Anup Katyal, an intensive-care physician in Missouri, was finally getting a break from treating hundreds of covid-19 patients at the hospital where he works. Then, catastrophe descended on India, his homeland.
Each day since, he has awakened to a flurry of messages from 20 relatives, friends and fellow doctors in India seeking medical advice.
Then, before bed, he has hopped onto Zoom with a family in New Delhi that contracted the virus and turned to a physician 7,700 miles away because local doctors turned off their phones and shuttered their offices.
The catastrophic coronavirus surge in India has devastated the country’s health-care system, with thousands of people dying as they wait for hospital beds or supplemental oxygen. Even before their conditions become dire, many newly infected Indians are struggling to find medical care as urban hospitals are stretched to their limits and bare-bones health systems struggle in rural areas and villages. Misinformation and misguided claims about purported cures, such as lemon drops, have proliferated as terrified citizens fend for themselves.
“It’s come to the point where the infrastructure has broken down,” said Achintya Moulick, the Indian-born chief executive of CarePoint Health, a chain of New Jersey hospitals, who has been in touch with hospital executives in India.
Doctors throughout the Indian diaspora, including in the United States, are trying to fill this void from afar through organized and unofficial channels. Some are sharing with their Indian counterparts lessons learned on the front lines of U.S. coronavirus surges. Others are making video calls to friends and relatives to check on their breathing and the care they’re receiving.
The collective efforts can make only a dent in a humanitarian crisis regularly resulting in more than 300,000 infections and more than 4,000 deaths a day, with experts cautioning that the real toll is far higher. But they have brought relief to thousands of desperate families – and to Indian American doctors battling a feeling of helplessness as they watch the horror unfold in their native land.
India is a pipeline for doctors around the world, including Katyal, who came to the United States in 1993 for an internal-medicine residency after completing his medical degree in India. He still practices in St. Louis as a critical-care physician at Mercy Hospital and sometimes manages patients across the nation through a virtual intensive care unit program. In recent weeks, the St. Louis ICU where he practices has treated fewer than 10 covid-19 patients a day.
“The moment we thought there was a respite here from my ICU standpoint, it’s unbearable now to see what’s going on in India,” said Katyal, 54.
He stumbled upon a Facebook post advertising a free telehealth platform organized by the American Association of Physicians of Indian Origin to connect volunteer doctors to patients with mild to moderate coronavirus cases abroad. His son Aditya Katyal, an undergraduate premedical student, joins to help him use the technology and double-check medical facts during these sessions.
For several weeks, Katyal has been in touch with the Garg family on the platform and directly through email and WhatsApp. He calls them after finishing his overnight ICU shifts. The family allowed The Washington Post to observe several of their sessions on the condition that the first names of family members in India not be published, citing concerns about retaliation from the Indian government and harassment from political activists who have targeted people who portray the government in a negative light.
The family’s nightmare began on what was supposed to be a joyous occasion – the birth of their second child.
The first hospital refused to admit the mother without a negative coronavirus test result. The second hospital conducted a rapid test that came back positive – and turned her away. As her husband drove her through the streets of New Delhi while she suffered labor pains, the mother eventually found a doctor willing to deliver her baby boy.
The next day, her 4-year-old son and her father-in-law – who live in the same apartment with her – tested positive. Her husband and mother-in-law soon followed.
They were not able to hold the newborn child, instead seeing him on video chat while he stayed with a great-uncle until the family members recovered.
Finding a doctor to navigate their recovery proved challenging. They reached a few on WhatsApp, but all shared the same boilerplate recommendations for a mix of medications without examining individual family members. The family has had to pay hefty fees to have a lab technician collect blood samples at their apartment building, where residents are trying to set up a temporary hospital bed and isolation area in a common area.
“Everyone is too overloaded, and the kind of experienced doctor you need is not easily available,” the father of the family said in an interview. “You can’t go to [some hospitals] if you are a covid patient. They will not entertain you, and tell you [you] need to go to a covid ward, which is only an emergency option.”
In the early days of his infection, the father depended on conflicting advice from friends and others who are not doctors but who shared tips from their own battles with covid-19, the disease the novel coronavirus can cause.
Indian doctors are treating as many as 60 patients at once and have limited time for in-depth conversations with relatives about how to best monitor and care for their loved ones when they leave the hospital.
American doctors can fill the void of reliable information, said Salim Saiyed, who oversees telehealth services as a University of Pittsburgh Medical Center executive.
Saiyed has witnessed the benefits of relaxing licensing rules so doctors in his hospital system can consult with U.S. patients virtually across state lines. But when doing that across international boundaries, there is a fine line between offering medical advice and providing medical care in violation of Indian government rules, which Saiyed said should be relaxed to mobilize more overseas doctors.
Some doctors “are sort of violating rules and [regulations] and hoping the government will not come after them because it’s an emergency situation, but we can’t hope and wish during such times,” Saiyed said.
Katyal cannot write prescriptions for the Garg family. Instead, he offers guidance on how to use the steroids and other medications they have obtained through personal connections – now common in India, where medicines are in short supply – and how to interpret their symptoms and lab results.
On their fourth English-language Zoom session earlier this month, Jatin Garg, a relative who lives in Texas, updated Katyal on each of his family members’ conditions. His brother, who woke up at dawn, looked on from another screen with oxygen tubes in his nose, a pulse oximeter clipped to his finger and a ceiling fan rotating overhead.
Katyal paid attention to the brother’s breathing and ability to speak, asking about his oxygen levels and the timing of his fevers. He advised him to double his dose of steroids, while warning that his wife, her condition improving, was approaching the two-week mark where steroids can do more harm than good.
The virtual sessions begin with volunteers and patients logging in to Zoom before organizers match doctors with patients who speak the same language to their own video chats for private consultations. This allowed Katyal to call in from Missouri, joining Jatin Garg and Garg’s brother from New Delhi. But halfway through Katyal’s session with them, a glitch kicked everyone off the platform and forced organizers to assign all the doctors and patients back to their to private individual sessions.
When they returned to the platform, Katyal said his advice should be shared with a family doctor in a position to offer direct care.
“The reality is, I will be very honest, there is no family doctor,” Jatin Garg replied. “We are consulting with very random places, so I will rely on your judgment and what is your science-based recommendation.”
Katyal nodded.
“These are trying times, and anything I can do to help, I am more than happy to do,” he said.
Sudhakar Jonnalagadda, president of the Indian American doctors group, said volunteers such as Katyal are trying to reduce the strain on hospitals. His organization can assist up to 100 patients at once during several Zoom sessions offered throughout the day on the eGlobalDoctors platform, which is secure and carries liability coverage, and he has urged the Indian ambassador to the United States to ease legal liability rules to encourage more doctors to participate. The Indian Embassy did not respond to a request for comment.
“Most of the patients have mild disease. They are scared they are going to die,” Jonnalagadda said. “This will give reassurance they can stay home and not go to the hospital.”
On the fifth session, Jatin Garg’s brother appeared on Zoom with no oxygen tubes in his nose and fresh from a good night of sleep.
His wife felt close to normal nearly two weeks after her symptoms had first appeared. His mother had not registered a fever in four days. His son never became seriously ill. But his father remained in a small hospital, unable to use Zoom. Diabetes and previous heart surgery place him at higher risk of succumbing to the virus, but lab work suggested that he was moving in the right direction.
“I really want to ask this question: Is he out of the woods?” Jatin Garg inquired.
“With this covid stuff, I’ll be very frank: If someone says they can predict accurately, they are not telling the truth,” Katyal replied.
His response proved prescient. Although the condition of Jatin Garg’s father continued to improve, his brother’s oxygen levels dipped below acceptable levels overnight.
Even though the brother still looked comfortable, Katyal did not want to risk a rapid deterioration, so he urged him to go to a hospital where he could receive remdesivir, a drug that shortens recovery times. The brother took a cab to the same small hospital that admitted his father, who was discharged Monday.
The treatment apparently worked. The younger Garg returned home Wednesday and reunited with his baby boy the next day.
There was no celebration with family members still weak and recovering. But for the first time in three weeks, they were all together and spared from becoming another tragic story as India’s daily covid-19 deaths hit record highs. And they see the doctor as a new member of the family.
“Imagine you go to a doctor’s office and the doctor just comes out of examining room for just a couple of minutes and never answers any of your questions,” Jatin Garg said. “(Katyal) was paying attention. He was giving time. He was available at any moment.”
