In the eighth of our Living With COVID-19 series, where we learn how fellow health workers are adapting and coping with the ongoing pandemic, we hear from Vivek V Pai, based in Mumbai, India. Vivek is one of India’s most prominent physicians and is currently the director of the Bombay Leprosy Project (BLP). He is a dermatologist and leprologist engaged in leprosy relief and research work for the last 32 years. India, especially Mumbai, has been one of the hardest-hit regions during the COVID-19 pandemic with an increasingly rapid rate of the number of cases. His words here describe how he has felt and what he is experiencing during this time.
I remember it was in early February this year when I was attending our National Dermatology Conference in Pune when the news started trickling in about the entry of SARS-CoV-2 in India, as the first reported case of India was on 30th January 2020 in Kerala. In March, news started creeping in about the gradual spread of the virus in metropolitan areas like Mumbai, Delhi and thereafter in other places in India and hence in the last week of March the nationwide lockdown was announced. Suddenly, programmes and plans on hand for routine activities, new and ongoing research projects, scheduled training and preparations for meetings and for conferences were tossed out the window and came to an abrupt standstill. This continues to be so as we are in extended lockdown till the end of July. However, the mission to ‘unlock’ has begun in Mumbai and in the rest of India with phases to bring back the derailed economy.
While there was nationwide lockdown, we remained open being part of essential health services to continue our care and services to leprosy patients and the most vulnerable, for which we are committed to, so that the care and treatment services to leprosy patients and persons affected avoided interruption as much as possible.
BLP through its Referral Centre in Mumbai is currently attending to a large number of leprosy patients referred not only from Mumbai but also from adjoining areas. They are either for confirmation of suspected leprosy, difficult to diagnose cases, the management of complications like chronic/recurrent ENL reactions, neuritis and nerve damage and suspected relapses. Such clinical problems are truly challenging but more so now, during a pandemic. BLP is well known for its rich technical expertise and its vast collective experience, providing comprehensive leprosy management services for free. We have continued over the last four and a half decades in urban and rural settings through a team of medical, paramedical staff and community volunteers. Besides the Referral centre service, we also operate satellite clinics in the slums of Mumbai and field areas comprising the Dharavi slum (Asia's largest slum) and many such slums. The aim of which is for leprosy elimination as well as it’s prevention and the care of it’s associated disability in urban and in rural areas adjoining Mumbai, integrating rehabilitation and academic contributions.
These are trying times due to the COVID-19 pandemic. Suddenly we have had to make a lot of changes in arrangements mainly for personal protective equipment to protect the paramedic workers, community health volunteers and support staff engaged in field and clinic work but also patients, accompanied persons and visitors visiting the centre.
With the cases of Coronavirus rising in Mumbai and adjoining region especially in the slums like Dharavi, all of which have become hotspots, the entire fieldwork for leprosy case detection activities such as house to house surveys, school survey (as schools are closed) and field follow up activities have come to a standstill.
As of the 27th July 2020, in India, there has been a total of 1,437,976 cases with 32,826 deaths. In Maharashtra State, there have been 375,799 cases with 13,656 deaths. In Mumbai there are 109, 096 cases and 6,090 deaths, but now with a good recovery rate of 63% which is the National average.
But life for everyone has changed to adapt to new norms, new ways and challenges of living using gloves, masks and face shields and protective glasses, frequent use of sanitizers. There is an increased conscious effort, reminding oneself of maintaining physical distancing, sanitizing the clinics and the office space has become the rule of the day.
Apart from the leprosy relief work which was continued, we have started supporting the endeavours of MCGM, Govt of Maharashtra and Govt of India for Covid-19 relief work as per the directives from Govt of India by participating in screening activities and camps for suspected Covid-19 patients in slums and hotspots. This has involved reaching out to provide protective provisions like masks, face shields, glasses, sanitizers and dry food ration packs and kits to migrants, the most vulnerable, leprosy patients, community health volunteers and those who have recovered from Covid-19 or those still in quarantine.
As a researcher, I am keen to know and understand about how the co-infection of leprosy and Covid-19 affects patients. What are the effects of this co-association, especially those on steroids and other immunosuppressants? I strongly feel that the other aspect that we must look into is how the transmission of Leprosy, Tuberculosis and other airborne diseases would be impacted considering the usage of masks and sanitising measures.
Overall, there is a strange sense of uncertainty and subdued apprehension amidst this calamity and the pace of life has markedly changed. Suddenly I find myself busy in several Webinars and Zoom meetings, consulting and advising patients on What’s app and teleconsulting platforms and it is pretty clear that digital life is going to be the present and future. The Covid-19 pandemic has been the turning point in this ‘digital turnaround’.
Most importantly, the pandemic has thrown up big challenges, especially in India, not only in carrying out the various aspects of life but also survival itself and we need to overcome these challenges in the times to come.
My sincere and heartfelt gratitude goes out to all our supporters, donors and well-wishers at this time
Dr Vivek V Pai
Bombay Leprosy Project
Mumbai, Maharashtra, India