Tag: n95 masks

Watch: Beware of Fake N95 Masks, Govt Says They May Be Detrimental to Health

While the valves filter the air that is inhaled into the mask, they don’t filter the air that exhaled out of the mask.

Across the globe, more than two lakh new COVID-19 infections are being added every day. In view of this, many efforts are underway to stop the contagion. One of the efforts is that the WHO has mandated the use of face masks. Experts have also recommended that countries follow a universal masking policy to reduce the spread of the coronavirus.

The Indian government has also made the use of masks mandatory in public places. Last week, the Ministry of Health and Family Welfare issued a notice warning against the use of N95 masks with valves. The advisory stated that using N95 masks with valves can defeat the purpose.

While the valves filter the air that is inhaled into the mask, they don’t filter the air that exhaled out of the mask. So if the virus enters a person’s respiratory pathway and the person exhales it into the mask, the valves will then toss it out into the air without filtering it. Watch the video to learn more.

How True Is Modi’s Claim That His Decisions Saved India From the Worst of COVID-19?

Prime Minister Modi uses only the visible – the hardware – to claim India is ‘better off because of right decisions at the right time’, even though the claim isn’t even true.

Prime Minister Narendra Modi’s claim on July 27 that India “is in a better position than other countries” even as a slew of successive lockdowns fattened the COVID-19 case-load curve instead of flattening it, reflects his tendency to make comparisons based on conveniently cherry-picked data.

Like others in government – including Vinod K. Paul, a member of the NITI Aayog, who wrote in the Indian Express on the impact of India’s lockdown on slowing the epidemic’s growth – Modi compares India’s lower infection and mortality rates with those regions where it is higher, conveniently ignoring the fact that many countries are doing better than India.

If we were to rank the performance of 213 countries and territories from worst to best on five broad measures, where coming first is to be the worst, this is how India fares:

  • Total number of COVID-19 cases: 3
  • Total number of COVID-19 deaths: 6
  • Total number of active COVID-19 cases: 3
  • Total cases per one million population: 99 (i.e. 104 countries do better)
  • Total deaths per one million population: 98 (i.e. 105 countries do better, including densely populated ones like Bangladesh, Indonesia, Nigeria, Ethiopia, Japan and Vietnam)

It is clear from these rankings that Modi’s claim that India is in a “better position than other countries” is specious. As for his boast about having taken the right decisions at the right time, the disastrous effect his poorly planned and executed national lockdown has had on the lives of millions of people, not to speak of the economy and even public health, has been so well documented by experts as to not require repetition.

The graph below plots the daily tally of new COVID-19 cases across India and daily recoveries. As long as the graph looks the way it does – with the blue new infections line climbing away from the green recoveries line – you don’t need to make comparisons with other countries or craft fancy statistical models of where India might have been to realise India today is doing very badly.

But beyond playing fast and loose with data, Modi’s claims on Monday also betray his government’s counterproductive preoccupation with just the ‘hardware’ of health governance (to borrow Dr Vikash Keshri’s turn of phrase).

In his speech, delivered ‘virtually’ to flag off “high-throughput” testing facilities in Mumbai, Kolkata and Noida, Modi claimed “the world is praising us”. The world, in fact, is not praising India at all. If anything, it has begun to notice how the case-load is increasing the fastest in India and that even this is likely an underestimate since India is not testing enough.

In his article, Paul presents a graph plotting the COVID-19 case growth rate since the first case was registered on January 31. According to this plot, the growth rate came down to 3.4% in the second week of July, down from a peak of 22.6% in early April and from a post-lockdown high of 4.4% in early June.

But what Paul neglects to tell us is how this (claimed) decline over time in the growth rate of cases in India compares poorly with other countries that have a high case load, such as the US and Brazil.

As Rukmini S. and Nikhil Rampal demonstrate, the growth rate of COVID-19 cases in India is one of the highest in the world: “Just 18 countries out of nearly 200 are growing faster, but all of them (except Argentina with 1.5 lakh cases) have only a few hundred or few thousand cases.”

Consider the following chart, from ‘Our World in Data’, which gives the doubling time of cases for the countries with the highest case load:

COVID-19 cases are doubling the fastest in South Africa and India among all countries with the highest case load. Source: ourworldindata.org

In the US and Brazil, cases are doubling every 41 and 33 days respectively, while in India it takes just 21 days for the case load to double. Apart from South Africa, where cases are doubling in 19 days, every other country with a large case load is doing much better than India.

Also watch: India’s COVID-19 Epidemic Is Growing at the Fastest Rate Globally

As with Modi, Paul’s defence rests almost entirely on officially recorded parameters that can be manipulated to compare favourably with the corresponding figures from the US and Europe, while ignoring others. The lockdown lends itself easily to such an exercise, given the trove of numbers and calculations associated with it. But zoom in here to spot what has gone unsaid. Paul celebrates the lockdown thus:

Several independent analyses give us a big-picture view of the situation we would have found ourselves in without the lockdown. Some estimates of cases averted run into crores. The Ministry of Statistics and Programme Implementation has estimated that based on a rational model, the lockdown prevented as many as 14-29 lakh COVID-19 cases and 37,000 to 78,000 deaths (with point estimates of 20 lakh and 54,000, respectively) by mid-May. Remember, even in mid-July, we have yet to reach such a high burden, and this could have been a grim reality in mid-May.

There are three curves in play here. This is my crude illustration (not to scale):

According to Paul, “The Ministry of Statistics and Programme Implementation has estimated that based on a rational model, the lockdown prevented as many as 14-29 lakh COVID-19 cases and 37,000 to 78,000 deaths (with point estimates of 20 lakh and 54,000, respectively) by mid-May.” The fatality estimates pertain to the middle curve. However, it is hard to see how Paul et al claim the estimate that the lockdown averted 54,000 deaths by May 15 to be both good and right without knowing the number of deaths that could have been averted overall (upper curve) and without explaining the fatality undercounting (reflected in the lower curve) that report after report by experts have found.

The upper curve pertains in particular to a debate among doctors and medical researchers that if a person with kidney failure died because she couldn’t access dialysis for a few weeks because the hospital had been converted to a COVID-19 care facility, her death should also be counted as a case of ‘death due to COVID-19’. There are lots of examples of such indirect consequences in India that a fixation with the ‘hard numbers’ would miss.

For example, as Modi trained his focus on the fact that India today manufactures great volumes of PPE and test kits, has set up a large number number of hospital beds and plans to improve logistics, he said nothing about the things that are not visible.

In April, the government had every phone call placed in the country begin with an automated message reminding the caller about their duties as citizens to control the epidemic. But what good is being asked to wash your hands if you don’t have access to running water? What good are “11 lakh isolation beds” if, as Vikas Bajpai writes, “the thoughts of an intimidating hospital environment, the expenses to be incurred, the wages foregone, of who will look after their children at home and finally the stigma have weighed heavily even in the best of times”?

Similarly, it is not good to have an ‘army’ of “foot soldiers” if they are not going to be properly paid and housed, and backed by managers who refuse government requests to modify death certificates, administer untested drugs and work with poorly designed insurance packages that deepen patients’ distrust of doctors.

Also read: ICMR Must Decide if it Is India’s Council for Medical Research or its Master’s Voice

It is not good to harp on a high recovery rate by taking advantage of India’s low scientific literacy (recovery rates increase naturally during an ongoing pandemic). It is incommensurable to say “we want to save each and every Indian” and then draft vague guidelines that help neither doctors nor patients or do science by press release, to claim “over three lakh N95 masks are being made in India today” without noting that the market is flooded with fakes, to hint at plans to “strengthen demand-supply chains in the block, village and zilla levels” without discussing a NITI Aayog proposal to operate government district hospitals in public-private partnership mode.

In effect, Prime Minister Modi uses only the visible – the hardware – to claim India is “better off because of right decisions at the right time”, even though the claim isn’t even true. And even if it were, this is only in terms of one disease, and only in the here and now, at the expense of so many healthcare crises India faces every year.

He has instead ignored the invisible – the ‘software’ – to be able to cherry-pick to make his government’s limited work look better. But zoom out and you can see the cherry tree has thousands of branches left barren both by years of neglect and poor policies at the present time. His government is as much to blame as the ones that came before but many of these specific missteps are his government’s alone. And who knows, we may just be rewarded with India hitting 2 million cases on the Bharatiya Janata Party’s big ticket day, August 5.

COVID-19 Investigation: The Indian Market Is Flooded with Fake N95 Masks

Many companies are exploiting the difference between certification and testing – and certification is a more involved process.

Bengaluru: Arnab Bhattacharya likes to joke that he is a mask-crusader. Two months ago, while the COVID-19 outbreak was spreading across India, his lab began testing the quality of N95 respirators – a kind of mask that protects wearers against airborne droplets containing the novel coronavirus.

Bhattacharya is a physicist at the Tata Institute of Fundamental Research, Mumbai. His work with masks began when COVID-19’s onset triggered a major shortage of N95 respirators from established manufacturers, such as the American firm 3M and Mumbai’s Magnum Health & Safety. This forced the Tata Memorial Centre, a major cancer hospital in Mumbai, to consider using masks from new manufacturers they weren’t familiar with. So the hospital asked Bhattacharya for help ensuring these respirators worked as their manufacturers claimed.

That is, they wanted to know if the respirators filtered 95% of particles larger than 0.3 microns, as N95 masks are meant to.

Since most readymade mask-testers, by companies like TSI Incorporated, cost several lakhs and aren’t easily available, Bhattacharya’s team jury-rigged one using an air-pollution monitor. They then tested their device on masks from established N95 manufacturers, like Magnum, and found the results to be reliable.

But when the team began testing other purported N95 masks, they were surprised. Some of the masks were “nowhere close to N95,” Bhattacharya said.

These poor-quality masks filtered only some 60-80% of 0.3-micron particles, putting healthcare workers at risk of infection. Intrigued, Bhattacharya began scouring online marketplaces for more N95 masks. He found many of them were indulging in false advertising.

For example, masks that were only effective against particles larger than 3 microns – which would work against bacteria but not virus aerosols — were labelled N95. Other N95 respirators claimed to be washable. Bhattacharya said this is unlikely because most such masks use electrostatic charge to trap small particles.

“You will kill it if you wash it, because it will lose the charge,” he said.

Still others claimed to be certified by agencies that don’t certify masks.

“I am appalled at the number of fake N95 masks,” Bhattacharya said.

Once he realised the extent of quality issues, he conducted multiple webinars to help both healthcare workers and non-experts understand them. But the problem of shoddy masks is not restricted to Tata Memorial Centre, or even Mumbai.

COVID-19 has triggered a surge in demand for N95 respirators. Subsequently, many manufacturers with little experience in making these products have stepped in – but few of them are producing effective masks.

“Almost 150 manufacturers have come up in the past three months. Some of them are basically counterfeiting brands,” Sanjeev Relhan, chairman of the Preventive Wear Manufacturers Association of India, told The Wire Science.

While there is little data on sales for N95 masks in India, which were low before COVID-19, the outbreak prompted public-sector firm HLL Lifecare to issue a tender for 6 lakh masks in March 2020 for government use alone.

Fake masks can endanger lives, so Relhan and other experts say it is crucial to do two things: rein in errant manufacturers and bolster the supply of genuine masks.

To do the first, according to Relhan, the Central Drugs Standard Control Organisation (CDSCO) must act against makers of faulty masks. Since April 2020, when India passed the Medical Devices (Amendment) Rules, all medical masks have been under the CDSCO’s purview. Manufacturers do have 18 months to transition before they comply with the Rules, but if the CDSCO wishes, it could shorten this period and invoke the Rules sooner, Relhan said.

Once CDSCO does this, it can require manufacturers to comply with the requisite quality standards for masks, such as IS:9473, developed by the Bureau of Indian Standards (BIS), according Anil Jauhri, an expert in quality certification systems. He previously headed India’s National Accreditation Board for Certification Bodies. “There is nothing stopping them,” he said.

But when The Wire Science asked the Drug Controller General of India, V.G. Somani, who heads CDSCO, whether the organisation plans to act against defaulting manufacturers, he didn’t respond.

Still, simply regulating the manufacture of N95 respirators won’t solve the problem. To comply with standards like the IS:9473, manufacturers need access to laboratories in which they can routinely test their products. But given the low demand for N95 masks until the COVID-19 outbreak, few manufacturers invested in such facilities, Jauhri said.

Even now, he argued, in-house labs may not be feasible for many small manufacturers. To tackle this problem, both Relhan and Jauhri are calling for either the Union health ministry or the BIS to set up labs able to test N95 masks.

“For N95 masks, there are currently no external labs, outside manufacturers’ facilities, to test for quality. It’s a big problem,” Jauhri said. By setting up such labs and allowing small manufacturers to access them, he added, India can kickstart the emerging respirator industry.

Why does quality matter?

A woman wearing a protective mask walks past a graffiti, in Mumbai, April 2020. Photo: Reuters/Hemanshi Kamani

There are many ways in which an N95 mask can fail. For instance, under IS:9473 and a similar American standard, called 42 CFR 84, an N95 mask must have a particulate filtration efficiency of 95%; must be breathable, which means when a wearer inhales air through the fabric, the air pressure mustn’t drop dramatically; must form a tight seal around a person’s face so that unfiltered air doesn’t leak inside; and must resist fire and withstand temperature fluctuations without losing its efficacy.

Only when these – and several other features listed in the standards – are met without exception can the mask block aerosols, like those that transport the novel coronavirus.

Across the world, several national agencies, including the BIS, certify masks that meet these standards. Of these, only the US National Institution of Occupational Safety and Health (NIOSH) uses the term N95. So strictly speaking, only a NIOSH-certified mask can claim to be an N95, although the term has become a catchall for all similar masks. So even though BIS and the UK’s INSPEC certify so-called FFP2 masks, which are broadly equivalent to NIOSH’s N95, people often refer to FFP2 masks as N95.

Other comparable devices are the KN95, meeting Chinese standards; P2, meeting Australian standards, and D2, meeting Japan’s.

A NIOSH- and FDA-cleared N95 healthcare respirator and surgical mask by 3M. Photo: SMS on the rocksj

When the COVID-19 outbreak began in India, given the demand for effective N95 masks, two government agencies other than BIS also began testing them: the South Indian Textile Research Agency (SITRA), Coimbatore, and a facility of the Defence Research and Development Organisation (DRDO) in Gwalior. But these two agencies offered only one-time testing, to help manufacturers refine their prototypes. And neither is a certifying agency.

Further, even the one-time tests are limited. Both agencies test only three of the many parameters under IS:9473, namely particulate filtration efficiency, breathability and flammability. They don’t test for many others, including leakage.

However, many Indian companies who got their masks tested by SITRA and DRDO are claiming to be certified today, TIFR’s Bhattacharya said. These misleading claims have become so rampant that both DRDO and SITRA have warned manufacturers to stop. But the companies continue to dupe healthcare workers into buying inadequately tested masks by using SITRA and DRDO logos.

Testing versus certification

Sometime in April, the Punjab state government began procuring N95 masks from a Ludhiana-based company called Shiva Texfabs Ltd. The company had only made yarns and knitting fabric until then, and was manufacturing N95 masks for the first time. One of the hospitals that received Shiva Texfabs’ masks was the Ludhiana Civil Hospital, which was treating COVID-19 patients.

Almost immediately, several of the hospital’s doctors realised the products were substandard. The masks had ear loops instead of head bands, so the fit wasn’t tight enough. They were also made of a flimsy material, a hospital employee who didn’t wish to be named told The Wire Science.

But things really came to a head when three of the hospital’s workers tested positive for COVID-19. “There was a hue and cry. Things just burst open. Staff nurses and junior doctors were crying,” the employee recalled. Convinced that the bad masks had led to the infections, doctors and nurses began a protest on May 19. Eventually, Ludhiana’s civil surgeon Rajesh Bagga stepped in and assured the workers that the masks would be replaced.

One thing that went wrong in the Civil Hospital episode was that government doctors were misled by the company’s claims. Bagga told The Wire Science that Shiva TexFabs’ masks had claimed certification by both SITRA and DRDO. Even today, Shiva TexFabs’ website continues to claim that its N95 masks are certified by DRDO, although it makes no mention of SITRA.

The Shiva TexFabs homepage at 1 pm on July 17, 2020.

But according to the BIS website, Shiva Texfabs has only applied for certification, and its first sample failed tests. An email sent to an ID listed on the company’s website went unanswered.

Many companies are exploiting the difference between certification and testing, although certification is a more involved process, Relhan said. For example, when BIS certifies a mask, it doesn’t just require a manufacturer to test the mask once under IS:9473, but also requires that the manufacturer have a quality control system in place to test every new batch of masks.

Such controls are necessary because small changes on the manufacturing line can result in an ineffective mask, several manufacturers told The Wire Science. Even the fabric used to make the mask can vary from batch to batch, they said.

Rakesh Bhagat, director of Magnum Medicare, which makes both NIOSH- and BIS-certified masks, gave the example of seams on the fabric of N95 masks, which are sealed using ultrasonic waves. “If you don’t maintain the same frequency of the ultrasonic waves, you can puncture the fabric, and the mask can lose its filtration efficiency,” he said.

Misleading guidelines

Given the confusion, the Union health ministry hasn’t exactly cleared the air. In March, the ministry released guidelines for the use of COVID-19 PPE. But these guidelines are at odds with those of some other national health agencies. The ministry’s guidelines call for N95 masks with exhalation valves, which are typically used in settings like coal-mines, because they allow exhaled air to be removed and keep the wearer comfortable.

However, in hospitals, where the mask is also supposed to prevent the transmission of COVID-19 from the healthcare workers to patients, these are a bad idea. “An exhalation valve is a big no,” Bhattacharya said. “It provides a zero-resistance path for exhaled air, so that all sneezes, coughs, etc. will go directly out without any filtration.”

This is why the US Centres of Disease Control recommends against masks with exhalation valves in hospitals, especially during surgeries, when a sterile environment is important. But the Indian health ministry’s guidelines have led to government procurement agencies like HLL Lifecare issuing tenders for N95 respirators with valves.

The health ministry also hasn’t clarified on the use of ear loops to fasten masks. NIOSH doesn’t allow manufacturers to install ear loops on masks for healthcare workers because typically they can’t be tightened. Only adjustable head straps are allowed. “When you use ear loops, the seal around the face is not perfect. Ninety percent of the time, such masks fail fit-tests. Then there is air leakage,” said Bhagat of Magnum Medicare. But many Indian manufacturers continue to make masks with ear loops.

Hundreds of fake certificates

A boy wearing a face mask rides in a cycle rickshaw on the eve of Ramzaan, in Delhi, April 2020. Photo: Reuters/Adnan Abidi

With few checks and balances to ensure quality in the respirators industry, shoddy masks continue to trickle into Bhattacharya’s lab – many accompanied by fake certificates.

In June, Bhattacharya received two masks labelled ‘EcoPanda 95’ that had been supplied by a Bangalore-based company to Tata Memorial Centre. One had an exhalation valve and the other didn’t. When Bhattacharya evaluated them on his tester, the valved mask only filtered 60% of small particles, and the valve-less one filtered 68%.

“These are the worst masks I have seen in the past two months,” Bhattacharya said.

When he cut up the mask with a pair of scissors, he saw why the EcoPanda masks were so porous. Instead of using heat or ultrasonic waves to seal the seams, the manufacturer had stitched them, leaving holes that let air through. What’s more, the mask was made of only two fabric layers, while typical N95 masks have up to five.

When The Wire Science contacted Vishal Pipada, the director of the company that had supplied the EcoPanda masks, he said the masks hadn’t been made by his firm but were from Global Air Filter India Pvt. Ltd., another firm in Bangalore. Pipada also shared five certificates for Global Air Filter’s masks, including one from the “Food & Drug Administration”. But The Wire Science found that at least four of these certificates were fake: they were issued by agencies that are not allowed to certify.

For example, in one of the certificates, a company called UK Certification and Inspection Ltd claimed to certify Global Air Filter’s mask according to EN 149:2001, the European respirator standard. However, only bodies notified by the European Commission can certify European standards, and UK Certification isn’t one of them.

On another certificate Pipada shared, an agency called “QCS”  had awarded a “Food & Drug Administration” certification to Global Air Filter. Jauhri, who recently wrote a document on how to spot fake certificates, said the US Food and Drug Administration doesn’t allow any external agencies to certify products under its name.

Fake certificates have become a booming cottage industry, and hospitals are having a hard time spotting them, experts say. Relhan cited the example of a government hospital in North India whose tender for N95 masks elicited the interest of 122 firms offering a range of certificates. “Can you believe it? Out of 122 certificates, 120 were fake,” he said.

There are no quick solutions to this problem, experts say – but CDSCO must start chipping in by acting against offending manufacturers. Relhan suggested it might also be a good idea for a body like the Quality Council of India to host a website where mask-users could check the authenticity of certificates.

The most important factor is greater awareness among users. There is complete confusion right now, Bhattacharya said, about what an N95 mask is and its specifications. And this he added won’t do because in India, which today crossed 1 million COVID-19 cases, people will need to continue using masks.

“The way things are going, masks are here to stay.”

Priyanka Pulla is a science writer.

The reporting for this story was funded by a public health journalism grant to Priyanka Pulla from The Thakur Family Foundation.

Delhi: 84 Nurses of City Hospital Say They Were Fired For Demanding Adherence to COVID Protocol

The Nursing Superintendent has denied the allegations and said that the hospital had been following the due process of renewing the yearly contracts of the temporary nursing staff.

New Delhi: A group of nurses at the Hakeem Abdul Hameed Centenary Hospital (HAHC) have accused their employer of wrongly “terminating” 84 of them “without any notice and without a valid reason.”

The nurses have speculated that the reason they were terminated was that they had been raising their voice against the poor management of the COVID-19 ward, and the medical staff attached to it, by the hospital.

The Nursing Superintendent (NS) of the hospital, however, said that they had only been following due process of renewing yearly contracts of temporary nursing staff, and that they had not terminated anyone.

A young nurse, who was a part of the agitation that occurred on July 13 and July 15 outside the hospital premises against the alleged termination, told The Wire that the nurses had been at loggerheads with the hospital management for over 15 days.

Accusations against the hospital 

On June 23, the nurses at HAHC penned a letter to the hospital management raising the issue of the poor condition of nurses and and accusing the hospital of various violations.

In the letter, the nursing staff at HAHC accused the hospital of denying them a COVID-19 test, and adequate quarantine facility after completing a COVID-19 duty.

“If I work in a COVID ward for seven days, I should get seven days’ quarantine facility, I can’t go back to my house where I may infect others,” a young nurse from HAHC said, on the condition of anonymity. “In my hostel, nurses who are working in the general ward live with nurses who are working in the COVID ward. How risky is that?” she said.

Also read: Delhi: More Than 2,000 Healthcare Workers Have Contracted COVID-19

In the letter, nurses at HAHC also accused the hospital of not giving them proper PPE and N95 masks. Another nurse who spoke to The Wire said that they were given 3M pollution masks instead of N95 masks and the PPE was of inferior quality and “did not properly cover [the] neck area”.

“We don’t have a proper donning and doffing area, where we can properly wear or discard our protective suits,” a nurse said.

As a result, 7-8 working staff members at the hospital have tested positive in the span of over four months since the hospital started a 219-bed COVID ward.

Surprisingly, the nurses also accused the hospital of not providing them with drinking water. According to a nurse, only 3-4 days ago, a water dispenser was installed after they protested.

“There was no water dispenser in the COVID ward since its inception. Packaged water bottles were brought for COVID-19 patients and we, nurses, were asked to buy the packaged water. On a different floor, one water dispenser is installed but how can we, who are attending COVID-19 patients, use a water dispenser that everyone else uses?” she asked.

“Finally, just 3-4 days ago, water was provided to us,” a nurse said.

Alleged termination of the nursing staff

The young nurse who spoke to The Wire said that since the nurses had accused the hospital of serious violations, the hospital management had used its power to not extend their yearly contract citing COVID-19 and have “terminated” 84 of them.

The hospital order informing staff nurses about the alleged termination was sent on July 11. The order said: “Extension in the contract of 84 staff nurses was due between Feb 2020 till July 10, 2020. These cases could not be processed due to the prevalence of COVID-19.”

Also read: Delhi: In Many Hospitals, Poor Working Conditions, Low Salaries Force Nurses to Resign

The order further states: “ The Competent Authority has approved the extension in the contractual appointment for all 84 nurses…till July 10, 2020 only. All these nurses therefore stand relieved from July 11, 2020”.

The young nurse said that none of the 84 nurses were given any notice before their alleged termination. Ideally, a one-month notice is required for terminating a contractual nurse.

“All nurses were on duty when they received a WhatsApp message about the termination. They were all terminated while on duty,” she said.

The IPNA and the UNA are two organisations who are helping staff nurses at HAHC raise their demands. The UNA has also written a letter to the chief minister of Delhi, Arvind Kejriwal to take cognisance of the alleged termination of nurses.

Nursing Superintendent’s defence

Speaking to The Wire, the Nursing Superintendent (NS) of the HAHC has defended the hospital. “They have not been terminated. They have been, with due process, relieved by the hospital because their contract had ended. We have called all of them for fresh interviews as per our protocol”, she said.

As per the rules of contractual employment, all the 84 nurses who have been relieved by the hospital have been asked to come for fresh walk-in interviews to renew their contract, the NS said.

“We will give them fresh offer letters like we do every year. Those nurses who are below average [in their work], they will be given feedback and their contracts will not be renewed. This also we do every year. There is nothing wrong in this,” she added.

On the other accusations, the NS said that after the Delhi government asked them to increase the number of COVID-19 beds in the hospital from 30 to over 200, there were many structural changes that were required to be done. According to her, some basic changes were made, a separate donning and doffing area was provided to the nurses. However, she admitted that some additions to the area still need to be made. “Painting of the walls, setting up of lighting etc. is gradually being done,” she said.

The NS also said that after the hospital became a COVID hospital, it had to bear enormous expenses and they did whatever they could to provide their nursing staff with appropriate PPE kits and masks.

When asked why 3M pollution masks were given to the staff instead of N95 masks, she said that the 3M masks were equally good too. “I am also wearing 3M masks, they are absolutely fine,” she said. “At the double-triple rate our management purchased masks for our staff.”

Also read: COVID-19: At Delhi Hospital Where Nurse Died, Others Say They Were Made to Reuse PPE

The NS also denied that the nurses were not given proper drinking water. “There is an RO at every floor,” she said.

According to the NS, while the hospital management did not put up nurses and medics at a hotel for quarantine, they reserved a 50 bed ICU for the nursing staff. In addition, 4 private rooms have also been made available. “Before this agitation, 67 nurses were quarantined in these facilities provided by us”, she said.

The NS has said that at least 40 of the 84 nurses who were relieved have now been issued fresh contracts. But both the young nurses who spoke to The Wire speculated that these fresh contracts had been issued because of pressure from the nurses’ union.

Member of parliament and CPI leader, Binoy Viswam also penned a letter to chief minister Arvind Kejriwal on July 13, saying that if the hospital “is not able to justify their termination, they must be reinstated immediately.”

The Wire has also reached out to the doctors of the hospitals to ascertain the claims of the nurses as well as the hospital management. The story will be updated when a response is received.

Five Delhi Hotels Turned Into Hospitals as Cases Record 1,000 per Day Increase

Providing thousand more beds, the hospitals would be attached to five private COVID-19 hospitals and possess all necessary equipment and support systems.

New Delhi: With new COVID-19 cases in Delhi crossing the 1,000 mark for the second consecutive day and the total number of cases reaching 17,386, the health department today requisitioned five hotels in the city, attaching them to COVID-19 hospitals, for augmenting the bed supply by a thousand.

The order, issued by Delhi health secretary Padmini Singla, said the hotels would be requisitioned by the concerned district magistrate.

Serious patients to be shifted to main hospitals

As per the order, Hotel Crown Plaza in Okhla Phase-I would be attached to Batra Hospital and Research Centre, Hotel Surya in New Friends Colony to Indraprastha Apollo Hospital, Hotel Siddharth at Rajendra Place to Dr. B.L. Kapur Memorial Hospital, Hotel Jivitesh at Pusa Road to Sir Ganga Ram City Hospital, and Hotel Sheraton at Saket District Centre to Max Smart Super Speciality Hospital.

The health department has also specified that the private hospitals, which would be getting additional space in these hotels, would use them to admit COVID-19 positive patients “as per the patient’s medical condition and in case such patients turn into severe at any point of time during their stay in the hotel, he/she shall be transferred/admitted in the attached private hospital at its scheduled rates”.

Converted hotels to have both regular and emergency equipment

The order also noted that private hospital would provide manpower (nurses and doctors) as also oxygen supply, either in the form of oxygen concentrator or oxygen cylinder, in the extended COVID Hospital in case a patient requires oxygen support. Also, provision for consumables like PPE kit, N95 masks, gloves, medicines and equipment like pulse-oximeter, thermometer, oxygen concentrator or cylinder will be made by the respective hospitals.

In these hotels that are being converted to hospitals, necessary arrangements for resuscitation services (equipment, drugs and medical consumables) would also be made to address any rapid deterioration in the clinical condition of a patient.

Also read: AIIMS Battles COVID Spread Among Staff, Surge in Cases Over Past Two Days

Patients to be charged max of Rs 5,000 for room, Rs 2,000 for oxygen

The hotels would be required to provide regular hotel services such as rooms, housekeeping, disinfection and food for the patients. For this, they will be charging a maximum of Rs 5,000 per day for five-star category and Rs 4,000 per day for three or four star category.

The hospitals would be allowed to charge up to Rs 5,000 per patient per day for their medical services and this would be inclusive of all consumables, services of doctors, nurses, paramedical staff and nursing staff. However, investigation charges, would be extra and oxygen support would also be chargeable separately at up to Rs 2,000 per day per bed.

The order noted that the linked hospitals would be able to accommodate their doctors and staff at the hotel, but at their own expense.

The order is being seen as an attempt to augment the availability of beds quickly since Delhi has seen a rapid increase in new COVID-19 cases. The city witnessed a rise of 1,106 cases during the past 24 hours.

Death toll rises by 82 as 69 unrecorded cases are reconciled

Meanwhile, the official death toll due to the coronavirus shot up to 398 today with 82 more deaths that took place in the last one month being added to the tally today upon proper verification of all cases. The government said on May 27, 13 deaths were reported.

Delhi deputy chief minister Manish Sisodia said the remaining 69 deaths had taken place over the past 34 days. “These cases are being recorded now due to late reporting by various hospitals or due to incomplete submission of information,” he added.

Delhi chief minister Arvind Kejriwal today said that “more than 80% of coronavirus positive patients either have no symptoms at all or show very mild symptoms and most people recover in about 17 days if they follow proper home isolation guidelines”.

In a 15-minute video and a statement, he also shared various home isolation guidelines COVID-19 positive patients and their neighbours should follow.

AIIMS Battles COVID Spread Among Staff, Surge in Cases Over Past Two Days

Over 195 members of the staff and workers have tested positive. While two have died so far, staff associations say that poor quality masks and PPE kits are responsible for the number of cases.

New Delhi: With 50 more healthcare workers and other staff at the All India Institute of Medical Sciences in New Delhi testing positive for COVID-19 over the past two days, the total number of cases at the premier research institute has gone up to 195.

Some office-bearers of the Resident Doctors Association have blamed the poor quality of mask and personal protective kits (PPEs) for the spread of the novel coronavirus therein.

Two deaths at AIIMS showed gravity of situation

Apart from a number of its staff getting infected by the coronavirus, AIIMS has also witnessed the death of two of its staff members due to dreaded virus.

The first fatality at the institute was reported last week when a man who worked at the hostel mess of the Rajendra Prasad Centre for Ophthalmic Sciences died of coronavirus on May 21 night. Though the hospital authorities said this worker had some cardiac issues and did not work in the patient area, tests revealed that he was COVID-19 positive.

Watch | COVID-19: Coming Weeks Will Be Tough, Says AIIMS Director

Immediately, the RDA wrote to AIIMS director and sought action against the hostel superintendent and the senior warden for their alleged “failure” to initiate protective measures.

The RDA general secretary Srinivas Rajkumar T. went on record to state that over a month ago that the Association had demanded regular screening with thermal scanner and availability of masks, sanitisers, etc, in the mess, but no action had been taken.

Son of deceased staff member alleges negligence

AIIMS was then rocked by another death – this time of its senior sanitation supervisor, Heera Lal. An affable person, who interacted closely with cleaners, ward-boys and disinfection staff, and was rarely absent from work, he first showed symptoms in mid May.

His son, Prahlad, accused the AIIMS authorities of a lackadaisical approach in dealing with his father’s condition and of providing sub-standard N95 masks to the staff. He told the media: “My father got the infection on May 15 and passed away on May 24, within nine days. He was still on duty when he first developed uneasiness and illness. Routine checks were done at AIIMS on the morning of May 15. COVID-19 test was not done and the doctors on duty suggested that my father should return for a COVID-19 test after he develops symptoms. By the time visible symptoms developed around May 19, my father was already in need of a ventilator.”

The general secretary of AIIMS New Delhi SC, ST Association Kuldip Singh, too corroborated his claims He said a blood test was first performed on Lal, and then he was told to go home and rest. Singh also alleged that Lal was not provided with “protective gear” though he was dealing with all kinds of infection sources.

AIIMS claimed it was providing proper protective gear

The AIIMS authorities later issued a statement denying this charge as “totally baseless and incorrect”. The institute claimed that it was providing all necessary gear such as personal protection equipment and N95 masks to all its healthcare workers.

The institute also claimed that, “Heera Lal was provided timely care and admitted immediately when he reported to the Emergency Department on 19th May 2020 … he presented with acute exacerbation of symptoms and was on ventilator support in ICU. Unfortunately, he succumbed, despite best of efforts by the treating team.”

However, the reply did not state why a COVID-19 test was not conducted on May 15, as that could have saved his life with prompt treatment.

Also read: AIIMS RDA Writes to PM Over ‘Backlash’ Against Doctors for ‘Raising Genuine Concerns’

Incidentally, AIIMS medical superintendent D.K. Sharma had also gone on record to rule out any laxity in dealing with Heera Lal’s case. He also claimed that the institute had issued hydroxychloroquine to all its “COVID warriors” much ahead of the Indian Council of Medical Research calling for such a move through its revised guidelines.

New cases reignite quality issue

Meanwhile, the issue of poor quality equipment being provided to the staff has resurfaced following the detection of new cases among staff members.

With the coronavirus infection having spread to three resident doctors, eight nurses, five mess workers and one MBBS student, apart from laboratory staff, technicians, sanitation staff and security guards over the past couple of days, it is again being alleged that the authorities have not taken proper and adequate measures to curb the spread of the coronavirus.

‘Issues about quality of N95 masks, PPE kits not addressed’

RDA general secretary Rajkumar today alleged that the “apathy of the government  and the AIIMS administration” was responsible for this situation. He said it was since March that the Association has been “writing and fighting for improving safety of hostel premises, sanitation, provision of stay and proper quarantine protocol and adequate testing” but lamented that there has been no “satisfactory response”.

“Even issues about quality of N95 masks provided and other components of PPE, have not been addressed. The N95 masks provided in many regions of hospital doesn’t meet even MOHFW (Ministry of Health and Family Welfare) safety standards, forget international standards,” he said.

Rajkumar also charged that protests are met with “threats of FIR from administration and attempts to jeopardise the career of RDA executives by administration.”

Both COVID, non-COVID sections affected

As per agency reports, the AIIMS authorities have in the meantime started contact tracing. A PTI report cited a source as saying that “healthcare workers and ancillary staff testing positive are both from COVID and non-COVID areas of the hospital. Employees from all kinds of departments like engineering, laboratories, offices, canteens, operation theatres and wards among others have contracted the infection.”

Overall, since February 1, a total of 195 healthcare personnel at AIIMS have tested positive. They include two faculty members, five resident doctors, 21 nursing staff, eight technicians, 32 sanitation workers and 68 security guards.

Andhra Pradesh: As COVID-19 Cases Rise, so Do Concerns About Lack of Equipment

Many districts also do not have testing laboratories, while doctors have complained about lack of PPE.

Vijayawada: The government of Andhra Pradesh has gone full steam to combat the COVID-19 pandemic, as K.S. Jawahar Reddy, special chief secretary of the Department of Medical and Health on Tuesday confirmed that the state is now in the “initial stages” of community transmission.

Up to April 1, only 44 positive cases were reported in the state but the numbers surged to 348 with four fatal cases as on April 10, according to the government’s media bulletin. Initially, only persons with foreign travel history tested positive for the virus, after which some of their family members got infected.

After more than half a dozen people who had no history of foreign travel were found to have the viral infection, the government started looking at the possibility of stage-III transmission. If the Centre decides to lift the lockdown, the Andhra Pradesh government is planning to continue restrictions on movement in identified and potential hotspots.

The lack of sufficient labs for testing suspected COVID-19 cases stares at the nearly 1 lakh doctors, paramedics, nurses and the other health workers engaged in containing the virus. Kurnool in Rayalaseema region, is one of the hotspots in the state and witnessed a sudden rise of cases in the span of a week. It does not have a virology lab for testing COVID-19 cases. The samples are collected and referred either to the Sri Venkateswara Institute of Medical Sciences (SVIMS) in Tirupati or to Anantapur district for confirmation.

West Godavari, the native district of health minister Alla Kali Krishna Srinivas aka Nani, also does not have a testing lab. But officials recently declared a locality named Tangellamudi, on the suburbs of Eluru city as a “red zone” after it saw a spurt in COVID-19 cases. Samples are being sent to Vijayawada for confirmation. West Godavari registered 14 cases, six from Tangellamudi area alone.

Also Read: Rainwear, Cloth Masks: Across India, Doctors, Nurses Grow Restive in Absence of Basic Protective Gear

There is only one lab in Visakhapatnam for the whole north coastal region, which includes three backward districts. A doctor, Sudhakar, heading an area hospital at Narsipatnam in the Agency area of Visakhapatnam, raised his voice over the lack of basic facilities, including personal protective equipment (PPE), face masks and kits. He was later suspended by the government, citing violation of conduct rules.

Many instances of doctors contracting infection

While the government has denied his claims, doctors who are treating COVID-19 patients are increasingly facing the risk of exposure. An orthopaedic doctor in Nellore is reportedly in critical condition after he was infected with the virus. District medical and health officer Rajyalakshmi was quoted in the media as saying that he could have contracted the infection from a patient he treated.

The infected orthopaedic was taken to a corporate hospital in the town for treatment, where nearly two dozen doctors and nurses have now been quarantined. It all speaks of the risk the health personnel are facing for want of PPE such as N95 face masks.

Man with a mask. Photo: Reuters

Confirmed cases of the viral infection have been shooting up across the state, after more than 1,000 people who returned from a religious gathering in Delhi’s Nizamuddin area. This has multiplied the task of screening for health personnel, especially when concerns exist about the lack of PPE.

To meet the challenge, the state government aims to carry out 2 lakh tests in a stipulated timeline. In an attempt to accomplish the task, the government has placed an order for procurement of 3 lakh rapid test kits from private manufacturers. Jawahar Reddy said the government could at present make available 12,000 PPEs, 20,000 N95 masks, 40 lakh gloves and 12 lakh surgical masks for the frontline health workers. Chief minister Y.S. Jagan Mohan Reddy on April 8 released testing kits indigenously manufactured by the AP Med Tech Zone in Visakhapatnam. The tech zone is aiming to produce 25,000 kits per day to meet the demand.

Dr C.L. Venkata Rao, former chairman of the state-run Swachandhra Mission, said six of the state’s 13 districts do not have virology labs for confirmation of COVID-19 cases. The Indian Council of Medical Research (ICMR) offers Rs 2 crore to medical colleges/hospitals if they are willing to set up labs. But the government could not utilise the facility for six districts, Venkata Rao pointed out.

Also Read: In India, Microbiologists Are Suddenly in Demand. Where Were They Until Now?

Patients in isolation wards protest poor facilities

In an isolation ward in Prakasam district, patients went on a relay fast protesting the lack of basic facilities in the ward. Most isolation wards, it is complained, are bereft of cots, beds and bedsheets and toilets. Venkata Rao urged the government to rope in private companies to supply mobile toilets attached to the isolation wards.

Complaints like these are cause for concern when the state is in a position to mobilise many ideal locations for use as isolation wards. Engineering colleges, farm houses, resorts and cottages of the endowment department could be used as quarantine centres and COVID-19 treatment wards, Venkata Rao suggested. Fleets of RTC buses and vehicles run by private operators, colleges and schools could be converted into mobile health clinics, enabling them to roll into interior villages, he said.

According to the government, there are 1 lakh registered allopathic doctors, 1 lakh registered medical practitioners, 40,000 Ayurveda and Homeopathy doctors and 2 lakh nurses for deployment to handle the pandemic.

AIIMS RDA Writes to PM Over ‘Backlash’ Against Doctors for ‘Raising Genuine Concerns’

“Instead of appreciating their efforts towards welfare of their peers and patients, they (doctors) have received a harsh backlash,” the letter states.

Mumbai: With instances of health care workers contracting COVID- 19 in Delhi increasing, doctors’ associations at different hospitals have begun to speak up of the precarious conditions they work in.

The Resident Doctors’ Association (RDA) of the All India Institute of Medical Sciences (AIIMS) has written a letter to Prime Minister Narendra Modi over the alleged targeting of the healthcare professionals for raising concerns relating to unavailability of personal protective equipment (PPE), COVID-19 testing kits and quarantine facilities in the hospital.

The RDA has issued a statement on social media and has said that their concerns and criticism should be taken constructively. “Instead of appreciating their efforts towards welfare of their peers and patients, they (doctors) have received a harsh backlash,” the letter states.

The letter signed by the AIIMS RDA president Adarsh Pratap Singh and general secretary Srinivas Rajkumar T, and junior representative Pawan Sinhamar states, “This is to bring to your notice that over the last few days, our frontline healthcare workers- doctors, nurses and other support staff- had come forward with their problems and issues related to availability of Personal Protective Equipment (PPE), COVID testing kits and quarantine facilities, on social media. The officials should view these inputs constructively.”

The RDA urged the government to create a “healthy space for debate and discussion to aid healthcare workers”. “All punishments are to be withdrawn and their honour restored,” the letter said.

In Delhi alone, at least 24 health care workers — doctors, nurses, sanitation staff — have tested positive of COVID-19. As of April 6, Delhi has reported 503 cases and seven persons have died due to COVID-19 infection in the capital.

Two days ago, at the central-government run Safdarjung hospital, resident doctors had put out an appeal to NGOs to help with PPE kits and masks.

“We are in dire need for the following: PPE kits – 50,000. N95 masks – 50,000. Triple-layer masks – 300,000. Hand sanitisers (500 ml bottles) – 10,000. Kindle donates the above-mentioned equipment and consumables in as much amount as feasible,” the association’s letter, which was widely circulated on social media, had stated.

Also read: Rainwear, Cloth Masks: Across India, Doctors, Nurses Grow Restive in Absence of Basic Protective Gear

The hospital administration, according to the PTI report, however, has denied the claim and said that there was no immediate shortage faced. Any help, they stated, would be to tackle a long battle ahead.

Safdarjung RDA president Dr Manish told PTI, “It (notice) was in the context of non-profit organisations that had shown interest in donating protective gear and medical equipment. But it has come to our notice that many people have misinterpreted the nature of our notice and have falsely attached bank account numbers asking for donation.”

“Safdarjung Hospital, hereby, clarifies that we never asked for money in any form and instead are only willing to accept donation of medical equipment through proper administrative channel via the office of Medical Superintendent, VMMC and Safdarjung Hospital,” he added.

“At present, there is no shortage of medical equipment in Safdarjung Hospital, but the future course of this pandemic still remains uncertain and therefore, requires us to be proactive in our preparedness for the same,” Dr Manish said, requesting people not to fall prey to any scam involving donations.

10-Year-Old Kashmiri, Worried Over Short Supply, on a Mission to Handcraft Protective Masks

Doctors in Kashmir have written about the frightening lack of protective masks and gear for those of them treating and testing COVID-19 patients.

Srinagar: After seeing her father, Tanweer Ayub and uncle, Ejaz Ayub, going to the market without wearing masks, Aayat Tanweer, from Karan Nagar in Srinagar, thought the time was ripe to give them a sound scolding.

“Why haven’t you worn the masks?” she asked both of them. Aayat is 10 years old.

She thought it best to offer them money to buy masks from the market. But the knowledge that masks and sanitisers were already in short supply in Kashmir stirred her.

In the evening, when her father and uncle returned home, they were surprised to see that Aayat had already crafted masks for them and the entire family.

Aayat watched videos on YouTube, where she learned how to make masks. These, she believes, will help the coronavirus from spreading.

Also read: Kashmiri Doctors’ Body Appeals for Protective Gear, Masks, Ventilators

Even though it is health workers and particularly vulnerable groups who need to wear masks, Aayat was unmoved in her resolution.

She began crafting more and more of them with whatever she had at home, sanitising all the fabric before using them.

After giving face masks to her family, she told them now she wanted to gift face masks to her relatives and neighbours, so that if they go out, they use it.

Every time she makes a mask, she washes her hands and tells her family to do so as well.

 “We had carry-bags at home and a lot of plastic, she used that in preparing masks,” said her uncle Ejaz.

Aayat’s mother, Nayeema Sultan, is a doctor of homoeopathy. Besides making clothes for her dolls, Aayat likes reading and loves crafts.

Since Friday, Aayat has made 20 masks and her goal is to make 100 in a week. She has made masks with rectangular designs which she feels will attract kids.

Aayat makes a mask.

“I need one tissue for each mask, scissors to cut, pencil to mark, a needle and thread, besides two plastic bags and elastic.”

In a video, shot by her uncle on Friday, she explains how to make the masks at home, “I also requested people to pledge to make 1 million masks, together with me,” she said.

The video made rounds on social media, and many people appreciated her concern.

The health crisis worries Aayat, a sixth standard student of Islamic International School.

“We should be able to protect ourselves against this virus by following preventive measures,” said Aayat. She is also worried about the doctors and valley’s health-care system. “Even our doctors don’t have masks,” she said.

The reason to share the video on social media, as per Ejaz was to make people wary about the situation. “Instead of being depressed about things we must take inspiration from our kids like Aayat. “She was reluctant to feature in the video first but then agreed because it will create awareness,” he added.

Aayat’s youngest sister Duha, who is just six years old also helps her sister. The Valley is particularly vulnerable under the circumstances.

The Centre for Disease Control and Prevention recently listed homemade masks as potential option. As per the guidelines, homemade masks should ideally used in combination with a face shield that covers the entire front, extending to the chin and sides of the face.

Doctors in Kashmir have questioned the shortage of masks and protective gear. They raised the issue of shortage of personal protective equipment such as triple-layer face masks and sanitisers.

Quratulain Rehbar is a Kashmir-based freelance journalist.

Indians Stranded in Coronavirus-Hit Hubei Wait for Sign of Hope

Many of the 70 Indians who had stayed back in Hubei were confident that the medical facilities in China for treating the coronavirus would be better than in India. However, the situation worsened.

New Delhi: Wearing a blue mask and the glare of an overhead light behind her face, Annem Jyothi spoke to the camera: “I am Jyothi. Today is the seventh day from the day that I have got rejected as a suspect of having coronavirus. Till now, I am having no symptoms of having coronavirus. I am fine and with good health condition”.

It was her second video appeal in last one week.

Jyothi was one of 10 Indians who were not allowed to board the two evacuation flights by Air India from coronavirus-hit Wuhan, as Chinese authorities did not consider them medically fit. In total, 80 Indians are still left in the central Chinese province of Hubei, as per Indian minister of external affairs S. Jaishankar.

Twenty-two-year-old Jyothi, a trainee at TCL, had been among the 320-odd Indians whose name had been on the second list of passengers for the February 1 flight. Before boarding the flight, all passengers were first screened by Chinese authorities.

Jyothi’s body temperature was recorded first at 36.9 Celsius degree. “The second recording showed 38 and then another third test showed 37,” she told The Wire on phone from her dormitory in Wuhan.

Shocked at the temperature reading, Jyothi said that these were probably a result of stress, long waiting and the cumulative layers of clothing that she wore against the cold weather.

So, while the others were boarding the flight, she was given an option to go in an ambulance to hospital or return home.

“I asked to return to my dormitory, as I didn’t want to go to a hospital as most of them would be full of cases,” she said.

Therefore, for the last week, she has been staying alone in the dormitory, which she once shared with other Indians. A male colleague was also similarly not allowed to board the flight and is also staying in another part of the building. “Right now, the Chinese HR officials are staying to take care of us,” she said.

Also read: From China to Chhawla: Indian Student Documents Flight from Coronavirus

In his statement to Rajya Sabha on Friday, Jaishankar had said that the Indian embassy was in touch with all the students.

Without much of hope of leaving Wuhan at an early date, Jyothi had recorded videos expressing her plight. The latest one was released on Friday.

“I have been talking with the Indian embassy every day till now about when I can go back home. They said they are talking with the Chinese officials and that the Chinese officials are reacting passively to the situation. I want to ask that… I am in such a critical place, in such a critical situation, where the possibility of infection in this area is so high. What if I get infected now? I cannot live in a place where the infection possibility is very high,” she stated.

Jyothi pointed out that while the Indians quarantined on return to Delhi are regularly checked, she has not been checked even once after leaving the airport. “…they have neither conducted any tests to say that I don’t have coronavirus. They have not kept me under observation, I am just living in my dormitory. They are not even allowing me to at least go back home”.

She is also worried about her Chinese visa was going to run out on February 19.

Ashish Yadav, an associate professor at Wuhan Textile University, is also now desperately looking for a way out from Wuhan. As reported by The Wire on January 31, he had voluntarily stayed back in Wuhan, worried about the risk of travelling with others on the plane and also concerned about the fragile condition of his wife.

Many of the 70 Indians who had stayed back in Hubei were confident that the medical facilities in China for treating the coronavirus would be better than in India. However, as Yadav realised, the situation worsened.

Earlier, Ashish and his wife, Neha Yadav, were allowed to walk around their university campus. But, it has now been completely stopped. “That’s when we realised that there is not likely to be an improvement and the conditions have become more serious,” Yadav said.

He realises that the numbers of Indians left may not be enough for a third flight. “I just need a certificate from the embassy so that I can go the Chinese authorities with it to leave Hubei and take a flight from the nearest airport,” said Yadav. He was hoping to reach Chongsha airport, which was still operating international flights as per a UK travel advisory.

Also read: As Wuhan Coronavirus Spreads, Hubei’s Indians Ride an Emotional Roller Coaster

But, this may not be an easy operation. On February 7, Bloomberg reported that the Chinese government had effectively closed the Hubei province off from the rest of the country, in an effort to make sure the deadly virus does not spread rapidly. There are also reports that anyone leaving Hubei would have to undergo a quarantine period of two weeks in their destination city.

Yadav has been making all efforts through his member of parliament and political contacts in India to get the Indian embassy to give him an authorisation letter. “This is on me. I don’t want more help than that. But, the Chinese authorities need to see a letter from the embassy”.

On Friday, the Indian embassy gave him an authority letter which requests “all relevant authorities” in China to assist him in his efforts to leave Wuhan with his wife.

But, now he is stuck at the level of the transport authorities. Showing a screenshot of a conversation with a local official, Yadav said that there was not much support from the authorities in arranging private transportation.

Meanwhile, the Indian embassy in Beijing, via its Twitter account, cautioned Indians in Hubei on Saturday and said that “restrictions on movement have increased in recent days”

Reading the tweet, he felt that that the underlying message was that Chinese authorities would not allow permission for private travel by road from Hubei to other parts of China.

But, Yadav has still kept his hopes alive, as he is waiting for an important call from Delhi. “I have hope that I will be back tonight or tomorrow. Let’s see”.