COVID 2.0-MY RETURN TO THE ZONE

 

I served in the covid zone of my hospital in mid-June 2020, at a time when the numbers were surging in the capital, and we were still a novice as far as treating these cases. Drugs were few and mostly ineffective and the treatment protocols were vague and confusing..        https://runningtobebetter.blogspot.com/2020/06/my-covid-diaries.html 

Ours is the busiest center in the armed forces which is the epicenter of the management of these cases since the beginning of this epidemic. Having one of the largest footfalls, and busy clinical departments with its experience in previous epidemics and being fortunately endowed with an effective and experienced physician duo at the helm of affairs, this hospital was best suited and rightly chosen for the mammoth task.

The number of cases were steadily rising through May and June, and with research and experience growing at a rapid pace alongside, drugs and treatment modalities were fast being introduced. Antivirals like Favipiravir and Remdesivir were found to have effect against the virus, and effective response to use of steroids dexamethasone and Methylprednisolone was identified. Identification of convalescent plasma taken from patients who had recovered from the infection and had developed antibodies to the virus, was a breakthrough as this helped provide quick passive immunity against the virus preventing its spread and effects. After the weak, almost ineffective drugs used earlier, these new players were a welcome change and gave a strong boost to our management capabilities.  Patients who walked into the hospital and were seen to be rapidly deteriorating and succumbing to the illness right in front of our eyes were now seen to be recovering and even coming out of ventilators, something unheard of previously.

These experiences were not just boosting the morale of the doctors and other staff who were working tirelessly for months, often with their efforts proving futile, but also gave confidence and a ray of hope to the numerous patients in and out of hospital and people in general.

When I returned to Delhi in end of July, from a much awaited months’ vacation trip to family at Pune, the commandant’s question if I would be willing for another stint in the covid zone sounded inviting. Having served at a time when things were far adverse, and results often dismal, I was keen to experience the improved scenario. There was no better way to do it than to go back, and I promptly accepted the offer.

The protocols for management had been well formulated and crystallized and number of in-patients, although similar were mostly asymptomatic or had milder disease. What experience had taught us, was the ability to identify patients with apparently mild disease (Normal vitals, oxygen status) who were more likely to deteriorate. We did this with reassessing them after a short walk which brought out the sinister changes which helped us treat them more aggressively and monitor closely. This along with use of convalescent plasma, steroid on top of the antiviral favipiravir, I feel gave us the most effective weapon to manage these cases by hastening recovery and improve survival.

Unlike the previous stint of 10 days in mid-June when I had seen around 300 patients getting admitted, and 20 of them succumbing to the illness, this time it was 204 with around 40 of them requiring oxygen

to begin with, and none having a fatal outcome. 

This was a heartening change and the impact of effective management protocols, drugs and experience of the management team was getting to be visible. The rest of the team and support staff who worked with me had gained a lot in confidence and experience, and positivity in their attitude towards the disease and patients was evident.

My regular runs within the 3km loop inside the hospital campus continued to give me that morning hour of me-time and endorphins, helped me to have a better frame of mind while interacting with the patients. Rounds through the wards in the warm and humid month in PPE was a challenge, but one gets used to it, knowing its importance to stay safe in the infected zone.

Management of Covid during this pandemic has been no less than a war. While its usually the fighting arms like Infantry, Armoured corps and the Artillery that fight in a war and doctors support by serving them, this war was fought by the medical corps, while the others stood beside and supported. Putting themselves at risk, the healthcare warriors have raged through this war and continue to do so. The core management team, that is outside the active zone, but relentlessly working by providing the much needed administrative support to the warriors is the backbone of this army fighting the war. I only hope that necessary recognition is given to the medical fraternity and their work acknowledged when the war is over and forgotten.  

Covid is going to be a long haul, and it is definitely going to stay with us in times to come. We will soon have to develop protocols, by which every hospital will have to manage these cases in designated areas, while they continue to go about treating the routine non-Covid patients. Otherwise, although covid patients will get the best of treatment, but it will be the rest who will end up being neglected. This is already becoming evident, especially in most non-Covid hospitals, where the fear of patient being covid positive and spreading to other patients and health care workers is dissuading them from working normally. While this issue is being addressed to a large extent by tele-medicine and out-patient care, it’s the specialities that require interventions and in-hospital care that are bearing the brunt. I am sure the coming times will see the positive changes in this aspect of patient care too. There is light at the end of the Covid tunnel, definitely. 

The next phase of this war would be highlighted by the likely surge of cases that’s expected in the winter months and introduction of vaccine in the near future. Till then, while a new team takes over the trenches, me alongwith rest of my team go through yet another period of quarantine after Covid duty and are raring to get back to the warzone whenever called upon to do so.