At ‘Ground Zero’ Indian-American physicians in Tri-state and Pennsylvania cope with COVID-19

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President Trump announces guidelines for America on Coronavirus. Seen in photo is Seema Verma, second from right, administrator of Centers for Medicare and Medicaid Services. (Photo: whitehouse.gov)

Indian-American doctors and other medical specialists and healthcare workers are probably the largest ethnic cohort of medical personnel on the frontlines of the Corona virus pandemic.

One has only to see the lineup of Indian-Americans who appear on national media to assess their importance in the U.S. healthcare system – from Seema Verma, administrator for the Centers for Medicare and Medicaid  standing next to President Trump during daily Coronavirus White House briefings, to Dr. Satish Pillai, deputy director for the Division of Preparedness and Emerging Infections at the U.S. Centers for Disease Control and Prevention (CDC), former Surgeon General Vivek Murthy, CNN’s top medical correspondent Dr. Sanjay Gupta to name just very few.

Last week when News India Times spoke to Dr. Aseem Shukla at his clinic in Philadelphia, he said a colleague had just been diagnosed with the Corona virus; that he had himself just taken off his PPE (Personal Protective Equipment) after dealing with a patient who came into the hospital based on a report of a possible exposure to COVID-19.

When he gets home after work, Dr. Shukla has to rid himself of his shoes and clothing, drop them in the wash, and change immediately in order to be with his family.

After the weekend, barely four days after the first interview, Dr. Shukla, a urologist at the University of Pennsylvania Health System, continues to streamline the hospital system along with his colleagues. “We are trying to cut down all non-essential surgery to create hospital space, and also if any of our staff has to stay away, plus to save on masks and ventilators.”

For his own part, “I am going through my 50-70 patients scheduled for the coming week, and turning many into video-calls. It means we medical personnel give up all our holidays to accommodate these patients later,” Dr. Shukla said. While the situation in Philadelphia is not as serious currently as NYC, he says, the interaction between the two cities is enormous and could change in the coming week or weeks.

At the Centers for Asthma & Allergy in New Jersey which has branches in New York City, Vice President Dr. Purvi Parikh, an asthma, allergy and immunology expert, deals on a daily basis with patients showing flulike symptoms, which at this time is scary to everyone in the backdrop of COVID-19.

Over the three days since she was first interviewed last week, one biggest change is the emphasis on “social distancing” advice to patients, she told Desi Talk. Now, those with fevers and coughs are being told to stay home and work from home; postpone all but urgent tasks outside; and avoid public transit.

“Most of our patients have lung disease or immune deficiency and we don’t want them to overwhelm the hospital system. So we are asking those who call with a fever and cough to not to go to hospital unless they are having breathing problems,” said Dr. Parikh, who is also a clinical assistant professor of Medicine and Pediatrics at the NYU Langone School of Medicine.

In her earlier interview Dr. Parikh had pointed to how a majority of those stricken in China had recovered. Meanwhile new avenues of assistance are growing here. She noted how private commercial labs were meeting some of the gaps in testing. Quest Diagnostics and Lab Corp were doing tests for COVID-19. “We’ve already had one test done and it was negative, and we got the result in 72 hours,” she said.

At the same time, she said, “We need to underscore that it is allergy season.”

“I got a number of calls over the weekend with patients reporting fever or cough. I determined who should go to hospital and who should stay home. If you can’t reach a doctor but if you develop breathing problems then go to hospital. But if you have fever and no breathing problem and can eat, then stay home,” she advised. “Everyone does not need to be tested,” she said.

Keeping in mind the fact that tens of thousands of Indian-American physicians like all other healthcare workers are delivering care round the clock, Dr. Parikh warned that they are the ones most at risk.

“A large number are of Indian origin, and we as a community need to help them. We as healthcare workers are on the frontlines and don’t have the option to stay home,” she said, urging people should not for example, hoard masks, “Because it affects these frontline workers and they need to be safe in order not to affect their own patients but also their communities when they come home.”

Dr. Suresh Reddy, president of the American Association of Physicians of Indian Origin, AAPI, has an inside view of what is happening with frontline workers who are dealing with the Coronavirus. The AAPI represents a total of more than 100,000 physicians and medical students, residents and fellows of Indian origin in this country,

“It’s like a global war and we are at the forefront in the United States,” Dr. Reddy told Desi Talk. “Even more Indians are in rural areas,” in the least-served medical locations, he noted.

The organization held a countrywide teleconference just a few days ago in which some 275 Indian-American physicians participated from around the country, Dr. Reddy said.  The meeting scheduled for an hour, stretched to three hours, as questions and answers flew back and forth from physicians in a variety of situations – small hospitals, rural areas, urban hospitals, clinics, and other medical settings.

Dr. Deeptha Nedunchezian from New York, an infectious diseases specialist and Dr. Arunachellum Einstein, an emergency room physician from Seattle, WA, answered queries. On its website (aapiusa.org) AAPI has created a blog where medical personnel can go to ask and answer questions relating to COVID-19.

Psychiatric Fallout

Physicians like Dr. Ketki Shah, chairman of the Department of Psychiatry at the Bronx Care Health System, throw light on what she and people in her specific department are dealing with — rise in anxiety not just among patients coming to BCHS, but also the staff.  The various departments in the BCHS see close to 650 patients a day.

Dr. Shah was interviewed twice over a week to determine the changes taking place. Initially, it was extremely challenging, she said, adding that she had never gone through such a situation in her decades of practice. “For example, I had one of our own staff so panicked that she could not take care of the patient. She was so terrified when a patient came in with a cough,” Dr. Shah recalled. On top of that, psychiatric patients are already cognitively impaired to different degrees. “Teaching these patients whose cognitive abilities are already impaired, on basic guidelines of self care like washing hands, etc. is really difficult,” Dr. Shah said.

The situation appeared to have improved over just a few days, “Though we are still juggling resources,” Dr. Shah said. Keeping the safety of staff and patients was foremost, so she and her colleagues began cutting down wellness visits, handling cases remotely, cancelling non-urgent events like education classes. “Now the staff feels more comfortable after the changes. The burden of crowded waiting rooms has been avoided, more masks and gowns are available to us, and anyone with any symptoms similar to COVID – we are calmly attending to them,” Dr. Shah said. “We are also staggering shifts so there is better coverage. We are sort of working as if we are at war with the virus,” she said.

“And we are keeping our fingers crossed that staff not get infected. That will be the biggest challenge,” Dr. Shah said.  “But safety is above all else,” Dr. Shah said. As of now, her small department of some 450 staff including attending doctors, nurses, social workers, residents, etc., 5 to 6 samples have been sent for evaluation to CDC for COVID-19.

“Right now we are dealing more with anxiety with this virus. But as time passes, we will see depression, PTSD, and how this is going to affect an ordinary person’s life when a loved one is lost, or jobs are gone, financial difficulties, not to mention the other long term effects of this virus about which so much is unknown,” Dr. Ketki said.

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