As Mumbai battles the Coronavirus pandemic, the first casualty seems to be the health care sector, both public and private, even before the battle has reached its half way mark. “The COVID-19 pandemic has struck a three-pronged attack on our health care sector,” said Dr Amar Jesani, editor of the Indian Journal of Medical Ethics and a teacher of bioethics and public health. “Firstly, it has infected health care professionals through patients; secondly, it has drastically reduced the health care work force and thirdly, these health care professionals are in turn infecting non-COVID patients under them.”

The health care system’s precarious state is reflected in eight of Mumbai’s top private hospitals emerging as hotbeds of infection and being declared as containment zones after a large number of their own nurses and doctors tested positive. In Wockhardt Hospital in Mulund, 53 staffers tested positive (including 40 nurses), with 21 staffers testing positive at Jaslok Hospital. At the high-profile Breach Candy hospital, four health care workers, three of them nurses, tested positive. Incidentally, the first private hospital that red-flagged the COVID-19 risk was Hinduja Hospital, which had quarantined almost 82 staffers as early as on March 13th, after treating a 64-year-old Dubai-returned Coronavirus patient. As on April 13th, 90 healthcare professionals have been declared COVID-19 positive so far. These include four doctors, two from Sion and two from Seven Hills Hospital, who were declared positive on April 12th.

The Maharashtra chapter of the United Nurses Association estimates that there are an additional 150-200 nurses under quarantine in Mumbai. “Since we are aligned with international organisations, we are aware of how things happened world-wide and didn’t want that to be repeated here in India,” said an office bearer of UNA. “But Mumbai hospitals didn’t give PPE to nurses, delayed quarantining and even refused to share health reports with their own nurses”.

The scene is not very different in the city’s 24 public hospitals run by the Brihanmumbai Municipal Corporation (BMC). Nurses are the worst hit. There are about 4,500 nursing staff working with BMC apart from nursing students who too share the health care load in civic hospitals.

Nurses protest lack of PPE

Sporadic protests were witnessed in civic hospitals like Shatabdi Hospital, Kandivali, V N Desai at Santacruz and Bhabha Hospital, Bandra, by health care staff protesting unsafe working conditions and lack of protective gear. Nurses at Shatabdi Hospital protested on April 2nd, demanding better safety equipment when about 40 staffers had to be quarantined after a patient tested positive. Similarly, about five medical staff including three nurses from V N Desai Hospital were quarantined after a patient tested positive.

The Nurses’ union alleges that most infections take place due to inadequate protective gear and faulty standard operating procedures. “Of the two nurses who manage a ward, only one of them is given a PPE in a COVID ward per day,” said Ranjana Athawale, assistant general secretary of the BMC’s  Nursing and Para-Medical Staff Association. “She has to wear it for hours and cannot drink water or visit the toilet for fear of spreading infection. It becomes difficult to keep the PPE on for their entire eight-hour shift as it gets very hot. The kits are disposable and can’t be washed or reused. With shortage of PPE, many nurses manage with disposable apron, regular gloves and mask as protective gear, wherever available.” Athawale added that many nurses, though scared, are forced to report to work due to threats of suspension.

A municipal hospital nurse, who was quarantined after a patient tested positive, told Citizen Matters: “A patient admitted in the casualty ward later tested positive forcing us all into isolation. About 40 of us were shifted to neighbouring hospitals. We had no change of clothes and the food served to us was bad. Home food brought by our relatives was denied. Though the place I was kept in was good, others had to stay put in unhygienic conditions and provided with stale bread for breakfast.” She has a two-year-old child now being taken care of by her husband in their rented house.

“Many nurses just back from their maternity leave were asked to work in COVID wards and threatened with suspension if they showed reluctance. I agree it is an emergency and its our duty to serve, but they could have shown consideration to pregnant nurses and young mothers with small kids. We can’t be serving society by putting our families at risk”. Though a swab report should have come in 24 hours, the nurse says that they were made to spend four days in isolation before getting her report. Those testing negative are asked to report back to work bypassing the 14-day quarantine requirement owing to staff shortage.

In a joint letter issued by the Mumbai chapters of the Jan Swasthya Abhiyan, the United Nurses Association, the Clinical Nurses Research Society and the Nursing and Para Medical Staff Union, nurses have demanded that they be provided proper PPE, proper infection control and triaging protocols, free treatment and care of infected nurses, continuation of salary during quarantine and treatment which should be considered as part of  duty hours. The United Nurses Association has moved the Supreme Court seeking mandatory protection kit for all health care workers in isolation wards.

Public hospitals bear the brunt

Municipal hospitals are undergoing major changes to face the pandemic challenge. Hospitals around high-risk zones have stopped treating non-COVID cases, except for emergencies. A senior doctor at a municipal hospital said: “We have stopped surgeries. Non-emergency wards like gynaecology (except maternity) and orthopaedic have been closed,” said the chief medical officer of a civic hospital. “Regular wards are being converted into COVID-19 wards by putting up partitions, sealing them, separating their toilets, putting up buzzer buttons near beds, ventilating them and isolating them from outside.” The shortage, he said, is not of doctors but of protective kits.

Mumbai’s Jan Swasthya Abhiyaan has demanded that the BMC ensure private hospitals do not profiteer from this pandemic and that charitable hospitals be roped in to provide free treatment and free anti-viral drugs to poor patients. It also sought that the state and the BMC coordinate to draft a comprehensive public health strategy involving all stakeholders to strengthen public health care in city, especially primary health care.

“Public health care had always been ignored in India with just 1.2 % of our GDP being allotted for health sector,” said public health researcher Dr Amar Jesani. Yet, it is the public health care system that has always come to the fore, as it did during the Surat plague epidemic in 1994,” points out Dr Jesani. “The private health care sector had shut shop and fleeced the situation denying health care to people at a critical juncture. Mumbai could witness a similar scenario.”  Dr Jesani is all for the government taking charge of the private health sector, as is being done in Spain.

It is high time the voices of these frontline health care warriors battling the virus, especially the nurses, get a serious hearing from doctors and state health authorities. The least that can be done is to ensure they are are given adequate PPEs before being sent to the coronavirus battle front lines.