Shreya* blinks as she surveys her face in the front camera of her phone, her fingers gingerly tracing the faint red marks on her face -- remnants of the long arduous hours spent treating coronavirus patients. But, some medical professionals, like Naina*, chuckle wryly when asked about such marks inflicted by the usage of personal protective equipment (PPEs). “I am only given a surgical mask. I don’t have to worry about marks, as the actual personal protective equipment (PPEs) remain elusive.” As the rest of the world groans about having to kill time amid the coronavirus-induced lockdown, an army of healthcare workers are toiling quietly and stoically, all the while remaining hidden from the ones they are saving. The risks they are putting themselves at also remain just as obscured.
Naina, a 25-year-old medical officer working at a quarantine facility in Maharashtra (she did not want the place also to be disclosed fearing it would give away her identity), aids doctors in collecting samples of quarantined patients who are COVID suspects. Instead of the recommended, tighter-fitting N-95 masks, she is provided with a surgical mask. A far cry from the hazmat suit included in PPEs, she was provided with an HIV gown or suit which she described as reaching only till her knees and not providing full coverage. According to her, no one at her centre has access to the full-fledged PPE.
“It is as useless as anything can be,” the grimace in her voice evident over the phone call. “Getting infected is probably inevitable because of this feeble protection. We just have to -” she paused for a split second, before adding quietly: “I am honestly very scared for my mother.”
As the rest of the country stays indoors amid the nationwide lockdown, many healthcare workers like Naina brave the insidious virus head-on, stifling the gnawing fears about their safety - which is aggravated by the dearth of adequate PPEs.
“Frontline warriors” - the authorities call them. Light candles, clap and clang plates for them, they thundered. However, a deafening silence meets their supplications for better safety.
Naina’s experience points fingers at a larger disconcerting reality - that hers is not a stray, isolated incident.
For instance, the Resident Doctors’ Association (RDA) of one of India’s most premier institute, AIIMS Delhi, had sent a letter on April 6 to Prime Minister Narendra Modi, stating how its frontline healthcare workers are being targeted by administrative authorities for having come forward with their problems related to the availability of PPE, COVID-19 testing equipment and quarantine facilities on social media. “In the face of the corona pandemic, it is the responsibility of the government to ensure that these ‘soldiers’ are heard, their opinion respected, rather than humiliated,” the strongly-worded letter stated.
Safdarjung Hospital in New Delhi, another nodal center for COVID treatment, had, in a letter by its RDA on April 3, said that its administration is in dire need of 50,000 PPE kits and N-95 masks each, apart from needing 3 lakh triple layer masks and 10,000 500 ml bottles of hand sanitisers.
Many healthcare workers BusinessLine spoke to also affirmed a shortage. They spoke on the condition of anonymity as they feared repercussions. To be sure, a doctor in Andhra Pradesh was reportedly suspended for complaining about the shortage of protective gear at his hospital.
Manish*, who was among the first lot of doctors posted at the international airport in Mumbai for screening passengers for the virus (prior to the nationwide lockdown), said that in the first two days of his more than two-week long duty, he and his colleagues were only provided sanitisers, gloves and masks. But, as the work got more demanding, they raised a demand for proper PPEs, which was fulfilled, he said. Luckily, none of them got infected.
A healthcare worker at Nair Hospital in Mumbai, said that while his hospital has an adequate supply, his friends posted in Aurangabad, Nagpur, Latur, Yavatmal, and Pune have been complaining of a dearth of adequate PPEs.
The Ministry of Health & Family Welfare did not respond to BusinessLine ’s emailed queries on this matter. How many PPEs the ministry has supplied so far, how it is ensuring the increasing demand for PPE is met, how it ensures its supply amid the lockdown, what percentage of funds the PM CARES Fund garners is directed towards healthcare workers and PPE, as well as its response to doctors’ claims that they are targeted for speaking up, were some of the other questions raised.
However, if one has to go by the guidelines issued by the Ministry of Health and Family Welfare (titled ‘Novel Coronavirus Disease 2019 (Covid-19): Guidelines on rational use of Personal Protective Equipment), healthcare staff at a quarantine facility involved in the clinical examination of symptomatic persons - like Naina - are recommended N-95 masks and gloves. The full PPE for Covid, which she lacks, is not recommended.
But, with the Indian Council of Medical research (ICMR) hinting at community transmission having started in India in a recent study, going by the stipulated guidelines can be counterproductive. The novel nature of the virus, along with the contradictory patterns it has been manifesting in various countries, also imply that such guidelines cannot be deemed sacrosanct.
What is more, even for the general public, face masks have been mandated in cities like Mumbai and Delhi.
At a time when the rest of the world is scared of even stepping out of their homes, debunking doctors’ pleas to ensure the best protection possible as they go to hospitals daily - the breeding grounds for the virus - raises questions.
Moreover, Naina’s fears still find backing in the health ministry’s guidelines, as a surgical mask - in lieu of an N-95 mask - does not provide full protection against the virus during clinical examination. Surgical masks are also reportedly not designed to protect the wearer from airborne infectious agents and hence, will not protect the wearer from being potentially contaminated by a virus such as the coronavirus.
There are examples from India itself that would lend credence to why healthcare professionals’ fears - which may not be always corroborated by the prevailing guidelines - are not to be belittled or debunked as authorities have been doing.
“No need to believe any rumour or have any fear regarding PPE. Our guidelines state that not only PPE should be made available, but they should be used rationally,” Joint Secretary at the Health Ministry Lav Agarwal had said on April 9.
But, recent incidents have shown that such a “rational”, judicious use of PPEs can have dire consequences. Take, for instance, Mumbai’s Wockhardt Hospital, where fifty-two staff members, including nurses, doctors and others, tested positive for COVID-19 a few days ago, leading the city’s civic body Brihanmumbai Municipal Corporation to declare it a containment zone.
According to the hospital, the source of the infection was a 70-year-old patient, who was admitted on March 17 for a cardiac emergency. “The hospital staff were unknowingly exposed to the infection...We are informing the healthcare sector at large not to be misled by asymptomatic patients,” a spokesperson for the hospital had said at the time.
“These are genuine concerns, but the government sees these inputs as opposition. When you see everything as for and against (the government), then it will be very difficult to justify anything,” said Harjit Singh Bhatti, National President, Progressive Medicos and Scientists Forum (PMSF), a non-profit non-affiliated organisation of doctors and scientists, who is also a former president of RDA, AIIMS, New Delhi.
Harjit argued that since it’s the healthcare workers who are attending to the Covid patients, their inputs should be taken positively, as well as addressed. “Instead of listening, they are targeting us, everyone has their career (to look after). So, it might be possible that we may remain silent for sometime, but the disease won’t be silenced for long,” he cautioned.
In addition to doctors, governments have also been flagging concerns related to the dearth of PPE. Aam Aadmi Party tweeted on April 4 quoting Delhi Chief Minister Arvind Kejriwal as saying : “We are facing a shortage of PPE kits. We have written to the Centre to supply the kits, essential for our doctors and nurses. But we haven't received even one PPE kit from the Union government so far.”
Nitish Kumar, Chief Minister of Bihar, had also demanded for PPEs and masks while attending Modi's first video conference with states on April 2, on the subject of coronavirus. "We demanded 5 lakh PPE kit, but got 4000. Against our demand of 10 lakh N-95 masks, we got just 10,000. We asked for 10 lakh Pl mask, but got just 1 lakh. Against a demand for 10,000 RNA extraction kits, Bihar got 250," the Chief Minister had said, according to a communique issued by the state government later.
“India lost around five weeks in the production capacity of PPEs. If we would have been provided with the specifications and the basic numbers of stockpiling required, we would have set targets and managed accordingly,” Sanjeev Relhan, the Chairman of the Preventive Wear Manufacturers Association of India (PWMAI), told The Quint in an article dated April 3. BusinessLine had sought the health ministry’s response to this as well.
This is clear cut murder, Harjit fumed, referring to the delay. “At this point of time (when the AIIMS director has said community transmission is likely), if there is no clarity on who will manufacture PPEs and when it will be delivered, this creates fear in the minds of healthcare professionals, (about) how we can protect ourselves, how will we save others.”
In AIIMS Bhopal, the medical staff deployed in the Covid emergency and Covid screening departments aren’t getting proper PPEs, as they are provided with an HIV gown instead, a source said. The routine emergency team doesn't even get N-95 masks, when, as per the health ministry’s guidelines, they need N-95 masks. “If the government cannot supply enough to institutes like AIIMS, forget about other institutes,” the source said.
Even those in the Covid intensive care unit (ICU) attended to suspected patients without proper PPEs or with an HIV suit for 10-12 days, said the source. But luckily, none of those patients turned out to be infected. They were later provided with proper PPEs, the source added.
“HIV suits are a lot like the (suits included in the) PPE for coronavirus, but they aren’t the same. It doesn’t provide full coverage. It exposes areas like your neck and parts of the head,” the source explained.
In another disconcerting revelation, a letter dated by the RDA in AIIMS Bhopal, dated April 9, said that its two PG resident doctors were assaulted by policemen on their way back home at night after their emergency duty. Addressed to the institute's director, the letter also said that the police assaulted the doctors, saying that “doctors are the reason why the coronavirus is spreading to the common man”.
Yuvraj Singh, one of the two doctors who were attacked, said in a post on Facebook, which was accompanied by his photo that showed his arm on a cast: “The reward!!! This is what we get after putting our lives at stake...The highlight is, this time, it's from another saviour of our society in this global crisis: the police! Today I was there, tomorrow it might be you ...The whole medical fraternity is working day and night without proper PPE provided to them, by putting our lives at risk. ...and this is what we get!”
“I guess we (healthcare workers) are crazy people. We know that we are not getting anything back. Even if something happens to a doctor, they will be made a pseudo hero for some days - it will be shown on TV, Facebook and WhatsApp posts. After that, everyone will forget. No one will remember,” said a resident doctor at AIIMS Bhopal, on the condition of anonymity.
No one talks about the healthcare system - only doctors ever talk about the healthcare system, he pointed out. “People don’t even realise that it’s not the doctors’ responsibility to improve the healthcare system. None of the government people will talk about the healthcare system and no one will question the government about this,” he continued.
Healthcare professionals that BusinessLine spoke to also talked about how some of them were evicted by landlords from their rented houses and apartments, apart from being ostracised by the rest of society in other ways.
There are also some who have voluntarily shifted to living in the hospital premises, lest their elderly parents be put at risk too.
“Being in the confines of the hospital, not going anywhere else and coming back to your room within the hospital campus - it is taking a toll on our mental health as well. There seems to be no way of escaping this,” lamented Maya*, an intern at AIIMS Bhopal.
Even those who are living with their families have to ensure that they don’t cross paths with their dear ones. “I am no different from the pet dog in our house. I have a separate plate, food, as well as a separate space to sleep at home,” quipped another doctor in AIIMS Bhopal.
Even as healthcare workers endure risks, seclusion, taunts and even assaults to save us whilst our only task is to ensure we stay at our homes, they remain as resilient as ever.
Maya is now convinced that she wants a career in the public healthcare sector. “I had juggled with this thought previously. I was confused between this and other lucrative specialties like cardiology or surgery. I am now sure though. We need more public health doctors. If they were more in number right now, we would have probably not had to deal with a pandemic like this.”
Meanwhile, Naina was wistful, albeit with a hint of excitement, when asked what she would like to do once the pandemic is behind us. “After all this is over - and I hope I don’t get infected - I am going to hug my mother. Like, I am dying to hug her,” she exclaimed.
“Diya nahi chahiyen, taaliyaan bhi nahi chahiyen, PPE de do (We don’t want lights and applause, give us PPE instead),” she added with a laugh.
Note: Names with a * next to it have been changed to protect identities.