In less than 48 hours, COVID-19 had taken two victims from among Bengal’s frontline health warriors– additional director of health service, Dr Biplab Kanti Dasgupta, and renowned orthopaedic surgeon Dr Sisirkumar Mandal (April 26-28). Even as the government deliberated whether the latter had died of the virus or comorbidities, the doctor fraternity put out a condolence message with an unusual demand. They wanted both doctors declared ‘Covid martyrs’ and cremated with full state honours.
“It will act as motivational inspiration for the dedicated workforce,” said their message. The request was declined but it sounds all the more poignant when you realise that 74 health workers in Bengal, including doctors and nurses, are today battling for their lives, having contracted the viral disease from patients; another 500 are in quarantine and are possible suspects.
“Going by the number of infected doctors and health workers, we fear that hospitals will soon turn into Covid epicentres. There will be a total collapse of the health system unless the government mends its ways,” says Dr Manas Gumta, secretary of the Association of Health Service Doctors (AHSD). His apprehensions are not unfounded–12 hospitals including 7 public and 5 private, have had to shut various departments for more than a fortnight, sending on an average 20 to 50 hospital staff on month-long quarantine. No one knows have many patients were infected.
West Bengal’s leading healthcare institutions–including Calcutta Medical College and Hospital, NRS Medical College and Hospital, R.G. Kar Medical College, SSKM, Howrah District General Hospital, School of Tropical Medicine, National Medical College, B.R. Singh Railway Hospital–have all been affected. These hospitals are in the heart of the metro districts, Kolkata and Howrah, which have contributed 80 per cent of the state’s 882 Covid cases so far.
“Several doctors with private hospitals are now mulling whether it’s worth the risk exposing themselves to patients in the absence of adequate protective gear, no SOPs and no rules of segregating patients at the source. Government doctors can’t even entertain such thoughts, but I know of at least one neuro-medicine specialist at Calcutta Medical College who has put in his papers,” says a senior doctor and member of the West Bengal Doctor’s Forum, requesting anonymity.
While ICMR guidelines mandate all symptomatic patients and asymptomatic high-risk patients be tested for Covid, many private hospitals such as Max and Apollo in Delhi now insist on a Covid test for all admitted and new patients to protect healthcare workers. They use the ‘other’ category in ICMR’s testing protocol to facilitate testing for asymptomatic patients without history of exposure. Bengal hospitals need a clear protocol on who and when to test patients to avoid a situation like Italy where hospitals became breeding grounds for infection, leading to 204,000 infections and 27,000 deaths in the country.
The PPE shortage
The rumblings are growing among doctors and health workers about inadequate safety gear, PPE, masks and gloves. “For healthcare workers, PPE is life and death. If they are not protected, it’s like pronouncing a death sentence on them,” says a leading member of the West Bengal Doctors’ Forum.
According to chief secretary Rajiva Sinha’s numbers, the state has so far distributed 419,000 PPEs; this is excluding the 7,000 that have come from the Union ministry of health. The government health services employ about 300,000 people. Out of this, nearly half are active in the field.
There are 15,000 government doctors, 60,000 nurses, 80,000 paramedics and Group D and E staff spread all over Bengal who are directly involved in the battle against Covid. The supply of 419,000 PPEs in the past one month is grossly inadequate.
“There has to be a steady supply of PPEs, at least supply of 12,000 per day. The WHO guidelines say that PPE can only be re-used after ETO sterilisation. I doubt if the districts have ETO sterilisation facilities. And again there are SOPs to be followed. How can we expect such awareness among hospital staff, when there has been no training, no mock drills?” asks Dr Rezaul Karim, a senior member of the AHSD. Other state governments such as Chhattisgarh, Kerala, Maharashtra and Delhi have released videos and guidelines on how to wear and dispose of PPEs, including masks.
Health department officials maintain that there are enough PPEs in stock and that hospitals are being given 60-100 PPEs on an average every day. However, a letter from junior doctors at Calcutta Medical College to the department (on April 20) punctures these claims. “We are not even getting N-95 masks before treating patients,” a portion of the letter reads.
According to the chief secretary, there are 7,000 Covid beds, 5,700 ICUs and 2,838 ventilators in both public and private healthcare facilities together in Bengal. But doctors have put the number of functional beds at less than 2,500. “Even the Covid-dedicated MR Bangur–which is supposed to have 1,100 beds–has only about 200 in functional condition,” rued a senior city doctor. MR Bangur, at present, has 300 COVID-19 patients.
Since coronvirus patients suffer from respiratory distress, respiratory specialists are mandatory in every Covid hospital. But they too are at a premium, mostly one to a hospital and even they are visiting consultants.
The most worrying issue is the absence of virologists and epidemiologists in the government’s COVID-19 expert committees. “In such a grave situation when epidemiologists should lead us through, administrative officers in the committee are coming up with fanciful theories, making people all the more vulnerable,” says a renowned government doctor.
Complaints about low testing are another area which has alarmed the medical fraternity. West Bengal has done just 14,620 tests with a test-rate of 147 tests per million as on April 29. The state’s testing is the lowest in the country among those who have had over 500 Covid cases. In comparison, Maharashtra has done 128,726 tests or 1,046 per million.
Why is Bengal testing less? Chief minister Mamata Banerjee has a ready answer–the Centre is not sending enough kits and testing is happening in only eight laboratories, as approved by ICMR. But National Institute of Cholera and Enteric Diseases (NICED, ICMR’s nodal COVID-19 testing facility in Kolkata) director Shanta Dutta vehemently denies there being any shortage. She says ICMR has dispatched 42,500 kits but they were getting very few samples till a week back.
ICMR has allowed states to conduct pooled tests in areas of low infection. Each PCR kit can now be used to test 5 samples, a strategy Uttar Pradesh, the Andamans and Delhi have begun to follow to maximise use of resources. Given Bengal’s 42,500 kits, even if half of these are used to test in low infection zones, Bengal could have done 106,250 tests. As it is, Bengal has hardly touched the 20,000 figure. ICMR has also allowed states to begin rapid tests. Despite not receiving resources from the Centre, Rajasthan, Tamil Nadu and Chhattisgarh have gone ahead and procured rapid test kits directly from suppliers to increase testing. However, Bengal has made no such proactive efforts. The fact that Bengal has witnessed a 300 per cent spike in Covid cases since April 24 is because testing has now increased. Chief secretary Sinha says Bengal is testing 400 cases a day.
This apart, the constitution of an expert audit committee to certify whether deaths occurred due to coronavirus or underlying ailments (comorbidity in medical parlance) is another black hole. The death figures in Bengal which was in the 10-12 range suddenly jumped to 57 on April 23. Sinha announced the figure but also added that 39 of these people died due to comorbidities.
Bengal has still not added these 39 deaths to its total Covid tally. States such as Maharashtra, Delhi and Rajasthan have been regularly including all deaths of anyone diagnosed with COVID-19 in its Covid tally, and have provided detailed and transparent analysis of those who have died. Availability of data is crucial for public health officials to predict the course of infection, plan for containment and understand the nature of the virus. If Bengal were to add the 39 deaths to its Covid count, the death rate for the state would be the highest in the country at 6.7 per cent, almost double that of the national average of 3.2 per cent.
Perhaps this explains why seven associations of doctors, cutting across political loyalties, on April 22 called CM Mamata’s attention to the fear and worry in the medical fraternity in Bengal.
But no one is listening. Whether Dr Dasgupta and Dr Mandal died of Covid or not will be lost in the plethora of confusing data the health bulletin reels out every day. But to friends and colleagues, he will be remembered for having done his duty till the last, supervising the entry and exit of stock and attending to patients, oblivious of being a carrier. Dr Dasgupta’s last words on his Facebook page read: “Trust God, even if the answer is WAIT.” Perhaps he was waiting for good sense to dawn on the government.
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