Coronavirus chaos everything inbetween

[Music]

it was the last week of january 2020 and

i was attending the annual conference of

intensive care society

it’s a conglomeration of more than 4 000

intensives across the world

we deliberate over scientific research

and clinical aspects of intensive care

management

new ideas are discussed problems faced

around the world are brought forward for

solutions

and of course we meet and meet friends

and colleagues and unwind over the three

days

of fact this academic feast one

particular aspect lingered in my

thoughts though

and that was coming from our southeast

asia colleagues they were very concerned

about this new virus from wuhan

which we all had heard of but we were

not sure how big

the problem was there was this concern

that this could take up a gigantic

proportion of a global pandemic

the thought was disturbing and frequent

to the core i but i made peace with

myself that it was not coming to my

shore so why should i worry about it

but the thought of a pandemic had

already been sown in my mind

well we came back to mumbai life

continued all through february

but by the first week of march in a

rapid turn of events

which were about to change our life came

the first realization

that a pandemic of never seen

proportions was going to hit us

there was a flurry of activity by the

government suddenly i was attending

these high powered meetings with

government officials

and epidemiology sales doctors we were

looking at strategies to tackle the

solution

in one of the initial meetings it dawned

upon me that the entire focus of this

virus and the devastating harm it was

causing

was going to be fought in the intensive

care and the high dependency units of

the hospital

icu and the people working in it we are

going to witness a new form of battle

which we had never seen or prepared for

listening to the doctors from china

reading the scientific material

social media post etc i realized that

there was a reason why i was invited for

these high-powered meetings

because even though we were a large

society there were only handful of us

who were senior clinicians who were

practicing intensive care solely

and we were going to play a major role

in this pandemic i decided for myself

that even this adversaries i was going

to look at

this as the once in a lifetime

opportunity to work in a pandemic

mind you the last one was 100 years ago

i started to prepare it

with my chin up as any other attitude to

carry

would have meant that i am going to let

the fear go better of me and stop me

from doing my duties as an intensivist

in honest truth even the financial

capital of the country mumbai had only

one infectious disease hospital and that

too in the government set up

most of us when we thought of infectious

disease thought of tuberculosis

which was endemic in our country and in

recent times h1n1

both of them we had come to terms with

their health scale professionals

and truly speaking did not pose a big

challenge to us or to the hospital

infrastructure

but this kovid 19 yes it had a new name

now

was a completely different beast to deal

with we were thinking that it was going

to be naive

to believe that even a soul one id

hospital would be able to deal with the

patient load

hence all public and private hospitals

who have been prepared

to deal with this patient screen them

and win them treat them

the process began the process began by

experts coming in for inspections to the

hospital

and no surprises found a facility to be

completely inadequate to deal with this

highly infectious virus

my hospital was no different we had to

form a quick action

team which basically started

brainstorming it

involved carving the new hospital within

the available infrastructure of the

hospital

separate entrances corridors segregation

of patients

people common areas to be used like i

like

ct scan mri everything needed to be

charted

and while all this was been done our

biggest challenge was to find manpower

to work in the pandemic

train them for personal protective

strategies and policies

motivate them to work ease their fears

and then realize

that just by wearing a pp suit their

efficiency dropped down by 20 to 30

percent

there was a lot of confusion fear and

trepidation amongst healthcare workers

many refused to work some of them have

some of them had genuine

some had lame excuses tried to escape

work it was a challenge to ally their

fears make them feel safe and motivate

them back to the work

it was i was supposed to travel to

australia at the same time

but because of the uncertain quarantine

and international lockdown rules

i basically stopped most importantly i

needed to be here

around the same time i got appointed a

member of the task force from

maharashtra government

it was in the recognition of my work in

intensive care and i was expected to

basically guide the state in the

critical care management aspect of the

of the pandemic which unfortunately was

the most complex one

for all of us the journey had well and

truly began

the path was uncertain and difficult

however there was one clear option that

we had to pave the road to the

destination

the destination being to see the back of

this virus which was challenging the

mankind

i personally adopted a multi-prong

approach and that was to learn

educate disseminate and learn again from

the experience

i started to interact with doctors from

china and southeast asia they were

actually seeing patients at that time

learned a lot of useful things and we

relied on the basics of icu management

which were time tested and had

established after undergoing the rigors

of clinical trial

we started educating fellow colleagues

we started disseminating knowledge

and intensive care at community at large

was relearning from each other’s

experiences

the task force published his first

guidelines at the same time

and and we you know they were very well

received and i was looked upon as a

person to go in for pursuance of

any code 19 related clinical matters

our icu was soon started to be

recognized as one of the best in the

city perhaps even the state

we were looking at a lot of educational

videos and information sheets being

rolled out from our unit

the icu outcomes support for themselves

it was a unit which was not sought out

now has now been sought after

because they were sickest of the sick

patients coming in and we still had

reasonable outcomes of the patients

a lot of important political and social

personalities were treated by us

and before we knew we were actually

basking in the small success of our icu

outcomes

the press talked about it the media

talked about it webinars became the new

norm to spread and share knowledge

the information would reach thousands

within the confines of their home

though life was still at a standstill

for a common man

because of the national lockdown we as

medical professionals had in fact more

and more work to do each day

well the daily routine was never the

same it was a different challenge every

day

with increasing cases we needed to

increase capacity and we needed to find

more manpower

i was enjoying the challenge that the

pandemic had brought forward

electronic medium had become the new

norm of communication

we did icu rounds on videos we’ve sort

of

did it because the entire team could not

be exposed every day into the virus

we spoke and counseled the families and

family members on the phone and video

calls

and i must say they thanked us

profoundly and even in the odd mortality

they only had words of appreciation for

the efforts which we put in

it looked like the trust deficit for the

doctors which the community had

developed

for the last few years had finally been

restored back

however as the destiny has its own way

of deciding i came down with going 19

and from being a caregiver i became a

care seeker

i was admitted to the quarantine section

of my hospital

the hospital room my team members who

are putting heart and soul to look after

me the fantastic nursing staffs the

attentive hospital management

all would seem like a perfect hospital

experience for any patient

but still deep within me i was having a

turmoil

i realized in those 14 days that what a

patient would feel

there was everything in the hospital

still so much was missing

i was realized and we were basking in

the work and the glory of

our iq success but the patients lack the

human touch

and the patient’s patient doctor

relationship was completely going to be

redefined

so there was no option for a ppe kit and

we were still going to have those

astronaut looking doctors come and

examine you

and even though i knew the faces behind

the mask i still felt that i was alone

in those 14 days

not to speak of my family who must have

gone through very very two tough weeks

staring at uncertainties of the disease

and latching on to the smallest positive

news

which probably made them happy that i

was recovering

well as days ago i went by i recovered

and i was back home

and within a few days back to work but

that moment of feeling alone in the

hospital linger around

and that brought a content change in me

we looked at the entire system and

overhauled the protocols to make them

patient friendly

while the barriers of personal

protective equipment were remaining

we were looking after the patients and

attention of the detail was basically

now to make patients feel as comfortable

as they can

their hobbies were nurtured icu was soon

going to be a different place

in all this illness and patience being

sick

patients were playing flutes playing

guitar drew paintings

we had regular news updates from our

doctors and nurses

and the dietitians were tailoring food

for them so that they felt better

these were small things which were

making a difference however

we needed to be done we also

simultaneously work towards community

awareness

regular facebook lives public awareness

speeches

addressing their fears comforting them

and most importantly providing them

correct information

they were conducted by me and some of my

like-minded friends

every week in hindi english and regional

languages

it made a small difference in our life

thinking that somebody may be benefiting

from what we were talking and what we

were doing

there was so much more to do soon the

academicians across the country public

figures politicians

doctors hospitals all helped in this

initiative

somewhere with us and some were doing

their own bit so the country was

witnessing a

different way in which they were seeking

information instead of the standard

facebook

and whatsapp forwards they were now

having several platforms to seek correct

and scientific information

as days and weeks passed by we started

to know the disease well

epidemiologists at the same time were

striving hard to control the spread of

the disease and policies were

being read after the constant change

from an outsider’s point of view it must

have looked like a chaos but trust me

there was a method to this process

and as we got better the process and the

results started to show up for

themselves

many people started to predict how the

how the virus would basically behave

and what part path it would take up some

would say that it would decline in 100

days some would say it would be

different

most got it wrong some may have probably

got it right as well but the truth is

that every pandemic wave decreases

it follows a different trend across the

world while in some european and

american continent it may peak in winter

in india it decided to peak in monsoon

and by the towards the end of the season

by around september end

stages started decreasing finally the

life was looking bright again

it felt like sunshine the economy was

moving

the bazaar gurus in the share market

must be finding it very very

good for them that the share market was

going up

and for a common man though it was back

to work and support the family

it often amazes me that the countrymen

we have a lot of resilience

and as a whole country we try to stand

up in in despite all the adversities

that we face all the time

there were smiles on people’s faces

while some families may have lost their

loved ones

it was basically still trying to put up

a put up a brave face

by hiding those memories in the deep

corner of their heart

authorities were happy people were happy

soon diwali came through

festivities came through there was this

wedding season which started up and

almost

everybody wanted to forget that a virus

called corona even existed

in midst of all of this the scientists

of our country and world were working

very hard to create a vaccine

they knew that the only effective way to

deal with was to vaccinate people

and this was learned from the history

from the smallpox and the polio viruses

and many more

we were all looking for the wildfire

forward for the vaccine announcement

and when it came through it looked like

there was going to be some solution for

this difficult problem

we as medical frontline professionals

felt as if a safety armor was

formally going to be surrounding us and

protecting us

and because the patient was still coming

and we still needed to work in icus

i sensed a small twinkle in my mother’s

and wife’s eyes

as the indian vaccination program kicked

off they must have thought that at least

some protection for me now

well as a healthcare professional i was

fortunate to be one of the first ones to

be vaccinated

all news channels and papers carried

vaccination drive in an extremely

positive way

and indeed would be 2020 had started on

a positive note

the big step forward however quickly

turned

into a into a hesitation as a news a few

complications from vaccine came through

and all along the vaccine and the

problem which we were trying to deal

with

was now basically to deal with the

vaccine hesitancy a new terminology for

me

a large part of our time was felt now

was spent now in dispelling these

doubts in the people’s mind be it at

work media platform social media

whatever it was

after all it’s very difficult to

understand what human mind thinks

and when we started to to sort of try

and change the thought process

after all it was going to be a very very

difficult task to do

but the history had shown that the only

effective way to deal with the various

is to actually have vaccination program

go ahead

with hard work from various quarters and

push from government officials and

scientists

finally the vaccination program came

back on track

but i have mentioned before that we

don’t take learnings from history

seriously

the previous spanish pandemic which lie

with spanish flu pandemic which was

there 100 years ago

had clearly shown us that a second wave

was coming

we as clinicians had fears about it but

somewhere the message about it got

diluted

in all the backpacking and how we at the

country had done exceptionally well in

controlling the pandemic

we probably lost that message and well

it may have been forgotten 100 years ago

but we didn’t even bother to look at the

europe and the american countries where

the second wave was well and truly

happening as we were trying to improve

from where to come out of the first wave

neither the authorities nor the common

man or doctors were actually expecting

what was coming

a little lag of time and the second wave

hit us like never before

within a span of six to eight weeks from

february 2021

india was reeling with cases again this

time the numbers rose spectacularly fast

and our healthcare system was stretched

to the limits

there was a shortage of life-saving

things like oxygen

drugs it almost felt like deja vu but it

was multiplied by three faults

as we are currently in the midst of this

second wave we are fire fighting for

essential life-saving things

while some cities and states are doing

much worse

some have started to show some

improvement the hope currently is that

the second wave which comes like a storm

probably should vanish like a storm as

well

again the mathematical models predict

that it could be 100 day cycle

we will have to see how accurate they

are this time around

i would like to summarize by saying that

i’m most certain with hard work and team

effort we shall again

come and be victorious in this wave as

well

the extent of damage to human life and

economy it causes

will remain to be seen just like the

first wave

the second wave would also go down but

the ferocity of that

would still be unknown because we just

need to wait out

while what we can do is that we probably

need to take the learnings from the

history

it is often said an experience that when

the second wave comes third one is

already staring at you

let’s take a pledge that we will not let

our guard go

go down now the second wave when it

declines we will mask up and vaccine up

that would be the mantra the government

needs to step up

surveillance testing tracing traiting

and microcontainment in a more effective

way when the wave actually goes down

at all cost avoid the third wave and all

it needs is that the government to

invest

more and more in healthcare and for us

to behave like responsible citizens of

the country

jai hind

you