By Vibhuti Agarwal
NEW DELHI—For many countries, battling the coronavirus has been a sprint to bring infections under control, then a struggle to keep it that way. In India, it has turned out to be a marathon.
No one knows that better than Dr. Santhosh Kumar, a 48-year-old infectious disease specialist who treated some of the country’s first infections back in February. He is still fighting the virus, these days building a 10,000-strong corps of health-care workers and volunteers in southern India to tackle yet another wave of infections.
In a country that could wind up with more infections than any other before the global pandemic is over, a marathon battle with the virus is a future that he is both resigned to and determined to confront.
“Coronavirus is not a disease that will be wiped out in a vast country like India. In India, there will be wave after wave,” he says.Daily confirmed Covid-19 cases, seven-dayrolling averageSource: Johns Hopkins CSSEIndiaU.S.BrazilRussiaSouthAfricaFeb. 2020Sept.020,00040,00060,00080,000100,000
As Indian authorities steadily expand testing and the virus spreads beyond the cities, the country has surpassed Brazil to have the second largest number of total recorded infections, with nearly 4.7 million as of Saturday. The average number of new daily cases in India recently surpassed the U.S. to lead the world, making India the hottest of the global hot spots for the virus. And although India’s cumulative total of cases is still just half that of the U.S., India’s stretched health-care system and massive population—at 1.3 billion, four times the size of the U.S.—make it all but inevitable India will eventually surpass the U.S. in total cases.
The total number of deaths in India from the coronavirus so far has been far lower than those in the U.S. and Brazil. Still, India has been reporting the most deaths of any country in the world on a daily basis for the past several weeks.The main entrance of the Thiruvananthapuram Medical College. Founded in 1951, it is Kerala’s oldest medical college.
Dr. Kumar and his brigade are key to preventing the number of deaths from spiking. They, and others like them, are struggling to stay ahead of outbreaks that threaten to swamp the health-care system. Even with sufficient hospital beds and equipment like ventilators, the deaths start rising once an onslaught of infections overwhelms the doctors and nurses available to provide care and treatment.
“Human resources are most important in hospitals. The sudden surge in numbers has uncovered the cracks in the system,” says R. Ravindra, president of the Private Hospitals and Nursing Homes Association.
Dr. Kumar’s experience with infectious diseases includes work in Africa with the Ebola virus and in India with an equally deadly outbreak of Nipah virus, a highly infectious brain-damaging virus transmitted to humans from bats and pigs. He has been racing to stay ahead of the coronavirus since February. That is when a medical student returned home from Wuhan, China—where the coronavirus first began to spread—to the Indian state of Kerala, where Dr. Kumar works in one of the country’s leading academic hospitals.
The young woman, among the first cases in India, recovered in two weeks without any known spread of the infection to others. Dr. Kumar deployed his experience from fighting Ebola to confront this new disease the world knew little about
“Setting up a treatment center for Ebola is the same as establishing a Covid facility,” he said. “The basic principle is you need to increase the number of barriers between the virus and the health-care workers.”
His second go-round with the disease came in early April, and was a lot more challenging.
In a small Kerala town, a handful of returning migrant workers evaded their required quarantine and sparked an outbreak that quickly filled the city’s 115-bed hospital with patients.
Dr. Kumar and a quickly assembled, 26-member team of specialists and nurses worked 16 hours a day—starting by converting a still-under-construction classroom wing of the hospital into an infectious disease ward in a day—to stay ahead of the cascading cases.
While no patients died, Dr. Kumar came away with a new respect for the strain a wave of coronavirus infections can put on even a dedicated medical staff. Yet this was just a warm up. The virus was gaining a foothold in the country’s biggest and most-crowded cities.
He was soon called on to help, by bringing an experienced 40-person team from Kerala to work at a private Mumbai hospital the government had ordered to take only coronavirus patients.
The severity and massive scale of the disease in India’s most crowded large city was intimidating.
Deaths in Mumbai were rising fast—a direct result of the hospitals reaching and then surpassing capacity. On June 1, 41 people died in the city of Covid-19 as 1,400 patients a day flowed into the hospitals. By June 10, the death toll topped 100 a day. By the end of June, deaths reached 150 a day as thousands desperately sought treatment each day.
“We would get at least 40 calls every day for ICU beds in the hospital. Family members would carry patients in ambulances from hospital to hospital, looking for an ICU bed. People were dying in ambulances,” said Dr. Kumar.
His biggest challenge was to make critical-care units functional in a short time, since the overwhelmed system was causing mortality rates to shoot higher in the country’s financial capital.
Inside the hospital, known as Seven Hills, teams worked in four six-hour shifts around the clock for two weeks—unable to eat, drink, cool off or even urinate in the hermetically sealed protective gear they donned for each shift. Then they went into isolation for a week and took a few days off before starting the cycle all over again.
To expand the staff pool, young doctors-in-training who completed their residencies were extended, while nursing students who hadn’t even finished their studies were thrown into active duty.
Dr. Kumar remembers one patient who arrived after being refused admission at five other hospitals before getting into Seven Hills through a family political connection—the sort of thing that starts to happen when hospitals fill and admissions are limited in India.
The 57-year-old man could barely breathe.
“Please save me,” he begged Dr. Kumar as he was being admitted.
After weeks in intensive care, the patient seemed on a strong path toward recovery, pronouncing himself on the mend while eating breakfast for the first time since entering the hospital. The hospital staff was confident that he would leave the hospital in a day or two.
He died two days later.
But there is no time for Dr. Kumar to rest, much less emotionally process losses like these. As July turned to August, he and his team were called back to Kerala, where the largest city in the state was seeing the sort of ominous rise in cases that overwhelmed Mumbai, where the situation had improved, though not by much.
Before leaving, Dr. Kumar knew he would face some of the same familiar math as in Mumbai: For every 1,000 patients, roughly 30 need intensive-care treatment requiring hospitalization for at least 10 days. The state’s 700 intensive-care beds were approaching half full. With cases expected to climb well beyond 5,000, at least 1,500 intensive-care beds would be needed.
“It’s actually the beginning of Covid-19 for Kerala,” he says.
So far, though, the state is doing better than expectations. Daily reported cases had reached about 3,000 in the state as of last week. But the number of severe cases requiring intensive care and lengthy hospitalization has been lower than expected, which Dr. Kumar attributes to improved treatments and success getting older residents with conditions that make the disease much worse to stay home and avoid infection.
The number of beds occupied in intensive-care units has fallen despite a one-third increase in recorded cases in the state since he returned.
Still, recorded cases are expected to more than double by the end of October, which could require double the number of existing intensive-care beds.
“That will overwhelm the state’s capacity,” he says. “We want to get our patients well as soon as possible, to try to create more beds. How long this will last is extraordinarily hard to figure out. It’s a test of our endurance.”
SOURCE : WALL STREET JOURNAL