First positive for COVID, then negative: Chennai nurse's death remains mystery

On May 24, when Valarmathi (56) called John Mary Pracilla, a 58-year-old nurse at the Rajiv Gandhi Government General Hospital (RGGGH) in Chennai known for her spirited service and smiling face, the latter said she was sick.

Valarmathi, who is the general secretary of the Tamil Nadu Government Nurses Association, immediately asked Pracilla to get admitted to a hospital since she had been supervising a COVID-19 ward. Pracilla followed her advice.

One week later, Valarmathi found herself crying to sleep since Pracilla was no more. The kind-hearted nurse, who had been treating patients for over 35 years, died on May 27.

Pracilla was supposed to retire on March 31. She had planned to spend the rest of her life with her 29-year-old daughter and disabled son.

“When Pracilla was asked to extend her service due to the pandemic, she did not hesitate, despite being diabetic,” said Valarmathi.

Pracilla had been going to work with an injury on her right leg. However, she caught a fever on May 21 and had taken three days’ leave. On the third day, her fever and cough intensified, which was when Valarmathi called her.

When Pracilla went to the RGGGH for treatment, she was admitted straight away to the COVID-19 ward, alleged Valarmathi. In three days, Pracilla was declared dead.

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Initially, her name was added to the list of COVID-19 patients. However, it was removed later, Valarmathi claimed.

RGGGH dean Dr R Jayanthi had told reporters that Pracilla’s name was mentioned on the case sheet by mistake. However, Valarmathi suspected that her name was removed so that the government need not pay her family a solatium of ₹50 lakh, as announced by Chief Minister Edappadi K Palaniswami on April 22.

With controversy surrounding the death of Pracilla, Valarmathi has several questions that remain unanswered. Why was Pracilla straight away admitted to the COVID-19 ward? Why didn’t doctors shift her to another hospital or a general ward after she tested negative, as claimed by RGGGH?

Why was she on COVID-19 medication? Why was her body wrapped in plastic and placed in a body bag? Why did doctors not collect nasal swabs from her body, when it is usually done on other deceased people? Why did the corporation disinfect her house if she was not infected by the virus?

On May 29, Valarmathi received a call from another nurse, who too was supposed to retire from service on March 31, but could not due to COVID-19. The nurse, who had been on duty at a government hospital, tested positive for the virus.

In fact, six nurses who were over 55 years were on duty at the Chennai Trade Centre that had been converted into a COVID-care facility. After Valarmathi’s intervention, the six nurses were released from duty.

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These points raise a serious question. Why was Pracilla or the other nurse, who had tested positive, asked to extend their services when Tamil Nadu has the highest number of registered nurses in the country?

The state had 2,93,105 registered nurses and midwives as of December 31, 2018. One in seven nurses in India was from Tamil Nadu, revealed the data provided by Union Minister of Health and Family Welfare Harsh Vardhan in Rajya Sabha on July 2, 2019.

However, the number does not seem to be enough during a pandemic like COVID-19, considering the fact that the state government has been appointing nurses on contract basis to tackle its spread.

It is a similar case with government doctors. Tamil Nadu has the highest doctor-patient ratio in the country. The state has one doctor for 250 people. But there does seem to exist a shortage of government doctors.

“Appointment of more doctors was one of our major demands when we went on strike in October last year,” said Dr GR Ravindranath, the general secretary of the Doctors for Social Equality. He too suspected that Pracilla’s name was removed to avoid paying her kin the compensation.

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“We have constantly been demanding the government to fill vacancies and create more posts,” he said.

This shortage of doctors and nurses was the major reason Ravindranath cited for the government engaging people above 50 years and with comorbid conditions on the frontlines of healthcare services to curb the pandemic.

Almost all COVID-19 wards in the state have at least a nurse aged more than 50, said Valarmathi.

But, in the case of doctors, government hospitals have been cautious about deputing persons from the vulnerable group, said N Ravishankar, state secretary of the Tamil Nadu Government Doctors Association. The government had issued an order stating that persons over 50 years and with comorbid conditions must not be engaged in COVID-related works, he said, adding that the order is being implemented.

However, a doctor, who has been on duty in COVID-19 wards for the last two months, said even medical practitioners who are in their forties have underlying health conditions like diabetes, heart disease, and asthma. “The hot weather makes it harder for healthcare staff in personal protective gear. Doctors with respiratory diseases will definitely find it difficult,” said the doctor, who too was in his forties.

Doctors in the lowest grades too will be around 35 years old. So, senior doctors will mostly be above 45 or 50. But, they visit COVID-19 wards only in case of an emergency, he said.

“It takes even longer for nurses to earn a promotion. They get promoted to top levels when they turn 50 or 55. So, most senior nurses will be above 50,” the doctor said.

He said the government did not maintain records on the medical history of healthcare staff. So, finding a doctor or a nurse with comorbid conditions is not an easy task. “But the government could have asked all doctors to assemble at a place in each district and segregated vulnerable persons from others,” he said.

It is not too late to depute young nurses in COVID-19 wards, said Valarmathi. “We have always been ready to serve people, despite any pandemic. But the government needs to protect us. Pracilla’s incident should never repeat,” she urged the government, with one more request: Please provide Pracilla’s children with the compensation. After all, she didn’t think twice about extending her service.