Penal Servitude for Doctors, Nurses- Administrators Delight


                         Life for health care professionals like  doctors and nurses is hard in present era, right from getting into medical college, passing the exams, gaining experience, work under new imposed legal environment, with  over-regulation and under the moral burden of over-expectations of society. The benefit of these difficult situation is reaped to the maximum by administrators and overpowering medical industry.

            Despite working amid of a national emergency in Covid-times, the meagre salaries of hundreds of doctor and nurses are not paid for months in Hindu Rao Hospital, Delhi

         Ironically where doctors are punished for small genuine mistakes or even poor prognosis during  medical treatment, the blunders of health  administrators are taken as trivial issues.  More ruthlessness, cunningness or cruelty towards health care workers is possibly becoming an appreciated quality of health administrators.  Why no punishment for the administrators for such blunders?

     Consequently, with no support from society, to whom they serve, doctor and nurses gradually are pushed to a penal servitude. If this is regarded as normal in present era, anyone would wonder, what does slavery constitute?

   No salaries  for doctors for four months

The doctors alleged negligence and apathy on part of the government and said that they were unable to run their basic errands and accomplish their daily routine due to non-payment of salaries.

  Irked over non-payment of salaries for over four months in a row, doctors at Delhi’s Hindu Rao Hospital announced that beginning Saturday, October 10, they would stop attending to patients including those suffering from Covid-19. Hindu Rao Hospital, the largest municipal hospital in Delhi with 900 beds, is currently a dedicated Covid-19 facility.The doctors alleged negligence and apathy on part of the government and said that they were unable to run their basic errands and accomplish their daily routine due to being unpaid for months.Abhimanyu Sardana, President of the Resident Doctors’ Association (RDA) of the hospital, said that several letters and reminders had been sent to Delhi Chief Minister Arvind Kejriwal regarding the issue faced by the doctors, who are frontline warriors at the Covid-19 dedicated facility. “Don’t ignore the basic needs and rights of doctors,” wrote the RDA-Hindu Rao.

            Be it any circumstances like working without any facilities, poor infrastructure, non-availability of drugs, inhuman duties hours over 48-72 hours or poor pay, the administrators would say, “you are a doctor, it is your moral responsibility.”  Armchair preachers and administrators will always remind them of moral duties, but easily forget their own.

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Covid effect: Reasons for costly oxygen


 

Oxygen has been a essential lifesaving therapy for covid patients. As large numbers require oxygen for prolonged periods because of post covid lung damage, the requirement has increased manifold. So it is in short supply and there is no dearth of people want to monetize the need. There are multiple reasons of shortage.

 The Indian express explains

   The delay in transportation of oxygen to dealers, conversion into cylinders and supply to hospitals can get long if even a tiny link in the supply chain falters.  

As Covid-19 sweeps across the country, urban and rural areas alike face an unprecedented spike in oxygen use. Around 3-5 per cent (over 50,000) of active Covid-19 cases in India have lung tissues damaged enough by the virus to require external oxygen support.

Since March, medical oxygen demand has grown from 750-800 to over 2,500 metric tonnes, and now, hospitals are struggling.

The supply 

In an ideal scenario, it takes 3-5 days for oxygen to journey from a manufacturer to a patient’s bed. But delay in transportation to dealers, conversion into cylinders and supply to hospitals can take longer if even a tiny link in the supply chain falters.

India’s big oxygen manufacturers, such as Inox Air Products, Linde India, Goyal MG Gases, National oxygen, use cryogenic distillation technique to compress air, feed it into distillation columns and get liquid oxygen. It has 99.5 per cent purity. This process, an official from Inox said, can take two-and-half-days.

The liquid oxygen is filled into special cryogenic transport tankers that maintain -180 degree centigrade temperature to travel to smaller plants in hinterlands, where liquid oxygen is converted into gaseous form, fed into cylinders and transported to the final destination – hospitals.

India has the capacity to produce 6,900 metric ton of liquid oxygen daily, health secretary Rajesh Bhushan said in a media interaction. According to the All India Industrial Gases Manufacturers’ Association (AIIGMA), over 2,500 tonne is being directed towards hospitals, most consumed by coronavirus patients, and another 2,000-2,300 tonne is industrial requirement each day. So if India is not exhausting its capacity of 6,900 metric tonnes, why is oxygen suddenly a concern?

Logistics

Medical oxygen demand has grown threefold in six months. “The issue is not of supply, it is of transportation and storage,” says health secretary Dr Pradeep Vyas, Maharashtra, which produces one-fifth of India’s oxygen capacity.

As demand surges, logistics are falling short. India has roughly 1,200-1,500 tankers for transport. Before the pandemic, the tankers were enough, but now they are difficult to hire and cost more.

Inox is the biggest manufacturer of liquid oxygen in India, with capacity of 1,911 metric tonnes per day. It currently supplies 1,400 tonnes, and has 550 transport tanks and 600 drivers to supply to 800 hospitals across India. But this may soon fall short.

It can take 5-6 days, for instance, for oxygen to travel from Inox Pune plant to Osmanabad, where a dearth of oxygen has emerged. The Centre is now working to utilise nitrogen tankers to transport oxygen. In just Maharashtra, 10 more tankers have been roped in.

Then there is the problem of storing this huge quantity of oxygen, says Saket Tiku, president of AIIGMA. Most rural hospitals do not have oxygen tanks as the need never arose before. A critical Covid-19 patient can need 30-60 litres of oxygen in a minute. One cylinder can run out in 15 minutes to an hour, depending on oxygen directed to patients.

States are looking at alternatives, from buying extra dura and jumbo cylinders to installing oxygen tanks as buffer stock. Inox has got the contract to fix 64 jumbo tanks across Covid hospitals to store 4 lakh litres.

Several states have also begun construction of oxygen generation plants that convert air into oxygen, and provide 93.5 per cent purity. But this construction will take months. The AIIGMA states that across India, 500 oxygen plants are in the process of construction, of which two major ones will be in Pune (Maharashtra) and Modinagar (Gujarat).

The price rise

Oxygen is generally quite cheap, but suddenly it has become expensive. A cylinder that would earlier cost Rs 100-150 now costs Rs 500-700 for refilling. With this, hoarding has begun. Fearful of not getting a Covid bed in hospital, people are keeping oxygen cylinders at home.

Before the pandemic, it would cost Rs 1.5-2 to refill a cubic metre of oxygen. But the cost of logistics has risen, so now Delhi will find refilling costs Rs 10-15 per cubic metre, and Mumbai Rs 15 per cubic metre. The government has fixed the cost of refilling at Rs 17.49 per cubic metre.

Several private hospitals charge patients Rs 1,500-3,000 for oxygen per day. “Based on our analysis, oxygen cost cannot exceed Rs 300-400 per patient per day in a hospital,” said Dr Sudhakar Shinde, IAS officer in-charge of fixing price cap for hospitals.

The industrial sector is bearing the brunt too. Requirement for oxygen had dipped to 250 metric tonne per day in March after lockdown. As restrictions were lifted, industries restarted work. Now, the industrial requirement is at 2,00-2,500 metric tonne. But there is limited supply.

Madhya Pradesh relied on Maharashtra and Gujarat for oxygen – as supplies from these states reduced, it has turned to Chhattisgarh for supply. In some states like Maharashtra, only 20 per cent oxygen produced can be directed for industrial purposes, rest are reserved for medical use.

What government is doing

There is also the wastage of oxygen – mild cases who don’t need it are put on oxygen support, sometimes leakages are reported from oxygen pipelines. An expert committee under MoHFW has fixed oxygen supply to 40 litres in intensive care units and 15 litre per minute in normal ward per patient per minute.

It has advised to monitor patients on oxygen support daily, and only put those with oxygen saturation levels below 94 on oxygen support. As per the committee, 20 out of 100 patients turn symptomatic and three of them critical. This is the pool that may require oxygen.

In Numbers 

India’s per day oxygen production capacity: 6,900 metric tonne

Current requirement: Over 2,500 metric tonne

Oxygen Transport tankers: 1,200-1,500

Active Covid cases: 9.75 lakh

On oxygen: 5.8%

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Potential Ray of Hope: Highly effective coronavirus antibodies


        Identification of highly effective antibodies, will not only provide a passive immunity, but can be helpful in developing vaccine as well. This discovery may be a potential ray of hope against Covid war.

Highly effective coronavirus antibodies discovered may lead to passive Covid-19 vaccine

     BERLIN: Scientists have identified highly effective antibodies against the novel coronavirus, which they say can lead to the development of a passive vaccination for Covid-19. Unlike in active vaccination, passive vaccination involves the administration of ready-made antibodies, which are degraded after some time. However, the effect of a passive vaccination is almost immediate, whereas with an active vaccination it has to build up first, the researchers said. The research, published in the journal Cell, also shows that some SARSCoV-2 antibodies bind to tissue samples from various organs, which could potentially trigger undesired side effects. The scientists at the German Center for Neurodegenerative Diseases (DZNE) and Charite – Universitatsmedizin Berlin isolated almost 600 different antibodies from the blood of individuals who had overcome Covid-19, the disease triggered by SARS-CoV2. By means of laboratory tests, they were able to narrow this number down to a few antibodies that were particularly effective at binding to the virus.  Highly effective coronavirus antibodies identified, may lead to passive Covid-19 vaccine The researchers then produced these antibodies artificially using cell cultures. The so-called neutralising antibodies bind to the virus, as crystallographic analysis reveals, and thus prevent the pathogen from entering cells and reproducing, they said. In addition, virus recognition by antibodies helps immune cells to eliminate the pathogen. Studies in hamsters — which, like humans, are susceptible to infection by SARS-CoV-2 — confirmed the high efficacy of the selected antibodies. “If the antibodies were given after an infection, the hamsters developed mild disease symptoms at most. If the antibodies were applied preventively — before infection — the animals did not get sick,” said Jakob Kreye, coordinator of the research project. The researchers noted that treating infectious diseases with antibodies has a long history. For Covid-19, this approach is also being investigated through the administration of plasma derived from the blood of recovered patients. With the plasma, antibodies of donors are transferred, they said. “Ideally, the most effective antibody is produced in a controlled manner on an industrial scale and in constant quality. This is the goal we are pursuing,” said Momsen Reincke, first author of the research. “Three of our antibodies are particularly promising for clinical development,” explained Harald Pruss, a research group leader at the DZNE and also a senior physician at Charite – Universitatsmedizin Berlin. “Using these antibodies, we have started to develop a passive vaccination against SARS-CoV-2,” Pruss said. In addition to the treatment of patients, preventive protection of healthy individuals who have had contact with infected persons is also a potential application, the researchers said. How long the protection lasts will have to be investigated in clinical studies, they said. “This is because, unlike in active vaccination, passive vaccination involves the administration of ready-made antibodies, which are degraded after some time,” Pruss said. In general, the protection provided by a passive vaccination is less persistent than that provided by an active vaccination, the researchers said. “It would be best if both options were available so that a flexible response could be made depending on the situation,” Pruss added.

Story of Moral slaves: How Doctors bear full brunt #Covid


              Struggling to become a doctor, slogging in wards to learn and earn degrees, work in inhuman conditions, listen to endless abuses, tolerate the false media criticism, dragged in courts for alleged negligence, work with fear of physical assaults, work without proper infrastructure and manpower, endangering their own lives, exploited by medical  industry and administrators, poorly paid and  still not respected.    Arm chair preachers would just say “yes, as a doctor, they should do it as moral duty.”

             The Indian Express has been wise enough and has been able to  express the situation to some extent, which is just tip of the iceberg.

             Low pay and long hours, doctors battle more than just Covid-19.

 Maharashtra estimates it needs 19,752 doctors, nurses and paramedics to fight Covid-19. As on September 15, 12,574 of the posts were vacant. Dr Rajesh Salagare is the only doctor at Raigad rural hospital since March. (Express photo by Tabassum Barnagarwala) Chest physician Dr Pravin Dumne has just done his rounds of the ICU at Osmanabad Civil Hospital and is now fielding queries from anxious relatives. Two hours into the PPE, he is drenched in sweat, with 22 hours more to go in his shift. Dumne has 150 Covid-19 patients under him. Since May, he hasn’t been able to take any break except for 12 days when he himself contracted the virus. Norms mandate one doctor per 10 ICU patients, Dumne is handling five times that. “There are times when multiple patients are critical and I can’t be everywhere. I feel helpless. We are losing lives,” he adds. As another relative complains about the lack of cleanliness in a ward, Dumne says, “I may quit government service once the pandemic is over.” Dumne isn’t the only one feeling the unequal load as coronavirus cases surge in Maharashtra, particularly its rural areas. The state estimates it needs 19,752 doctors, nurses and paramedics to fight Covid-19. As on September 15, 12,574 of the posts were vacant. Of the 1,700 Class I doctor posts (including specialists) the Public Health Department needs to fill, like Dumne’s, only 538 are filled. In May, Maharashtra was forced to ask Kerala for help. Forty specialist doctors came to Mumbai on a bus, to handle critical patient load until July. The shortage is even more intense in rural areas, where urgent advertisements by the government for specialists have yielded little response. In rural Nagpur, as many as 93.6% posts are vacant, followed by Thane at 79%. The last permanent posting in Osmanabad, an aspirational district under NITI Aayog, was three years ago. It needs 150 nurses and 40 doctors. The state government has been deputing Ayush doctors to civil hospitals. “Not all of them can handle serious patients,” Dumne points out. He and Dr Tanaji Lakal are the only two specialist doctors for Covid patients at Osmanabad Civil Hospital. Dumne was moved here from the PHC at Samudrawani village, following the pandemic. Dumne and Lakal alternate working for 24 hours continuously followed by one day off. In July, when Dumne got the coronavirus, he had to join back within 12 days, instead of the minimum 14. The number game In Raigad, 400 km away, Dr Rajesh Salagare has been the only doctor handling the entire rural hospital since March. The three other doctor posts at the hospital have been vacant since 2018. The previous night he was called for a delivery at 2 am; this morning, he was back on OPD duty at 9. “I am just an Ayush doctor. If something goes wrong, I will be held responsible,” he worries. It’s not just the long hours that deter doctors from rural duty. A government MBBS doctor in rural areas is paid Rs 60,000 per month and is expected to be on call 24 hours, their counterparts in Navi Mumbai get Rs 1.25 lakh, and in Mumbai and Thane, Rs 80,000 per month. Navi Mumbai, Thane and Mumbai mandate eight hours on Covid duty at a time, apart from providing hotel accommodation. As a chest physician, Dumne could earn up to Rs 2 lakh in urban areas, instead of the Rs 60,000 he gets now. His August salary came only a few days ago. The 100-bed Covid facility in Ratnagiri depends on Ayush doctors from nearby PHCs. One such doctor, who requested anonymity, says he sees over hundred suspected cases a day. He got his pending salary of Rs 40,000 for four months, till July, only a few days ago. “Everyone calls us corona warriors, but look at how we are treated.” Dr Pravin Dumne (in white) at Osmanabad Civil Hospital. (Express Photo: Tabassum Barnagarwala) An administrative officer at Ratnagiri Civil hospital, who is waiting for his pay since July, shows text messages exchanged with seniors. “If the government doesn’t respect us, why will a doctor want to work here?” he says. Ratnagiri Civil Surgeon Dr Ashok Bolde says the delay in salaries is on the part of the National Health Mission’s state office. Dr Sadhana Tayade, Director of the Directorate of Health Services, however, says, “Salaries are paid on time to doctors.” On why the poor response to advertisements, she says it is because “doctors are scared to work in Covid wards”. The government has begun tele-ICU services to plug the gap of specialists in rural hospitals of Bhiwandi, Aurangabad, Jalna and Solapur. Physicians in another city monitor ICU readings of patients in rural hospitals and call up on-duty doctors to direct treatment protocol. But tele-ICU has not reached every rural hospital, nor can it help everyone.          Next younger generation of aspiring doctors, who is  witnessing to the cruelty shown towards health staff, may be forced to think about their decisions to become doctors.

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Dead Body swap # Covid; unprecedented stress- Bizarre mistakes


Two incidents of dead body swaps have happened in last few months. Strangely two mistakes out of   correct millions  are enough to label hospitals, doctors  or health systems  as  callous. Covid times are  toughest times for health care staff and hospitals as well.

   Definitely it is sad and  painful  incident. Without doubt, swapping bodies and causing distress to relatives is really shocking.  There will be a  demand for exemplary  punishment to  health  care workers involved. There is a little doubt that they will meet the stringent punishment, as this is regarded as unpardonable, given the involvement of health care staff.

  But is that the right way? Will chopping the hands, that were trying to rescue, is of help?

          No one will like to see, how health workers have been  stressed. Under the unprecedented circumstances, how fewer number of frontline workers have been battling the pandemic.

      Armchair preachers cannot imagine the stress and the hard work, these   warriors are burdened with. There can be multiple ways to look at these unforeseen mistakes.

  1. Punish the health workers, make an example by taking away their jobs. So everyone  will learn.
  2. Check the faults in the system, make the whole system fool-proof by learning from the mistakes, so it becomes more robust with times to come.
  3. Counselling   of the personnel involved along with improving the system.
  4. Understand the stress and circumstances of front line workers and improving their working conditions, so as to reduce their  burden.
  5. Check the past record, if someone has done thousands right things, do not hang him for a single error, especially intoday’s unprecedented circumstances.  

Most desirable  at such crucial times will be encouragement and psychological support to front line workers.

Bodies swapped at private hospital in Delhi,

NEW DELHI: A private hospital in southwest Delhi’s Dwarka committed a grave error by handing over the body of a Christian woman to the family of a Covid-positive Hindu woman. The 69-year-old woman, Garikapati Parisuddam, was not infected with the novel coronavirus and had passed away on Monday morning.

AIIMS sacks one, suspends another for swapping of dead bodies

An ambulance with four corpses – including that of Anjum B – left from the hospital on Tuesday afternoon. Three of the persons who had died were Hindu and were taken to a crematorium before the van left for the ITO burial ground.

  Just  delivering professional death sentence for  single, system errors  or unforeseen mistakes will have  future implications.  It is like chopping the hands,  that were trying to help.

           As Corona has unmasked the real risk to health workers and society has dealt with heath workers shabbily. Next younger generation of aspiring doctors, who is a witness to the cruelty shown towards health staff, may be forced to think about their decisions to become health workers. Possibly the administrators need to ponder now, who will treat people  in next pandemic.

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Doctor’s death: saved uncountable lives- still not counted


In an era, where Reel Heroes are worshipped and Real Heroes are not    counted even after sacrificing their lives, is an unfortunate  and disheartening for  the whole community of doctors and nurses. It is surprising that  doctors, who saved uncountable lives, did not move the administrators enough  to get them counted.  Such  incidents  are not only  painful to the medical fraternity but also expose the hypocritical  attitude of the administrators as well as  the insensitive approach of society towards health care workers, although everyone expects doctors and nurses to be sensitive towards everyone else. Such indifferent   attitude demoralizes and causes deep discouragement to the front line doctor and nurses, but sadly remains a routine business for administrators. The pain of being  treated like a dispensable disposable remains as  a deep hurt within.

         But at the same time, mere tokenism as an expression of concern is also not desirable. What is really required is a sincere effort to reduce the mortality of health care workers, to provide them better working conditions. An honest effort to find the cause of mortality among doctors and reducing it, help to the families of the health care workers is required. Due acknowledgement and true  respect to their sacrifice  is expected from civilized society.

“382 Doctors Died Of Covid”: Medical Body Says Centre “Abandoning” Heroes

Indian Medical Association has shown its displeasure over  the Government  statement on coronavirus in parliament, which had no word on the doctors who died in the line of duty, and the  statement that the Centre had no data as health is a state subject.  Accusing the government of “indifference”, “abdication” and “abandonment of heroes”, the country’s top body of medical practitioners said in such a circumstance, the government “loses the moral authority to administer the Epidemic Act 1897 and the Disaster Management Act”.

So far, 382 doctors have died of coronavirus, the IMA said. In the list it released, the youngest doctor to lose his life was 27 years old and the oldest was 85.

But while acknowledging the contribution of healthcare workers during the pandemic, the health minister made no mention of the medical professionals lost to the disease, the IMA said.  

“To feign that this information doesn’t merit the attention of the nation is abominable,” the IMA statement read. “It appears that they are dispensable. No nation has lost as many doctors and health care workers like India,” the statement added.

The IMA pointed to Union minister Ashwini Kumar Choubey’s statement that the Union government does not have any compensation data as public health and hospitals comes under the states.

“This amounts to abdication of duty and abandonment of the national heroes who have stood up for our people. IMA finds it strange that after having formulated an unfriendly partial insurance scheme for the bereaved families to struggle with the ignominy of the Government disowning them altogether stares at them,” the statement read.

Such a circumstance also exposes the “hypocrisy of calling them corona warriors on one hand and denying them and their families the status and benefits of martyrdom,” the IMA said.

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Plasma therapy- life saving for Covid?


  Few months ago, there was a hope and  presumed scientific reason to believe that plasma therapy will be a wonderful option in Covid pandemic. But the said belief needed to be strengthened by robust trials. As trials continue, the belief that plasma therapy will save lives, have not been proved  clear. Now again there is a doubt in the mind of doctors, whether it will save lives or it may not. What ever future may hold, it is clear that it needs more trials, more evidence. Covid virus has again proved to be more smart.

Delhi: Plasma therapy’s life-saving abilities in question, doctors caution on its use (Times of India)

NEW DELHI: A day after TOI reported about an ICMR study that showed administering convalescent plasma to Covid-19 patients did not reduce death risk, top doctors of AIIMS, Institute of Liver and Biliary Sciences (ILBS) and Lok Nayak Hospital stressed the need to rethink who should get the therapy. In the trial by Indian Council of Medical Research, which involved 464 hospitalised, moderately-ill Covid-19 patients, researchers observed that some participants had higher antibody positivity than their plasma donors. “The difference in age and severity of illness, with donors being younger and having milder disease, could have driven this difference. While all Covid-19 survivors were encouraged to donate plasma, an overwhelming majority of the donors were only mildly sick, young survivors. Recovered patients who had moderate or severe disease were generally reluctant to return to hospitals for plasma donation,” the ICMR study noted.  Earlier the institutes  did not check the level of neutralising antibodies in the donor, which led to poorer outcomes. “The ICMR study re-affirms our assessment based on a trial conducted on 29 patients who received plasma therapy at ILBS. It showed no mortality benefit. However, there was significant benefit in terms of clearing of viral load in those who received the therapy in addition to standard care compared to who received only standard care,” he said. The ILBS director added that only patients with mild-to-moderate illness should be given convalescent plasma. “The therapy has to be given within 24 to 48 hours of diagnosis. Also, detailed assessment of presence of sufficient levels of neutralising antibodies in the donor should be mandatory,” Dr Sarin said. At least 100 Covid-19 patients at the state-run Lok Nayak Hospital have been given plasma therapy till date. Dr Suresh Kumar, its medical director, said larger studies might be needed to assess its benefits. “Remdesivir did not show significant benefit in Covid-19 treatment in some studies. Still, the drug is being used in select patients because it has certain benefits and there is no other known cure. Similarly, plasma therapy may not help reduce death risk but our experience shows it does help in faster recovery in a small subset of patients,” he said. ILBS and Lok Nayak Hospital are conducting a study involving 400 Covid patients to assess the benefits of plasma therapy. Rajiv Gandhi Super Specialty Hospital is also taking part in the study. The ICMR study was conducted at 39 tertiary care hospitals — 29 teaching and 10 private — across the country. According to the study, released on MedRXIV, a preprint service for medicine and health sciences, mortality was documented in 13.6% patients who received plasma therapy in addition to standard care and 31 (14.6%) patients who received only standard care. The trial results also indicated that there was no difference in progression to severe disease among moderately ill patients treated with convalescent plasma along with the best standard of care.

Covid pandemic to infected plastic pandemic


Now, while we are fighting the COVID-19 pandemic, plastics use is increasing again. But, while the pandemic is just temporary, plastic pollution will be long lasting.  

For our current battle to fight the COVID-19 pandemic, we see a dramatically increasing demand for personal protective equipment (PPE) which comprises various plastic and rubber items. Moreover, there are many other fresh, clean plastic items widely used in medical applications for creating a sterile environment, such as pill casings, disposal syringes, catheter, and blood bags. These items are also made of synthetic polymers such as polyvinyl chloride (PVC) and PP, which are not biodegradable. Therefore, it would be not surprising to see that the COVID-19 pandemic is generating tons of medical waste.

dumping Covid-19 infected waste in public places

               The Biomedical Waste Management Rules, 2016, define biomedical waste as“any waste that is generated during the diagnosis, treatment or immunisation of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps.” Therefore, broadly, any waste generated from treating patients comes under the ambit of biomedical waste.

As per available data, India produced approximately 600 tonnes of biomedical waste per day before the coronavirus first hit.

However, ever since Covid-19 showed up on our shores, the amount of biomedical waste produced in India has increased exponentially. This is mainly due to two factors:

  • Medical facilities themselves are producing far more biomedical waste as they battle the virus. As of August 30th, more than 4.14 crore tests to check for the virus had been conducted in India. Further, with over 36 lakh persons having tested positive for the virus, medical facilities have also been producing a lot more medical waste as they treat these patients. Therefore, all of the cotton swabs, samples, injections among other medical inputs necessary to test and treat these patients become highly contagious bio-medical waste that needs to be treated and disposed of with utmost caution.
  • Due to the infectious nature of the coronavirus itself and the strategy of home quarantining of asymptomatic COVID-19 Positive patients, adopted by the country, a major part of affected household waste has now become biomedical waste. The amount of waste that is hazardous is large due to the fact that India has some of the worst waste segregation numbers in the world. This forces infrastructure that is already burdened beyond capacity to handle mixed waste that it is not equipped to handle.


Treatment facilities and growth in biomedical waste

A factor that infinitely complicates India’s fight against Covid-19 is that as per available data, India, a country of more than 1.3 billion people, has only 198 Biomedical Waste Treatment Centres (BMWTCs) and 225 medical centres in the country with captive waste treatment facilities. Simple maths tells us that India’s infrastructure to process biomedical waste was already inadequate during pre-Covid times. However, post-Covid, India is truly staring at a disaster of alarming proportions if it does not rapidly increase its biomedical waste treatment capacity.

There have already been multiple instances of Covid-19 infected waste being dumped in public places including in Delhi and Vijayawada. In addition to this, due to the rapid and sustained increase in biomedical waste due to Covid-19, most BMWTCs are running out of capacity to handle the waste. For instance, the two BMWTCs in Delhi have a combined capacity of handling 74 tonnes of biomedical waste in a day.

However, a report submitted by the Environment Pollution (Prevention and Control) Authority to the Supreme Court of India showed that Delhi’s biomedical output had risen from 25 tonnes per day in May to 349 tonnes per day in July. Similarly, Covid-19 related waste in Mumbai rose from 12,200 kg per day in June to 24,889 kg per day in August, essentially doubling in three months. A similar situation has arisen in West Bengal as disposal facilities there too have reached maximum capacity.

Proper waste segregation and disposal is need of the hour. Disease burden may keep on rising, if proper steps are not followed.

Covid paradox: salary cut for doctors, others paid at home


What a paradox!!  Firstly the doctors were employed on contract basis at meagre salary, only for Covid. At a time when other employees of government getting salaries while sitting at home while doing nothing, these contractual doctors were  drowned in pool of Covid patients, risking their lives.

        Cruel heights of insensitivity and  as an epitome of poor governance,  salaries of these 900 doctors were subjected to  massive deductions. They had no choice, but to resign.

       Ironically, on one hand every one appears to rue about  non-availability of doctors, but on other hand they are given a shabby treatment. For example everyone wants to employ doctors on contractual basis and hence paying them poorly and clearly with an intention to “ use and throw policy”.

Salary cut, 900 Kerala Covid doctors resign
THIRUVANATHAPURAM: Nearly 870 doctors appointed to Covid first-line treatment centres (FLTCs) across Kerala have tendered their resignation over deductions in their salary. They were among the 1,080 MBBS graduates who passed out of government medical colleges this year and appointed on Covid duty on a temporary basis. While they were promised Rs 42,000 a month, what each finally gets is Rs 27,000. “From the amount, Rs 8,400 was deducted in the name of the government’s salary challenge, apart from TDS and professional tax. Now, we are getting only Rs 27,000,” said , state president of Kerala junior doctors association 2020-21. The association has fired letters to the chief minister and health minister seeking their urgent intervention.

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Covid-Death of Doctor, nurses: No uniform support mechanism for families


87k health staff infected with Covid, 573 dead

Society, administrators and  Governments prefer to ignore  the fact that doctor’s  and nurse  life is at as much risk as a soldier while treating   infectious diseases. Corona has merely unmasked the risk but the danger has always existed  with other disease like  HIV, hepatitis B, open tuberculosis, Ebola and  half a dozen more communicable diseases.

Doctors and nurses have continued to work along with such risks  but the apathy shown by everyone towards health care workers, have left them  demotivated and discouraged.  

Corona deaths among health care workers are causing tremendous  anxiety.  Conditions under which they are forced to work  are giving   them a feeling  of being  victimised.  All of their years  of accumulated   medical knowledge does not make them  either invincible or  confident  about the future, as there is no uniform mechanism to support their families. The courts have also  failed to give  assurance of any kind.

Once health care workers, doctors and nurses, become a patient  themselves, they realise that their resources are scanty and they are  neither rich nor VIPs, and their families are not assured of a decent compensation.  In such circumstances they realise that they have been made scape goats due to their call of duty and society has no gratitude. A feeling of deep hurt creeps in. A feeling hurt of being  no more than sacrificial lambs in the end.

They feel let down and  abandoned by the world for no fault of their own.

WHY SUCH APATHY? There needs to be a uniform law to support families of  health workers. Moreover, health workers are crucial  for the society, irrespective of their place of work. They may be in Government sector private or in isolated practices.  The  absence of uniform support mechanisms is becoming evident and is enough to dissuade the aspiring doctors to take up challenging roles.

 Compensation given to family members of doctors after their death because of communicable diseases are trivial and  non-uniform. It is little in monitory terms as well as in terms of respect. Death of doctors and nurses has been passed off as something routine and trivial matter. Just for example, it is less than course fee of private medical colleges  or usual  compensations sought by patients in malpractice suits.

      Future medical students should note the trend and count this factor, when they choose to be a doctor.

87k health staff infected with Covid, 573 dead

NEW DELHI: More than 87,000 healthcare workers have been infected with Covid-19, with just six states — Maharashtra, Karnataka, Tamil Nadu, Delhi, West Bengal and Gujarat — accounting for three-fourths (around 74%) of the case burden and over 86% of the 573 deaths due to the infection, official data showed. Maharashtra alone, with the highest number of over 7.3 lakh confirmed Covid-19 cases so far, accounts for around 28% of the infected healthcare workers and more than 50% of the total deaths, according to the data. While Maharashtra, Karnataka and Tamil Nadu had tested more than 1 lakh healthcare workers each till August 28, Karnataka reported only 12,260 infected healthcare workers — almost half the burden in Maharashtra. Tamil Nadu reported 11,169 cases that included doctors, nurses and Asha workers. The three states together accounted for 55% of the total cases among health workers. A large number of Covid-19 infections and even deaths of healthcare workers in particular states is being viewed with concern by officials and public health experts, who say risks to frontline workers can jeopardise India’s fight against the pandemic.

21 occupational risk to doctor and nurses

Are doctors, nurses dispensable disposables

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