The Weekly Dose: Indian doctors on the covid-19 front line, in their own words

Eight doctors treating patients with COVID-19, exposed to possible cases or at heightened risk of exposure, describe how the virus has affected their work, reveal the inner workings of their hospitals in this period, and lay bare the often poor and inconsistent support offered by the powers-that-be to their efforts. At the time of writing, private hospitals have not yet started diagnosing or treating corona-positive patients; since government doctors are not permitted to speak to the media, I have concealed their identities.  

Physician at a tertiary-care hospital in Maharashtra

We have received our first positive case just last week, so the worst is yet to come. But we are already facing a severe shortage of masks, sanitizers and other essential Personal Protective Equipment (PPE). We are spending from our own pocket to protect ourselves during OPD and ward rounds. Apart from the designated isolation ward, no other place is being sanitized as per protocol.

Dr Roshan Radhakrishnan, consultant anaesthesiologist at a private hospital in Kochi, Kerala

A complete PPE kit would involve not only masks but also long-sleeved gowns, shoe covers et al. We have not reached that stage yet. Doctors have definitely become more strict about wearing masks at all times though.

I personally expected a drop in the number of elective (non-emergency) surgeries, but as of now, the OT case list remains the same, surprisingly.

Dr Amrita Basu, ENT surgeon in private practice, Malda, West Bengal

I am taking a more detailed travel and contact history from my patients and people I am in regular contact with. I am counselling patients about the need for rescheduling elective surgeries. 

A junior doctor at a referral centre for infectious diseases in West Bengal 

Training about hand hygiene was organised for faculty and nurses. Training for junior doctors was planned only after two-three of us went and begged the authorities to educate us. They forget that we are the first line of contact. 

Today, when we went to work, we were not given N95 masks. This is the state in all state medical colleges. We are being told that if you are not working in the Emergency Room (ER), there is no risk of exposure. But what about patients in wards and OPDs? The authorities say, “We have been working here for 30 years, since before you were even born. We've lived through H1N1, and we have been using normal surgical masks only.”

People look at us and say, “Oh, but the mortality in your age group is so low”. My own friends said this when they saw me wearing a mask before Stage-II of the epidemic. But we can become carriers, and spread it to someone else. 

A man with Covid symptoms came to the ER and said he had been to a high-corona burden nation for a vacation. The medical officer (MO) told him that he needs to get admitted for isolation. The man said, “You know what? I'll come back tomorrow morning to get admitted”. And the MO said, “Fine, just make sure you don't come in contact with anyone else”. In a country like ours, where most people travel in crowded buses or trains, how is this even possible? This is how lightly they are taking it. 

A physician at a tertiary care centre in Mumbai

When I joined this post, N95 masks were in plenty and could be found just lying around. But in the last 10 days, even ordinary surgical masks aren't to be found. That's the real reason health personnel are scared; even basic things aren't available. Have you seen an N95 mask? You can't wear it for more than a day or two. If you use it for longer, it begins to itch. We have asked the sister-in-charge to keep masks under lock-and-key and to issue one to someone only after taking his or her signature. 

The number of cases is very underreported. Testing is being done only of those with significant travel history. The government doesn't want to accept that transmission has started to people who have no history of travel or contact with such travellers. I read that we are using 10% of our testing capability. Despite having the facility, we are not using it. Why? This is best known to the authorities only. 

A few days ago, a 70-year-old man who had travelled to Saudi Arabia, and whose corona-like symptoms had started there itself, came to Casualty after returning to India. We sent him to Kasturba Hospital for Infectious Diseases (until today, Mumbai’s only centre to test for corona, and isolate positive cases) but they sent him back because apparently, Saudi Arabia does not have a high corona burden. But India's first corona fatality had a history of travel to Saudi Arabia. 

We cannot even test our own elderly, critical patients in our ICUs who have sudden-onset, severe pneumonia. The samples we send are not accepted by Kasturba; they want patients to be sent there, and they will decide on a case-to-case basis. Even if we have a corona patient in the ICU right now, we will not know, because we cannot diagnose it. 

Those with flu-like symptoms should be directed to different OPDs. At present, patients with the flu and patients with diabetes wait together for hours in the same crowded area. 

A surgeon at a secondary care hospital in western India

OPDs usually have two relatives accompanying each patient. We see about 300 patients every day; that's 900 people entering one small room. Because citizens are not going to work, our OPD attendance has actually increased at a time like this. The chances of transmission are very high. But my department has understood that the municipal corporation is never going to allow us to shut our OPD and elective surgeries officially.

We have decided to prescribe 15 days worth of medicines to patients who need it and to call all follow-up cases only after 1st April. Suture removals and changing of dressings will continue to be done. But no elective surgeries; only trauma cases will be operated. Usually, our unit does 8-9 surgeries every day by operating on two patients on two different OT tables at the same time. By operating on just one case at a time, we will now limit our work.

Obviously, we will not let emergency services be affected. But someone who has had knee pain for 15 days is not an emergency, and shouldn't come to the hospital. It is a risk for both the patient and doctors. 

My unit head is shutting his private practice for 15 days; he doesn't want anyone to come to his clinic. Only perioperative patients should come. All doctors who can do this should do this. Because in India, this is just going to get bigger. 

Medical Officer at Kasturba Hospital for Infectious Diseases, Mumbai

Whoever comes to Kasturba knows that testing is done only in Kasturba. We have been seeing patients who say things like “My neighbour on the fifth floor was tested positive, now I want to get tested". There are guards at the entrance who direct patients to an exclusive corona-screening OPD. 

After a careful history is taken, we admit suspected cases for isolation. Initially, there was just one ward for this; now an entire building is dedicated. Another ward is being cleared out because we are running out of beds for isolation.

Initially, the test report would come in three-four hours. Now, reports take 24-36 hours to come as we get lots of patients to test. Positive cases are shifted to a special isolation ward. It is a regular ward with open windows, but with one difference. Earlier, ward beds were crowded together and there was very little space between them. Now, there is at least three-four feet distance between two beds. 

Kasturba is the only hospital in Mumbai which admits patients with hepatitis and other infectious diseases. We have not stopped seeing patients in the general, non-corona OPD.

Physician at a secondary-care hospital in Mumbai 

The symptoms of corona could actually be that of a normal flu. The treatment is not going to change. But once the fear is in someone's mind, it is better to get tested. Clinically, I know that there will be no difference in the treatment. Isolation is only to prevent transmission. 

People in my hospital are generally being level-headed. But naturally, no one wants to be posted in the isolation ward. I was telling my colleagues that in fact, that will be the best place to be - you will be the ones to get all the protective equipment, and if you use it, nothing will happen to you!