Riddhima Bhatia reports half an hour early for her six-hour shift at the All India Institute for Medical Sciences’ Trauma Centre in Delhi. She is one of the doctors on duty at the new intensive care unit set up to treat Covid-19 patients.
This is a high-risk environment. Patients with acute infections are constantly shedding the microscopic particles of the coronavirus. It covers surfaces, shoots out as patients cough or sneeze, hangs in the air in fine aerosol droplets as the severely ill are intubated with ventilators.
Before she enters the ward, Bhatia must be clad in the full personal protective equipment prescribed for high-risk zones. It is a set routine – wear your hospital scrubs and get your temperature checked by the staff. Wash your hands, drink water, use the washroom – over the next six hours you will not be able to do so. Then starts the elaborate ritual of “donning”. It has to be done right. The smallest gap could mean exposure to the virus.
“Donning is supervised by staff so that we don’t make mistakes,” said Bhatia. The gloves come on first. Then the coverall, a jumpsuit made of impermeable material that will not admit fluid or air, zipped up to the chin. The shoe covers are slipped on next – hospital floors are supposed to be hotbeds of infection. Then the N-95 respirator mask fitted over the mouth and nose, goggles on the eyes, a hood to cover the head and a face shield, giving doctors the appearance of astronauts or advanced motorcyclists. Finally, a second pair of gloves.
Before entering the ICU, she must check her face shield one last time. “If there is a lot of fogging, that means the mask is not properly fitted,” Bhatia explains.
Then it’s into the fray.
Inside the ICU, it is a rarefied world. Even though the ward is air-conditioned, it is sweaty inside the suit. The only sensation you have is through your gloved hands. The protective gear cuts off sound, so to communicate you must rely on sign language, writing or talking loudly. This last can only be done by moving to the central area, away from the beds. After four or five hours, even the most carefully fitted mask will shift, and the shield grows cloudy, making vision difficult.
“But we were prepared for this,” she said. “The protocol was set and we received training from mid-March, when the ICU was set up.”
Frontline gear
Bhatia considers herself lucky. Across the country, doctors, nurses and other health workers are on the frontlines of the fight against the virus without adequate protective gear. The ministry of health and family welfare has prescribed different kinds of protection for health workers, depending on the level of risk they are exposed to in their job.
Those categorised as low risk, such as people checking temperatures at airports, ASHA (Accredited Social Health Activist) workers on field surveillance and ambulance drivers, need to wear gloves and the surgical mask fashioned out of three layers of fabric. Moderate risk workers – nurses in the holding area of hospitals, staff handling the linen of Covid-19 patients and the clinical management of isolation rooms – have to wear N-95 masks and gloves. Those in the high risk category – doctors and nurses working in ICUs, laboratory staff collecting samples and workers packing dead bodies – must be covered from head to toe in the way Bhatia described.
Necessary though they are, PPE, especially the complete kit, adds to the physical strain of gruelling schedules. With summer approaching and temperatures soaring across India, hazmat suits and gloves grow even more uncomfortable.
‘Like a sauna bath’
Meena Bohra, a nurse at the Silchar Medical College Hospital in Assam, is posted on duty at the general ward for Covid-19 patients. She works an eight-hour shift, from 4 pm to midnight, for seven days, then goes into quarantine for 14 days. Unlike the ICU, the general ward is not air-conditioned.
Bohra is thankful for the proper PPE reserved for high-risk category workers. In the early days of the outbreak in Silchar, they had to make do with HIV kits. “There is a vast difference,” she explained. “HIV kits have no shoe covers, no hood – just a simple gown. The coronavirus would be like, this is a joke.”
Now, she goes through the same supervised “donning” process as Bhatia, with some additions – three pairs of gloves instead of two, a triple-layer surgical mask as well as the N-95 mask and two shoe covers, not just one, and a pair of boots over that. Between each step of the process, you have to keep sanitising yourself.
“One day feels like one year,” she said. “It’s so suffocating.”
Across the country, Anamika Bhowmik, a nurse in Mumbai, was in agreement. Bhowmik weaves in between the ICU and the general ward for Covid-19 patients. The two wards are next to each other in the hospital where she works.
“The general wards don’t have AC – they have fans but it is recommended we don’t switch them on because droplets causing infection might get dispersed,” Bhowmik said. Not that fans help much with the heavy PPE suits. “You might sit in front of a fan but you won’t feel anything because the air does not penetrate the suit. Your hair gets damp. The mask fogs after a while because of the heat from your forehead. It’s like a sauna bath. And the more you sweat, the more you get thirsty.”
But drinking water or going to the washroom in the middle of the eight-hour shift is an emergency option. The suits are for one-time use only, so every time you leave the ward, you need to cast it off and put on a new one before you enter. With PPE shortages mounting, both nurses and doctors balk at this. “There is an economic cost to it,” Bhowmik said.
Under the Mumbai sun
While Bhowmik sweats it out in the hospital, Jaimukund Gaekwad must brave the streets of Mumbai in a hazmat suit, face mask, gloves, goggles and hood. From 8 am till about noon, Gaekwad collects waste from hotels and homes where people are quarantined. Every morning, they are handed fresh suits, which are thrown out with the garbage when they are done.
It is a stressful job and their suits get wet with sweat, but Gaekwad would rather have a suit than not. Earlier, they had been told to reuse them, Gaekwad said. “But we said we won’t wear it two-three times, we will only wear it once.”
But as the weeks wear on, health workers have grown more accustomed to the weight of the suits, the way the shield fogs up and the mask digs into their face. “There is no way out of it,” said Bhowmik, matter of fact.