Death after death - sleepless nights for healthcare workers

Mr Joseph Jennings said the first wave of the coronavirus pandemic left him physically exhausted.

Then things got worse.

"The second wave has broken our hearts," added the 35-year-old intensive care unit (ICU) nurse from the southern state of Kerala.

A few days ago, his team had to tell a 15-year-old about his mother's death. The boy and his younger brother were the only ones in their family who had tested negative for Covid-19.

"He wanted to see his mother and kiss her one last time. I don't know how we managed that situation. Last week, we had a lady with a six-year-old and a three-year-old. She passed away. Her husband used to come every day. That was emotionally traumatic for me," said Mr Jennings, adding that, like many of his colleagues, he has found it difficult to sleep on most nights.

Along with other ICU nurses, he has become witness to patients' last words and caretaker of last wishes. "The patients all say they want to be with family, they want a peaceful death. One lady begged me to take away the oxygen mask so she could die peacefully," said Mr Jennings.

Healthcare workers are scarred from witnessing so many deaths and young patients - with no co-morbidities - taking a turn for the worse. They also face extreme anger and see families grieving as the second wave of Covid-19 infections puts immeasurable pressure on India's health system.

The country has recorded more than 27 million cases of infection, with the government saying the second wave is now on a "downswing". The number of new daily cases has fallen from over 400,000 early this month to under 200,000, even as daily deaths due to the virus have dropped from over 4,000 to below 4,000.

Yet, India's healthcare workers have stood as a bulwark against chaos, even as the system appeared to be on the verge of collapse.

And their work is not done.

Last week, a doctor tweeted a picture of herself in full protective gear at her hospital. It went viral as the accompanying text expressed the anger and frustration felt by so many.

"I am 24, posted in ICU, with eight to 10 new mucormycosis cases daily, heavy viral load, risking our lives to save patients," she wrote on Twitter in response to a controversial yoga guru calling conventional medicine "a stupid science".

Mucormycosis is a serious and rare fungal infection that has been observed in Covid-19 patients.

Baba Ramdev, the guru who made the claim, is perceived to be close to the ruling Bharatiya Janata Party and has a large following. He apologised after being asked by Health Minister Harsh Vardhan to withdraw his remarks.

But the Indian Medical Association (IMA) has asked the government to file a sedition case for other remarks that have since surfaced - including the guru's claim that 10,000 doctors have died despite being vaccinated against the virus.

The IMA's Uttarakhand branch has sued Baba Ramdev for defamation to the tune of 10 billion rupees (S$183 million).

Doctors have also had to make some tough calls amid the second wave of infections, deciding which patients should receive oxygen at the height of the shortage in end-April and the beginning of this month.

Dr J.A. Jayalal, president of the IMA, said: "There is a lot of tension. This will have a scarring effect. People are dying in spite of all of our good efforts. Patients come in acute condition. We are not able to save (them all). There is a shortage of drugs. It's a stressful situation. And it definitely makes an impact on our minds. Lots of people are stressed out and burned out.

"But this is our calling. We are trying to counsel them. We (doctors) have helplines among ourselves. We are getting calls from junior doctors. Some of them want to leave the profession."

IMA said 513 doctors have died of Covid-19 during the second wave of the pandemic which, at its peak, overwhelmed hospitals and kept crematoriums blazing. In the first wave, 748 doctors died.

In February, the government said 116 nurses had died but figures on nurse deaths during the second wave have not been released.

India also faces a shortage of doctors and nurses. According to a government report, the doctor-to-population ratio in India is 1:1,511 against the World Health Organisation norm of 1:1,000. The nurse-to-population ratio is 1:670 against the norm of 1:300.

There were more than 1.1 million registered doctors and over 2.9 million nurses in 2018.

Dr P.S. Sona, president of the Trained Nurses Association of India Kerala state branch, said: "The number of staff is not enough for the patient load. The government has offered professional tele-counselling. But nobody is going for that - we just share (experiences) among ourselves."

Some healthcare workers are stunned at the sight of their own wards.

Dr Dipshikha Ghosh wrote on Twitter: "Looking at ghost-like white PPE (personal protective equipment)-clad figures walking around inside Covid units is something that even I feel weirded out by, in spite of being exposed to it for over a year.

"I can't imagine how it must be for patients, for whom this is the first hospital admission."