‘You cannot do anything’: Indian American doctors struggle with COVID-19 crisis back home
The much-celebrated ebb of coronavirus infections in Los Angeles in recent weeks has not brought the relief that Dr. Neha Nanda anticipated.
As head of infection control for Keck Medicine of USC and its hospitals, Nanda has for the past 16 months closely tracked each twist and turn of the pandemic and awaited the moment when cases would begin to plummet.
But the recent decline of the coronavirus in California has coincided with an explosion in India, where Nanda grew up and her parents still live.
“Yes, everything is opening up, but the other part of your brain and part of your heart feels kind of guilty in rejoicing. ... Most every day I’m getting messages that someone died in India,” Nanda said. “It’s people who you love, who you know, who saw you as a child, and you cannot do anything.”
India has become the latest epicenter of the coronavirus worldwide, as overwhelmed hospitals there deplete supplies of beds, high-flow oxygen and necessary medicines. In a single day last week, the country reported nearly 4,000 deaths.
The dire situation has been particularly hard to watch for the large number of Indian American healthcare workers who spent the past year battling the pandemic in their adopted country. The American healthcare system relies disproportionately on Indian doctors, with 1 out of 10 physicians in the U.S. identifying as Indian — the majority of whom were born in India, according to census data.
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Some say they have considered packing their bags to go help, but are unsure how much assistance they could provide and how safe it would be. The CDC is currently advising against travel to India and warns that even fully vaccinated people could become infected due to variants.
Instead, many Indian American doctors are holding webinars to provide advice to physicians in India, drawing on their expertise treating COVID-19 patients in the U.S. over the past year. Some are raising money to send supplies, but with flights limited, how soon they will arrive is uncertain. Almost all are fielding panicked Whatsapp messages from friends and family, some of whom are sick themselves.
“There’s a huge tragedy that has completely taken over India and we are trapped here,” said Dr. Vincent Rajkumar, who works at the Mayo Clinic. “There’s that feeling of helplessness, and at the same time, we just feel like we have to do something.”
The disaster in India took many by surprise. After a year with relatively few COVID-19 cases and deaths, many had come to believe that India had escaped a major surge, perhaps because of the young average age of its population or immunity due to past infections with other viruses.
But when cases began to rise in March, they didn’t stop. The latest wave has crippled the nation’s healthcare system and forced sick patients to wait hours, if not days, for beds. The Biden administration announced last month that it would send N95 masks, oxygen concentrators as well as supplies to manufacture vaccines to help with the crisis.
But there remains no end in sight.
Dr. Abhijeet Nakave, a hospitalist in Virginia who left India in 2005, said his phone beeps throughout the day with questions and updates from his loved ones back home. His family, who live in the state of Maharashtra, describes “a war zone,” he said.
Nakave’s 31-year-old cousin was hospitalized with COVID-19 because he was struggling to breathe. He worries about his parents and other relatives too.
“Anytime I hear a phone call at night, my heart skips a beat,” he said.
To try to help, Nakave has been giving advice to COVID-19 patients in India through a service he launched last month called MDTok. The online platform allows doctors in the U.S. to do telehealth visits and is currently free for COVID-19 patients in India.
The patients are largely people with mild COVID-19 cases who are staying home and want guidance for how to monitor their symptoms, he said. Sometimes Nakave will also field questions from the patient’s frightened child, often in another city and unable to visit the sick parent.
More than 100 doctors in the U.S. have signed up through the platform so far, Nakave said. He hopes that it will reduce the strain on India’s overburdened healthcare system, even if only a little.
“In the beginning, I used to always say, ‘Sorry to hear that,’ but how many times can you say that to everyone?” he said.
Nakave tapped into the extended network of U.S. doctors with ties to India. Of the roughly 4 million people of Indian ancestry living in the United States, more than 100,000 are doctors.
The U.S. began recruiting doctors from India and other countries more than half a century ago to help meet the demand for healthcare services after Medicare was created in 1965. Because India is a former British colony, doctors there spoke English and had a leg up.
Also in 1965, the U.S. abolished its race-based quota system for immigration, which allowed more Indians, particularly highly skilled workers such as doctors, to enter the country, said Jeanne Batalova, senior policy analyst at the Migration Policy Institute.
Second- and third-generation Indian Americans may pursue medicine in great numbers because of cultural pressure, or the influence of parents who worked as doctors themselves, said Harvard healthcare policy professor Dr. Anupam Jena, whose mother emigrated from India as a doctor.
“This will feed on itself a little,” Jena said. “I knew what it was like to be a physician: She took me to the hospital, I met nurses. I had exposure to that early on.”
In recent weeks, the American Assn. of Physicians of Indian Origin, which calls itself the largest ethnic medical organization in the country with roughly 13,000 members, has raised more than $2 million in aid for India. Last week they helped ship 1,000 oxygen concentrators to New Delhi and are now trying to secure ventilators to send, according to Vice President Dr. Ravi Kolli.
“As physicians, we could not stand aside and do nothing,” said Kolli, a psychiatrist in Pittsburgh. “The whole point of our organization ... and the whole point of being physicians is to provide treatment, to help.”
The organization, formed in 1982, has also been hit hard by COVID-19. A past president died from the disease last year. Multiple officers also developed serious cases and are still recovering.
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Still, Kolli said hundreds of members have volunteered to fly to India to help treat patients there, but are seeking guidance from Indian officials on how to get temporary licenses.
The pain of the crisis in India has been exacerbated by how difficult it has been to make a difference on the ground due to travel bans and other restrictions, said Dr. Sunita Puri, a palliative care physician at USC.
“When I was seeing the coverage, both of the mass cremations and of people gasping for air in the street, I just kind of broke down. I couldn’t take it,” she said. “What makes this tragedy a double tragedy is that people want to help, but their help will inevitably be delayed.”
And then there are the emotional struggles. Nanda, the other USC doctor, spoke to a childhood friend in India recently who told her she had COVID-19 symptoms. Nanda felt herself disengage and talk to her friend only like a doctor, instead of a loved one.
Connecting fully with the crisis, and holding the realities of her two countries feels almost impossible, she said. It has also dulled the hope she had been feeling earlier this year.
“Before April, I was saying we were in the last innings, and now what I’m saying is that we are in the last innings, and I think the innings are really long,” she said. “I don’t think I have the same optimism that people have if they are living in this world only.”
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