If steps are not taken to decongest Thiruvananthapuram Medical College immediately, the COVID-hit tertiary health centre will in no time collapse under the disproportionately huge, even avoidable, responsibilities being heaped on it.

Along with the long-term sustainability of the Medical College, there is yet another grave concern. Junior doctors, especially post-graduate students who take most of the treatment load, are falling prey to the virus, like valiant but unarmed fighters in a freedom struggle.

COVID vs Medicine Department

The Internal Medicine Department, which mostly handles COVID patients in the Medical College, is virtually hollowed out. Five junior residents (PG students) and one medical officer have by now tested positive. (This is not counting the residents who had tested positive in other departments like Cardiology, Paediatrics, Respiratory Medicine and Surgery.)

Over 20 others, designated high-risk contacts, in the Medicine Department have gone into quarantine. In fact, all doctors in the department are considered 'low-risk' contacts.

"The staff shortage is so acute that even high-risk PGs continue to work after giving their samples. This, in normal case, is breach of protocol but they have no choice," said Dr Nidhin George Kodiyan, the president of Kerala Medical PG Association.

Dangerously exposed warriors

At the moment there are about 42 PGs manning both the COVID and non-COVID wings of the department. And nearly half (20) are first-year PG students who had joined less than a month ago. "It is not right to leave the treatment to the first-years without anyone to guide them," Dr Kodiyan said. His talk frequently broken by dry coughs.

"I have developed strong symptoms," he said. His first test was negative and his second test is scheduled today. He is near certain he has the virus. "Four PGs with me had tested positive. Most probably, I too will have to be admitted," Dr Kodiyan said.

Almost the entire second-year batch has been made dysfunctional; either they have tested positive or are high-risk contacts. Three or four among the 'high-risk' PGs still take turns to work considering the huge workload.

The final year students are having their practical examinations and so were asked to keep away from the hospital. But when the situation worsened, they have stepped in, risking both their health and future.

Single door trap

And now the only doctors left are taking 12-14 hours of daily duty when accepted medical guidelines say their duty time should not extend eight hours.

Senior Medical College doctors Onmanorama contacted said the Medicine Department was bound to fail. "I will be surprised if anyone doing duty in the Medicine ICU does not contract COVID," said Dr Ajith Prasad, a senior surgeon in Thiruvananthapuram Medical College, and also the president of Kerala Government Postgraduate Medical Teachers Association (KGPMTA).

The COVID ICU has just one entry point. "The WHO protocol says that the donning and doffing (wearing and removal) of PPE kits should be done at enclosures created on either sides of an ICU. But here, both the actions, donning and doffing, are done at the same place, and very close to the patients. Worse, patients pass through this small entrance to go to the bathroom," Dr Prasad said.

Left alone with the virus

It is as if these junior residents are of no value that they could be easily sacrificed, no questions asked.

Since there are not many PG mates left to share duty, one junior resident has to be inside the COVID ICU, in full PPE kit, for 12 hours at a stretch. "There is no specific room for PGs to rest. What is there is a small block near the patients for the PGs to sit. There is no ventilation either. We had asked for a separate rest room for doctors but till now our request has been ignored," a PG student who did a 12-hour shift in the ICU said.

12-hour mummification

To remain trapped inside the PPE kit for hours together is yet another health hazard. "By two hours you sweat profusely and before it is four hours you are dehydrated. You cannot drink water while wearing the kit. And then to wear the kit for 12 hours, though the kit would be changed in between, is a primitive kind of punishment," Dr Kodiyan said.

A PPE kit is not supposed to be worn for more than four or five hours at a stretch. So when these dehydrated on-duty PGs change their fatigued PPE kits for a new one after four or five hours, it will be done inside the ICU and near COVID patients with a dangerously high viral loads.

Quarantine violation, by force

The Respiratory Medicine wing, which also deals with COVID patients, is also suffering a crisis of dwindling healthcare staff. It is a relatively small department and already three PGs have tested positive and many have gone into quarantine.

The resident doctors who have been marked as 'high-risk' contacts, considering the shortage of staff, have now been asked to get back to work before their quarantine period is over. "Already, some PGs who are primary contacts of the positive PGs continue to work hoping that they will be saved by the N-95 masks they had on them when mingling with the PGs who had turned positive," a medical officer associated with the Respiratory Medicine Department said.

Reserve MCH for severe patients

Senior doctors say the only way to stave off a breakdown is to decongest the hospital. "The Medical College is a tertiary care centre and minor COVID cases should be treated at the secondary level hospitals or the first line treatment centres that are being set up now. Even if the tests are conducted in the Medical College, asymptomatics or those with only mild symptoms should be back-referred to smaller hospitals. Something should be done to urgently ease the pressure on the Medical College," said KGPMTA president Dr Prasad.

The increasing volume of COVID patients is also leading to the dangerous neglect of non-COVID patients. Surgeries have been kept to the minimum and ambulances are used only to transport COVID patients.

Threat of ICU crowding

Just when de-congestion is seen as a remedy, the Chest Diseases Hospital at Pulayanarkotta, in the outskirts of the capital city, has announced on Monday that all patients requiring admission should be referred to the Medical College.

Reason: Some of the hospital's staff, including doctors, have tested positive and, therefore, all in-patients have been designated as primary contacts.

"If more patients with acute respiratory distress syndrome (ARDS) now flock to the Medical College, there is every chance that the ICUs in the Medical College will be filled up soon," a Respiratory Medicine doctor said.

Response of Medical College

We tried to get in touch with the MCH authorities, including superintendent Dr M S Sharmad, but they were not available for comment. However, an official statement from the MCH authorities said that it was under the supervision of the Infection Control Team and that arrangements in various wards and ICUs were done according to COVID guidelines laid down by the Institutional Medical Board.

"No one in the COVID wing of the MCH has been infected," the statement said. "Even in non-COVID wards, activities are being done strictly according to protocol. Every ward has a designated place for donning and doffing of PPE kits. And the staff has been given training on the use of PPE kits many times," the MCH statement said.

Further, it said that reports to the contrary were born out of the politically-minded allegations levelled by certain people.