January 10 was the third day Shivani Jogdand, 32, spent lying in the compound of the government-run Sion Hospital in Mumbai. A cotton bag containing her spare clothes lay bundled next to her, while two relatives sat by her side. “There are other ailments apart from Covid-19. How long should I keep waiting?” asked Jogdand, pressing her palm against her stomach to relieve some of the pain.

Jogdand had travelled to Mumbai from Nanded, 585 km away, in the hope of getting an endoscopy done to investigate the pain in her stomach. But the hospital asked her to first get herself screened for Covid-19 using the RT-PCR or reverse transcription polymerase chain reaction test.

She gave her sample for testing on January 7. With no money for a hotel, she spent the next three days under a shed on the hospital premises waiting for the result.

Earlier, Covid-19 test results in Mumbai would be available in 24 hours. But with a steep rise in infections since mid-December, the labs are taking three to four days to deliver results. In a month, Mumbai has ramped up daily testing from 30,000 to 70,000.

On the third day, when Jogdand’s test report still did not come, the hospital cancelled her endoscopy appointment.

Jogdand’s situation reflects the multitude of problems that patients and healthcare systems are grappling with in the latest wave of the pandemic in India. Daily Covid-19 cases across the country climbed to 2,64,202 on January 14, as per the dashboard of the Ministry of Health and Family Welfare.

So far, the third wave has not seen the devastating scenes of breathless patients and overwhelmed hospitals that had characterised the deadly second wave that swept through the country in April-May 2021.

But the third wave is causing a different kind of crisis.

For one, many non-Covid patients are finding it difficult to access healthcare services even though the government has not shut down non-Covid services, as it did during the previous waves of the pandemic.

In fact, to ensure patients like Jogdand are not denied healthcare in the absence of test reports, the Central government on January 10 directed hospitals not to test non-Covid patients unless essential.

But many hospitals continue to insist on the test reports, nevertheless. Some are even putting on hold procedures such as knee implant, cosmetic procedures, cataract surgeries, treatment for benign tumours. Only emergency surgeries, such as in case of accidents and caesarean operations for delivery, are being undertaken.

This is partly because of a sudden and acute staff shortage as many medical and healthcare workers are getting infected in quick succession, draining hospitals of their manpower.

But more fundamentally, the overarching challenge that healthcare systems face in the third wave is how to contain the spread of the virus. The Omicron variant driving the current surge is highly transmissible. As a result, patients are infecting health workers and vice-versa. Hospitals are faced with difficult choices – from admitting patients with or without test reports, cancelling or putting off surgeries to asking unwell medical staff to report to work.

Infections bench health staff

Since December 10, the active Covid-19 caseload in India has climbed from 93,000 to over 12,72,073, as on January 14, according to the dashboard of the Ministry of Health and Family Welfare. Government estimates show that only 5-10% of the active cases require hospitalisation, down from 20-23% during the second wave.

While the burden of severe disease is not as high, the rapid spread of the infection has ended up putting several health workers in isolation. Data from the Maharashtra

Association of Resident Doctors shows 481 resident doctors have tested positive since January 1. At Sion Hospital alone, 157 doctors, nurses and other medical staff have tested positive since December 20.

The number of infected medical workers is so high that several of them are working despite being ill to help their colleagues.

At the start of January, Dr Sasi Mouli, a junior consultant surgeon in Lilavati Hospital, developed a sore throat, quickly followed by a fever, body ache and cough. Several of his colleagues had tested positive, so Mouli was not surprised when his report said he had Covid-19.

On January 5, 34-year-old Mouli, fatigued and suffering from body pain, was admitted to an isolation ward at the hospital where doctors administered the antiviral drug remdesivir and paracetamol. Between bouts of sleep, he saw the strain on nurses and doctors. “There were very few of them looking after patients in our ward,” he said. Mouli knew that several like him were either in quarantine or isolation and after a day or two, he decided to help out.

Mouli filled case papers, admission forms and discharge summaries for patients in his ward from his bed. When nurses were busy, he put intravenous cannula for patients. He got discharged on January 9 but was back at work after two days. “There is some weakness, but it’s okay,” said Mouli.

Dr Sasi Mouli, a junior consultant surgeon in Lilavati Hospital, began helping out with patient care while he was admitted to the hospital for Covid-19.

Like Mouli, a junior resident doctor from Sion Hospital’s medicine department said that after her roommate tested positive, she developed a high fever a few days later too but decided not to get tested. She continued working instead. “I was working in a Covid-19 ward. So I knew even if I was positive, I would not infect patients. Plus there is a genuine staff shortage, I just couldn’t leave,” she said.

Dr Anant Bangar, a paediatric surgeon handling Covid-19 admissions at Lilavati Hospital, said healthcare workers are aware of the burden their absence puts on the health system and many of them are returning to work immediately after their isolation ends, or are choosing to work from hospital beds. “Thankfully, most have mild symptoms. The recovery time is quick,” he said.

At Breach Candy Hospital, chief executive officer Dr N Santhanam said the infection began spreading so rapidly among health staff from December-end that there was little time to make alternate arrangements. Santhanam said the government should not have delayed booster doses. “If boosters were administered earlier, health workers may have been saved from this round of infection,” he said.

The staff crunch at Sion Hospital’s gynaecology department illustrates the strain doctors as well as the healthcare system are grappling with. The department has a sanctioned strength of 54 doctors but there is a 33% vacancy, according to a final-year resident doctor. Which means there are 36 doctors, of whom 15 have now tested positive. The department handles 250 patients at a time.

“The number of deliveries are the same every day. Instead of eight-hour duty, we are working for 12 hours, sometimes more, to compensate for other doctors,” said the final-year resident doctor. The Maharashtra government had to reduce the Union health ministry’s mandate of seven-day isolation to five-days for healthcare workers to ensure that staff return to work sooner.

Some private hospitals in Delhi and Mumbai are asking Covid-infected nursing staff, who are asymptomatic, to return to work earlier than the mandated five days. They are posted in isolation wards where the risk of transmission to non-Covid patients is negligible.

TC Jibin, from the United Nurses Association, said he foresees this issue lasting for a short duration. “In cities, cases have risen fast amongst health care workers and started falling too,” he said.

An image taken inside the Covid-19 isolation ward in Sion Hospital. Photo: Dr Akshay Yadav

Patients worst affected

Like Jogdand, several other patients are bearing the brunt of the current situation. Not far away from Sion Hospital, 50-year-old Vijay Durafe had been waiting on the pavement outside Lilavati Hospital in Bandra since the morning of January 10 to get admitted for an urgent but minor procedure to dissolve a blood clot in his leg.

While the blood clot is not life threatening, Durafe had been in pain since the past few days, with his leg swelling up.The hospital required an RT-PCR test but Durafe was confident of testing negative as he had no symptoms such as a cough, cold or fever. As it was a private hospital, the result came sooner – he had tested positive.

“I don’t understand, I don’t have any symptoms,” he kept saying as doctors requested Durafe to return after few days of isolation or seek admission through the municipal corporation, which has begun monitoring the admission of Covid-19 positive patients in the 80% beds reserved by the government in private hospitals.

Calling the municipal corporation’s war room, however, would mean waiting for several hours before being allotted a bed. Durafe got a bed ten hours after he reached the hospital and paid an advance deposit of Rs 80,000. Within hours of admission, a doctor said the surgery could not be carried out as long as he is Covid-positive. Durafe was discharged and asked to return after a few days.

Lilavati Hospital’s Dr Bangar said many admitted patients are incidentally testing positive for Covid-19 leading to surgeries being postponed if they are not urgent. Bangar said if a child is suffering from hernia, he operates to ease the pain, but if a child requires circumcision, he may avoid operating for now. “We decide depending on the severity. With the risk of hospital infection high, even patients are wary,” he said.

For now, however, private hospitals are still able to carry out more elective surgeries than government hospitals.

On January 10, Devidas Waghmare, who has been suffering from splitting headaches and requires neurosurgery, stood outside Sion Hospital contemplating his options. Fifteen days ago, the Nashik resident first went to the privately-run Somaiya Hospital but realised he could not afford treatment there. He then decided to try his luck at Sion Hospital. Doctors in the outpatient department gave him medicines but he is still waiting for a surgery appointment.

“Today, they asked me to call after a week to check if a date for surgery can be given. They keep postponing,” he said. Waghmare, who has to take a three-hour journey to reach Mumbai, is running out of savings to spend on food and shelter.

“Elective surgeries are the first to suffer,” agreed hospital dean Dr Mohan Joshi. The rise in Covid-19 cases and the shortage of healthcare workers had left the hospital with “no other option”, he said.

Dr Gaurav Lodha, a resident doctor at Sion Hospital’s medicine department, admitted that this left patients frustrated. “If a patient is coming to the hospital, then he is seeking comfort from an ailment, else he would not come. Cancellation of elective procedures definitely affects their quality of life,” he said.

A doctor with Covid-19 helps another patient in the isolation ward of Lilavati hospital.

Patients, staff infecting each other

The fear of patients and medical staff spreading the infection to each other remains a major concern too, with hospitals struggling with containment measures.

Lodha said Omicron has led to widespread community transmission. “Hospital is always at higher risk of infection than community setting despite all precautions. Patients are infecting health workers and vice versa,” he said.

A doctor at JJ Hospital said more health workers posted in non-Covid wards are getting infected than those in Covid-19 wards. “Perhaps because in Covid-19 wards they take ample precautions through personal protective equipment. But what this underlines is that the infection is so widespread,” he said.

Unlike earlier when there was regular testing, it is now more need-based. Doctors and medical staff who want to get tested can do so. Those who are asymptomatic after being exposed to the virus can also get tested but there is no compulsion.

Sandhya Fernandes, a social worker who helps patients seek healthcare, said the worst-hit are dialysis patients who face a higher risk of severe infection due to renal failure, which is considered a comorbidity. “A lot of renal disease patients are getting infected after dialysis. For infected people, there are limited options available for dialysis,” she said.

Renal failure patient Raviraj Patil, 37, requires a dialysis twice a week and is scheduled to undergo a kidney transplant in February for which he had to get a series of fitness tests done at the hospital. “When I went for pulmonary function tests, they asked me to get RT-PCR done. That is when I found I was infected. The infection could have come from anywhere, the dialysis centre, the hospital I visited for tests daily,” said Patil.

Patil was asymptomatic, but as a Covid-19 patient he could not go to the dialysis centre as there was risk of spreading the infection to others. “I started inquiring in Ulhasnagar and found that dialysis centres were charging Rs 4,000-7,000 for a session for Covid patients. The usual cost is Rs 1,000. I could not afford that,” he said. Patil called up nearby districts and eventually found a government-run centre in Mumbai, 50 km from his home in Ulhasnagar . “I had to admit myself in the hospital because I was Covid-positive and could not travel so far twice a week,” he said.

In the private sector, meanwhile, doctors fearful of getting infected are switching back to online consultation. A nephrologist in Mumbai said he is speaking to patients over video calls again, a practice he had ended after the second wave.

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.