including masks, for healthcare personnel.
“We have a very limited number of masks, not even one for each. We needed close to 300. We are yet to get that,” a staffer at Howrah District General Hospital said.
A doctor said the government had “issued guidelines for reusing PPE, but we are not able to do so”. “These PPE can’t be reused or we do not have enough means to sanitise these PPE again,” the doctor added.
According to the health bulletin issued Sunday, 22,950 PPE and 15,550 N95 masks were sent to Howrah district, but the doctor contested these figures. “These numbers must be for media bulletins. We do not see that many being used in actuality,” the doctor said.
In Uluberia, the ESI hospital, a Level-I facility, has 25 Covid-19 patients, but no oxygen support or ventilator, and the doctors and heath staff were seen moving without masks.
“This is a Level-I hospital, we have patients who are either asymptomatic or with mild symptoms. If needed, they can be shifted to Level-III or IV,” hospital deputy superintendent S. Gayen said.
Gayen’s statement is in line with the SOP adopted for the classification of medical facilities (as part of the Covid response), but the prospect of shifting patients at short notice is an arduous one in a district where the hospitals are already short of the requisite facilities and are separated by long distances.
Amid all this, the district is also grappling with a shortage of doctors.
The Howrah Municipal Corporation (HMC) has put out a request on social media seeking voluntary participation of private doctors. “We are expecting more people to volunteer,” a senior HMC official said.
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And Smt Mamata Banerjee continues to be the darling of the limousine liberals.
History shows that in the wake of a collapse of a communist regimes the power ends up in the hands of residual part of the security apparatus, oligarchies, criminal gangs or some despot who was shouting the loudest. The Power has never gone to any balanced leader.
So in West Bengal we have DIDI. It is one thing to be a street fighter and another to be an efficient administrator. The administrative competence and ability cannot be out sourced to to few English speaking sycophants, who keep singing the praises of the leader even in the normal conversation.,
How the cities and their cultures were systematically exploited by the politicians is obvious from the hot zones.
In spite of a balanced , honest and committed approach it is not going to be easy to set thing right. Even if one of the three qualities is missing the disaster is inevitable.