India's frontline doctors say surge in Covid-19 cases is ‘tip of the iceberg’

Doctors in critical care units tell ‘The National’ they fear rising death toll as entire families fall ill

A woman takes care of her husband who has Covid-19 as they wait outside the casualty ward at Guru Teg Bahadur Hospital, in New Delhi, India. Reuters 

Family members mourn after a man is declared dead amid a surge in coronavirus cases in India. Reuters

A patient with breathing problems is seen inside a car while waiting to enter a hospital for treatment, amid the spread of the coronavirus in Ahmedabad, India. Reuters

India’s second Covid-19 wave is devastating, with more than new 200,000 coronavirus cases recorded each day. Reuters 

Dr Rajesh Bhagchandani, centre, a director at Apex hospital in Bhopal city, intubates a patient. He feels helpless that the hospital, which is now reserved for critically ill Covid-19 patients, cannot accommodate more people who require oxygen. Dr Rajesh Bhagchandani

Dr Himanshu Dewan, director of critical care at QRG hospital in Faridabad, a town near India’s capital New Delhi, says the number of deaths will climb because patients do not have access to treatment. Dr Himanshu Dewan

A health worker arranges oxygen cylinders that are being used for Covid-19 coronavirus patients at a private hospital in Allahabad. AFP

Dr Himanshu Dewan, director of critical care at QRG hospital in Faridabad, a town near India’s capital New Delhi, is acutely aware a patient could die on the road if turned by hospitals that cannot admit more Covid-19 cases . Courtesy: Dr Himanshu Dewan

A man carries an empty oxygen cylinder to get it refilled at a private refilling station, for his relative who is suffering from the coronavirus disease, in New Delhi. Reuters

Patients with breathing problems are seen inside an ambulance waiting to enter a Covid-19 hospital for treatment in Ahmedabad. Reuters

A health worker collects a nasal swab sample from a woman in Amritsar. AFP

An Indian police officer distributes face masks in Hyderabad. AP Photo

A health worker administers the Covidshield vaccine at a government hospital in Hyderabad. AP Photo

People wearing masks wait to test for Covid-19 at a hospital in Hyderabad. AP Photo

A health worker takes a mouth swab sample at a hospital in Hyderabad. AP Photo

Nuns wait to take a test for Covid-19 at a test center in Kolkata, Eastern India. EPA

Frontline doctors battling India’s soaring coronavirus cases fear they have not yet seen the worst of the current surge.

Medics painted a dire picture of packed wards with no oxygen, from which many patients are turned away.

Doctors who spoke to The National said medical teams were at breaking point as they delivered news of a patient death to families every few hours.

On Saturday, India recorded the world’s biggest one-day jump in coronavirus infections for the third consecutive day, taking its three-day total to nearly a million.

“This is just the beginning. I still see marriages, birthdays, family gatherings taking place,” said Dr Himanshu Dewan, director of critical care at QRG hospital in Faridabad, near New Delhi.

“This is pulling us down because if the healthcare sector continues to get overwhelmed, you will see many more deaths.

“If we are unable to take care of patients who need us, the numbers will go up much, much higher.”

The shortage of oxygen is prompting the public and hospital administrators to appeal online for cylinders. Hospitals in many cities have put up signs stating that they have paused admissions because of a lack of supplies.

At QRG hospital, oxygen is being depleted at a pace never seen before.

“The tank normally lasts us a week. Now it does not last two days,” Dr Dewan says of the hospital’s 1,500-cubic-litre supply.

The run on oxygen started after numbers shot up from two to four Covid-19 cases per day last month to 220 beds occupied in two weeks.

“There are hospitals around town that have exhausted their supply or are nearing exhaustion. We have not fallen short so far but it is a real struggle,” Dr Dewan said.

“The way things are going, it may be us next.”

Vaccinated medics still catching virus

Images of weeping relatives across the country pleading with doctors to take in barely conscious patients have filled television screens in India.

Dr Rajesh Bhagchandani recounted harrowing scenes at Apex hospital in Bhopal, which is reserved for critically ill Covid-19 patients.

“It’s very painful. We are literally seeing patients daily begging us for a single bed but we are helpless,” he said.

“To treat a critically ill patient you need a bed, a ventilator, a source of oxygen. Without this, you cannot treat seriously ill patients in the corridor.”

Medics are treating entire families who test positive for Covid-19.

"We cannot see the light at the end of the tunnel. It's totally dark," said Dr Bhagchandani, a director at the hospital.

“Patients are continuously coming in. We don’t know when this will stop. They have severe infections with co-morbidities.”

“This is still the tip of the iceberg. We are expecting 10 times more cases soon because in each family someone is suffering from Covid. The difference from last year is that now the whole family is falling ill.”

Dr Bhagchandani said the 50-bed hospital’s resources are spread thin between patients who need the ventilator and those whose condition can be managed with mobile oxygen cylinders.

“We have to be very selective because we cannot take in patients who have a high oxygen requirement,” he said.

“That really pinches our heart. We are trained to save lives but because of rationing of oxygen we have to refer them to another hospital where oxygen may be available.”

Deaths in ambulances 

With hospitals filled to capacity, doctors try to stabilise each new patients until a bed is found elsewhere.

Dr Dewan says the numbers started to rise in late March after the Holi festival, when people dropped their guard.

The ferocity with which the virus spread has overwhelmed medical services that coped with a gradual rise during the first wave last year.

Dr Dewan said staff are acutely aware that if “we turn away someone without a proper plan that patient will die on the road”.

“We want to prevent deaths in the ambulance and on the road so we give the patient oxygen while we try to find them a bed somewhere else in town,” he said.

The hospital, like many around the world, is working with reduced staff. Some doctors and nurses are testing positive with mild symptoms despite taking both Oxford-AstraZeneca vaccination doses, and must self-isolate.

“Most of us are mentally and physically exhausted,” Dr Dewan said.

“This exhaustion has not taken a toll but if this continues, our clinical delivery of services is bound to be impacted.”

Young patients with long-term damage

The hospital has one fatality each day and breaking the news to relatives can often cause outbursts.

“Most are not ready to accept that someone who was talking to them three days ago is no more. In their mind, the person may have hypoxia, shortness of breath, but he could talk. Their surprise develops into anger against everyone – the hospital, doctor, the disease,” he said.

“Some come back to apologise because they realise it’s not the doctors’ fault. It’s the unpredictability of the disease that took the patient’s life.”

Many young patients who are discharged will need long-term monitoring for conditions such as lung damage due to low oxygenation. Others have suffered heart attacks and strokes and will need specialist care at home.

“This limits their quality of life, possibly their life span,” Dr Dewan said.

“These patients are in their thirties, forties and fifties and need counselling because of the comorbidities they develop.”

The federal government has been blamed for a lack of clarity on rules.

While exhorting people to stay safe, politicians including Prime Minister Narendra Modi held crowded election rallies for state elections.

Thousands were permitted to gather at a Kumbh Mela festival in northern India.

Each state has different rules on gatherings and this has encouraged people to move weddings and celebrations to neighbouring cities with more lax rules.

Dr Dewan had strong words for people who continue to disregard social distancing norms and attend family celebrations without wearing masks.

“You cannot have a more sad state of affairs. If you don’t wear a mask, you don’t stop the chain of transmission. Somebody is going to die. It may not be you, it could be your colleague, your friend, your family member. Somebody else will die for no good reason,” he said.

“People act as if Covid has gone away forever. People have forgotten about social distancing, masks. My worry is people are still not bothered.”