On March 26, a doctor working at a Mohalla Clinic, which provides primary healthcare to patients, in Maujpur tested positive for the coronavirus disease (Covid-19), which had already infected 53 people in the national capital by then. It was the first case among the healthcare workers (HCWs) in Delhi. In the next 30 days, more than 250 medical staff across city hospitals tested positive for the viral infection, the official data shows -- an indication that the deadly virus was spreading fast. And even doctors, the ‘frontline warriors’, are vulnerable to the pandemic.
Despite wearing personal protective equipment (PPE) kits for 8-10 hours on a trot, the healthcare workers have been paying a heavy cost in the pandemic.In Delhi itself, more than 300 healthcare workers have been infected with the Covid-19 in the last one and half months.In some hospitals, more than 50 staff have reported positive, forcing many to shut their Outpatient Department (OPD) services.
On Sunday, three doctors of Hindu Rao Hospital and as many doctors from Kasturba Hospital tested positive. Husbands of two nurses working at the Hindu Rao Hospital tested positive for coronavirus.
Hospitals becoming hotspots
Despite being frontline workers, the medical fraternity in Delhi was taken aback after the first confirmed case among the healthcare workers was reported from the mohalla clinic in Maujpur.The doctor had come in contact with a woman coronavirus-infected patient from Dilshad Garden. His wife, who also works at a mohalla clinic at Babarpur, and daughter tested positive too.
The next cases emerged almost simultaneously from two hospitals — Maharaja Agrasen in Punjabi Bagh and the Delhi State Cancer Institute in Dilshad Garden. While Agrasen had six such cases, the the Delhi State Cancer Institute reported 26.The situation turned worse at the DSCI when the infection had spread to two cancer patients admitted there. Both succumbed to the virus later.Within a few days, some more hospitals — private, state-run and centrally controlled, started reporting cases where their medical staff tested positive.
The Lok Nayak Jai Prakash Narayan Hospital (LNJP), Ram Manohar Lohia Hospital, Safdarjung Hospital, AIIMS, Lady Hardinge Medical College, Deen Dayal Upadhyay Hospital, Jag Parvesh Hospital, North MCD-run Hindu Rao Hospital, Sir Ganga Ram Hospital, GB Pant Hospital, GTB Hospital, Apollo Hospital, Moolchand Hospital and few others were among them.
Non-Covid hospitals face more wrath
Babu Jagjivan Ram has be en the worst-affected city hospital so far. At least 75 medical staff of the 100-bedded multi-speciality district hospital, under the state government, located in Jahangirpuri have tested positive.“One of the reasons behind it was that many suspected Covid-19 patients from Jahangirpuri area, which has been listed as a hotspot, had visited the hospital for check-ups,” a source at the hospital said. Last week, all the 33 healthcare workers of Max Hospital in Patparganj who had tested positive have been shifted to a quarantine facility at Max Hospital in Saket.
Besides, at least 45 HCWs at the state government-run Baba Saheb Ambedkar Hospital tested positive. The hospital was initially one of the designated hospitals for the coronavirus. Later, it was switched to its normal services. Dr Harjit Bhatti, president of the Progressive Medicos and Scientists Forum, had earlier told this newspaper that the non-Covid-19 hospitals were reporting more positive cases because the Centre was not declaring the ‘community transmission’ had begun.
“All hospitals had initially underestimated the disease and were not following strict protocols. A major reason was the ICMR, which did not accept the pandemic had reached its stage-3 (community transmission) in Delhi. No matter how stringent measures are taken by hospital administrations, it’s always difficult to keep hospital premises infection-free. Our HCWs need more PPE kits because they are less in numbers, and if they fall sick, the entire system might collapse. This in return, may put a lot of people in danger,” Bhatti said.
HCWs at the designated hospitals are also bearing the brunt of the outbreak. Hospitals such as LNJP and Lady Hardinge Medical College have the most positive cases among HCWs. RML and Safdarjung hospital, both under the central government, have also reported confirmed cases.
Why are doctors affected
Doctors are exposed to Covid-19 patients for a long time. They have to spend hours every day with them, said a health specialist, who did not wish to be identified.“During such a crisis, if health workers fall prey to the virus, then there will be further staff crunch. Hospitals can’t afford fewer workers at this time. But this is something unavoidable. Doctors and nurses across the globe have been infected with the virus, many of them have died,” said the health specialist.
“The HCWs are constantly exposed to Covid-19 patients because of two major reasons. Firstly, most of the patients are asymptomatic, and when they visit non-Covid hospitals it automatically puts doctors at risk. Secondly, HCWs are not properly protected with PPE kits,” added Bhatti.
Dr Srinivas Rajkumar of the AIIMS resident doctors’ association said inability to modify hospital protocols, lack of quarantine facilities, unavoidable work-related exposure to objects (pen, phones, medical equipment) and contact with patients make these HCWs more vulnerable to the disease.
How is it affecting healthcare
With more and more positive cases, hospitals are shutting their services temporarily. Many private practitioners are sceptical about opening their clinics, while those associated with hospitals are scared of going out.“This is such a time when no doctor can or should refuse to provide services. But every day, there is news of HCWS getting infected. This has certainly created unwanted pressure on us. There’s nothing but the just passion that keeps us going,” said a city-based gynaecologist.
Doctors demand better facilities
Ever since the Covid-19 virus broke out, doctors have been demanding better facilities for them. Resident doctors and medical forums have repeatedly raised the issues of the poor quality PPE kits, owing to which hospital administrations had restricted interactions of their staff with the media.
“We had received defective or incomplete PPE kits. Nursing staff are hoarding PPE kits. However, it is not the only reason why doctors are getting infected. The government has to make a designated separate donning and doffing area for PPE kits — it is still not available at many hospitals. There should be a provision for duty rooms away from Covid-19 wards, a separate path leading from the duty room to the donning area to the ward, a separate path to return via the doffing area,” said a doctor associated with one of the designated Covid-19 hospitals.
“PPE kits usage guidelines have been formulated assuming that non-Covid-19 hospitals are not catering to the patients affected by the pandemic. Under the current testing guidelines, all patients can’t be tested for the Covid-19 and hence, preventive measures should be taken along with changes. OPD services should be curtailed for the time being and all hospitals should strengthen telemedicine facilities to cater to patients and to keep the contact of healthcare professionals with patients to the minimum,” said Dr Shivaji Dev Barman, president of the Federation of Resident Doctors Association.
Delhi govt’s bizarre order
Last week, in a bizarre circular, the Delhi government sought written explanations from coronavirus positive doctors and healthcare personnel working at non-Covid hospitals on how they contracted the infection. After a hue and cry in the medical fraternity, the government put its order in “abeyance”. It
said medical directors are “indiscriminately” sending medical workers in quarantine for 14 days.
