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
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