December 13, 2020
A Despicable Distinction.
India has just achieved the despicable distinction of having One Crore Covid cases. Soon our death toll may touch 1.5 lakh from Covid-19. The world shall reach 75 crore cases and a staggering 16 lakh deaths. Surprisingly, all this happened in only 9 months. Unbelievable.
In a matter of 9 months, 300,000 Americans in a country which excels in modern medical research and advancement have succumbed to Covid-19 alone and the number is still rising.
The First Covid Patient of Odisha travelled in a Railway AC coach.
Odisha today counts 3.25 lakh covid cases and 3000 deaths. It took exactly 9 months. Today is 13, December.
On march 13 the first Covid patient of Odisha came from Italy to New Delhi by air. From the quarantine centre of New Delhi airport, he took the Rajdhani Express to come to Bhubaneswar. All the train escorting staff of that train became suspect. They are isolated and tested as per guidelines. Since then the train escorting staff based at BBS became regularly positive. They would be referred to CH for Testing, Contact Tracing and treatment. We would send them to capital hospital. There, Nasal swab would be taken and sent to RMRC. RMRC will send the report to state IDSP ( Infectious Disease surveillance program). If positive they would share it to the concerned local bodies, BMC in our case. Before long the patient will receive the ominous call from nowhere. “ You are Positive.”
Next an ambulance will draw up in front of your gate and you will be whisked away to an unfriendly Covid Hospital for 10 days, just like that. No relaxation. We the hospital responsible for the care of such patient will be left to read it in newspaper next day. Another positive case. Our only way to confirm is by calling the patients whom we have referred, that too after several days,”Have you got the call ?” “No. Not yet. That means you are negative. Don’t worry.” That was March 2020.
Worst part of the nightmare is, next day morning a sticker will be pasted in front of your gate, This house is under observation. And neighbours will avoid your family like a pariah. Nobody will bring you a supply of groceries or even your daily medicine. It is much worse than having leprosy during the biblical era.
Soon the infection spread among the railway beneficiaries regularly. Shri Harihara Swain TTE of BBS became the first Railway casualty of this pandemic.
Twin threat
The Covid-19 Pandemic imposed two unprecedented restrictions.
- The highly infectious Covid-19 posed immense health risk to railway employees and beneficiaries. The mode of delivery of health care services changed to virtual from the convention. Physical contact was prohibited. All treatment has to be virtual and information based.
- The Epidemic Act gave the Urban Local bodies such as Bhubaneswar Municipality sweeping authority to curtail movement of people and goods on medical ground. Everyday there will be fresh SOPs regarding restriction of manpower and movement of staff and offices. Railways being a transport organisation are maximum affected by this. Medical department has to liaison with the state health authority to implement those regulations as adaptable to our working while ensuring smooth working of our offices.
Twin Responsibility
- As DRH/KUR was declared as an exclusive Covid Hospital by the Railway Board, Central Hospital has the envious responsibility to cater to the dual responsibilities of managing both covid and non covid patients under one roof. It required complete bifurcation of Infra structure and manpower of the hospital into Covid and non covid units.
- We have to keep liaison with both State IDSP (Infectious Disease Surveillance Program ) and BMC ( Bhubaneswar Municipal Committee) for testing, contact tracing and treatment of Railway beneficiaries. Simultaneously we have to augment our facilities to cater to a respiratory emergency.
Infrastructure modification
- The existing hospital building was partitioned into Covid and non Covid section. Covid section was moved to the back of the hospital. Its entrance was 180º away from the entrance to the regular OPD.
- Later on four Porte-Cabins are constructed away from the main OPD building. The general out patients were screened here to separate fever cases from regular patients and are diverted to Covid section before entering the main OP building.
- Quarantine Beds– The existing dormitories were converted to10 quarantine beds as per railway board’s guideline.
- Isolation Beds- 34 beds ( half of the sanctioned bed strength) were partitioned off for covid patients. They are equipped with exclusive donning and doffing facility and all equipments ( Piped gas, Ventilators, Multi monitors) to handle a respiratory emergency.
The State authorities had done a surprise inspection of Covid preparedness in our hospital and were highly satisfied.
Covid stores
Dr A Senapati, the then MD/CH was nominated as the Covid In Charge for the zone.
NSR of Rs 11,99,67,841/- was vetted by the finance department for emergency procurement of medicines, medical consumables and medical equipments for the zone for covid management.
Equipments, medicines and other materials amounting to 9.8 crores were received at the CH within three months.
Dr R.K.Mahapatra, Ch Pediatrician was nominated as nodal officer to oversee receipt, inspection and distribution of the material to 3 divisional hospital.
Ware housing-
Basement of Railway auditorium was utilised to unload this huge amount of materials. It became inadequate. Later on they were moved to Railway stadium for safety purpose.
The whole country was under lock down. Only Emergency movement of vehicle was allowed. It was a Herculean task to distribute these stock to WAT, KUR and SBP. Time was important. Life saving items like Ventilators, PPE kit must reach the divisional hospitals as soon as possible. With the help of SMM/CH, who arranged truck from stores department and with one single train running between BBS and Vizag, it was a miracle that all the materials were distributed in time. Liaising with and cooperation from BBS station parcel staff must be mentioned here.
With hard work, all the NSR items were inspected and passed for payment without any suppliers’ grievance.
Covid testing-
Initially, BBS has only one testing facility- Regional Medical Research Centre ( RMRC). For decongestion purpose, they were accepting samples from Capital hospital only. We have to send all our suspects to capital hospital for detection. The capital hospital would communicate their results only to state not to Railways.
Our train escorting staff were becoming regularly positive and it became a road block.
Dr R.K.Mahapatra was made the nodal officer for Covid testing and liaising with the state IDSP and BMC for results.
Covid Swab Collection-
After liaising with ICMR, Central Hospital was recognised as a separate Virus Research Diagnostic Laboratory ( VRDL). We got our unique ID on 7.4.2020. VTM ( virus transport media) were received on loan from the IDSP. A special Sample Collection KIOSK was placed in front of the fever clinic.
The First samples were collected on 13.5.20 and sent to RMRC for RTPCR test. Reports were collected from IDSP.
Till date 775 samples have been collected and sent to RMRC in bio safe manner. ( 13 December)
Antigen testing-
The RMRC test results took more than 24 hours. Often reports were not available to us. Hence the bedside and Rapid Antigen test was started in our hospital. On 5.7.20 – Permission and authorisation was taken from ICMR to carry out In-house covid testing.
Antigen test kits were procured and received on 30.7.20.
From 1st of August In house antigen test is being done in our hospital.
Till date 1076 tests have been completed.
Kits were distributed to KUR and SBP as per their request.
Rapid Response Team-
There was no treatment available for this novel Virus. Testing, Tracking and Treatment is the only available method to control the pandemic. Railway staff and beneficiaries were getting diagnosed at different places. To track them a Rapid Response team was created with both personnel and medical department under AHO/BBS. The primary job of the HI in the team is to immediately sanitise the residence and work place of the positive cases. The personal people would call the person over phone and trace all contacts who may have high risk exposure to the patient and recommend their names for testing. Another important job was to certify availability of facilities for home isolation at their residence.
Armed with epidemic act, BMC had the authority to pick up every positive case and put them up in the dedicated Covid Hospital. No railway staff was willing to go to Hi tech, Blue wheel hospitals. Isolated Covid ward was started for them.
Covid patient care-
- Fever clinic-
Central hospital catered to both covid and non covid patients, It was imperative that we have a strong triage centre to weed out the covid suspects at the entrance and direct them to covid section.
Hand wash facility, foot operated sanitiser dispenser, and infra red thermometer were available at the main entrance. People suspected of fever were directed to fever clinic at the back of entrance. Rest of the patients were seen at the Port cabin outside the main building. Only patients who need specialist opinion or admission were allowed into the main building. Our doctors along with contractual doctors have to manage the clinic round the clock for 9 months.
The existing medical surgical, gynec wards were abolished. Those wards were converted into Suspect ward, Pre test ward, Post test ward and Isolation ward. Every newly admission case will be tested within as soon as possible. If she has fever and cough she will stay in suspect ward. Patients admitted due to any other reason except fever will be held in the pre-test ward. After testing if they are negative they will be moved to post test ward. If found positive they are shifted to the special Isolation ward.
B. Isolation ward-
As per railway boards direction 50% beds were separated as Isolation beds. Partitions are created to isolate them from the rest of the hospital. Piped gas was provided to these beds on an emergent basis. These beds are equipped with most modern facilities like ventilators, multi parameter monitors, oxygen concentrators. Staff are sent to Apollo hospital for ventilator training again on emergent basis.
Till today 202 patients were admitted to our isolation ward.
27 cases have to be referred to higher centre for management of complications.
As on date 175 cases have been cured and discharged from our hospitals.
There was zero case fatality due to covid in our hospital.
But there were 8 casualties from the cases referred to higher centres due to complications.
Dr S Pradhan was the nodal officer for management of covid cases.
All the staff on duty have to wear full PPE mandatorily inside the isolation ward. Rest house was arranged for them to keep them away from their family. They are put on quarantine for 5 days after a14 days stint. On the penultimate quarantine day they all are tested. If negative they are put back on duty. Staff are rotated as much as possible. Because of rigid covid precaution, the incidence of covid positivity among Isolation ward staff was much less than staff on duty in OPD, casualty and office.
C. Home Isolation –
As per certification of our RRT or as advised by BMC, 173 staff and beneficiaries are kept in home isolation. Regular monitoring of their health was made. They are issued standard medicine packets as per advice of our doctors. Later on oximeters were procured to issue to all persons who remained at home isolation on demand.
Dr D Gita Devi was the nodal for keeping contact with all cases in home isolation. She had to monitor their health over telephone and move them to hospital if indicated.
D. Plasma therapy
Database of all cases cured was kept for donor of plasma therapy.
Dr P Sahoo was the nodal officer for plasma therapy.
E. Video conferencing facility –
It is difficult to isolate a person from his near and dear ones for 10 days. They become worried to know about the well being of their relatives. S&T department has added a video conferencing facility for the relatives to talk to the patient at scheduled visiting hour.
Human Resources-
As Central Hospital has to continue its normal work, Work load of Covid required extra hand to manage.
Wak-in-interview was conducted in the month of march to engage para-medical staff on contractual basis. Till now 16 nurses, 4 pharmacists, 2 dressers, Lab technician and X ray technician one each have been engaged.
4 Contractual medical officers were engaged initially. At present only two CMPs are working.
Regular in house training was given to all the existing staff to orient them about the pandemic.
Vaccine-
Ground work has already been laid down by Dr Rupa Kapil ( CHD at CH) for vaccination when it is delivered to our hospital by railway board.
Behind the Screen-
All the while the hospital has to run all its regular OT, OPD and indoor activities. It was the constant encouragement of Dr A Patnaik, MD/CH and the indomitable zeal of Dr (Mrs) R Kapil , CHD at CH saw to it that both covid and non covid activities should run together smoothly without hindering each other. All the IRHS members, matrons, stores peoples have stood solidly behind this sterling performance of our hospital. After all it’s a team effort. The names quoted above are merely happenstances on the record book.
The End Game.
Every day I will check my mail repeatedly for the results. The positives will be inked red. There were days when my mail will be all red. But from 24th of November the colour changed. The antigen tests first became all negatives. Antigens pick up only 60% infections and miss a few. Subsequently from first of December, our RTPCRs also returned black. After 17 days, suddenly our antigens picked up one positive. It was late in the evening. I was surprised. Is it a false positive ? Is it due to contamination ? The person was staying 10 kms away from our hospital. So we broke him the sad news and requested him to come with his family for contact tracing. This time samples were sent to RMRC. Out of 6 samples sent on 12/12 three have turned red. They are exactly the 3 members of his family. So for the first time we recorded 4 cases in this month.
Yesterday, the last covid patient was discharged from our hospital. The ward was temporarily closed for fumigation.
It seems the grand wheel of the pandemic is grinding to halt. Like the wheel of a mail express, it will take a while to completely stop.
I only pray that we have seen the last of our admissions and pray that there is no second wave.
Dr Ramakanta's Ideas 