Every time she inserts a tube into the windpipe of a patient with respiratory illness, an anaesthetist at a government hospital in Haryana worries about her own safety.
What if the patient is infected with the new strain of coronavirus that has caused a global pandemic? The virus attacks the respiratory system and healthcare workers attending to such patients are particularly vulnerable to infection.
To prevent exposure to the virus, they must wear special protective equipment. This includes gowns, gloves, eye shields and masks, according to the World Health Organisation. For certain procedures, like the insertion of tubes, called tracheal intubation, the WHO recommends special N-95 masks.
But the Haryana hospital does not have such personal protection equipment, said the 27-year-old anaesthetist, who spoke to Scroll.in on the condition of anonymity. “We do not have enough masks, we have to wash the same one and reuse them,” she said.
The only gowns, or coveralls, available in the hospital, she added, are those designed for protection against HIV – not against the coronavirus.
A 28-year-old doctor who works in the emergency ward of Patna Medical College and Hospital has also been using an HIV gown for ten days. “It will only protect us against contact with blood and not something that could enter our respiratory system,” he said.
The hospital has around 20 patients suspected of the Covid-19, the disease caused by the coronavirus, but safety gear was available only at the flu counter for three doctors working in three different shifts, he said.
So far, the hospital in Haryana has had any confirmed cases. But that does not rule out accidental contact with yet-undiagnosed patients, the anaesthetist said.
In fact, several instances have been reported across India where medical workers have been infected with the virus in precisely this way. For instance, three nurses in two hospitals in Mumbai had tested positive for the virus after they were likely exposed to patients who did not have international travel history nor showed Covid-19 symptoms until they developed them later, The Hindu reported on March 31.
While the health ministry has not officially released any numbers, the news agency ANI cited unidentified officials as saying that 50 medical staff, including doctors, nurses and paramedics, have tested positive for Covid-19.
As Covid-19 infections among health workers rise, the shortage of safety gear is sparking rebellion among doctors.
On April 1, Delhi’s municipality-run Hindu Rao Hospital rejected the resignations of around 10 doctors and nurses who cited poor quality of personal protection equipment. The hospital has a screening facility where patients showing symptoms of Covid-19 – dry cough, high fever and breathing difficulties – are examined.
A doctor from the hospital who spoke to Scroll.in on the condition of anonymity alleged that the coverall provided to them was of poor quality and tore easily, exposing their clothes. “Water can easily pass through the material,” said the doctor, who is posted at the medicine department.
The hospital staff had not even provided its staff with a layer of scrubs, or operation theatre dress, to wear over their regular clothes. “We are supposed to wear a layer of scrubs before wearing the suit, but the hospital does not have any OT dresses,” he said. “Everything is just in the air.”
Apart from inadequate safety gear, the doctor also pointed to the hospital’s poor infrastructure that could cause more harm. The doffing zone, where health workers remove their safety gowns at the end of their shift, was located inside a bathroom without a safe way to dispose of the material, he claimed.
“There is no proper medical waste bag to keep it in and there is just one dustbin,” said the doctor. “If you remove the dress wrongly then that can also expose others to infections.”
The hospital at present has converted its nursing centre into an isolation ward and is another building located 400-metres away from the screening ward, he alleged. “To get to the nursing home you have to cross a children’s park and a building that accommodates doctors,” the doctor said. The screening ward is where patients with symptoms of the virus are examined and the isolation ward is where those considered high-risk are admitted to get tested. These two facilities have to be within the same building to prevent others from getting exposed to the virus, the doctor said.
“The guidelines state that both these wards have to be close by otherwise there is risk of exposing others,” he said. “It could spread in the whole hospital campus.”
Dr Anu Kapoor, the medical superintendent of Hindu Rao Hospital, refuted the allegations and said that the hospital had not yet started its isolation facilities. “We are following the instructions that we are getting and any patient would be transferred to other hospitals in an ambulance that would get sanitised later,” she said.
India is facing crippling shortages of health safety gear for a number of reasons: the government did not create stockpiles by banning exports and it failed to place orders with manufacturing firms in time. It released the guidelines for safety gear manufacturers on March 24 – the same day it announced the nationwide lockdown. This meant workers in many places have been unable to report to manufacturing units because of restrictions in movement, despite manufacturers being ready to produce.
“If we become patients, then it will be a mass tragedy,” said the doctor at Patna Medical College and Hospital. “Some of us may not be treating Covid-19 patients but any patient that enters the hospital is a suspect.”
The anaesthetist at the government hospital in Haryana said that the administration had “woken up late” to the problem of safety gear shortages. “When something has been declared as a pandemic you have to be prepared,” said the doctor who spoke on the condition of anonymity. “But there were no plans, no mock drills or action taken in March.”
On March 30, the Ministry of Health and Family Welfare tweeted that around 3.34 lakh coveralls were available in hospitals across the country and that another three lakh would be donated from abroad by April 4.
But the doctor in Haryana said this was a minuscule number compared to the need across the country. “The requirement is in lakhs,” the doctor said. “A doctor in an isolation ward changes their suit twice in a 12-hour shift. We do not even have enough for one shift.”
The shortages have meant that doctors have had to forcibly use ineffective substitutes like raincoats and helmets to continue treating patients, Reuters reported on March 31.
The shortage of protection equipment was felt acutely in Bihar as well. Around 83 junior doctors from the Nalanda Medical College were advised to go into a 15-day quarantine after they showed symptoms of the virus, Caravan reported on March 24. The report stated that the junior doctors were not provided with personal protection kits.
At Patna Medical College, the doctor said that hand sanitisers were not available and that a solution of chlorhexidine was being used as a substitute. “It is like Dettol and only works as an antiseptic,” he said. “It kills the bacteria but not the virus. Hand sanitisers kill 75% of the virus since it may not be possible for us to wash our hands all the time.”
Diversion of funds
While doctors were facing acute shortages, Dr Srinivas Rajkumar T, general secretary of the Resident Doctors’ Association at All India Institute of Medical Sciences alleged that the administration had diverted funds amounting to Rs 50 lakh that was raised to procure PPE for the staff to the Prime Minister Citizen’s Assistance and Relief in Emergency Situations fund without consulting the doctors.
“The amount was specific to procure at least around 50,000 to 100,000 PPEs,” Rajkumar said. “Around mid-March we raised the issue of non-availability and got the amount through the CSR [corporate social responsibility] initiative from Bharat Dyamnics,” he said. Bharat Dynamics is a public sector undertaking under the Ministry of Defence.
AIIMS Medical Superintendent Dr DK Sharma dismissed the allegations. “To the best of my knowledge, we have not received any such grant or contribution from the firm,” Sharma said.
He acknowledged the hospital had corresponded over email with the firm. “I had personally telephonically spoken to their executive,” he said. “I had told him that we are thankful for the offer and that they can transfer the amount to AIIMS account and we will procure requisite PPE kits and give them a utilisation certificate.”
“But after that they didn’t respond or gave any money as is being claimed,” he added. “As we have not received any money from this firm, there is no question of diverting it.”
Most doctors who spoke to Scroll.in did not want to be identified for the fear of action being taken against them by the hospital authorities.
When the doctors at the Patna Medical College raised their concerns with the administration last week, according to one doctor, the authorities told them: “Krantikari banne ki koshish mat karo.” Don’t try and become revolutionaries.
Many of the young doctors are in the final year of their postgraduate medical degree. Their careers depend on the final grading by their department heads. “They could mark us badly during our internal exams,” the doctor said. “It does not depend upon our knowledge but on the rapport we have with them.”