Delhi doctors ‘forced to work with Covid’ as relaxed testing guidelines mask true scale of Omicron wave

With India in the midst of an Omicron-fuelled coronavirus wave, doctors working in Delhi’s top hospitals say new policies to restrict testing mean they are being forced to work gruelling shifts while Covid positive.

Though the healthcare system has not been stretched to the same degree as during last year’s second wave, India’s Covid figures are rivalling the peak last summer, and the country recorded 286,000 cases on Thursday alone.

Cases have dipped slightly since they hit an eight-month high last week of over 300,000, but experts are concerned there is also not enough testing – the national positivity rate remains at almost 20 per cent, meaning one in every five people getting tested has Covid.

Despite this, Delhi has now relaxed some restrictions, including a weekend curfew, and will let markets reopen fully, while cinemas will begin showing films again with 50 per cent capacity. Political leaders, including Delhi’s chief minister Arvind Kejriwal, have played down the severity of the Omicron variant.

Nonetheless, doctors at major hospitals across Delhi told The Independent they had been seeing a significant rise in seriously ill Covid patients since the beginning of the year, while vulnerable patients are still requiring oxygen support in large numbers.

At the same time, scores of healthcare workers have also tested positive, to the point where there are major concerns about a shortage of staff to handle the increased workload. In the first weeks of January, the number of healthcare workers infected with Covid in Delhi was reported to be over 750, although no government data has been released on this.

Some doctors working at leading Delhi hospitals told The Independent that dozens of their colleagues were still sick and yet continuing to work because of the strain on hospitals and the instructions not to test.

Testing has been on the decline since a new set of guidelines issued by the Indian Council of Medical Research asked asymptomatic people not to get tested unless they were “high risk” individuals who might require hospitalisation.

The guidance also does away with testing for “asymptomatic patients undergoing surgical/non-surgical invasive procedures, including pregnant women in/near labour who are hospitalised for delivery”. Testing should only be carried out if it is “warranted or symptoms develop”.

A doctor from Safdarjung Hospital, one of Delhi’s largest public facilities, said hospitalisations had increased manifold from the first week of January to the middle of the month, and that on some days as many as 30 to 40 per cent of doctors had been under isolation.

“The speed with which Omicron infects patients is much more than any other variant,” said Dr Naresh, a Covid ward doctor at the hospital, adding that when he joined the ICU on 10 January he only had four patients. “In three days the entire ICU filled up,” he said. Later that day he tested positive himself.

“It isn’t true that the virus is milder, the people with comorbidities (pre-existing conditions) are still ending up in the hospital and require oxygen support,” he added.

Several doctors The Independent spoke to said their hospitals had been forced to cut down on elective procedures as resources were diverted to Covid wards.

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While some experts said the move was aimed at reducing the “panic” around surging cases and the pressure on medical and testing facilities, and sympathised with the tough choices the government has had to make, doctors on Covid ward duties said the guidelines were “problematic”.

And there are fears among doctors that reduced testing means the severity of this Covid wave and the rate of hospital transmission is being underestimated.

“The current numbers are highly underreported, since most patients are getting cured at home, which is good. However, this also means that in order to avoid further infections, people should be isolating as soon as symptoms occur, and testing should be encouraged, not discouraged,” a senior doctor at a government hospital in Delhi told The Independent, asking not to be named for fear of repercussions.

This view was echoed by several senior doctors across the city, with many of them stating that relaxing the rules on testing was resulting in increased pressure on healthcare professionals, many of whom are forced to continue working despite high exposure.

“We warned of a situation like this earlier,” said Dr Anuj Kumar, an emergency doctor at Safdarjung Hospital. “Hundreds of doctors are infected in every hospital. I am working in an emergency ward and there’s unprotected exposure,” he said, adding that testing and isolating play a crucial role in protecting both patients and staff.

A number of hospitals have opted to continue routine testing of patients on admission before medical procedures, as was the norm earlier in the pandemic, in defiance of the guidelines.

Some doctors took a pragmatic view, suggesting the healthcare system would collapse if all doctors were regularly tested and the majority turned out positive, and that letting them work despite the heightened infection risk was the only practical option for many administrators.

“Because of high contagiousness, [the Omicron variant] is spreading very fast, and if all asymptomatic doctors take tests and half of them are positive, it is going to be catastrophic for the healthcare [system],” Dr Sruvankar Dutta, a junior resident at Delhi’s All India Institute of Medical Science said.

“The decisions right now are not entirely based on science but on the limitations of resources,” Dr Dutta added.

However, Dr Manish Kumar, a spokesperson for the Resident Doctors Association, which represents staff at several Delhi hospitals, said: “Asking health care workers not to get tested and continue to work is only hampering patient care and doctors’ health. That’s eventually getting harmful for the nation’s healthcare.”

He added that internal transmission in hospitals was a big concern, and that if the infection were to spread to patients who were being admitted with pre-existing conditions, the situation could quickly turn severe, ultimately leading to more deaths.

Acknowledging the reduction in tests, health ministry official Arti Ahuja said in a letter to state governments that the new guidelines needed to be read in conjunction with earlier ones which recommended “strategic and focused testing”. She said decisions on testing should fall upon doctors’ discretion.