Dr Rajesh Gupta in his OPD
A year back, all we knew about coronavirus was that it began in China and spread quite fast in Europe. We knew that it was causing respiratory illness with flu-like symptoms. Being a pulmonologist, I was trying to read as much as I could about similar diseases and their spread in the past. I felt that there was an urgent need to keep myself and my team updated. What if it entered India? How many people would it potentially affect?
We closely followed what was going on in China and Europe through webinars, which helped us a lot in understanding the symptoms the virus was causing, the complications it could lead to in people with comorbidities and how it was killing elderly.
Since it was an aerosol-based infection, one of the main concerns was to protect the treating doctors and nurses. They come into close contact with patient’s aerosol during clinical examination and interventions. So, world over doctors came up with innovations, they designed glass boxes to intubate patients.
In January, India reported its first case. When we decided to open the Covid Care center in our hospital, we talked to our team of doctors if they are ready to treat Covid patients. Since it was a highly contagious disease, we were expecting some resistance but there was none. It gave us a lot of confidence. We conducted training for 32 doctors, 60 nurses, technical team and all non-medical staff. We developed protocols, and procured PPE kits. By March, when the cases started surging, we got enough time to prepare ourselves mentally as well as infrastructurally to treat Covid patients.
I decided to follow a personal protection routine. I started carrying two sets of clothes—one for hospital and the other for home. I have three children, I was worried about passing the infection to them. I would take a bath and steam, gargle everyday after coming back from home. I would rigorously and regularly sanitise my equipment, I started leaving them in my car. I stopped wearing watch and any other accessory.
Back in hospital, we created an ORANGE ZONE, where we would admit patients in separate rooms. The medical staff in that area would don full PPE kits. Those who would test negative, would be shifted to the Non Covid GREEN ZONE in a separate block. Those testing positive for Covid, would be shifted to RED ZONE in another block.
In April, 15 of our colleagues were traced as contacts of Covid patients. We admited them in the hospital. None of them developed the disease but the exercise gave us a dry run. We identified and addressed all small and big gaps in our preparation to handle Covid patients.
We admitted our first Covid patient on May 20, 2020. We were advising most patients home quarantine and care, and were admitting few who we knew needed hospital care. Still, we anticipated that there would soon be a drastic increase in the number of cases who would require hospitalisation. Though we tried to be as judicious as possible in hospitalising Covid patients, beginning September, all the Intensive Care Units, HDU and ward beds were full. We had many critically ill patients on ventilators, high flow nasal cannula. We started using medicines like Remdesevir. We began using convalescent plasma therapy, which was showing wonderful results. The entire hospital staff was working day and night. Some who contracted the disease, were coming back to work as soon as they were turning negative.
Discharging a patient didn’t mean end of care, we realised the need for continued care as some patients were facing severe post-Covid symptoms. For such patients, we launched our Post Covid Care Clinic, which worked every Thursday.
It was November, and we all had been working without any break. We wondered how long we would be able to continue full steam. Perhaps, the reward of sending people home alive even after severe illness was what kept us going. By now, many of the doctors and nurses had been hit by Covid. Thankfully, they had suffered mild disease.
By Dec 15, we had treated 1000 patients with a survival rate of 912/1000 (91.2%).
Covid brought a significant change in our working—professionally, our method of functioning had taken a 180 degrees turn. Now, we could not give that ‘personal touch’ to the care. We had to put on protective gears and maintain a certain distance from the patients.
Covid brought a significant change in our working—professionally, our method of functioning had taken a 180 degrees turn. Now, we could not give that ‘personal touch’ to the care. We had to put on protective gears and maintain a certain distance from the patients.
My day would begin with donning PPE with the help of our nursing staff. I would then check my N 95 mask for any leak, goggles for their fit. I would first go to the ORANGE ZONE (Suspect Area) where I B around 10-12 patients and decide with the doctor posted there about the next steps to be taken. From there I would walk through the Green Corridor to the Covid wards where I see patients with mild disease. After that I would go to the Covid ICU/HDU where I saw about 20-25 patients every day with severe disease facing a potentially life-threatening illness. After that I carefully doffed my PPE in the doffing area. Then I would walk through a dedicated corridor to a washroom, take a bath and change into fresh scrubs. It was a tiring process but our caring nursing in-charge would keep a cup of coffee ready for me to recharge. We then would plan the rest of the day with the ground staff. One of our team members would update the family members of the patients about their health status on the phone.
In summers, it was extremely difficult to stay in the PPE even for a few hours. I bow to the younger doctors and nurses who worked in these unbearable conditions for 6-8 hours at a stretch. In a PPE kit, you get drenched in your sweat, it is difficult to breathe, your breath fogs your vision. You cannot drink even water or go to the washroom. It clouds your thinking ability. But still, you have to keep alert.
In the OPDs, however, we protected ourselves with an N 95 mask and face shield. A regular hand wash and sanitizer in between patients was a must. Video-consultations, though less than perfect, provided an opportunity for those seeking treatment without coming to the hospital.
At home, I was concerned about my family. I stayed isolated for 45 days in a separate room in my house even when I had no symptoms. However, eventually I gave it up as it was emotionally draining for the children. On the positive side, the family learnt to enjoy every moment they spent at home together.
“Sabka number ayega”, we used to say to each other jokingly about the possibility of us contracting the virus. Soon, the joke became a reality.
“Sabka number ayega”, we used to say to each other jokingly about the possibility of us contracting the virus. Soon, the joke became a reality. I was taking rounds in the hospital wards one day, I started feeling a strange pain in my muscles while climbing stairs. A little while later I felt a burning sensation in my eyes. I took a paracetamol and felt better. I called my wife to prepare an isolation room for me. I got myself tested and went home and stayed in Isolation. I started medications (Ivermectin and Doxycycline).
Next morning, I got the results--I tested positive for Covid 19. I didn’t have any symptoms except a little body-ache for a couple of days. I monitored my oxygen saturation regularly. The second week of illness is an important time because the cytokine storm, which leads to breathlessness and fall in oxygen saturation, usually appears during this time. On day 14, I again tested positive. But it was alright because I knew that mild cases test positive for longer periods. I tested negative on day 17 and joined work the next day. I was very particular about wearing PPE Kit in the covid ward, and wearing N-95 mask and hand maintaining hand hygiene outside it but how and where I got exposed, I cannot say.
None of my family members had any symptoms. They all tested negative on day two of my illness. I gave them prophylactic Ivermectin. By the God’s grace, no one fell prey to the virus.
This was the first time in the last 15 years that I had a break from work for more than two weeks. I read literature, religious books, watched movies and made a couple of paintings. I ate nutritious home-made food and exercised in my room. I got time to introspect—in my career I have seen many babies being born, their family members distributing sweets in the entire hospital. I have witnessed many painful departures. Covid-19 gave me an opportunity to understand the value of relationships in life and in death.
My perspective on life, and more so death, changed by the time my quarantine ended.
I wanted to return to my duty as soon as possible. And I did.
(The writer is additional director, pulmonology, Fortis Hospital, Noida)