'People are dying. We are helpless'

'Some VIP or minister should come to the ward and see how people are suffering.'
'The pain and suffering of the relatives of the patients who are admitted; let them hear their desperate pleas for medicines and oxygen and ventilators and ICU beds; the cries of the kith and kin of doctors and nurses who are being eaten by the pandemic.'

Dr J A Jayalal is president of the Indian Medical Association which has sent a letter to the Union health ministry to 'wake up'.

The IMA -- a pan-India voluntary organisation with a membership of 350,000 doctors -- has lost 126 doctors to the second wave and 736 doctors to the first wave.

"Pregnant women are dying, young children are dying, doctors are dying, nurses are dying; the elderly are dying," Dr Jayalal tells Prasanna D Zore/Rediff.com in the first part of a revealing interview.

You have written a letter to the Union health ministry and suggested it 'wake up' and mitigate challenges'. What kind of inadequacies do you find in the health ministry's handling of the COVID-19 second wave?

The Indian Medical Association has suggested implementation of a complete, nationwide lockdown for 15 days. But the Union government doesn't seem to be in favour of this suggestion.

We had also asked for free vaccination for all Indians irrespective of their age brackets.

All the poor people in the 18-44 age groups may not have enough money to spend on the vaccines and they might opt out of getting vaccine shots, thereby putting them at risk of infections. By extension, they can then expose more people to the risk of infection.

The Union government announced that all those between 18-44 will get vaccines after May 1, but now the situation is that vaccine doses are not available. There are long lines of those wanting to register on the Cowin app, but are unable to do so for whatever reasons.

You may have your reasons, but once you make an announcement it is your job to make the vaccines available. Instead of reasons, please offer solutions.

There are lots of options with you that you can use. I am not saying that you are not facing difficulties,, but when the prime minister has made an announcement, then the administration should work doubly hard to make it happen.

Manpower is yet another problem.

They postponed the NEET PG exam and now there is chaos. Even after one week nowhere are junior doctors joining (the fight against COVID-19).

There are 178,000 such doctors. Well-trained doctors waiting to join the fight against the pandemic, but for some reason they (the National Board of Examinations) are not conducting the exam; they will postpone the exams to protect these test-takers from Covid.

You are conducting these exams to make these doctors work in the Covid ward, then what is the difficulty in conducting the exams for them?

This is not like postponing the exam for Class 10 or Class 12. That is not going to have any impact. By not conducting the exam you are denying these doctors, these frontline healthcare workers, from joining the fight against the pandemic.

The Government of India is listening to the people who are conducting these exams (the National Board of Examinations) and other bureaucrats, but you are not listening to the people who are facing an acute shortage of manpower on the field to fight the pandemic.

The IMA has suggested a complete lockdown. To what extent will this help in breaking the spread of COVID-19?

The chain can be broken once we deploy measures to prevent its spread from one person to another. One infected person can easily pass on the infection to 50 other people.

We are not having adequate testing facilities. There are lots of infected people who are roaming around with symptoms like mild fever, running nose, and cough without even knowing that they are positive. But for the next 14 days they will remain positive and as they come in contact with more people around them they silently keep spreading the virus exponentially.

If you don't go for a lockdown, infections will continue to spread unchecked.

When you go for a lockdown, which may not have an immediate effect in bringing down the number of cases, but given the maximum incubation period of the virus is 14 days, and once these positive people stop roaming around and spreading virus due to the lockdown, the onset of the third wave will be delayed to a great extent (in terms of numbers) and time.

Going for things like 'micro containment zones', 'focused lockdowns', is not going to stop the spread of COVID-19. It will spread like wildfire.

Do we have the manpower to handle the same pandemic when it swells during the third phase? We simply don't have that kind of manpower.

When you have a centralised lockdown, it may lead to financial worries, but then plan the lockdown to the last detail and do it in a time-bound manner. Give people time to prepare for it. Give them money to cope with the lockdown.

People need to be convinced that the nationwide lockdown will be to their benefit. The economic hardships of not going for a lockdown now will be far greater than going for a lockdown and giving the people enough money to survive during this lockdown.

Has not announcing a complete lockdown worsened the COVID-19 pandemic in India?

Definitely.

Look at the states where lockdowns were strictly implemented and compare their situation with states that went for anything less than complete lockdown. There were decrease in the number of cases and positivity rates in the former case, but in states like Tamil Nadu where there was no lockdown the cases are increasing rapidly now. They have announced a lockdown from today (May 10) but this will take the next 14 days for the number of cases to come down.

Hospitals are now full with patients. There is not enough manpower to deal with the deluge of cases, not enough medicines, ICU beds, ventilators, oxygen cylinders, etc.

Suppose if the country is at war, then everybody has to get used to restrictions. Today, India is at war with COVID-19; it is a far bigger and powerful enemy than any we have around us; without restrictions on the movement of people, winning against this enemy will bring in enormous economic, mental and health costs.

Now, when Tamil Nadu is under lockdown, and if Andhra (Pradesh) is not under lockdown (for instance), then the people living along the borders of these two states will continue to intermingle and move around.

Localised lockdowns will prove highly ineffective; we need a uniform, nationwide, lockdown.

Tamil Nadu had fewer cases two-three weeks ago, but today the number of cases has jumped to more than 27,000-28,000 every day.

When you are anticipating such scenarios, then it is imperative you take a decision.

Why do you think is the Union government dithering on announcing a complete lockdown?

Maybe, they are worried about the economic fallout of such a decision. Even otherwise, the economy is going through a downturn; from the last one year people are suffering (economic hardships).

But look at this dilemma this way: when one patient gets infected, S/he spends so much money on medicines, hospitalisation, ICU beds, et.

People as young as 30-35 years are getting paralysed, dying because of the Covid infection. This one person then spreads the infection to 50 more and then you repeat the cycle of hospital spending, running desperately for oxygen and other life-saving drugs and then you have 50 more people spending the same amount of money as did the first one.

You cannot compare the deaths of people to people losing their jobs and their earning capacity. While both need to be controlled and taken seriously, the need of the hour is a complete, national lockdown.

The government, however, always cites economic hardships for the people belonging to the lower economic strata for not imposing a national lockdown like the last year.

What's the situation on the ground as far as providing for adequate Covid medical care is concerned?

People are dying just like that. We are helpless.

I was in the ward the other day. Just ten minutes ago I saw a patient with 95 saturation (oxygen level) and when I came back after finishing my round the person was no more.

That's the situation on the ground.

Pregnant women are dying, young children are dying, doctors are dying, nurses are dying; the elderly are dying. IMA too has lost hundreds of doctors to the second wave.

Somebody, some VIP, some minister should come to the ward and see how people are suffering. They should not go to only Apollo Hospital or AIIMS. Come to see (the situation on the ground in) local, regular hospitals.

Let them come and see the difficulties the entire ecosystem of healthcare workers are going through. The pain and suffering of the relatives of the patients who are admitted; let them come here and hear their desperate pleas for medicines and oxygen and ventilators and ICU beds; the cries of the kith and kin of doctors and nurses who are being eaten by the pandemic.

Five-six ambulances will always be in waiting outside such hospitals because there is not enough oxygen or ICU beds available as these hospitals are filled to overcapacity.

When there is no oxygen available in government hospitals, people rush to private hospitals. But the situation is no different there. Where to go, how to manage such deluge of patients is the question facing everybody.

We are in a very difficult situation; this is not the time to talk politics; not the time to point out who is at fault. We ae not saying that the PM is at fault, or the health minister is at fault.

I am saying that the bureaucrats are responsible for all this (mess; the shortage of life-saving equipment and medicines to fight COVID-19).

• PART II: 'Difference this time is the suddenness of death'