“I was a little guarded when the first four suspected cases of COVID-19 were admitted to the hospital in the early hours of March 17. But there were two nurses to look after the four patients who had travel history to countries with COVID-19 cases at that time,” said Anna (name changed), a nurse in her fifties working at Lok Nayak Hospital. To her relief, all four patients tested negative for the virus and were discharged within 14 days.
Three and a half months later, Anna is recuperating from fever and weakness at her home. She tested positive for COVID-19 in the second week of June.
“Initially, there were a lot of administrative issues and everyone was scared about the spread of the virus. Things stabilised with time and facilities for workers improved. But the workload increased too,” Ms. Anna said.
Workers and officials of Delhi government-run Lok Nayak Hospital, the largest COVID-19 facility in the city, and Guru Teg Bahadur Hospital told The Hindu that compared to the initial phase of COVID-19 outbreak many facilities have improved and the system to fight the disease has stabilised. But the number of severe cases being brought to the hospital has increased considerably, and wearing PPE and providing health care has become more difficult.
“In the first batch, there were two nurses for four patients. But now, there are two nurses for 18-20 patients. The patients who came early on were not in a complicated condition and we just had to give them HCQ tablets or paracetamol. But now they need more care as they have breathing problems and we need to keep a closer watch and help the patients with every little problem as attendants are not allowed,” Ms. Anna said.
She said the workers are getting exhausted with excessive workload, an issue highlighted by Medical Director, Lok Nayak Hospital, Suresh Kumar.
“The number of patients has gone up and also more sick patients are coming in. Such patients need extra care, which is taking a toll on nurses and doctors,” Mr. Suresh said. Lok Nayak, which has 2,000 beds, has admitted 5,777 patients till June 23 and 4,169 of them have been discharged, said the official.
Mr. Suresh said controlling the spread of the infection among the workers is another challenge. “About 80 hospital workers have contracted the infection so far,” he said.
At least 13 healthcare workers, including doctors, have died after testing positive for the virus in city hospitals. A Delhi government spokesperson did not respond to calls and messages inquiring the actual death toll of health workers due to COVID-19.
When it began
Mr. Suresh said initially the challenge was to go through the policies of World Health Organization and other agencies and prepare standard operating procedures for the staff on how to treat patients, put on and remove PPE suits and create a system to fight the disease.
“Two weeks before the first COVID-19 patient was admitted, we conducted one-hour training sessions for the workers. There was a strong fear in the minds of doctors and nurses and we tried to address them,” the MD said.
He said that in the first few weeks of the outbreak conducting the test was a problem. “Initially, our lab could test only 50 samples in a day and there was a delay in getting results from other labs. Now we have revamped our microbiology lab at Maulana Azad Medical College and we can test up to 400 samples per day.”
He also said Lok Nayak has been treating people from outside Delhi. “About 20%-25% of COVID patients have their homes outside Delhi. For instance, they may be working as a driver or a security guard in Delhi but the addresses they give to us are of their home towns in Bihar or Uttar Pradesh,” he said. “Patients coming from other States for treatment maybe around 10%, but it is difficult to give an exact figure,” said Mr. Suresh.
He said they have tried to do their best and have even conducted 1,140 dialysis sessions since March 17, which is the highest by any hospital in Delhi.
Current condition
Dr. Sunil Kumar, Director-Professor of GTB Hospital, who was the medical director of the hospital till June 27, said communication was one of the biggest challenges.
“Everybody wants highly personalised care, but not every COVID case needs such personalised care and people need to understand that. When someone is in ICU, that person needs more care and we do give them personalised care,” he said.
“Healthcare workers are feeling burned out and motivating them is also important. Right now we have enough personnel, but if the patient load increases, we would need more staff,” Mr. Sunil said.
A member of the nurses’ association of GTB Hospital said the pressure is increasing and they need more workers as the number of patients is going up. The MD said the hospital has enough staff at this point. As of July 2, only 274 of 1,500 beds at the hospital were occupied.
The MD of Lok Nayak Hospital said hiring more staff is not easy amid COVID-19 pandemic. “Earlier in June, there were 14 vacant posts of senior resident doctors in the medicine department and we advertised for a walk-in interview. Only two candidates came for it and we hired them. People are not applying as they are reluctant to work in a COVID hospital,” said Mr. Suresh.
He said the hospital will need 25% more healthcare workers when the total number of patients crosses 1,000 and even more if it crosses 1,500. As of July 2, 709 beds were occupied in the 2,000-bed facility.
Ms. Anna said there should be a rotation of workers to reduce their workload. “People working in non-COVID hospitals and COVID hospitals with lesser cases are getting the same salary as us, but their workload is less. This is not fair to us. There should be rotation of staff between different Delhi government hospitals, so that the staff of one hospital is not overburdened with COVID duty. Many are leaving behind their young children at home and coming to duty and staying at hotels,” she said.
“We have fewer nurses than actually required and extra nurses have not been hired since the pandemic broke out. In fact, the number of nurses has gone down. If the number of patients increases, we won’t be able to manage with the current strength of healthcare workers. We had highlighted this issue when the Chief Minister [Arvind Kejriwal] visited the hospital last week,” said Shoukat Ali, vice-president of the nurses’ association at Lok Nayak Hospital.
