On the Frontlines: Indian-American health workers are at ground zero fighting COVID-19

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According to the American Association of Physicians of Indian origin, AAPI, every seventh patient in the U.S. is treated by an Indian doctor. That easily puts them as probably the largest ethnic cohort of medical personnel on the frontlines of the Corona virus pandemic.

Dr. Aseem Shukla is at his clinic in Philadelphia, when he answers the call from News India Times. He says a colleague was just diagnosed with the Corona virus. And a short while ago, he donned his PPE (Personal Protective Equipment) to deal with a patient who came into the hospital based on a report of a possible exposure to COVID-19.

A surgeon, Dr. Shukla is a urology specialist, in the University of Pennsylvania Health System.

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.

Dr. Parikh, who is also a clinical assistant professor of Medicine and Pediatrics at the NYU School of Medicine, is doing her part to allay unreasonable concerns, by trying to “exercise rationality.”

“The facts are that a majority of people, even in China, has recovered, The World Health Organization has report 70 percent made a recovery, even those in high risk categories. We worry about those with underlying issues like heart or lung disease etc., but even they have recovered,” Dr. Parikh noted. “And there are zero pediatric deaths.”

Nevertheless, some cautions needed to be exercised. “We made one change – “At our clinics, we are asking people if they have a fever over 100.4, have either traveled abroad, or been in contct with somebody who has been diagnosed. We are advising them accordingly,” Dr. Parikh said.

Clinics dealing with allergies and immunology in particular, see patients who are sneezing and coughing year round, she noted, especially in the current flu season. “So we are taking it case by case. We are educating people too. We are pushing hard for patients to get flu shots to minimize flu cases so that we don’t overburden our ERs,” she said.

Keeping in mind the fact that hundreds and 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 to, for example, hoard masks etc., “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.”

In Southern California, in contrast to Northern California, the number of cases of COVID-19 is relatively low so far, noted Dr. Jayanti Patel, chairman of the Board of Trustees of the Indian Medical Association of Southern California. While as a general surgeon, he is not in direct contact with as many patients as a primary physician, Dr. Jayanti Patel said IMASC has put out messages to communities to adhere by guidelines of the Centers for Disease Control, which include frequent handwashing, not touching face, not attending large gatherings or being in a closed room with a large congregation of people. “We are encouraging people to adhere to social distancing of 6 feet from anyone coughing, and for those with underlying diseases to stay home – ‘not to kiss babies,’ as it were,” Dr. Jayanti Patel said. As health practitioners, doctors always wash hands and wear gowns and they continue to do that, he added.

Dr. Saad Omer, an infectious disease expert and director of the Yale Institute of Global Health, speaking to CNN, also reaffirmed social distancing as one of the “appropriate” ways to help flatten out the rate of increase in COVID-19 cases – that would give the health system time to catch up on testing etc. and to move to pro-active testing as was being done successfully in South Korea.

That is close to what Dr. Jyotin Patel, past chairman of the Board of Trustees of the Indian Medical Association of Southern California, a 41 year old organization, told News India Times.

Dr. Jyotin Patel expects a rise in the number of cases in Southern California, within the next few days or weeks because of the lack of test kits or a pro-active approach. “If we get enough kits, then we can instruct patients to say home and not flood hospitals,” he said, adding, “We are really worried about Corona peaking. The County may not be able to keep up with the testing.”

As a family practitioner, Dr. Jyotin Patel, whose clinic is in Laguna Miguel, California, sees numerous patients daily, and he has set down a system to screen for COVID-19 pending the supply of enough test kits. Patients who show any of the symptoms in this season of influenza, come in through a side door and give their culture, which is screened for the Staff bacteria and flu. If those are not present, they are told to return home and self-isolate and the culture is sent to the Orange County medical agency for COVID-19. The results of that test take 4 days to come back to his office.

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.

“It’s a very, very challenging,” she said when asked about the situation with the outbreak of COVID-19. “I have never gone through this kind of experience before. Every hour there is a new challenge,” she said, with new directives coming down the pike from CDC, the need to reallocate resources within the hospital, calming healthworkers, etc.

“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 recalls. 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.

“But safety is above all else,” Dr. Shah said. Questions on how to reduce visitors, and now also to screen those coming in are added burdens, not to mention the cancellation of most meetings and working with teleconferencing, plus trying not to decrease the productivity of the clinic are big issues still unfolding.

“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, adding, “With the flu at least we know how to manage it.”

Media’s Role

Physicians News India Times spoke to had some suggestions for media coverage of the spread of COVID-19.

“I don’t have the right answer about media coverage,” Dr. Shukla admitted. “One doesn’t want it (COVID-19) to be minimized because we just don’t know enough, But media ha”s to be careful and responsible not to spark panic.”

At the same time, Dr. Shukla said, “A lot of us in healthcare are also looking to the media for information.”

Media is useful in keeping people informed about things like school closings, cancellation of meetings etc., said Dr. Parikh. “But it’s a fine line, a balancing act – we’ve seen a lot of anxiety or panic with people stealing masks from hospitals, or accusing Asians for the virus. Too much media coverage is making some people crazy,” said Dr. Parikh. “Presenting both sides of the story such as that a lot of people are recovering, and to stay home in case of any signs,” these could be messages from the media that could help stem panic.

“The situation is fluid, which is a challenge for the media environment. There is no easy answer. Though we have to be careful not to politicize it,” cautioned Dr. Shukla.