India’s Doctors — At Home And Abroad — Face Covid’s Unrelenting Toll

Ravaged by Covid-19, India is desperately trying to contain a pandemic that has infected nearly 30 million people and claimed — officially — nearly 400,000 lives. Others put the toll closer to 4 million deaths.

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Medical teams, traumatized by their experiences, recently called it a “a war zone.”

In April, doctors and other clinicians working in a hospital in Gurgaon were attacked by family members after patients died of Covid-19, likely from lack of oxygen. A few weeks afterward, they hid in the canteen to avoid a repeat assault.

India’s doctors have been overwhelmed, watching patient after patient take their last breaths due to lack of oxygen and other basic medical supplies. The latest shortage is amphotericin, a medication used to treat mucormycosis, a rare but dangerous fungal infection emerging in Covid-infected patients.

To make matters worse, Covid-19 is tearing through rural villages where poor health care access is making accurate case counts impossible. Neighboring South Asian nations are facing a similar burden, but at different trajectories.

“The last couple of weeks have been extremely exhausting, physically and mentally,” Karishma De, a trauma medicine resident at New Delhi’s All India Institute of Medical Sciences hospital, shared with one of us (L.R.) by Facebook Messenger. “I’ve lost many friends and family members.”

Doctors, of course, aren’t the only ones affected. Nurses, respiratory therapists, and other frontline workers are drained. India’s crematorium workers are overworked and underpaid in a grisly role with no relief in sight.

Covid-19 has only intensified the epidemic burnout among health care workers. A recent study among health care workers in Maharashtra found that 55% feared contracting Covid-19 and 66% feared transmitting the virus to their family members. Some doctors have treated up to 200 Covid-19 patients in one shift, up from the average of 40 to 50 patients a day before the emergence of the disease. More than 1,000 doctors have died in India during the pandemic, a number that is certainly an undercount.

Half a world away, the dire situation in India is affecting thousands of U.S. doctors of Indian origin, like the three of us, who are struggling in different ways. We care for patients in diverse clinical settings in three distant corners of the country — New York City (L.R.), Sacramento (R.G.), and Houston (B.L.). Yet our shared experiences in dealing with India’s Covid-19 crisis are eerily similar.

We constantly receive messages on WhatsApp and social media from relatives in our motherland, rife with confusion and anguish: “Your aunty is so weak, she’s having difficulty breathing, her heart rate is 150 but hospitals won’t take her.” Dozens of relatives were diagnosed with what is likely the Delta strain (B.1.617.2) since the surge began. We’ve spoken to family about securing hospital beds, ambulances, oxygen and other lifesaving therapies. One critically ill relative received a liter of intravenous fluids before being told to leave the hospital — he was not sick enough to be admitted.

“We have 230 sick Covid patients in the hospital, and doctors are worried about their health and their families while taking care of patients,” physician Pankaj Kumar, additional director of critical care at Fortis Hospital in Shalimar Bagh, New Delhi, told one of us (B.L.) in May. “We’re exhausted.”

Attempting to secure medical resources and delivering medical advice via phone, Skype, and social media to relatives and friends 13 time zones away is challenging, to say the least. Yet this has been the experience of thousands of Indian physicians in the U.S., many of whom have already been traumatized by working around the clock and seeing death daily within our own borders over the last year. We are now horrified by the wildfire spread of a virus that is proliferating across India and into neighboring countries such as Nepal, Bangladesh, and Afghanistan.

The same must be true for our colleagues with family members in South America and other hard-hit regions of the world.

For most physicians, medicine is a calling. The three of us, like most of our colleagues, chose this profession out of a genuine desire to change lives for the better. But in the face of mounting administrative demands, prolonged hours, and limited access to PPE, our faith in the U.S. health care system eroded. Yet instead of calling out these problems — a result of systemic toxicity — many doctors around the world have tamped down their sorrows in order to complete the task at hand.

Addressing the mental toll of Covid-19 among physicians, survivors, and family members, will be an uphill battle. India has not had a history of assessing mental illnesses like depression and anxiety due to a lack of screening, funding, and available mental health providers in rural and urban areas. Stigma toward people with mental illness is also a barrier to care. These public attitudes are linked to a massive treatment gap. According to India’s latest National Mental Health Survey, between 44% and 95% of those in need of mental health care failed to receive any treatment.

With this sparse baseline infrastructure, the pandemic will create years of psychological scars, worsened by a paucity of trained providers: India has only 0.75 psychiatrists per 100,000 residents.

Why should people in the U.S. and other countries care about what is happening in India? Because the country’s mental and physical toll will dramatically impact its ability to sustain the economic and social support it provides to the U.S. and other countries around the world. In addition, the contagious Delta variant, which has wreaked havoc in India and the U.K., has spread to more than 80 countries in the context of loosened mitigation measures and low rates of vaccinations in many countries. The U.S. could see the Delta variant becoming its dominant strain within a few weeks. Spread of this and other variants, including the new Delta plus variant, could lead to more lives lost and further exacerbate burnout.

A sick Indian workforce will have significant economic implications in the U.S. as the world’s second-most populous country, a major nuclear power ally and trading partner, and an important source of finished pharmaceuticals and active pharmaceutical ingredients. The U.S. relies on India for 40% of over-the-counter and generic prescription drugs, as well as technical and medical expertise.

We hope the global community will respond in several ways. Resource-rich nations like the U.S. have a moral and social responsibility to ease the mental and physical torment of its longstanding ally. In addition to vaccines, medications, supplies, and funding, as well as improving the long-term oxygen supply, India needs health care personnel in rural and urban populations including ICU teams with culturally trained therapists. World leaders must also pressure India’s officials to increase targeted, feasible mitigation measures such as masking and distancing.

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