COVID outbreak in Delhi’s Max hospitals; health workers say quarantined nurses forced to resume duty
At least eleven nurses who worked at the Max Super Speciality Hospital, in Delhi’s Patparanj area, have tested positive for COVID-19. This is the second hospital promoted by Max Healthcare—one of India’s largest healthcare providers in the private sector—to develop a cluster of infections among its employees. Earlier this month, at least 39 nurses from Max’s Saket hospital—a dedicated COVID-19 centre—were sent into quarantine after a doctor, a nurse and a parademic tested positive. But more worrying have been accounts of healthcare workers employed at Max’s hospitals, which seemed to reveal a troubling irreverence by the administration towards following basic quarantine protocol for the safety of its staff.
Multiple healthcare workers told us that at both Max facilities—in Saket and Patparganj—nurses who were exposed to COVID-positive patients were allowed to return home or to their hostels, instead of being quarantined at the respective hospitals. More alarmingly, the healthcare workers said that Max did not even allow its nurses to isolate themselves for 14 days, as prescribed by the Indian Council of Medical Research and the World Health Organization. According to a healthcare worker at Max’s Saket facility who wished to remain anonymous, fearing repercussions from the hospital administration, a nurse who was supposed to be under quarantine was asked to resume duty within three days of her isolation. Similar allegations emerged from Max’s Patparganj hospital, where two healthcare workers told us—also on the condition of anonymity, fearing for their jobs—that nurses under quarantine were taken to the hospital from their hostels and asked to assist with a surgery.
These allegations are grave because not only does one of India’s leading private healthcare providers stand accused of risking the lives of nurses who are at the front line in the battle against the COVID-19 pandemic, but also those of the patients and other health workers at the hospitals. Meanwhile, Max has represented itself, in a press conference and in emails exchanged with us, as an institution that has been proactive in ensuring the safety of its healthcare workers, with widescale testing of its staff and isolation wards in its hospitals. The contrasting accounts raise several grave questions, many of which have been left unanswered by Max.
The first outbreak took place at the Saket hospital, and Max issued a press statement about it on 13 April, noting that three healthcare staffers had tested positive. The statement added that there was “no chance” that they had contracted the infection from the hospital. But the statement also indicated that two patients who were initially admitted for cardiac issues had later tested positive for the novel coronavirus, on 9 April. It stated the administration had traced 39 healthcare workers who were exposed to the two patients, and had placed them under quarantine “in a separate and isolated wing at Max Hospital, Saket.”
The healthcare worker at Saket questioned the Max administration’s statement that the staff did not contract the virus at the hospital. “On what basis is the management saying that?” the worker asked. “There are two patients who are positive in the hospital already.” The worker continued, “Though they are saying that the staff are under quarantine, the quarantine is not being implemented properly for the staff.” According to the worker, at least one nurse who had attended to the COVID-positive patients and whose test results had already returned negative, had been asked to resume duty within three days. “The rule is that the staff who looked after positive patients should be quarantined for at least 14 days,” the worker said. The healthcare worker said that the nurse had resumed duty by 14 April, but four days later, she was back under quarantine again.
Around the same time, Max was dealing with another COVID-19 outbreak at its Patparganj hospital. Healthcare workers at the hospital said that in mid-April, a nursing superintendent tested positive after having operated on a patient without knowing that he was infected with the virus. While the superintendent was then isolated and given the necessary medical attention, her colleagues were neither quarantined nor tested until 20 April, when Max Healthcare announced that it will test all its patients and employees for COVID-19. That day, in a virtual press conference, Abhay Soi, the chairperson of Max Healthcare, announced that the hospitals would commence precautionary COVID-19 testing for all its employees and admitted patients.
At both hospitals, the nursing staff had been directed to stay in quarantine at their respective homes or nearby hostels where some of them reside. The healthcare worker from Saket questioned the administration’s decision. “They should never have let the staff go home. They share rooms with staff who work in several departments of the hospital or their relatives,” the worker said.
The concerns appeared to have been well-founded. On 18 April, when we spoke again, the Saket healthcare worker said that “two staff members tested positive in one hostel, so all the staff on the first floor are under quarantine.” The worker added, “The staff whose reports show negative have been asked to quarantine at home. Only those who work in close contact with patients are being quarantined in the hospital. Those who had indirect contact are in quarantine at homes and hostels.” According to the Saket healthcare worker, the hospital’s isolation ward had 350 beds and the nurses should have been quarantined there. “Seven nurses and two doctors are positive now,” the Saket worker added.
Healthcare workers from the Patparganj hospital told us that a similar situation had developed at their hostels, where nearly one hundred and fifty staff members had to be tested due to the outbreak. According to a Patparganj healthcare worker, things came to a head when a group of nurses were asked to work when they should have been in quarantine. “Many people are positive in our hospital,” the Patparganj worker said. “We are worried because the hospital is not following the quarantine guidelines … if the hospital does not follow government’s guidelines, they risk our health.”
As the crisis escalated at the two hospitals, we were exchanging emails with Tanushree Roy Chowdhury, the head of Max Healthcare’s corporate communications team. Chowdhury’s response presented strict protocols that were inconsistent with the accounts narrated by the healthcare workers. “Any staff member who has been contact traced (medium and high risk) are supposed to hospital quarantine for 5-7 days,” Chowdhury wrote. “A COVID test is carried out on day 6 as per exposure history. Once the reports are negative, they resume duty from day 7.” She did not directly address why the staff was quarantined at the hostels and not the hospital, instead simply stating, “Any staff who tests negative is allowed to go home.” To a query about the nursing staff being asked to work, Chowdhury responded, “There is no question of having quarantine staff come to work at the hospital. The reason we are testing all our healthcare workers is to ensure that we do not have infected and asymptomatic healthcare workers risking others in the hospital.”
On 22 April, Chowdhury wrote to us, “58 healthcare workers from Max Hospital, Patparganj were tested on April 20th. So far 3 individuals have reported positive for covid 19.” But according to a healthcare worker from the Patparganj hospital, at least seven nurses had tested positive. The Saket worker, too, told us that same day that seven COVID-positive nurses had come from the Patparganj facility. We wrote to Chowdhury again asking her about the inconsistent numbers, and she responded the next day with significantly different figures.
“From April 17th we have tested 220 nurses at Max Hospital Patparganj,” she wrote. “These are approx. 33% of the nursing population at the hospital. All of them are working in the high risk areas such as emergency and critical care. Out of these 11 nurses have tested positive. 6 nurses out of these have been contact traced to one single nurse who acquired the infection from family members who too tested positive.”
The uncontained eruption of coronavirus cases among their ranks has panicked healthcare workers, for their safety as well as the safety of their patients. “My worry is not that we will get infected, it is that we should not pass it on to our patients,” a second healthcare worker from the Patparganj hospital said. “When we turn up for work at the hospital, we will come in contact with so many patients, we worry we will infect our patients.”
The outbreak at Max’s Patparganj Hospital is a repeat of what has happened at three private hospital in Mumbai: Wockhardt Hospital, Bhatia Hospital, and Jaslok Hospital. On 6 April, the Bombay Municipal Corporation declared Wockhardt a containment zone after over forty nurses tested positive for the virus. At Bhatia Hospital, 45 health workers have contracted the virus, and 57 employees at Jaslok have tested positive.
Public-health experts maintain that hospitals turning into hotspots during a pandemic is a grim glimpse at the future, if the government does not step in and regulate the sector more closely. “In many states, private hospitals are involved in provision of treatment to COVID-19 patients but governments have rarely defined the terms of engagement,” Malini Aisola, a co-convenor of the All India Drug Action Network, a health-sector watchdog, told us. “One viable model may be for governments to provide free or subsidised treatment at private hospitals, while taking ownership of COVID care in private facilities. This could involve reimbursement at fixed rate and supporting running costs of the COVID facilities. Critically, it must include government oversight including of testing and infection control protocols, functioning of Hospital Infection Control Committees (HICC) and of treatment charges, if being permitted.”
According to a bulletin issued by the Delhi government on 25 April, the national capital has 1,702 active positive cases of the virus, and has seen 54 deaths. The bulletin noted that Max hospital had 92 cases of COVID-positive individuals admitted at the hospital, ten cases in the intensive care unit and six patients on ventilators, recording the highest number of ICU patients after the government-run Lok Nayak Jai Prakash Narayan hospital. Emails sent to Satyendra Jain, the health minister of Delhi, and Jasmine Shah, the Delhi Dialogue Commissioner for the Aam Aadmi Party, went unanswered. The story will be updated as and when they respond.
The coronavirus pandemic, which has infected near three million people worldwide and killed nearly two hundred thousand, has taken a huge toll on people on the frontline of this battle: the doctors, nurses and other workers at hospitals and clinics. The pandemic has pushed some of the wealthiest regions within inches of a healthcare-system collapse. Spain has the world’s highest reported rate of COVID-19 infection for doctors and nurses, with fifteen thousand health workers now sick or self-isolating, making up 14 percent of confirmed cases in the country, according to the country’s health ministry. As a result, labour unions representing the healthcare workers have now filed a lawsuits across the country, in an effort to compel the government to ensure adequate protection to them.
In India, the central and state governments as well as the hospital administrations must all learn from these global warnings. Several healthcare workers in the country have already died in this battle against the COVID-19 pandemic, including at least five who died in April itself. Ensuring the safety of these front line workers is of paramount importance, and any compromise in that regard has grave consequences in our ability to curb the relentless spread of this virus.