(Names have been changed to maintain privacy) Image is representational only.
The doorbell rings. Meera attends to the person at the door. She is a BMC worker who is collecting statistics and counselling residents. Recently a few people tested positive for Covid – 19 a couple of buildings down from where Meera lives. The BMC has since then started a tracking and awareness drive in the area. Do the cases in close proximity cause fear or anxiety? No. Not at all. Meera and her husband are both senior doctors. Meera lives in Navi Mumbai and works at a government hospital there. As doctors, they have both accepted these things as part of their life.
The hospital where Meera works has designated an area specifically for Covid – 19 patients. They continue to receive OPD patients, but doctors have been asked to put all planned surgeries on hold. They are now especially focused on patients with respiratory issues and the ICU is on in full blast. It’s true that the current reorientation of resources towards fighting the Covid – 19 pandemic means that their hospital is not able to cater to other patients as well as earlier, but Meera believes that the administration, police, and NGOs are geared up and will definitely help in any emergency. Plus, there are medical facilities spread across the city, including private medical practitioners. In emergencies, she is sure they will help too.
Meera is clear that no one can be 100% prepared for any eventuality. Even so, she admires the administration’s proactive handling of the current pandemic. It is not perfect, but the administration is willing. Ventilators and PPE are lacking everywhere, including in a so-called developed nation like the USA. Meera’s hospital too needs all this. Red tape is the first thing to go. In normal circumstances government hospitals must go through a prescribed procedure to procure any medical equipment they might need. This involves raising tenders and so on. Now this process has been bypassed and they’re asked to buy PPE with money made available from the municipality. The administration should continue to procure required medical equipment though, even if sellers are charging a bit more. Now is not the time to think about the money, we cannot pick and choose now.
This is an extremely fluid situation. That cannot be stressed enough. Every moment authorities are learning. They put a protocol in place, realise the problems that arise therefrom, and immediately make changes. This approach of the administration thinking on its feet is what has kept India from reached stage 3 so far. Health authorities and the administration are learning from other peoples’ experiences. The approach is, if something is working somewhere, in Bangalore for instance, lets implement it here. In Mumbai, Seven Hills hospital is demarcated for suspected cases to be quarantined, and Kasturba is for all positive cases to be quarantined. This specialisation of hospitals will help contain infections and required machinery can be diverted there. A high-level panel of doctors is in place who are constantly sharing and learning from each other’s experiences.
NGOs and private donors are also stepping up. Generous people have made donations so that hospitals can get what they need. Donations need to keep coming though, because hospitals are nowhere near having excess of required medical equipment, and they will always need more. Hospitals are actively scaling their capacity to handle the Covid – 19 outbreak. If they get the PPE & medical equipment they require along with space and appropriate infrastructure, they will be able to deal with the crisis even if India reaches stage 3. If the appropriate medical infrastructure is not put in place, it will be a difficult situation for healthcare workers to face. They will be put in danger of exposure. Meera states emphatically, doctors are not God! They are also human beings who are as vulnerable as the next person. If doctors & nurses on the frontline get infected, then what? Who will take care of patients? The situation will spiral out of control.
Meera praises young medical residents who are going out of their way to trace people, test them, and contain the infection. They are doing this for the good of the people, they don’t want people to suffer. Medical staff cares. But some people have given fake addresses, and when doctors head out to do surveillance, sometimes it’s like looking for a needle in a haystack. Then there are incidents of medical residents being asked to move out of rental accommodation and so on. Healthcare workers are well versed with standard precautions and disinfection procedures, which makes it extremely unlikely that they will pose a threat to residents in their buildings. Meera wonders whether it’s out of ignorance or fear that people are being selfish. Once a healthcare worker gets into PPE gear, they can’t even use the washroom, they can’t eat. Otherwise they’ll have to change the PPE, and we don’t have enough PPE to keep changing them whenever we want. So, medical staff stay hungry and put themselves in great physical inconvenience to do their jobs. These doctors are in their early 20s. They are just beginning their careers, their lives. It’s unfair to treat them like this. Meera prays that young residents are taking care of themselves, getting enough rest and nutrition. On their end senior doctors do what they can. They see that the residents are provided with adequate nutrition, and take on their normal duties so that residents can focus on fighting the situation caused by the outbreak of Covid – 19. But residents insist on coming in, or promise to come if they are needed, even when they are told to rest after working for more than 12 hours. Even then, if they are called, residents follow through. Meera simply states, we have good people with us.
When the crisis began, Meera’s husband asked her not to go to work. He did not want anything to happen to her. He said to her, you resign. In his years as a doctor with the defence forces, her husband contracted TB as an occupational hazard. Meera also retired as a defence doctor. They are both above 55 and have underlying health conditions that make them higher at risk. Their personal experience with TB made the current crisis all the scarier. But Meera put her foot down. She decided to take all the necessary precautions and continue work. She started taking her supplements regularly and a disinfectant is always in her purse. In the hospital Meera and other health care staff use standard precautions such as masks, gloves, etc. very strictly. When she comes back home, she doesn’t pause for even for a moment and goes straight for a bath.
Most of the people in Mumbai have risen to the present occasion. They are going to the market only for their daily needs. If that process is also streamlined it will be great. The administration needs to be more alert so that incidents such as what happened in Delhi do not happen again. A hotspot for the multiplication of cases was created which is causing havoc in the whole country. What was the administration doing? What was the police doing? Perhaps if travellers coming from abroad had been quarantined without exception instead of only being screened for fever, the outbreak could have been contained at stage 1 in India. People are pretty smart; they will find a way to circumvent any system put in place. If someone has a fever and they take a paracetamol, their fever won’t show up in a thermal screening. But how much information did we have at that time to take these decisions? The good thing is, the administration is constantly learning and adapting.
The main thing we need to do is to avoid droplet infections from spreading. In many ways our culture of sweeping and mopping every day is helping us in this situation. Meera believes that if citizens follow the guidelines laid down by authorities, stage 3 of the outbreak can be prevented. Yes, the infection has spread to densely populated areas such as Dharavi. But even there, if everyone understands their responsibility, the infection can be contained. Though not completely. It will spread, it is going to take its course. But hopefully, it can be limited to a manageable scale. Meera appeals to everyone, please, follow the protocol the government has put in place. They have done so after consulting experts, so just obey the guidelines. Healthcare workers are ready for whatever task is thrown at them. The administration, the police, everyone is rising to the occasion. It is now the citizens who will decide whether we heal or make the situation worse. If we are disciplined, we will be able to get through the situation without a lot of casualties. If not, we’re going to face a very, very difficult situation.
Meera and her husband take care of each other. She pushes him to keep healthy and rested, and he pushes her. He puts an apple and an orange in her bag and calls her during the day to check if she’s eaten the fruits. And she does the same. Meera has always been a loner, so she doesn’t really miss social activities. But Meera and her husband do miss going out for their morning walks. She hasn’t consciously thought about how her daily life has changed in the current situation. They have that fauji attitude of uthna hai, karna hai, chalo kiya. That sort of thing. By the time she comes back home she is so tired she just eats her food and goes to sleep. No time to think.
Photograph: Representational image, taken from Wikipedia