Monday, April 6, 2020

Many health workers in Delhi infected by Covid-19

All hospitals, including private ones, have been screening every patient for fever, cough and travel history before they are allowed in.

Doctors examine patients at a hospital in Delhi.
Doctors examine patients at a hospital in Delhi

In just over a month since the first Covid-19 case was reported in Delhi, at least 24 healthcare workers—doctors, nurses, sanitation staff—have tested positive for the disease in the city.
While a couple of them had a history of international travel, some of them—like the doctor couple who worked in two mohalla clinics in north-east Delhi and a resident doctor of respiratory medicine in Safdarjung Hospital—were infected via their patients. For the others—like the two doctors and six nurses from Delhi State Cancer Institute and the resident doctor from AIIMS—the source of infection is unclear.
Around 108 staff members from Sir Ganga Ram Hospital had to be quarantined after coming in contact with two Covid-19 cases unknowingly. Similarly, around 81 people from Maharaja Agrasen Hospital were quarantined after two of the patients admitted to the hospital for almost 20 days tested positive for the disease. One doctor, three nurses, and a member of the housekeeping staff have also tested positive at the hospital.
All hospitals, including private ones, have been screening every patient for fever, cough and travel history before they are allowed in.
So far, Delhi has reported 503 cases of Covid-19, of which 320 are linked to Tablighi Jamaat.
So many healthcare workers have taken ill, at a time when the Delhi government is preparing for a surge in the numbers of up to 1,000 cases a day.
Why are so many healthcare workers getting infected? Experts believe it is because they are out and about during the lockdown.
“Currently, most people are at home so they are not being exposed to the infection. However, doctors are out and about. They are also more likely to come in contact with people who have the infection at hospitals and clinics. And, no matter how much screening you do, there is bound to be 20 to 30% of the people who will not have fever or cough yet will be able to transmit the infection to the doctors,” said Dr Jugal Kishore, head of the department of community medicine at Safdarjung Hospital.
So, what can be done? Virologist Dr Jacob John says universal respiratory protection is what will keep the doctors safe for the upcoming surge.
“I have been saying this. Everyone needs to wear a mask. Patients—even if they are going to a hospital with a broken toe—should wear a surgical mask. The doctors should all wear N-95 masks. But that is not all, they should also wear goggles that can be sanitised every day to prevent the infection from entering through their eyes. This is for every doctor, even in clinics. As for those in Covid-19 wards, the government has to ensure proper protection. We need all our doctors when the numbers shoot up,” he said.
For judicious use of the limited personal protective equipment (PPE) stock and to ensure no cross-infection, the Delhi government has dedicated two of its hospitals only for Covid-19 patients.
“No other patients will be seen in these two hospitals. This is a great step by the government to prevent cross infections. This also ensures that our PPEs are used judiciously, at the same time all our doctors and healthcare workers get adequate protection,” said Dr JC Passey, medical director, Lok Nayak Hospital campus, which is one of the two centres to become dedicated Covid-19 hospitals. No doctor from the hospital has got the infection so far, even though it has the highest number of Covid-19 positive and suspected cases.
The government has also ensured that after working for 14 days at a time, all the healthcare workers in the Covid-19 wards get to stay in hostels on campus or in luxury hotels so that they do not go home and pass on the infection.
Central government hospitals like Safdarjung and Dr RML, which also have isolation wards, have arranged for accommodation for healthcare workers in hostels on campus.
The 28-year-old Covid-19-positive senior resident from the physiology department at the All India Institute of Medical Sciences had passed on the infection to his wife who was nine months pregnant. She delivered a healthy baby boy at the hospital on Friday. The sanitation worker from AIIMS trauma centre, who tested positive for Covid-19, had passed on the infection to his wife, another sanitation worker in Charak Palika Hospital.
The shortage of quality PPEs—full-body suit, goggles, mask, gloves, and shoe covers—is another problem that the governments are facing in their Covid-19 fight.
“Due to the shortage in the market, several small manufacturers have come up and their products are not always quality, but one or two out of five manufacturers can give us decent PPE kits,” said an official from Lok Nayak Hospital.
The Delhi government has asked the centre for around 200,000 PPE kits and their Central Procurement Agency (CPA), which is responsible for buying all medicines, consumables and equipment for Delhi government-run hospitals, already has a tender in place for 1,20,000 PPE kits with three companies, which are being supplied piecemeal.
Most hospitals have just about enough and are working on using them judiciously. “We have around 1,800 kits in our store, around 500 are needed in a day. But, there is another shipment scheduled to arrive on Tuesday,” said a doctor from Safdarjung Hospital.
“The doctors are a part of our society and they are susceptible to the infection like everyone else. We need to examine where all of them got the infection from. Plus, we also need to ensure not only the availability of PPE kits but also that they are being used and taken off properly,” said Dr DK Sharma, medical superintendent, AIIMS.

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