Ferocious second wave tests nerves as Assam's medical fraternity continue with COVID-19 duty without leaves, extra allowance

For Ritusmita Shivam, a 27-year-old health worker, days and nights have merged into one. It’s getting hard for her to keep track of time while work pressure increases significantly as the second wave of the COVID-19 pandemic continues to wreak havoc in India. Shivam works as a radiotherapy technician at Fakhruddin Ali Ahmed Medical College and Hospital in Barpeta town of Assam.

Health workers like Shivam who were on COVID-19 duty during the first wave have been roped in again to fight the second wave. She and several others have to be at the dedicated COVID-19 ward for a week. Post that, they get a home quarantine for another week, and then they are brought again for either general or COVID-19 duty. Shivam said, “It’s a never-ending cycle.” She did get some respite in between for a few months when Assam was reporting fewer cases than now which have been between 4,000 and 5,000 cases almost every day of late.

Shivam’s colleague Samragee Dutta, 41, wasn’t on COVID-19 duty during the first wave. But this year, she too has been roped in. “I have been very scared. Not so much for myself… I have worked in different hospitals for many years now and that has made me quite resilient but I am scared for my son who is only 14,” Dutta said. Doctors, parents and officials across India say that more children are being infected with COVID-19 and need medical intervention in the second wave.

In Assam, the positivity rate, which was not more than 7 percent during the peak of the first wave, is hovering between 9 and 10 percent during this second wave. Until 15 May the total caseload of the state was 3,24,979 with daily cases having risen to almost 5,000 every day. On 17 May, the daily tally was the highest ever for the state with 6,394 positive cases and the highest single-day toll till date as well with 92 deaths.

The day-wise curve of positive cases has drastically increased since 26 April 2021. On 1 May 2021, the total number of Covid-related deaths in Assam was 23, which jumped to 81 within a couple of weeks. Amid a fresh surge in cases with mortality ratio and case fatality ratio seemingly higher than the first wave, responsibilities of healthcare workers have increased exponentially, leaving them overwhelmed.

Nurses on duty at the Sonapur district hospital is Assam. Image courtesy: Basana Das

Dr Diganta Buragohain at the department of medicine at the Gauhati Medical College Hospital (GMCH) said that all the fatal cases are eventually referred to their hospital. “We are not able to help as much as we were during the first wave,” he said.

According to doctors and nurses, the rate of infection and recorded deaths were far lower in the first wave. “This wave, most patients who have been admitted come with a SpO2 level as low as 60. People with no comorbidities have died,” Dr Chayanika Choudhury from the psychiatry department of GMCH who has been on Covid duty, said.

“Lot of patients are going through lung damage and are suffering from COVID pneumonia,” Basana Das, a staff nurse at the district hospital in Sonapur, said.

Buragohain pointed out that the “total number of cases is too high and therefore the severity is high too”. “People are getting infected faster,” he added. Moreover, the official numbers, doctors and health workers said, are a vast undercount. “Actual numbers are higher than the official figures. A lot of people might have mild symptoms and they might not even got themselves tested,” Buragohain said.

Doctors wearing PPE kits at the Gauhati Medical College and Hospital in Guwahati in Assam. Image courtesy: Dr Chayanika Choudhury

Rural areas in Assam, especially areas such as the tea gardens and the chars (riverine areas) are already bearing the brunt of poor health infrastructure. According to reports, over 200 workers and staff members from at least two different tea gardens in upper Assam's Dibrugarh district have been found to be coronavirus positive which forced the district administration to declare it a containment zone. The death numbers, too, are higher than the official figures. “For instance, if there are 80 deaths reported in a day, one could assume that the unofficial figures would be somewhere around 150,” Buragohain said.

“Sometimes a patient’s condition deteriorates while they are in home isolation, and they are brought to the hospital for treatment but their condition is so severe that medicines don’t help. A lot of patients have arrived at the hospital and have died within a few hours,” Das said.

Doctors, nurses and lab technicians, this reporter spoke to said that the shortage of medical staff is being felt acutely. Choudhury of GMCH said there is an acute shortage of cleaners, sweepers and ward boys. Nurse Das said at their hospital every worker ends up doing a lot more work because they are “extremely staff-crunched”.

Most healthcare workers have seen their lives change completely since the pandemic began. Choudhury recalls how she has been on COVID-19 duty since July 2020. “The second wave has made it even more hectic. Some of us don’t even get that one-week quarantine anymore,” she said. “Life hasn’t been normal. It’s a war-like situation,” she added.

For Das, “stress has increased a lot”. But as she puts it: “It’s my job and I have to do it. I do have a fear that I might spread the virus to my family members though,” said the 27-year-old nurse.

Both Shivam and Dutta of the Fakhruddin Ali Ahmed Medical College and Hospital rue the government’s decision to stop their dearness allowance (DA). The Union finance ministry in April last year issued an order freezing the dearness allowance to the central government employees till July 2021. “We don’t get any leaves anymore and on top of that, there is no extra allowance. As healthcare workers fighting from the front lines, we deserve more,” Shivam said.

Although the institution belongs to the state government, the salary norms are more or less similar to the Central government thus affecting employees of the state government as well.

“If there are no incentives, how do you expect a better quality of service?” asked Choudhury. “Our casual leaves have been cancelled. Won’t there be burnout? Who will take care of the post covid trauma and stress of the healthcare professionals?”

Buragohain is experiencing anxiety personally. “Sometimes in the middle of the night I experience shortness of breath, perhaps it is anxiety. We are scared despite being vaccinated. Every morning I wake up and check my oxygen levels,” he said.