In the end, when the history of the Covid-19 pandemic is written, credit would be given to many for battling the virus but the maximum space would perhaps be devoted to the frontline workers: doctors, nurses, hospital staff, public health workers, community health workers (majority of whom are women), sanitation workers and everyone who worked directly with those who were infected or could have been infected in the line of duty. In one of its official responses, the government acknowledged that in the fight against Covid-19 in India, by the end of August 2020, nearly 87,000 frontline workers had been affected and nearly 600 of them had died. The actual number could be slightly higher.
The assessment of a fight against an enemy has to be context-dependent. Covid-19 has been a pandemic of unprecedented magnitude. All these factors make its prevention and recovery a challenging task.
The need for improving India’s healthcare system was being discussed even before the pandemic. Yet, when the pandemic happened, there was no choice but to fight. And the Indian healthcare system, despite all the challenges, mounted a concerted response.
Three government buildings where a lot was happening
Many people while crossing the Maulana Azad Road near India Gate in New Delhi do not know that the indistinct Nirman Bhawan building houses the Union ministry of health and family welfare (MoHFW) of the Government of India. It is as easily missed as the National Centre for Disease Control (NCDC) at Shamnath Marg in north Delhi and the Indian Council of Medical Research (ICMR), behind the iconic AIIMS. However, all three of these institutions were the nerve centres of the fight against Covid-19, each looking at some aspects of the country’s response. Their focus was on epidemiology, public health and medical care. During the pandemic, these institutions have been as busy on Saturdays and Sundays as if it were a weekday. These offices were not closed even when the entire country was under lockdown. They were clearly the ‘essential of the essential services’.
Responding to the Covid-19 pandemic required the engagement of all stakeholders, and every relevant department and institution was involved. The prime minister’s office, the ministry of home affairs and NITI Aayog were coordinating many of the responses. However, health was a crucial aspect and the MoHFW was the nodal ministry responsible for it.
At the state level, the departments of health had rarely received the kind of attention as they did during the pandemic. While all sectors worked together, at the state level, the pandemic response was supervised by the offices of the chief ministers as well as the highest levels of administration.
Exposed to risk, yet undeterred
Doctors and health staff were working for long hours and at times with very limited resources. Yet, often, even in their normal course of duty, they were abused and harassed. When community level health workers went to the field for contact tracing, wearing the full PPE in the extreme heat, they were attacked; this happened in different parts of the country, be it Indore in Madhya Pradesh, Munger in Bihar or Bengaluru in Karnataka. Despite this, each one of them continued to do their duty.
Fifty-six-year-old Dr Asheem Gupta was an anaesthesia specialist working in Delhi’s Lok Nayak Hospital. A passionate and dedicated doctor, he was involved in fighting Covid-19 from the very beginning. When on 3 May 2020, the Indian Air Force showered flowers over select Covid hospitals across India, a very pleased Dr Gupta told a news channel that though work conditions were difficult, it was the passion to save lives which kept him and his fellow health staff motivated. He succumbed to Covid-19 at the end of June 2020.
Dr U.C. Ghosh was posted at a community clinic in Delhi. He was sixty-five years old. Being at high risk, he was advised by the authorities to go on leave if he wished to do so. However, he chose to continue to work. He got infected and did not survive.
Ambika P.K.,a 46-year-old nursing officer at a private hospital in Delhi, contracted and died of Covid-19 in the last week of May 2020.9 Many members of the nursing staff contracted Covid-19 and recovered.
By the third week of July, it was reported that from health workers to sweepers, nearly 102 Brihanmumbai Municipal Corporation (BMC) workers had died of Covid-19. These included 27 workers from the Solid Waste Management department who collected garbage, including biomedical waste, from assigned areas. Among those who had died were police personnel, community health workers, drivers of essential service vehicles, security guards and sweepers in the hospitals.
Dr Zahid Abdul Majeed, wearing the PPE coveralls, was with a patient who was being transferred to the ICU. Suddenly he noticed that the intubation (a procedure where a tube is placed in the trachea in the neck of a person to ensure breathing) pipe had been displaced. This could have been life-threatening for the patient. The PPE along with the face cover blurred his vision, which was not good enough to conduct a complex procedure to reposition the intubation pipe. Dr Majeed took off his protective gear and re-intubated the patient. This was in the line of his duty, where he risked his own life to save the life of a patient. He was sent for a mandatory isolation of fourteen days, as per standard procedure. His story is the story of hundreds of health workers fighting every single day in India, and across the world.
A nursing staff from a leading nursing home said, ‘I, along with others, received an hour-long training and was soon posted to the [Covid-19] ward. Initially, there was clarity on very few things. Nearly all of us had fears, everyone, doctors, nurses and other staff. Initially, there were just a few patients, but soon the number of patients increased and the load per doctor and nursing staff went up as well. There were many serious patients. It causes a lot of mental stress. Our family members remain worried. But they know this is war. And soldiers do not run away in a war. They fight till the end. I will also do the same.’
Responding to the Covid-19 pandemic required the engagement of all stakeholders, and every relevant department and institution was involved. The prime minister’s office, the ministry of home affairs and NITI Aayog were coordinating many of the responses. However, health was a crucial aspect and the MoHFW was the nodal ministry responsible for it.
Various agencies, institutes and organisations reprioritised their roles and resources to ensure they contributed to the pandemic response.
In March 2020, the National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, set up a 24x7 call centre to provide counselling to people in distress. Since then, several thousand calls have been responded to during the pandemic by trained psychiatrists, psychologists and other counsellors. NIMHANS has connected with nearly 130 mental healthcare professionals to help people in need of mental health services.
Doctors for You, a small non-governmental organization ensured that volunteers as well as doctors and nurses were available wherever needed. They engaged with governments for setting up isolation and quarantine centres in a few cities and states of India. Community-based organizations such as the Lok Swasthya Sewa Trust and Ekjut continued to work, during the lockdown and afterwards, with women at the grassroots level and the rural population to generate awareness about diseases, address mental health issues and to facilitate access to health services.
We have seen the images of Covid-19 patients, in a happy mood, sitting comfortably in Covid-19 facilities playing a game of chess. We have read stories of doctors, nurses, police personnel and other frontline workers returning to their duties soon after recovering from their illness. Personal tragedies, challenges, and struggles notwithstanding, all of us can do something for another. This is how the pandemic has been fought so far by everyone in India. There are heroes all around us, thousands and millions, who just don’t happen to wear capes. These are people from all walks of life who are working to defeat the virus and stop the pandemic. All we have to do is recognise these ‘heroes without capes’ and give them their due respect and recognition, every single time, always.
Excerpted with permission from Penguin Random House India.
Views are personal. Lahariya is a medical doctor and leading public policy and health systems expert; Kang is an infectious-disease researcher; Guleria is director of the All India Institute of Medical Sciences, New Delhi.