Warriors in white: ‘Help us help you’

Three months since China reported the outbreak of the 2019 novel coronavirus in Wuhan, India’s frontline health workers have been stretching their limits to keep the country safe. Everyone, with PM Modi in the lead, believes the Indian response would not have been what it was but for the conviction of the healthcare workforce

Doctors and nurses hold an awareness event at a government hospital in Jammu. PTI

Aditi Tandon in New Delhi

Seen in the backdrop of the human loss Covid-19 is causing across the world, especially the EU, the US and Iran, India’s national data signals a ray of hope. A mix of early preventive strategies on public health and administrative fronts has helped India restrict the virus to imported cases and their immediate contacts so far, which means the disease hasn’t begun transmitting in the community.

India has so far done well to contain the virus banking on the commitment of the public health cadre, robustness of disease detection and boldness of political decisions to lock down traffic from China when the whole world was still mulling hard decisions.

‘We stay at work for you. You stay at home for us,’ was the message AIIMS senior resident Amarinder Singh Malhi posted on Twitter. PM Modi backed it.

“We began screening passengers from China on January 21 much before WHO declared Covid-19 a public health emergency of international concern on January 30. India’s first technical group meeting for Covid-19 containment happened on January 8. China reported the outbreak on December 31,” says Health Ministry’s joint secretary Lav Agarwal.

Administrative decisions apart, everyone, with Prime Minister Narendra Modi in the lead, believes that the Indian response to Covid-19 would not have been what it was but for the conviction of the healthcare workforce.

That explains why PM Modi will personally lead a national thanksgiving for corona warriors at 5 pm today as the country observes a people’s curfew to halt the virus by following government’s social distancing norms from 7 am to 9 pm. These warriors on their part have only one larger request — help us help you.

PK Dash, a 63-year-doctor with Delhi’s municipal corporation, says the system is doing the best it can. “But we can do better with people’s help. People’s arrogance is shocking. A young symptomatic male visited my clinic last week and said nothing can happen to him. WHO has said the youth are not invincible. Do people understand why social distancing is necessary? The answer is simple – when an infected person coughs, droplets fall well within the 1-3 metre diameter and anyone in that range can get infected. Hand washing is crucial because the virus lives on surfaces for 12 to 48 hours and anyone who touches is at risk. PM’s Janata Curfew call is crucial. People staying indoors will mean breaking the chain of virus transmission,” says Dash, who has not taken leave in two months.

Frontline workers say they are not looking for credit. But each one of them is aghast at reports of educated people returning from Covid-affected nations and ignoring isolation protocols to put others at risk. As many as 7,000 contacts of 258 Covid-positive Indians have been traced by the Integrated Disease Surveillance Programme, India’s apex public health plan, led by the National Centre for Diseases Control.

“We are in stage 2 of virus transmission where we have only imported cases and their contacts among the infected. We are trying to keep the virus from entering the community. But what are we seeing? Educated foolish people are risking their lives and those of others. Kolkata’s first Covid-positive case is a Harvard student whose mother is a bureaucrat and father a doctor. The boy returned from Harvard, ignored the 14-day self-quarantine rule and roamed freely, infecting others. The result — an already strained health system had to spare resources to trace the people this boy met between landing in India and testing positive. This was avoidable. Wasn’t it?” says Kolkata-based Sanghamitra Ghosh, secretary general, Indian Public Health Association.

Epidemic Diseases Act

Maharashtra, West Bengal and many other states have now invoked the 1897 Epidemic Diseases Act to penalise people who spread infection. States are also using Section 144 of the CrPC to crack down on large gatherings against overcrowding. Frequency of metros and buses has been significantly reduced. But people’s wholehearted support in this fight is still awaited.

In Lucknow, a case has been registered against singer Kanika Kapoor, who returned from London last week and ignored her symptoms to party across the city. At least 500 of her contacts, including several politicians, are now being traced and isolated.

Three Kashmir-based youth, PhD students at Aligarh, escaped quarantine this week and landed back home, meeting several people along the way. They were later found and put back in isolation.

Ghosh points to another Kolkata-based doctor couple who returned from Dubai and came to work without complying with the 14-day home isolation rule meant to cover the incubation period of the virus. They were later isolated. As health cadres deliver with limited supplies of protective equipment, a section of doctors and nurses were isolated in Lucknow this week after a junior resident at King George Medical University tested positive — India’s first case of healthcare workers’ isolation from contact with a Covid-19 patient.

Across OPDs in hospitals, symptomatic persons continue to visit seeking medical services or simply to ask doctors if they are Covid-positive.

“We have been in hard situations and have done the best we could for protection. But people need to understand that everyone does not need to be tested. Also if the disease explodes in the community, testing, isolation beds and ventilators won’t help. We have to condition ourselves to think about protection rather than testing and hospitalisation because there is no treatment for Covid-19 and going forward, management for every patient will not be possible,” says Anil Gurtoo of Lady Hardinge Medical Hospital, Delhi, a sample collection centre for Covid-19 in the capital.

Gurtoo says people are obsessing about testing when they should be obsessing about social distancing.

“Even today our ventilator support system is strained. If we pool in all public and private sector resources of Delhi, we can manage a few thousand. No country can prepare enough for this kind of a pandemic. So, people must stay indoors for some weeks and help the country break the chain of viral transmission,” Gurtoo says.

“We stay at work for you. You stay at home for us,” was the message AIIMS senior resident Amarinder Singh Malhi, originally from Amritsar, posted on Twitter. PM Modi backed it. Malhi says doctors are working round the clock to help patients and reduce hospital infection but they cannot achieve much without people’s support.

“All hospitals must now close down OPDs. Only emergency services should run. The next eight weeks are crucial to halt the chain of Covid transmission and social distancing is the key. People should stay home if they want to applaud us,” says Malhi. Doctors also stress the need to not panic and say this is the flu season and many people will experience general symptoms. Not all of that would need testing.

A whole team of virologists, epidemiologists and lab technicians are currently involved in detection and management efforts to contain Covid-19 with testing capacity increased from 52 labs under ICMR to an additional 49. Private labs are being gradually roped in to build testing capacities that would be needed should India see community transmission.

Asked how the disease has been contained so far, Tanzin Dikid, NCDC Joint Director, says the integrated disease surveillance programme of NCDC is very robust.

“IDSP network now exists in 700 of India’s 712 districts. National, state and district surveillance officers are constantly monitoring disease trends and clusters to watch out for community transmission if any. NCDC is constantly guiding state health departments with contact tracing. It’s a mammoth task and is key to blocking the chain of viral transmission. Our challenge is a weak public health cadre in most states. Maharashtra, Kerala and Karnataka with strong cadres are doing better,” says Dikid.

India has traced nearly 7,000 contacts of Covid-positive persons.

On the successful Indian response to the pandemic so far, VK Paul, Member, Health, NITI Aayog, says, “We imposed travel and visa restrictions, enforced universal screening of air passengers much earlier than most nations and kept enlarging the scope of restrictions. NCDC led from the front in robust detection and contact tracing. The strategies kept the virus under check.”

But experts are wary of how the virus will behave. Nothing is known of the Covid-19 strain, and global research is underway to find a vaccine or a drug that works against it. “Our best case scenario is the onset of summer and the hope high temperatures will blunt the virus. Till that happens, social distancing is the answer. We must remember there is no treatment. The PM has already spelt out the way forward — protect yourself, protect the country, protect the world.”