"We don't want your salutes," says Dr Hamid Mehmood, consultant anesthesiologist at the Dow University of Health Sciences. "What we desperately need right now are the PPEs (personal protective equipment)."
"Walking out of my home at 7:30 in the morning, leaving the kids asleep, I ask myself every day — 'Do I really have to walk in that isolation ward of patients with Covid-19? Am I safe... the worst thought is am I bringing that virus to my home, to my kids, wife, and parents? What if I become a carrier?'".
The anesthesiologist adds: "My only survival in these desperate times is via the PPE because I cannot distance myself from my patients. My arsenal, scarce though, is my trustworthy PPE."
Helping Covid-19 patients in increasingly harrowing circumstances, Dr Mehmood says if healthcare workers get sick, then there isn't going to be anyone to treat the patients.
Ensuring a smooth supply of the very basic PPEs, sanitisers, and bleach is taking up precious time of the Jinnah Postgraduate Medical Centre's executive director Dr Seemi Jamali in her battle with this virus.
"We have PPEs for now, but we will require a lot more," she says.
Dr Shobha Luxmi, who heads the isolation ward at the DUHS, says she has enough PPEs "at least for now", but what her hospital needs immediately and urgently are sanitisers. At the moment, they are rationing on PPEs and diluting sanitisers to make them last longer.
The ration has extended to the N95 masks as well.
"Our N95 masks are our lifesavers, but in short supply. We use them very carefully and after each use put them in brown bags marked with our names to be re-used, till these wilt away," says Dr Muneeba Ahsan Sayeed, infectious diseases physician at the DUHS.
"And can you please tell your readers, these masks are not for them, so do not cause shortage for us?" she asks, her voice filled with sadness. She says these masks are worn by healthcare workers so they can protect themselves while treating contagious patients.
At the Indus Hospital (IH), they have found a solution to make their PPEs last longer as well as to double their protection. "We wear another disposable gown on top of the one that comes with the PPE," says Dr Fivzia Farooq Herekar, consultant internist and infectious disease specialist at the IH.
At the DUHS, they wear another pair of lower quality gloves over their latex ones and shed it after seeing a patient.
Doctors getting sick, hospitals short-staffed
Already, it has been reported that six doctors, some very senior ones, in Karachi have contracted the virus.
"I think if doctors and paramedical staff elsewhere in the country are protesting and are hesitant to report to work, if not provided proper PPE, then it's justified," points out Dr Herekar. "Their panic is genuine."
"But the situation is going to get worse," anticipates Dr Mehmood. "We just don't have enough manpower even if we have the PPEs for them. Our janitorial staff, even our nurses are too scared to go near a Covid-19 patient for fear of catching the virus," he says.
Most hospitals, including private ones, had always been short of ancillary staff. "Some patients on ventilators who cannot move at all, need to be turned every couple of hours, some need to get their soiled pampers changed, or a patient's room needs clearing and cleaning, which involves moving his/her stuff."
At a minimum, Dr Mehmood says, a hospital taking care of 10 elderly patients infected with Covid-19 (and some on ventilators) needs 35 people for the duration of 24 hours — with each doing a six hour shift. "These include ward boys, sweepers, porters, phlebotomists, radiographers, on-floor duty doctors, nursing incharge, shift incharge, and the most important person, the consultant doing the rounds," counts the anesthetist.
With Pakistan sitting on a ticking "time bomb" of Covid-19 patients, Dr Mehmood anticipates the virus will hit the elderly whose health condition is already compromised, especially those who are diabetic and those who are suffering from hypertension.
"We will need assistance for taking them to the washroom, help them with eating, you know little chores that do not require any special medical skill," he says.
So what they will need, soon, says Dr Mehmood, is a brigade of young, energetic educated people who can, once provided a crash course in biosafety, quickly understand instructions on how to wear the PPE properly and store and doff it off carefully as well to avoid contamination.
Willing to volunteer, but not without proper SOPs
Twenty-five-year-old Mohammad Ismail, who founded a virtual group of science students, called Scientists Against Covid-19 Pakistan (SACP-19), and which today has over 3,500 young and eager Pakistanis from across the country, agrees with Dr Mehmood.
He says: "Even we would prefer that the most trained/most experienced people from among us go first as they are more likely to be careful compared to an eager undergrad who could make mistakes in their excitement."
Ismail adds that the only reason SACP-19 has not connected its young volunteers to the authorities so far has been the lack of availability of proper PPEs.
The SACP-19 is working to arm its members with a set of standard operating procedures (SOPs) in the Covid-19 context to ask of local authorities and hospitals as to whether these are being followed, before the group forwards its list of available volunteers.
The SOPs also require the availability of "isolated accommodation as it is not advisable for these volunteers to go back home for at least three weeks," points out Ismail.
What it's like to wear the PPE and the N95 mask
Not quite a hazmat suit, the basic personal protective equipment that healthcare workers in Pakistan are asking for includes a coverall made of an impermeable material, latex gloves, a face shield, goggles and masks (both N95 and the three-layered surgical mask).
It takes about 10 minutes to get into scrubs, wash up and wear the PPE. "Do not rush to wear the PPE as it needs to be donned on properly," advises Dr Herekar.
But it is not the most comfortable of equipment everyone agrees and "adhering to the PPE protocols is quite a challenge" says Dr Sayeed.
"You sweat profusely," she says, adding that one cannot remain in it for more than four to six hours. That is probably because DUHS is not air conditioned.
However, most doctors prefer and feel safer to not be in an air-conditioned isolation room which may not have a negative pressure when a hepa filter is used, increasing manifold the chances of catching an infection.
"The infection is air-borne and without a hepa filter that controls the spread of particulate matter through ducts, those inside the wards can catch the disease," says Dr Mehmood.
In addition, Dr Sayeed says: "You cannot drink, eat, go to the washroom," once you've donned it. But the IH has a room next to the isolation ward where doctors can go sip some water if they need to.
But more than the coverall, it is the N95 mask that is terrifying.
"Breathing in and out takes a huge effort and your communication is impaired, and you need to speak louder to be heard," says Dr Sayeed. "It saps my energy."
"It needs getting acclimatised to," agrees Dr Herekar, adding: "For those not used to it, or wearing it for the first time, it can cause dizziness."
"And what a relief it is when you doff it," she says, adding that "it does take both a physical and mental strain on you".
A person wearing a PPE and working for 6-8 hours is the same as a doctor completing a duty that lasted 36 hours, she says.