New Delhi: As her hospital ramped up preparations for a mock drill to prepare for COVID-19 patients during ‘janata curfew’ Sunday, a second-year resident doctor in the national capital stayed put at home, waiting for a call.
The call she was waiting for anxiously would let her know if the patient she treated in the casualty ward of her government hospital Friday had tested positive for coronavirus. If he turned out to be a confirmed case, she and three consultants who treated him would have had to be quarantined for 14 days, else they could return to work.
The hospital had trained resident doctors, the first line of screening and treatment, for treating coronavirus patients. But the doctor, who didn’t wish to be named, said she realised how ill-prepared she was Friday.
On that day, the hospital had no isolation wing, no protocol to screen patients with COVID-19 symptoms, and didn’t have enough N-95 or even three-ply masks (three-layer mask) for the staff. While the doctor had one, the chief nurse had to scramble through her locker to find two for her colleagues.
The 40-minute exposure to the 20-year-old patient with suspected coronavirus symptoms ensured that she and her colleagues spent two days in isolation.
The good news arrived for her when the patient tested negative and she was asked to join back Monday.
However, similar perilous stories have played out across states like Kerala, Maharashtra and Rajasthan, with doctors and staff having been unintentionally exposed to coronavirus due to lack of personal protective equipment (PPE) and masks.
According to the Narendra Modi government’s guidelines for the coronavirus crisis, hospitals cannot turn away COVID-19 patients. They will have to, instead, mobilise enough resources to treat them while ensuring protection of health workers. But hospitals across the country are finding it difficult to provide N-95 masks and protective gear to doctors.
As the outbreak widens in the country, with nearly 500 confirmed cases now, doctors across Delhi, Mumbai, Uttar Pradesh, Jammu and Puducherry spoke to ThePrint alleging that there is a lack of N-95 masks, sanitisers or PPE in their hospitals.
‘Understand the pain’
In a letter to his hospital staff on 20 March, Puducherry’s Jawaharlal Nehru Institute of Post Graduate Medical Education and Research (JIPMER) director Rakesh Aggarwal wrote, “I am aware of the shortage of many items, including masks and other personal protective devices.”
He added, “I do understand the pain and fear that each of you is going through in working on the frontline without the necessary materials.”
Aggarwal said the hospital has been working with the government to overcome this shortage. He advised that the staff should not use higher-level PPE in common areas which will worsen the shortage. “Please see that masks, hand sanitisers and liquid soaps are not pilfered.”
However, a resident doctor from JIPMER told ThePrint that she had to save up and use the mask she received in an operation theatre to work in the casualty ward as she didn’t want to infect others while having throat pain and breathing difficulty.
In Uttar Pradesh, Haris Khan, a professor of microbiology and medical superintendent at JN Medical College, Aligarh Muslim University, said last week, “We have an adequate stock of N-95 masks but we don’t know how long this epidemic will last, so we cannot use and finish off all of the masks at once.”
JN Medical College is one of the 121 government centres testing COVID-19 samples.
His comment came after over 750 resident doctors from the hospital threatened to “self quarantine” last week if they were not given PPE as well as masks needed to protect themselves.
Khan said most of the doctors’ demands were accepted and those working in critical care and emergency will get N-95 masks.
However, the hospital’s Resident Doctors’ Association president Dr Hamza Malik told ThePrint, “Hospital administration said they would distribute 200 N-95 masks but how good will these be for 750 resident doctors?”
Malik also claimed that while the hospital has placed an order for 200 PPEs, these weren’t available yet.
‘Asked for N-95 masks, was given transfer orders’
Doctors in Jammu and Delhi also expressed similar concerns, with one even claiming retaliatory action from the government over demands.
Dr Balwinder Singh, who works at the orthopaedic department in Udhampur’s district hospital in Jammu said, “We don’t have N-95 masks or sanitisers here.”
Singh, who is also the president of the Doctors Association of Jammu, claimed he was handed out transfer orders when he raised the issue of lack of masks with authorities at the state’s Directorate of Health Services. The order was revoked after the association threatened to go on mass leave, he said.
Meanwhile, the demand hadn’t been met as of Friday. “Hospital has told us there is a shortage of N-95 masks in the market and we were given surgical masks,” Singh said.
Doctors are stuck in a humanitarian crisis, said Harjit Singh Bhatti, national president, Progressive Medicos and Scientists Forum.
“If doctors do not report to work, they will be called irresponsible but without adequate protective gear, they are at risk since this virus is deadly,” he said.
‘One doctor for 1,400 patients, what happens when they are sick’
Now, days after the crisis at Safdarjung, the nursing staff there has purportedly been given 50 N-95 masks for an entire ward for a week.
“We had to sign an application that we will use it for six days,” said a Safdarjung nurse who didn’t want to be named. She said the hospital now has enough stock of masks and sanitisers after reports about the shortage came out.
In Mumbai, the resident doctors said they do not have access to N-95 masks, and are forced to reuse the thin two-ply mask for three-four days each.
“We are forced to use the plastic apron from HIV kits to protect ourselves,” said Kalyani Dongre, a resident doctor at Nair Hospital, and an advisor in the Maharashtra Association of Resident Doctors.
Nair Hospital is one of the nine government hospitals in the city that has kept isolation beds ready for COVID-19.
“India has one doctor for 1,400 people, who will care for the 1,400 when that doctor falls sick?” asked Dongre.
The government wants private hospitals to create isolation beds and treat COVID-19 patients but has not bothered to help in procuring enough safety gear for the hospitals, said V.K. Monga, Indian Medical Association, Hospital Board of India.
Monga said despite the government adding masks and sanitisers into Essential Commodities Act, there is still rampant overpricing and massive shortage of sanitisers, masks and even thermal scanners.
“Simple two-ply masks that were costing Rs 2 are now costing Rs 250,” he said, urging the government to buy and provide the supply at a subsidised rate to private hospitals as well.
However, K.K. Aggarwal, former national president of the Indian Medical Association said, “Government cannot fulfill its own requirement in public hospitals, where can it provide masks to private doctors?”
He added that doctors above the age of 60 are asked to work from home due to the risk to their lives.
Global shortage, doctors cannot run as machines
The shortage of PPE, however, isn’t limited to India. Last month, World Health Organization (WHO) chief Tedros Adhanom Ghebreyesus spoke about the shortage being exacerbated by inappropriate use outside of patient care.
“Global stocks of masks and respirators are now insufficient to meet the needs of WHO and our partners,” he said.
Global medical journal, The Lancet’s editorial last week said, “It is vital that governments see workers not simply as pawns to be deployed, but as human individuals.”
Urging governments to ensure the protection of healthcare workers, it noted that 3,300 workers were infected while 22 died in China. “In Italy, 20 per cent of responding health-care workers were infected,” said the journal.
Meanwhile, the Union health ministry said there is no shortage of masks in the country. “There are sufficient numbers of N-95 masks in the country,” said Lav Agarwal, joint secretary, Ministry of Health and Family Welfare.
The export of N-95 masks has been stopped and a joint secretary level officer has been deputed to work with states to coordinate with their supplies, Agarwal said.
Last week, the ministry requested all hospitals to avoid non-urgent hospitalisation and minimise elective surgeries to prepare for “meeting challenges posed by Covid-19”.
This report has been updated to correct a quote.