COVID-19: No Road-Map, Each City Coping with Own Ad-Hoc Guidelines, Says IMA's Dr. N. Dahiya

Dr. Navjot Dahiya, vice-president of the Indian Medical Association (IMA), was one of the first doctors to come out and openly accuse Prime Minister Narendra Modi of being a “super-spreader” of the coronavirus. An orthopaedic surgeon working with Global Hospital in Jalandhar, Dahiya believes the views of the medical fraternity were deliberately sidelined right from the when the crisis began, resulting in a killer second wave this year.

Q. You are probably one of the few doctors to have gone public with your angst and accused the PM of being a “super spreader” by holding political rallies in poll-bound states and allowing the Kumbh Mela to take place amid a second wave of pandemic.

A. When the first wave of the novel coronavirus hit India, our medical fraternity worked hard to instil COVID protocol behaviour within the public at large, whether it was social distancing or the wearing of masks. When the second wave hit us, my hospital (Global Hospital) was immediately converted into a COVID hospital where patients and medical staff were expected to follow all protocols. At the end of 2020 and through early 2021, we were telling our patients to adhere to protocols but they would turn around and tell us that we were only instilling a sense of fear in them, especially since the PM and his Cabinet were seen addressing big political rallies without bothering to wear masks.

Modi had behaved in a similar manner last year, when the first COVID-19 patient was found in India in January 2020. Our PM was busy organising a large gathering of over one lakh people to greet the then US President Donald Trump in Ahmedabad. That was also a super-spreader event at that time. We have lost an entire year because no attempt has been made to strengthen our health system during the last twelve months.

Q. What stopped the medical fraternity from speaking out and criticising the PM and his Cabinet during all these months. Why are you doing it now?

A. Our hospital – like most hospitals across the country – is facing a shortage of Oxygen and life-saving medicines. We are feeling completely helpless. Our hospital is too small to be able to set up its own Oxygen producing plant and we are dependent on the government to replenish our supplies. Several projects for installing Oxygen plants had been pending with the Central Government for clearance, with no heed being given to such an important need by the Modi government.

But, to say that we have not voiced our criticism earlier is wrong. We have been critical of the government, but our criticism has been ignored by the media. During the last six years we were extremely critical when the Medical Council of India was dissolved. We were on the roads protesting when doctors and purses were attacked in Kolkata during the first wave of COVID-19.

We voiced strong protests against the government when it introduced the Clinical Establishment Act which made it mandatory for smaller nursing homes and maternity clinics located in mohallas and by-lanes to invest in expensive equipment. This CEA blatantly favours large corporate hospitals because how are smaller clinics expected to be in a position to invest in high-end equipment given that the paying capacity of most patients in India is very little? We doctors held several mahapanchayats in Delhi against the fee hikes which resulted in students today having to pay a lot more money to get a medical degree. We are a poor country and that must not be forgotten.

Q. How is it that the medical fraternity did not demand that the government lay down a road-map to handle the pandemic?

A. There have been repeated requests from our side to establish protocols, set up Oxygen plants and strengthen our indigenous pharma industry. When the first wave came there were not enough PPE kits and we were importing kits. Now the situation has changed. But we need technocrats to advise bureaucrats, which is not the case.

Q. ...but labelling the PM as a super spreader?

A. In our country people rely on religious and political leaders and emulate what they do. When our political leaders are seen doing roadshows and holding rallies, people take a cue from that. So, while our front-line health workers are following all COVID protocols, the same protocols are being blatantly disobeyed by our politicians, thereby creating an atmosphere for this surge. The result is there for all to see. Dead bodies are piling up in crematoriums and there are long queues of ambulances outside hospitals in almost every city of the country.

Q. But the state of Punjab also went ahead and held panchayat elections. It is not that Punjab CM Amarinder Singh showed any discretion...

A. Yes, Punjab went ahead and held panchayat elections, as did several other states, including Madhya Pradesh and UP. I do not know what the Constitutional compulsions were that they had to go ahead with such a move.

Q. Even if the government had not prepared a road map, surely the medical fraternity could have prepared one and put it out in the public domain?

A. We doctors are already firefighting trying to save the lives of patients. We are not political people. Our interactions with the government are at the level of SDMs and deputy collectors, who simply do not understand our point of view. To give you an example, with the present shortage of oxygen, the government started making allotments to each hospital. One hospital gets 40 cylinders, the other gets 20 cylinders and so on. But what if, in the middle of the night, we get four more patients? Where are we going to generate the extra Oxygen from?

There has to be a uniform policy about how much oxygen will be supplied and how much will be set aside for contingencies. As a doctor, I receive a minimum of 15 to 20 phone calls from people in Delhi every day who want to shift their patients to Jalandhar as they are faced with a shortage of beds and Oxygen in Delhi. This is happening throughout Punjab and this is the surest way of spreading the virus to every corner of the country.

My question is: Why has the Modi government failed to conduct an elementary mapping and resultant policy of requirement of Oxygen and drugs for the 30,000 or so hospitals and nursing homes if there is 100% occupancy?

Q. Are you saying there are is no road map in place?

A. We have not been supplied with any such road map. As a private practitioner I still do not know what system will be implemented when and what I have to follow. Each city is coping with its own ad hoc guidelines. For the first time now we have been given Google sheets to fill out. All this needed to be worked out much in advance. People must be told how much they have to pay and which hospitals listed is offering what kind of services.

Q. What is the situation like in Punjab?

A. We are much better placed. Speaking for Jalandhar I would like to point out that when we began facing a shortage of Oxygen, we created an informal association of nursing homes and pooled our resources and are helping each other with oxygen and other supplies.

Q. You have also been very critical of Modi government’s handling of the farmers agitation.

A. Even on the issue of the farmers’ agitation against the Farm Laws, Modi has not acted in a responsible manner. He made no serious attempt to solve their problems. During a pandemic he allowed farmer groups to gather in large numbers, thereby causing a serious threat of the infection spreading.

Q. Should the blame for this second wave must also be placed on the shoulders of the Health Minister Harsh Vardhan who, incidentally, is a qualified medical practitioner?

A. There is no doubt that the Health Minister must be held accountable, but the general impression is that all decision-making is vested with the PMO and their team of bureaucrats.

Q. When are we likely to see this rising curve leveling off?

A. In Punjab we saw NRIs coming in with the UK variant. There is a flattening of the curve around Jalandhar (Doaba) but that is not the case in the Bathinda and Malwa region. I cannot say for the rest of the country. Every fourth person is testing positive today. I am not a virologist but maybe another 15 to 20 days. Following scientific knowledge and all COVID protocols is the only way to control this pandemic.

Rashme Sehgal is a freelance journalist.