Punjab health workers use diluted sanitisers, cloth masks; health minister says state is “prepared”

“The residents of Govt. Medical College, Amritsar, like many medical institutions across the country, are working in conditions that provide absolutely no protection against contracting the virus that knows no boundaries,” the Resident Doctors Association of Punjab’s chapter in the institute said in a letter dated 25 March. The association stated in the letter that there are “no masks, gloves or sanitisers available, let alone PPE kits”—personal protective equipment—“for those working in the emergency.” Two residents of the hospital have been admitted in the isolation ward for symptoms of COVID-19. 

“Examples of doctors working in these times, succumbing to the virus, seem to not have made an impact in this institution,” the association noted. It specified that repeated attempts at conversation about this “pitiful condition” to the authorities have failed. “Residents have been ordered to work, disregarding their own safety and the entire concept of the spread through healthcare workers.”  

The letter illustrates how healthcare workers in Punjab risk contracting the virus themselves while battling the COVID-19 pandemic. As of 26 March, the state had reported 33 cases of the virus. Doctors from government hospitals across the state also told me that they are facing a shortage of the essentials required to treat COVID patients, such as PPE, decontamination suits, hazmat suits, and even sanitisers. The hospitals are not equipped to deal with the outbreak, according to them. The crisis in Punjab assumes significance in light of the situation in Italy, which has seen the highest number of COVID-19 cases in the world—health workers in Italy make up nearly eight percent of the total cases in the country. In Rajasthan’s Bhilwara district too, fifteen health workers who were working in a hospital that treated a patient with COVID-19, have reportedly tested positive with the virus.

Balbir Singh Sidhu, the Punjab health minister, denied that there was any shortage of protective gear in Punjab. “We are the most equipped state in India talking about fighting the COVID-19 outbreak,” he told me on 25 March. “We have enough masks, sanitisers, PPE sets and ventilators. Health workers, including doctors, are getting everything, they need. Who says we are short of stuff?” 

Sidhu had earlier acknowledged that the state can potentially see a high number of coronavirus. On 23 March, he wrote a letter to his union ministry counterpart, Harsh Vardhan, stating that ninety thousand non-resident Indians entered the state in the month of March. “Many of them have symptoms of COVID-19 and are further spreading the disease through their contact/transmission,” Sidhu wrote. “We require more extra manpower, specialist, Intensvists, Anesthetists, Pulmonologists, doctors and nurses. We also require medicines, logistics, Ventilators and many other items. To meet these urgent demands and rise to the occasion to defeat this disease, Punjab State requires additional funds of minimum Rs. 150 Crores from Government of India.”

However, when I asked him about the letter, Sidhu said that the money had been sought to further strengthen the existing healthcare system in the state, “for tackling the future viral infections post the COVID-19 outbreak.” He seemed to be prematurely claim the state’s victory over the virus.

Conversations with doctors from across the country revealed that leaders such as Sidhu are denying the reality. “There is no essential equipment and no disinfectants. We are inadvertently exposed to possible carriers during OPDs”—duties in the Out Patient Department—a doctor who works at a community health-centre in Fatehgarh Sahib told me. The doctor told me that the OPD in her hospital could have been run on a rotational basis, but her hospital authorities did not take that option. “Sub-standard sanitisers are purchased and diluted with water” in the centre, the doctor said. According to the doctor, the staff is forced to use masks made from the hospital bedsheets and “ordinary disposable masks which offer no protection in this viral infection.”

Most doctors I spoke to complained about a dearth of N95 masks, a part of the required PPE. Dr Harish Malhotra, Patiala’s civil surgeon, confirmed to me that not all doctors in the district are being provided with the N-95 masks. “Not all doctors require the N95 masks—only the ones in the isolation wards and those handling the COVID-19 positive patients require it. We are providing surgical masks, two- and three-layered masks to the staff,” he said. Surgical masks do not offer protection from viruses. “Things are in pipeline. I am ready to give all that we have if anybody requires it,” Malhotra said, referring to N95 masks. A doctor who works at a civil hospital in Patiala pointed out that this is not an effective strategy. “How would we know if a patient is positive or not?” he said. “Number of tests being carried out in the state are much lesser than required,” he added. 

Sidhu told me that the state has “more than five hundred ventilators.” He also claimed that the health ministry has sent over twenty thousand masks to the Shahid Bhagat Singh Nagar district. The district, popularly known by its previous name, Nawanshahr, has reported 19 cases of COVID-19 till 26 March, the maximum in Punjab. However, a doctor aware of the situation in Nawanshahr said that it is facing a huge shortage of masks. A private doctor based in Patiala, who is a senior office bearer of the Indian Medical Association, Punjab, told me, “There is not a single ventilator in Nawanshahr and just one in Tarn Taran district, with a huge NRI population.” He said that before the outbreak, there were only 49 ventilators in the government hospitals across the state and around three hundred in private hospitals. “In case of a spurt from the current stage two, we would be overwhelmed due to the ill prepared health department in the state,” he said. 

Sidhu had told me that the state government has ordered 70,000 PPE kits and of them, two thousand are arriving in Punjab each day. Whatever PPE kits arrived so far are extremely low quality, according to Bhagwant Singh, a surgeon and the vice president of the IMA, Punjab. The staff must be trained to wear and remove the kit properly, but “there has been no training so far.” Videos available online would be the only training tool for the medical staff in the state, he added. A PPE kit can be used for just six–eight hours and must be discarded after that. “A PPE kit does not allow you to answer nature’s calls and six hours is the maximum a person can control,” he said. “These cannot be reused since the outer layer is totally infected.” 

Two doctors at a hospital in Amritsar told me their hospital is suffering from a dearth of PPE sets. Doctors working in the “flu corner”—the area where all patients with flu-like symptoms are examined—just have two PPE sets that they have to use for 12 hours. “Those working in Emergencies in gynaecology, paediatrics and orthopaedic departments are getting nothing,” one of the doctors at the Amritsar hospital said. 

Singh thought that community transmission has started in the country. According to him, if health workers are made to work without required protection, it can lead contracting the infection and becoming carriers of COVID-19. Worse, he said, it can lead to a shortfall of the medical professionals in the state. “We are already facing a staff shortage and need health workers on a rotational basis,” he told me. Singh added that the COVID-19 outbreak in China was brought under control as healthcare workers from around the country were mobilised to its epicentre in Hubei. “But in case of India, the entire country is fighting against the pandemic and is under lockdown. Under such conditions, the resources will be restrained, and manufacturing would also go down and even the transportation would be hit.”