03rd April 2020

The following is an account as narrated by a family member of a nurse working in a private hospital named Wockhardt Hospital in Mumbai. The account highlights negligence and mismanagement on part of Wockhardt hospital in taking adequate precautions to contain the spread of the virus to non- COVID patients. Issues that emerged pertained to improper management of COVID positive and suspected cases; lack of Personal Protective Equipement for frontline nurses; and issues in quarantining and testing frontline nurses. This has led to many nurses getting infected and unknowingly spreading COVID 19.

Management of COVID positive and suspected cases

1. On 20 th March 2020 two suspected cases and two COVID 19 positive cases were brought to Wockhardt Hospital from Kasturba Hospital. The two confirmed positive cases were kept in the COVID ward. The patients who were suspected of having COVID 19 were kept in the general ICU ward where non- COVID patients were also being provided care.

2. The nurses who attended the suspected cases were not provided with surgical or N95 masks, leading to their direct exposure.

3. The two suspected cases were tested and turned out to be COVID positive. By this time staff members and other patients in ICU had already been exposed to the infection.

4. On 31st March media reported1,2,3 that a 70-year-old heart patient developed symptoms of COVID 19 at Wockhardt. However, they missed reporting that he been admitted to the same general ICU ward where the two suspected cases of COVID 19 had been provided care.

5. On 28th March, two nurses working in the same general ICU ward tested positive for COVID 19, and many other nurses began showing symptoms.

6. 8 more nurses were tested positive in the following days. 14 more are suspected to be corona positive, they are in quarantine at hospital.

Personal Protective Equipment

1. Nurses in the general ICU ward where the suspected patients were admitted were not provided Personal Protective Equipment (PPE) or even surgical masks.

2. Nurses who enquired about PPE were told the hospital has ordered it but it is yet to arrive.

3. Nurses were discouraged from wearing a mask in the non-COVID section of the hospital to avoid spreading fear and panic among general patients.

4. Surgical masks were made available on 25th March onwards, but the availability was still short, and all the nurses did not receive it every day.

Quarantine and testing of frontline nurses

1. Instead of quarantining staff members who were showing symptoms, the hospital asked them to continue to stay on duty. One nurse who was directly exposed to a COVID positive case was on duty till 1st April morning. Another nurse who had developed symptoms for few days had to remain on duty till she fell very sick.

2. All the nurses who were attending to a patient, who was first suspected and later turned out to be COVID positive, were not quarantined or tested. Only two of the nurses were tested, both of whom turned out to be COVID positive. More nurses began showing symptoms in the following days.

3. The Brihanmumbai Municipal Corporation (BMC) conducted an inspection at Wockhardt hospital on 1 st April. Nurses who identified themselves as having been exposed to COVID 19 positive cases were reprimanded by senior hospital staff and management for identifying themselves to BMC officials.

4. All the nurses have quarantine seal from BMC on their hands, as they have directly or indirectly been exposed to infection, the hospital continues to ask many of the nurses to be on duty. On 2nd April most of the nurses refused to go on duty. As per BMC’s instructions, the swab of all the nurses staying at the hostel are taken for tests on 2nd April.

5. Nurses were initially quarantined in their hostel rooms. BMC asked the hostel authorities to give separate rooms to 10 of the nurses as they were exposed directly to a tested positive patient. They were not provided separate quarantine rooms but continued living in their usual hostel rooms along with other nurses who were working in the hospital, possibly exposing them to infection. For instance, one of the quarantined nurses who was directly exposed to a positive patient was sharing a room with 8 other nurses.

6. A few hours later, the 10 nurses who are to be quarantined in separate rooms were taken into the main hospital building to be quarantined. All of them were quarantined together in a ward.

7. Nurses who were working in the COVID section of the hospital had been asked to vacate the hostel. The hospital did not arrange separate accommodation for nurses working in the COVID section of the hospital. These nurses were using the quarantine ward to rest and recuperate, and even sleep. Some slept on the unoccupied beds in the quarantine ward, and some slept on the floor, leaving less than 1 metre distance among the quarantined and on-duty nurses. They also used the same bathroom as the quarantined nurses.

8. Nurses with symptoms were transported in the same hospital bus as the other nurses, increasing the possibility of further spread.

9. The quarantined nurses were later shifted into two rooms housing five nurses each, with a common bathroom. Again a temporary arrangement, the hospital sends on-duty nurses or new quarantine nurses to these wards without taking the account of the number of beds and the distance to be maintained between the beds. The quarantined nurses have been shifted thrice in a span of two days. Whether the rooms they were occupying were disinfected remains unknown.

10. The quarantined nurses do not receive food in the rooms. They, and staff members working in the COVID ward eat their meals in the same staff canteen as the other staff members of the hospital.

members who are not provided PPE risk spreading the infection to other patients and staff members. Hospitals have been emerging as hot spots for COVID 19 in other parts on India as well. It is the duty of the hospital administration and management that staff members be provided PPE and ensure proper infection control protocol to safeguard patients, staff members, and the public at large. The need of the hour is to leverage all healthcare resources at the disposal of states to expand the capacity to treat infected patients, and not diminish the same by negligent acts that put healthcare workers at risk of infection and death.

Some of the nurses have contacted the Chief Minister of Kerala and have told him about their plight. Families of some have spoken to the Malayalam media. The Chief Minister of Kerala has assured them that their concerns will be resolved. For more information, contact:

1 https://timesofindia.indiatimes.com/city/mumbai/mumbai-3-nurses-catch-virus-while-tending-to-patientswith-no-covid-19- signs/articleshow/74903860.cms?

2 https://www.thehindu.com/news/cities/mumbai/three-nurses-with-2-south-mumbai-hospitalspositive/article31212744.ece

3 https://www.indiatoday.in/india/story/three-nurses-test-covid-19-positive-in-mumbai-36-high-risk-contactsin-worli-koliwada-identified-1661924-2020-03-31

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