8 Hospitals in 15 Hours: A Pregnant Womans Crisis in the Pandemic – The New York Times

Her baby was coming, and her complications were growing more dangerous. But nowhere would take her an increasingly common story as Indias health care system buckles under pressure.

NEW DELHI Neelam Kumari Gautam woke up at 5 a.m. with shooting labor pains. Her husband put her gently in the back of a rickshaw and motored with her to a hospital. Then another. Then another. Her pain was so intense she could barely breathe, but none would take her.

Why are the doctors not taking me in? she asked her husband, Bijendra Singh, over and over again. Whats the matter? I will die.

Mr. Singh began to panic. He knew what he was up against. As Indias coronavirus crisis has accelerated India is now reporting more infections a day than any other nation except the United States or Brazil the countrys already strained and underfunded health care system has begun to buckle.

A database of recent deaths reveals that scores of people have died in the streets or in the back of ambulances, denied critical care. Ms. Gautams odyssey through eight different hospitals in 15 hours in Indias biggest metropolitan area serves as a devastating window into what is really happening here.

Indian government rules explicitly call for emergency services to be rendered, but still people in desperate need of treatment keep getting turned away, especially in New Delhi, the capital. Infections are rising quickly, Delhis hospitals are overloaded and many health care workers are afraid of treating new patients in case they have coronavirus, which has killed more than 13,000 people in India.

There is currently little or no chance of admission to hospitals for people with Covid-19, but also for people with other intensive care needs, read a warning just issued by the German Embassy in New Delhi.

At the same time, Indias economy is nose-diving, and the coronavirus pandemic has cost this country more than 100 million jobs. Desperate to turn the economy around, Mr. Modi has rejected health experts counsel to put the country back under lockdown, saying that India must unlock, unlock, unlock.

When things got better, Mr. Singh and his wife had hoped to buy an apartment in a gated community in Noida, a satellite city of New Delhi crammed with tall glass buildings, many malls and many hospitals. She worked on an assembly line producing electrical wire. He serviced machines at a printing press.

Together, Mr. Singh, 31, and Ms. Gautam, 30, earned a respectable $8,000 a year, putting them solidly in Indias rising middle class. Two wheels of a well-oiled machine, making our family go around, Mr. Singh said.

Their son, Rudraksh, turned 6 just before their new baby was due.

As Ms. Gautam entered her ninth month, she ran into some health problems and spent five days, in late May and early June, in the hospital for pregnancy-related high blood pressure, bleeding and possibly typhoid.

On June 5, as she began to go into labor, the first hospital they tried was the ESIC Model Hospital, a sprawling government facility in Noida. Mr. Singh said that the first thing the doctor said to her was, Ill slap you if you take off your mask.

They were shocked, Mr. Singh said. But Ms. Gautam was having trouble breathing. They didnt argue. She begged for oxygen, which the hospital had, along with ventilators. But instead of helping, the doctor told them to go to another government hospital, on the other side of town. There, too, she was turned away.

An administrator at the first hospital declined to comment, and a doctor at the second hospital said Ms. Gautam needed intensive care, which the hospital couldnt provide.

Even before Covid-19 arrived, Indian hospitals were beleaguered. The Indian government spends less than 2,000 rupees (about $26) per person per year on health care. The hope during Indias lockdown, which began in late March but was mostly lifted by early June, was that the restrictions would slow the spread of the virus and give cities time to scale up hospital capacity before the worst hit.

That didnt happen, or not nearly enough, and Delhi now finds itself thousands of beds short the central government just repurposed hundreds of railway cars to be used as sick bays. And still there is great confusion about admitting patients who dont have coronavirus.

Some hospitals say they need to test every patient before treating them. Others simply perform a quick temperature check.

Several Indian doctors said that private, profit-driven hospitals were terrified to accept new patients particularly those with breathing problems because they didnt want to risk getting shut down, which has happened to private clinics if one of their patients tested positive for the coronavirus.

Government policy has created this chaos, said Rajesh Kumar Prajapati, an orthopedic surgeon and former medical school professor.

As complaints began to pile up that hospitals were turning away sick people, the powerful home ministry issued a directive re-emphasizing that all hospitals should remain open for all patients, Covid and non-Covid emergencies.

But clearly not everyone has been listening. A 13-year-old boy in Agra died of a stomach ailment in April after being turned away from six hospitals, his distraught family said. Another boy, in Punjab, with an obstructed airway, was rejected from seven hospitals and died in the arms of a family friend, who happened to be a doctor but was not given any help to save him.

This is inhuman, said Dheeraj Singh, the doctor in Punjab.

Cases like these caught the eye of Thejesh G. N., an electronics engineer in Indias tech hub, Bangalore. He helped build a database tracking publicly reported deaths and found that at least 63 people have died in recent weeks from being denied critical care. Most health experts believe that the number is far higher.

The third hospital that Ms. Gautam went to, Shivalik Hospital, was the one that had treated her for her prenatal troubles. This time, doctors gave her a little oxygen, but Mr. Singh said they feared she might have coronavirus and abruptly ordered her to leave.

We are a small mother and child hospital, said the hospitals director, Ravi Mohta. We did what we could.

Updated June 24, 2020

A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise comes with issues of potential breathing restriction and discomfort and requires balancing benefits versus possible adverse events. Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. In my personal experience, he says, heart rates are higher at the same relative intensity when you wear a mask. Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who dont typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the countrys largest employers, and gives small employers significant leeway to deny leave.

So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was very rare, but she later walked back that statement.

Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus whether its surface transmission or close human contact is still social distancing, washing your hands, not touching your face and wearing masks.

A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nations job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

If youve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

The couple hobbled back to the rickshaw. Ms. Gautam was fading. She stopped talking and began heavily sweating. She clung to her husbands hand.

It wasnt simply that the doctors couldnt help her, Mr. Singh said. It was as if they didnt want to help her.

They didnt care if she was dead or alive, he said.

At a fourth hospital, a branch of Fortis, an Indian health care giant, Mr. Singh pleaded for a ventilator. Mr. Singh said the doctors response was: Shes going to die. Take her wherever you wish.

In a statement, the hospital said that it had no space for her, tried to stabilize her and then offered to take her by ambulance to another hospital. Mr. Singh said that the hospitals efforts were cursory and that there was no offer of an ambulance.

They tried three other hospitals, hurrying from one to the other, losing precious time. When all refused, Mr. Singh called the police.

He said that two officers met him at the entrance of the Government Institute of Medical Sciences, a large public hospital, and tried to persuade the doctors to admit his wife. But the doctors wouldnt listen to the police officers, either.

Administrators at that hospital declined to comment.

After that failed, they raced in an ambulance to Max Super Specialty Hospital in Ghaziabad, more than 25 miles away. It was now late afternoon, still bright, around 100 degrees outside. More than eight hours had passed since Ms. Gautam and her husband had set off from their home, eager to meet their new baby soon.

But the Max hospital their eighth that day gave them the same heartbreaking answer: no beds.

Ms. Gautam closed her eyes and whispered: Save me.

Mr. Singh told the ambulance to rush back to the Government Institute of Medical Sciences.

He hunched in the back, leaning over his wife, pleading with her not to give up. He looked down at her face. She reached up and clutched his shirt. Her hands tightly clenched the fabric.

As they finally pulled into the hospital, she stopped breathing. Her neck slumped. Mr. Singh jumped out of the ambulance, grabbed a wheelchair and frantically wheeled her into the emergency room.

At 8:05 p.m., after 8 different hospitals and 15 hours, Neelam Kumari Gautam was pronounced dead. The baby also died.

A preliminary government investigation said: Hospital administration and staff have been found guilty of carelessness.

She has not been the only pregnant woman to die in labor after being turned away. The same thing happened to a young mother in Hyderabad and another in Kashmir. In that case, the family said, the hospital staff were so uncaring that they didnt even help with an ambulance to take the body home. The womans family had to wheel her body down the road, in a stretcher, for several miles.

As the authorities consider criminal charges in Ms. Gautams case, her husband spends his days at home looking after his son, Rudraksh. The boy asked him to throw away all of his mothers clothes.

They remind me of her, he said.

The spark has gone out of Rudrakshs eye, Mr. Singh said.

A few days ago, he told his dad that when he grows up, he wants to be a doctor, so I can make dead people come alive.

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8 Hospitals in 15 Hours: A Pregnant Womans Crisis in the Pandemic - The New York Times