Doctors, the vanguard of COVID-19 response, face crippling shortage of protective gear

Indian doctors, best known for their excellence and compassion around the world, are earning a lot of plaudits for fighting a one-sided battle against COVID-19 at home - but very little else.

As TV images of blue-clad medics being chased by stone-throwing mobs in MP and Bihar have shocked the country, these may well be among the lesser of the life-threatening troubles doctors, nurses and health workers face.

Shortage of protective health gear in India has forced some doctors to use raincoats and motorbike helmets while fighting the coronavirus, exposing the fragile state of the public health system ahead of an anticipated surge in COVID-19 cases.

Sources say that the Ministry of Health has a sizeable quota of N-95 masks considered mandatory to battle coronavirus, but for some unexplained reason, it is not willing to part with such critical equipment. One Central Government Health Services (CGHS) doctor confided that when a requisition was sent to the `higher-ups’ in the ministry, they were told that such masks were meant for immigration authorities to scan at airports. In another similar instance, no reply was forthcoming from senior officials.

It is mandatory for doctors and the attendant staff, including nurses, who are looking at suspected patients closely, to be clad with personal protective equipment or PPE. This includes a full kit – masks, anti-virus shoes, eyewear, gloves and a throat cover. There are enough PPEs with the ministry of health. Yet, for some inexplicable reason, they are being saved for a rainy day, putting thousands of doctors at life-threatening risk. The Director General of Health Services, who is the only technical man in a government manned by rank generalists and whose views should count in such a situation, has kept an unusually low profile in this hour of crisis.

Trying times

The medics are really up against it and can hardly be blamed if they are worried. A Guwahati-based doctor, who reportedly took anti-malaria drug hydroxychloroquine amid the COVID-19 outbreak, died at a private hospital earlier this week. Last week, a health worker in Kashmir lost his life after attending to suspected coronavirus cases. On Wednesday, five more doctors tested positive for COVID-19, taking the toll of such virus-suspected doctors in the national capital to seven. Last week, 14 medical staffers at New Delhi’s Ram Manohar Lohia Hospital, including doctors and nurses, have been sent into home quarantine. They were part of a team treating COVID-19 patients at the hospital. Their samples are being tested.

The worst-hit are CGHS, mohalla clinics and government health facilities like primary health centres, where doctors and health workers are operating in the most perilous circumstances.

The situation is headed towards a breakdown. In Uttar Pradesh, India’s politically most powerful state, drivers of around 4,700 ambulances that mainly serve government hospitals, went on a strike last week demanding proper safety gear and health insurance to fight a virus that is threatening to careen out of control, if not tacked with a degree of urgency.

In Bihar’s government-run hospitals, doctors, nurses and other healthcare workers are examining suspects without any basic safety gear. The lack of PPE has led to healthcare workers threatening to resign and putting in increased requests that they be sent to quarantine as a precautionary measure. “We are given HIV kits instead of PPEs. It is suicide that we have chosen to do…Once we are infected, we could be infecting others too,” said a resident doctor at Patna Medical College and Hospital (PMCH), Bihar’s largest medical college and healthcare centre, in a Facebook post.

Public hospitals in India are working overtime and according to some doctors, they have been forced to work for 24-hour shifts, screening innumerable cases. People are waiting up to seven hours to get tested, and quarantine areas are overcrowded. Pictures of a hospital handling such cases shared on Twitter showed a wash basin filled with what looked like vomit and rusted cot frames.

In advanced countries with much sounder public health systems, doctors and health workers are using hazmat suits or hazardous material suit, also known as decontamination suits. It is a piece of personal protective equipment that consists of an impermeable whole-body garment worn as protection against hazardous materials. They are combined with self-contained breathing apparatus (SCBA) to ensure a supply of breathable air and are most effective in a toxic environment, something that is close to the Indian situation today. With even basic gloves and masks missing, hazmat suits remain a pipedream in the country’s context today.

As for the PPE kits available, Air India pilots who flew back COVID-19 patients from various parts of the world recently, have written to the health minister saying that the quality of the PPE kits used on the flights were decidedly below par. Obviously, someone has made a killing on their purchases.

Under the trying circumstances, there is a strong case for allotting more funds and personal benefits to those at the vanguard of the anti-COVID battle like doctors, nurses and para-medics. It could also include policemen and others at the frontline. That would be at least one way to provide some incentive to those risking their lives because a long battle lies ahead. If largesse is being rightly distributed to those in need, there is no need to keep out the most vital cog in the health machine.

Ranjit Bhushan is an independent journalist and former Nehru Fellow at Jamia Millia University. In a career spanning more than three decades, he has worked with Outlook, The Times of India, The Indian Express, the Press Trust of India, Associated Press, Financial Chronicle, and DNA.