New Delhi: Dr Ajeet Jain of Delhi’s Rajiv Gandhi Super Specialty Hospital (RGSSH) doesn’t mean to cause a shock, but he doesn’t like to be in complete PPE gear when he deals with Covid-19 patients.
While his colleagues serve the Covid ward and ICU in full personal protective equipment (PPE), which includes a coverall suit, surgical cap, face shield, N95 mask, shoe cover, and gloves, he dons just three items for protection: A snug N95 mask, covered with a triple-layer surgical mask, a face shield, and a surgical cap.
“This doesn’t mean I’m careless. I’ve made a calculated decision, and I’m not advocating or encouraging others to follow my lead. But so far, it has served me well,” said Dr Jain, nodal officer and head cardiologist at Rajiv Gandhi Super Specialty Hospital.
Healthcare staff in PPE will go down in history as one of the defining images of the world’s battle against Covid-19. Through the pandemic, the medical community has constantly reiterated the need for adequate numbers of quality PPE, which is seen as an indispensable accessory for those on the frontlines of tackling the pandemic.
However, Jain gave up the full PPE suit out of choice. The decision was driven by three factors — experiencing spells of dizziness after wearing full PPE for long hours, the sheer expense of a complete kit, and the science behind how Covid spreads.
“I took the decision after much deliberation and discussion with my colleagues. This is my understanding,” he said. “What we know is that the virus spreads through aerosol spray that enters the body through the nose and mouth. If those two parts of the body are properly sealed, and you’re careful not to contact your nose and mouth with a part that has been exposed, how will the virus get in?”
Shedding some of the PPE items, he added, has made him more vigilant about maintaining precautions. “I immediately disinfect any part of my body that has been touched, I never touch my face, and I go to bathe as soon as I’m done with my round.”
Jain hasn’t worn a full PPE kit since 16 June. In the two and a half months since, Jain said he has treated at least 1,000 patients. He has been tested for coronavirus five times — twice through RT-PCR, twice through rapid antigen, and once for antibodies — and all his results have come back negative.
The science of PPE
Union Health Ministry guidelines describe PPE as gear designed to safeguard the health of workers by minimising the exposure to a biological agent.
An observational study published in the British Medical Journal (BMJ) this June stated that “appropriate personal protective equipment is effective in preventing infection in healthcare professionals who work in highly exposed environments”.
Conducted by researchers from China and the UK, the study involved 420 participants — dressed in protective suits, masks, gloves, goggles, face shields, and gowns — tending to Covid-19 patients. Among other things, the participants performed aerosol-generating procedures, which have been linked to a potential risk of airborne Covid-19 transmission.
According to the study, none of the participants reported symptoms of Covid-19 or tested positive during its 6-8-week duration.
“However, this study does not address the question of what the minimal level of personal protective equipment should be to effectively prevent infection among healthcare professionals,” the authors of the study said.
They noted that most healthcare staff affected were “infected in the early phase of the outbreak and the main reason was probably a lack of appropriate personal protective equipment”.
Speaking to ThePrint, RGSSH director Dr B.L. Sherwal said Dr Jain is taking all precautions.
“Dr Jain wants to see for himself if he can treat Covid patients without wearing the coverall, gown, and gloves, but while strictly maintaining all other precautions,” he said.
“It was difficult to admit him without full PPE in the beginning, but, at the same time, he showed courage in doing that. We think it’s important to observe him so we can learn more about the role of PPE,” he added.
“I want to stress that he’s taking every precaution necessary. We need to know the exact route of aerosol-related infection. If that can be blocked, that itself is the best PPE.”
Sherwal emphasised that they don’t exercise any laxity in ensuring the staff stay safe.
“Only 50-odd members of our 800 or so staff have contracted the virus. This is among the lowest in the city hospitals,” Sherwal said. “Most of these happened in the beginning. After we introduced a workshop on donning and doffing (putting on PPE and taking it off), the infections went down considerably.”
The disinfection routine
As soon as he’s done taking a round of a Covid ward or ICU, Dr Jain rushes to the nearest shower house, not stopping for anything. He scrubs his whole body for seven-and-a-half minutes. The first round is for three-and-a-half minutes, after which he rinses, then repeats the cycle another two times for two minutes each.
“This is the same method you use for your hands and arms before going in for cardiac surgery,” Dr Jain said. “I’ve adapted it for my Covid work, so I scrub my whole body, including face and head, this way.”
Without full PPE, Jain said, he is freer on patient rounds. There is also the fact that patients, fearful during their stay in isolation, can “see and recognise my face and feel a sense of comfort”.
“It really helps that they can see me. They feel more comfortable and less like they’ve been outcast. I’ve been doing surgeries for 28 years now. I’m used to going hours keeping my hands perfectly still and away from my body, without touching my face,” he said.
Jain added that he’s open to criticism from the medical fraternity for his choices, but hopes this provokes discussion too. One rule, however, will never change, he said.
“There’s no escape from staying vigilant if you want to stay safe from the virus,” he added. “PPE can’t be a substitute for basic precautions.”