COVID-19: Why Bihar is Sitting on a Ticking Time Bomb

New Delhi: In compliance with the Central Government, the Bihar Government responded with restrictions on movement to mitigate the risk of spreading the coronavirus, but has apparently invested little attention in improving its fragile health sector. Doctors, nurses and sanitation staff — who are prone to the infection, do not have protective gear such as gloves, aprons, long-sleeved gowns, goggles, surgical masks, face visors and respirator masks; they are even short of sanitisers.

Doctors from different medical colleges and hospitals recently met the Health Department’s Principal Secretary Sanjay Kumar. Instead of motivating the doctors, Kumar allegedly threatened them. “Apne aap ko bhagwan na samjhen. Main abhi chahun to at least 5-10 doctors ka registration cancel kara dun (Don’t think yourself to be god. If I wish, I can get at least 5-10 of you de-registered.).”

This happened after junior resident doctors of Jawaharlal Nehru Medical College and Hospital, Bhagalpur, wrote to their medical superintendent (MS), urging him to provide them with basic safety equipment.

“We interns, batch 2015-20, are requesting for proper equipments during duty hours as we are in the front line with risk of exposure to COVID-19 (sic),” read the letter accessed by NewsClick. It had a list of demands, such as closure of all non-emergency OPDs, PPE (Personal Protective Equipments) to all ACO/COT/labour room personnels, masks (surgical as well as N-95) in appropriate numbers, sufficient numbers of gloves, hand sanitisers/spirit in all departments and disinfection of ACO/COT/labour room at regular intervals.

Shockingly, the medical superintendent’s reply cited ICMR (Indian Council for Medical Research) guidelines and told them that they do not need to wear N-95 masks and PPE.

“With regard to your application dated March 24, 2020, the Principal Secretary, Ministry of Health, Patna, has given a clear direction via video conferencing that the doctors working in the OPD and the Emergency Ward do not need to wear N-95 masks and PPE. They need simple masks and gloves,” the MS replied to the students, annexing a copy of the ICMR’s guideline and forcing them to work in the same conditions.

When the interns objected, they were allegedly threatened with termination of their internship or an extension. The doctors said they are not provided with sanitisers or gloves and are forced to buy them on their own account, as they come in contact with at least eight to ten COVID-19 suspects on a daily basis.

“If this infection is transmitted to even one of the interns, it will eventually ruin entire hostels and will be further transmitted to patients who are not infected. Despite there being safety guidelines on paper, nothing is done on the ground. We admit 8 to 9 suspects everyday at our own risk. The administration wants us to continue and die in the line of duty without any protection, else see our career ruined,” a junior resident doctor told NewsClick on the condition of anonymity.

He claimed that the family of a patient affected with the coronavirus was sent home recently, after being advised to self-isolate. “Due to a lack of awareness, people are refusing to self-isolate. There is no system in place to trace such patients and ensure that they are staying at home. The police is doing nothing except beating up those violating the lock-down,” he added.

He mentioned that there are no testing kits available in Bihar and that doctors are using disposable HIV protection gear to examine patients in Patna.

“Amid the lockdown, when female interns demanded for a van or bus since their hostels are far away, the MS denied it as well, arguing that he cannot provide us with the same,” he added.

Reacting to the allegation, JLNMCH MS Dr R.C. Mandal said: “Let them (the students) complain.” After he hung up, Mandal texted back, saying that he “cannot talk right now.” When asked for a suitable time, he did not reply.

Resident doctors at Patna Medical College and Hospital (PMCH) have similar complaints. A senior doctor from the hospital made a damning revelation. He said that till March 25, there had been only between 20 and 22 beds for those suspected to have coronavirus symptoms. “The order to create a 100-bed isolation ward is only on paper. There is no implementation on the ground. The decision to convert PMCH’s departments of ophthalmology and dermatology into isolation wards is also on paper,” he revealed.

Junior doctors at the PMCH also complained about a lack of basic infrastructure and safety equipment. They said the investigation of coronavirus suspects in Bihar has been extremely negligent. “There are fears that the state may become the Wuhan of India,” said a group of Junior Doctors.

“Separate flu counters for coronavirus suspects have been fully operationalised. Therefore, patients reach the Emergency Ward directly. The patient from Munger who was declared COVID-19 positive after his death at AIIMS, Patna, was first brought to PMCH. He had a travel history to Qatar. He was initially brought to the Tata Ward of the PMCH’s old emergency ward. Even after it was declared that he had an infection, the ward has not been sanitised so far. Fearing infection, the doctors left the ward and have begun sitting in an open space. Some of the doctors started treating patients in the girls’ common room. These doctors repeatedly demanded the sanitisation of the entire Tata Ward, but it has not happened yet. This is extreme negligence,” they told NewsClick.

He said that the administration woke up and supplied PPE, masks, sanitisers and spirit to only a few senior doctors after the media reported about. Juniors still suffer a lack of basic protection gear. “They have been asked to treat patients without safety measures. They have been threatened with termination and other consequences if they fail to comply with orders. Several doctors who are deputed to the emergency ward have not given even simple masks and gloves. When they raised the issue, they were given HIV prevention kits, which do not guarantee protection from a coronavirus infection. This is the situation at PMCH, considered the last hope for more than 12 crore people of Bihar. Even doctors here are pushed to their death. We cannot imagine what happens if doctors get,” he said.

He claimed that at present, at least three to four resident doctors of the Emergency Ward are suspected to have been infected by COVID-19. The doctors are “scared”. Sick doctors have isolated themselves.

“It does not matter if we die tomorrow while treating patients. But it will be a murder and the government must be held accountable for its criminal negligence,” said Bharti.

PMCH doctors say they are helpless and that they are doing a disservice to their patients in the name of treatment. Since there are only 20 to 22 beds, those that come are sent back with self-isolation guidelines and basic medicines. Once a batch of suspected patients leaves, the space they leave behind is filled with another group of patients.

And this is not just about Patna. Five testing facilities were supposed to have become operational in Bihar by now. The entire state relies only on one testing centre, the Rajendra Memorial Research Institute in Patna, for sample-testing. It leads to a delayed diagnosis and treatment.

There is also a sense of confusion about the samples taken earlier and their investigation. Doctors from different departments who had collected samples have refused to take samples from any further suspects sample without necessary safety kits.

“Therefore, the actual figure of how many suspects have been investigated is questionable. The number of positive cases could be higher because precise data can only be found if the suspects are properly examined in time. While the world is cautious and making an effort to control the pandemic, we are doing nothing. Bihar is sitting on a ticking time bomb, which can explode at any point in time,” he concluded.

Nalanda Medical College and Hospital (NMCH), along with the Indira Gandhi Institute of Medical Science (IGIMS) and the All India Institute of Medical Science (AIIMS), Patna, have been designated to treat patients infected with COVID-19. Speaking about reports of just four positive patients so far, a junior resident doctor from one of the three hospitals said, “The truth is that the numbers are much higher. But due to a lack of screening and contact tracing, we are not able to identify people.”

When asked what happens to someone with symptoms of the coronavirus, Bharti said: “The person will be admitted to the isolation ward. Once they test positive, they will be sent to the NMCH. But, there is no arrangement for their transport. Even those who drive the government’s ambulance do not have safety gear,” he added.

PMCH MS Dr. Bimal Karak could not be reached for comments.

Aside from IGIMS and AIIMS, Patna, the NMCH has been declared as a designated hospital for the treatment of coronavirus patients. But, after 86 resident doctors of the hospital quarantined themselves after they too showed symptoms, the NMCH is said to have emptied its ward.

“The medical superintendent is threatening senior and junior residents with termination from the hospital. They are silent on necessary arrangements. They have either kept the government in the dark about arrangements to deal with the situation or the government is not paying heed to the threat, which is looming large,” said a doctor of the hospital.

The medical superintendent at NMCH MS also refused to comment, saying he was “busy” and at a meeting.

Bihar has only three hospitals for COVID-19 infected patients at the moment: AIIMS, IGIMS and PMCH. However, these hospitals do not have the resources to deal with such patients, who are not being treated. Doctors, who are working without protective gear, are examining patients while risking their own lives and becoming potential sources for community transmission.

Bihar is among a number of states with a lack of facilities or poor management, as shown by senior hospital staff. On March 26, students at Rohtak College in Haryana shared a video which showed how they were being forced to attend lectures despite the lockdown.