Mumbai invokes an 1897 law to draft doctors in its virus fight

Workers labor during the construction of a 1,000 bed non-critical hospital for covid-19 treatment in Mumbai, India, on May 6, 2020. MUST CREDIT: Bloomberg photo by Dhiraj Singh.

One of India’s largest cities is invoking a colonial era law to draft thousands of doctors to work in its hospitals, fueling concern that the medical system is becoming overwhelmed by virus cases despite the country’s weeks-long lockdown.

Letters have been sent to as many as 75,000 doctors in Mumbai with a private practice, requiring them to sign up for at least two weeks duty at one of the state-run hospitals, according to T. P. Lahane, director, Medical Education and Research under the Maharashtra state government. Those who defy the order risk prosecution and imprisonment under the Epidemic Diseases Act of 1897 and losing their license to practice medicine.

While India’s densely-packed cities and vulnerable population sparked fears it could see an explosion in virus cases, the nation has seen just over 56,400 infections and just 1,890 deaths so far, compared with more than 75,000 fatalities in the U.S. Still, the world’s largest lockdown — with more than 1 billion people confined to their homes — isn’t flattening India’s virus curve, unlike Italy and Spain where infection rates had begun slowing at a similar stage of their lockdowns.

Within India’s climbing tally, Mumbai accounts for about one-fifth of the country’s virus cases, and there are already signs its health care system is close to breaking point. A Twitter video this week showed a hospital ward allegedly in Mumbai’s Lokmanya Tilak Hospital where corpses of virus victims tied in black plastic sheets were left on beds next to infected patients.

As the financial hub, it is more globally connected than other Indian cities and has Asia’s most-congested slum, Dharavi. While the latest diktat signals that authorities are bracing for a deluge of fresh cases, it also risks alienating the nation’s front line forces against the virus and complicating its containment efforts.

“We can’t say for sure when the virus will peak in Mumbai but we have to be ready for it,” said Lahane, referring to the need for private sector to pitch in as fatigue starts setting in among health care workers at state-run hospitals. “Our hospitals’ staff have been working constantly since the last two months while the number of patients, positive cases and treatment centers have been increasing in the city.”

Doctors over 55 and those with co-morbidities will be excused. “If they are closing down their clinic, sitting at home and not working in a hospital, then government will initiate action,” Lahane said.

The public health care set-up has done nearly all the heavy lifting in India’s virus fight so far. Roping in private sector doctors — especially those who are not working — to give respite to their overworked peers in government hospitals seems fair, but the heavy-handedness of the approach has alarmed many.

Bloomberg spoke to half a dozen doctors and most expressed outrage at being coerced into mandatory duty. Some pointed to the irony of such an order from local authorities at a time India’s Prime Minister Narendra Modi has asked citizens to support health care workers by clanging plates and the air force has organized flower showers. All the doctors asked not to be identified for fear of a backlash.

Although the state of Maharashtra — where Mumbai is located — is controlled by a former ally and now rival of Modi’s ruling party, Shiv Sena, doctors were looking to the federal government for leadership. Despite the hardship caused by his nationwide lockdown, Modi’s approval ratings have climbed to 83%, signaling widespread approval for his actions during the virus crisis.

A senior Mumbai-based physician specializing in renal care called it an arm-twisting tactic that lacked dignity. The fact that a century-old law is being invoked underscores the nation’s lack of preparedness in handling epidemics, this doctor said.

Using fear to force doctors to work will only discourage them and shows a lack of respect for those risking their own lives, according to another city-based doctor. Asking physicians to volunteer would have been a far better approach, this doctor said.

The Epidemic Diseases Act gives authorities special powers. The legality of the order will have to be tested against a doctor’s right to practice or not practice and the medical code of ethics, according to Lzafeer Ahmed, a New Delhi-based lawyer.

Some medics were also worried there wouldn’t be enough good quality personal protective equipment when they do show up for virus duty.

No one seems ready for a legal fight for now. The Association of Medical Consultants on Thursday (May 7, 2020) advised its members to “voluntarily apply since that is the need of the hour,” according to a statement shared by the industry lobby. It also asked its members to request adequate protective equipment, proper lodging, hygienic food, transport and insurance cover.

Nearly 550 health care workers have been infected in India, the Hindustan Times reported. While some may have contracted the virus while treating patients, a doctor in a Mumbai state-run hospital said many of her colleagues were catching it from dormitory rooms in medical colleges where they often share beds as doctors alternate through the day and night shifts.

As infected doctors are pulled out of action, it places further strain on the nation’s health care systems which were underfunded and rickety even before the virus hit.

The Lokmanya Tilak Hospital, meanwhile, has formed a committee to probe the veracity of the video showing corpses in one of the wards, it said in a statement Thursday, and would take action against anyone found guilty.

“It has been observed several times that the family members are not available to claim bodies of patients who have died,” the hospital said in the statement. “We need to call them repeatedly and still they avoid claiming the bodies.”

The looming public health crisis in Mumbai will need more than just doctors to beat back the virus. It’ll need other staff such as nurses, sanitation workers, clerks and hospital guards, according to a pulmonary specialist in Mumbai.

Securing the support staff may be more difficult. Some are scared, some are getting sick, some stay in containment zones while some can’t come because public transport has ground to a halt in the lockdown. Securing that support staff may be more difficult, according to a pulmonary specialist in Mumbai who has been treating patients and asked not to be named fearing a backlash from authorities.

The doctors in Mumbai’s private sector nevertheless have to show up unless the order is quashed in a court.

“It seems to be a case of excessive delegation,” said Ahmed, the lawyer in New Delhi. “Unfortunately, until the order is struck down by a court or withdrawn, doctors would have to abide by it.”

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