From pay cuts to FIRs, doctors in India are reeling under the COVID-19 treatment burden and government complacence. The government’s indecisiveness led to a “total paralysis of regular healthcare service in India and severely impacted millions of people who were in dire need of medical services”.

On 23 September, Kushal Singh, a 33-year-old physical therapist employed at the Akash Hospital in Dwarka, Delhi, died after battling severe complications from Covid-19 for over a month. Singh’s family claimed that he had contracted the virus ‘while working tirelessly as a COVID warrior at the hospital’. Singh, who was admitted to the hospital’s emergency five days after developing fever and then having difficulty in breathing, had been put on an ECMO, and various other life-saving devices. Soon his lungs collapsed and doctors suggested an expensive lung transplant. As the cost of his treatment spiralled out of the family’s means, his brother started a fundraiser on a crowdfunding platform in a desperate bid to raise money for his treatment.

While Singh was battling for his life, the Indian government said in reply to an MP’s question in the Lok Sabha that it had no data on the number of doctors who have lost their lives due to Covid-19. Private body Indian Medical Association (IMA) released data that it had collected, which indicated that as of 11 September, at least 364 doctors had died while on the frontlines treating the disease. It has also submitted a detailed report on the working conditions of doctors and other healthcare workers to the Rajya Sabha, but hasn’t received any response from the government so far. On 16 September, the number had climbed to 382.

RV Asokan, honorary secretary general of the IMA, told HuffPost India that the association’s representatives in each state have been independently keeping track of doctors infected with Covid-19 and their condition through their personal networks and that the number they put out was the minimum deaths they have recorded among doctors in India due to Covid-19. “The data is not comprehensive, meaning these are the least numbers we have records of. There could be more,” he said.

According to IMA’s data, the most number of doctors died in Tamil Nadu as of 10 September—61. Next on the list were Andhra Pradesh (41), Gujarat (38), Maharashtra (36) and Karnataka (35).

Of these deceased doctors, said Dr Asokan, a fair number work at private hospitals and do not benefit from the government’s insurance scheme of Rs 50 lakh, which is supposed to cover the cost of treatment for medical professionals working on the frontline.

“The Government‟s non acknowledgement of the sacrifice of private doctors is a matter of great concern. A good percentage of the private doctors who have lost their lives are General Practitioners. As a class they are the first point of contact for everyone and spend quality time with patients before the patient is diagnosed as Covid. Non ownership of their services amounts to indifference,” IMA said in the report submitted to the Rajya Sabha.

Weeks after the IMA released data on the death of doctors, the central government is yet to get in touch with the country’s largest doctors’ body for a discussion. Individual states, however, have tried to compensate doctors. In West Bengal, after a 61-year-old doctor passed away, the government promptly fulfilled the family’s insurance claim and paid Rs 10 lakh. However, his family’s claim on the centre’s scheme was rejected because he was not a ‘government doctor’.

“Kerala has treated doctors fairly according professional autonomy and refraining from harm. UP, Maharashtra, Karnataka and AP have been the worse states when it comes to treating doctors,” Dr Asokan said.

The IMA’s report submitted to the Rajya Sabha earlier in September revealed the gaping loopholes in policy and implementation that put an unfair burden on the health infrastructure in India, endangering the lives of healthcare workers.

The report begins with tracing the effects of the lockdown on the healthcare system. While the report says that a strict lockdown helped ‘manage’ the outbreak better, a lack of clarity about policies resulted in the shutdown of small and medium clinics, rendering several healthcare workers jobless overnight.

“Small and medium clinics and hospitals were shut. Some are still shut or are weakly functional, resulting in poor access to health care, loss of jobs/livelihood among health care staff, and resulting in increased cost of health service delivery. Diagnosis and treatment of acute and chronic infectious and non-communicable diseases have all taken a backseat. The impact of Covid-19 creating setbacks on efforts to eliminate TB, or manage NCDs like hypertension and diabetes, are estimated to be high, but are yet to be fully and accurately known,” the report states.

Pointing out that a lack of proper timely guidelines on running non-Covid facilities and treatments was a huge mistake on the government’s part, the report claims that the government’s indecisiveness led to a “total paralysis of regular healthcare service in India and severely impacted millions of people who were in dire need of medical services”. “All private hospitals were advised to defer treatment and medical interventions required for other chronic ailments. Further, the Government instructed to keep 20% of the capacity for COVID without working out a feasible mechanism to support the sustenance of the operations,” the report says.

Voicing concerns about how migrant workers were treated during the lockdown and in the consequent months, the report states that these people are unlikely to place their faith in government institutions, including healthcare. The migration, resulting in loss of income and faith in government institutions, would lead to an increase in non-Covid morbidities, added the report, as out of fear, stigma and a traumatic experience from a government decision, people are least likely to visit hospitals for non-Covid ailments until it’s too late.

In a SWOT analysis of the government’s mitigation plans on Covid-19, the report points out that the government of India has been insisting on the use of the Rapid Antigen Test which is faster and cheaper, but has turned out to be extremely unreliable. According to the IMA, this is being done to amp up testing numbers irrespective of how effective the testing is, considering it has reported that 20-30% of the negative reports have turned out to be false. “According to ICMR, RT-PCR test is considered as Gold standard. Even if there is an element of delay in getting RT-PCR test report, but it is much more reliable than Rapid Antigen Test kits,” the IMA report states.

The report also says that the actual number of infections at present in India is at least 4 times the number recorded and projected and at this rate India is likely to see 40 lakh deaths and 120 lakh critically ill patients in the next 2-3 years. Currently, India has witnessed at least 6.15 million cases of COVID-19 infections and at present has 9,47,576 active cases. At least 96,318 people have died in the country from the disease in the past few months..

The report makes shocking revelations about how resident doctors — fresh graduates or postgraduate students who have to pick up a lot of the work in the hospital — have been suffering due to long work hours, no mental health help and pay cuts. The report says that residents at government hospitals have been posted at ICUs, no matter what their specialty is. Though the government had mandated a compulsory 14-day quarantine period between two shifts at a COVID facility, most residents are being summoned back without adequate break.

The report outlines that resident doctors are working 15-20 hours a day and 110-140 hours a week whereas the number of hours approved by the Central Residency Scheme 1992 is just 48 hours a week. “Most of the hospitals do not provide Duty rooms to resident doctors, doctors are forced to sleep in treatment rooms, nursing stations or other temporary arrangements,” the report says.

The report also talks about district administration in states threatening doctors to work in COVID-19 facilities. Private practitioners were initially asked to keep their clinics and hospitals open so that non-Covid patients would not suffer. Now in various Tier II & III towns they are forced to give their services for dedicated Covid hospitals for 8 to 10 hours a day leading to neglect of their own institutions and patients. They are not being adequately compensated as well,” the report states.

It adds that there have been several instances of government administrations forcing elderly doctors with co-morbid conditions into working at COVID-19 facility or making them open up their clinics. Government officials at state and Centre levels have been reportedly threatening doctors that their licences will be revoked under the Epidemic Act and Disaster Management Act if they don’t do the government’s bidding.

Dr Asokan said that the government of India has never had a process to forge a proper relationship with private doctors, something that has hurt the latter during the pandemic significantly. Having their own interests in healthcare, the government also has a sort of conflict of interest engaging meaningfully with private healthcare.

While some states have fared slightly better than the others, Dr Asokan said generally the governments’ response to healthcare workers has been ‘an exercise in hypocrisy’.

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