Two-and-a-half-year-old Devan (name changed) is one of the youngest COVID-19 patients in Delhi. His father too has tested positive, as has his three-month pregnant mother who works as a healthcare worker at the Delhi government-run Dr. Baba Saheb Ambedkar Hospital.
A total of 106 employees of the hospital, including doctors and nurses, have tested positive for the virus. This is the highest number of COVID-19 infection among healthcare staff in any hospital in Delhi. While the hospital claims to have taken all precautions to avoid the spread of the virus, its healthcare workers claim it failed to “properly isolate” suspected cases and strictly follow standard protocol.
The Medical Director of the hospital, M.M. Kohli, did not respond to multiple calls and text messages. A senior hospital official, however, said: “Not all of these cases are hospital-acquired. Many of the employees come from hotspots and they could have been infected there.” The official said the hospital is now taking “extra care”.
The infection ‘source’
In the second week of April, the hospital announced that cubicle 1 of the Medicine Emergency Ward 1 will be kept for patients suspected of COVID-19 infection, said sources.
In the next one week, more than three patients died in cubicle 1 and at least one of them, a 40-year-old woman, tested positive for COVID-19. Since then, the infection has spread among the hospital employees, said the sources.
The Hindu spoke to six healthcare workers, including doctors, who worked in Ward 1, and all of them said that cubicle 1, which is separated from cubicle 2 only by a shoulder-high wall, did not provide “proper isolation”. They also claimed “lapses” on the part of the hospital and said the spread could have been avoided to a “large extent”. Several workers said they had raised the issue with senior doctors and the HoD (medicine), but the “lapses” continued for about one week.
“We used to go home after working in Ward 1 as there was no facility to stay. We were worried that we would infect our family members too. We raised the issues regarding cubicle 1 but the hospital did not listen to us,” said a healthcare worker who tested positive.
“Everyone who worked at ward 1 is worried. A lot of us have tested positive and many of our family members are also infected,” said a second healthcare worker, who tested positive.
Family members of at least four employees of the hospital have tested positive, according to workers.
Across the city, more than 350 healthcare workers in different hospitals have been infected with COVID-19.
The hospital’s Head of Department (medicine) Harender Kumar told The Hindu , “It was very difficult to separate suspected and non-suspected COVID cases as the hospital was not built that way. The problems began when our hospital was turned from a COVID hospital to a non-COVID one. When it was a COVID hospital, we had all the facilities. Most of the healthcare workers who have tested positive in Delhi [over 375] are employed in non-COVID hospitals.” On May 3, the president of Federation of Delhi Government Nurses, Jagdish Kulhari, wrote to Chief Minister Arvind Kejriwal and the Health Secretary complaining about the “mismanagement” at Dr. Baba Saheb Ambedkar Hospital and requested them to take action against people responsible for high number of healthcare workers testing positive. He said that no action has been taken so far.
Families allowed
Patients with issues such as diabetes, respiratory problems and high blood pressure are admitted to Medical Emergency Ward 1, which has at least 36 beds and six cubicles. The ward has six cubicles with a “nursing station” at the centre, where doctors and nurses sit.
A couple of days after the hospital’s announcement, a senior doctor sent a message on an internal WhatsApp group of the hospital on April 17. The message, accessed by The Hindu , read, “Every unstable patient coming to ward 1 and being suspected of COVID 19 will be kept in first cubicle of ward 1… No or minimal attendants allowed in that cubicle. Only one fixed junior resident and one fixed staff in every duty will enter for his or her sampling and treatment.”
Though isolation was mandatory for suspected patients, the healthcare workers said families and attendants were allowed to visit cubicle 1. In fact, the patients in cubicle 1, their attendants and others admitted to Ward 1 used the same toilets.
“Her [the woman who died] sister was sitting on her bed and holding her hand,” said a doctor. The patient’s husband also confirmed that her sister was with her the whole time and she did not wear PPE.
“The family members never used PPE. There were not enough PPE for us, how could we give them to family members?” asked a healthcare worker.
Five of the six healthcare workers complained about problems with using PPE. “Multiple times I went inside cubicle 1 without PPE. There would be so many patients at the ward that one doctor wearing PPE could not be assigned for cubicle 1 the whole time,” said the doctor.
They also said that PPE kits were not available to them in the first two-three days after the cubicle was earmarked for suspected cases, PPE kits were not available to them.
Meting with HoD
All the six workers agreed that cubicle 1 was ill-equipped to handle suspected COVID-19 cases. It did not even have a separate set of workers to attend to the patients. “Everyone here agrees that it was not made according to standard protocol,” said another doctor. “Family members of suspected patients were roaming in the ward. They would come to the nursing station to inform if the patient had some problems. How can isolation be done in medicine emergency where patients keep coming 24X7?” asked the healthcare worker.
“We kept talking about how it was not proper and almost every day we told doctors that the patients should be shifted somewhere else,” another worker said.Worried about the spread of virus, several doctors and nurses met the HoD (medicine) and complained about the problems with cubicle 1. “They still did not shift the suspected cases out of ward 1,” a worker, who attended the meeting, said. Another worker also confirmed that the meeting took place.Around April 20, after the issue was raised multiple times, the hospital shifted the patients from cubicle 1 to ‘Ward 2A’, an isolation facility earmarked only for suspected cases. Ward 2A was planned keeping in mind the “benefit” of patients and healthcare workers, said Dr. Kumar. The new wardhas a separate set of healthcare workers, said hospital officials.
Delay in results
Several healthcare workers said their samples were taken on April 23, but the report did not come till May 1. A second sample was taken on May 1 and the reports came on May 3, in which many tested positive. “In these 10 days, we were under home quarantine and risked infecting our families,” a worker said.
The 40-year-old woman died on April 18 and her report came out on April 20. The nurses and doctors who attended to her met the HoD on April 21, but their quarantine order was issued on April 22. Many workers said they worked on April 21 and 22 and later tested positive. “If they had quarantined suspected cases on time, less number of people would have been infected,” a healthcare worker said.
