Working as a Doctor at a COVID Ward in Guwahati | Coronavirus Guwahati

Wednesday, 28 October 2020


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Trials and Tribulations of Being a Doctor at a COVID Ward in Guwahati

Dr Angirash Bhattacharyya | September 13, 2020 13:58 hrs

COVID 1.0

I did my first COVID duty in Mahendra Mohan Choudhury Hospital (MMCH), Guwahati from 17th to 23rd June 2020. 85% of the cases were apparently normal. The scenario at Gauhati Medical College & Hospital (GMCH) was almost the same with a few more serious cases. The patients were largely on oral medications of antibiotics, vitamins, and other symptomatic treatment. They were anxious but largely stable.  


But over the last two months the disease has taken a severe turn and the proportion of serious COVID patients has drastically increased. In a parallel world the responsibility of the citizens has decreased bitterly. Suddenly people started to be reluctant to use masks as if it is a hindrance to their freedom. 80% people coming to GMCH either do not use a proper mask or even if they do, they don’t wear it appropriately. 


I also witnessed corona experts in every other household who judged corona based on the death rate. Due to lower death rate in the state, people have started to feel that there is nothing much to be worried about. Over a period of time, ‘Lockdown’ became a textbook term and ‘Unlock’ an official license to throng together. 


Even after repeated vicious cycles of lockdown and unlock, the picture of COVID and its casualties still stand in a grey zone for the general public. 


COVID 2.0


To give you a picture of the real scenario of COVID let me share with you a note about the GMCH super-specialty COVID hospital. 


I was posted at the GMCH super-specialty COVID hospital from 17th to 23rd August 2020. It is considered as the epitome of COVID care as the most serious cases referred from all corners of the state come here. 


Due to the pandemic, postgraduates, interns, and residents of all the departments are managing the COVID cases. 


We are supposed to wear PPE kits both in the COVID and emergency ward. I had eight hours of duty in the COVID ward. Wearing the PPE Kit is a tedious process; it takes almost thirty minutes to wear the PPE kit and seal ourselves (the process is called donning). 


In the general round we check the pulse rate, temperature, and other necessary checkups of the patients depending on their co-morbidity. To check around 100 patients it takes at least 8 hours. Inside the COVID ward there is a ‘COVID phone’ which is used by doctors to communicate with the team outside the ward. 


As we have evolved with the virus, oral medications have been simultaneously complimented with injectables and Convulsant Plasma Therapy. A highly protocol-based treatment followed here is:


1) For stable patients with saturation of Oxygen in blood (SPO2)>95% (ideally the normal saturation should be maintained between 94-100%)
-Mainly oral medications are given


2) For patients SpO2 <95%
-Oxygen inhalation, Inj Low Molecular Weight Heparin, Inj Dexametasone {they are injectable agents to enhance the saturation of oxygen} + Oral medications as above.


3) For Patients with SpO2 <95% even after above
-Inj Ramdesvir (Injectable Antiviral Medication), Convulsant Plasma therapy in addition to all above


4) For Patients with SpO2 <95% even after above:
-Inj Tocilizumab (Interleukin 6 inhibitor) is administered in addition to all above.


All co-morbidities like diabetes, hypertension, and thyroid disorders are attended parallely. It has been observed that with the help of injectables and plasma, there has been noticeable rapid improvement of the patients. But painfully we have still not been able to undo the bitter fact that people are dying - almost every day. 


Many a time, the SPO2 (oxygen saturation) drops so drastically that a person who had been talking to you hours back might be frozen in your hands and you have no other option but to stand helpless. Many of these incidents are also attributed to the fact that since the past few days, people have shown a reluctant attitude towards COVID testing. They refrain from voluntarily coming out for testing when they have minor symptoms for the fear being taken to quarantine camps or hospitals. 


As a result, when the patient reaches a facility like GMCH, the condition is markedly deteriorated. The ICU team at GMCH has left no stone unturned to bring hundreds of lives back from near death and that's the reason why people are over optimistically apprehending the disease. 


PPE kits have become as common an ornament for doctors as the stethoscope. Eight hours of constantly wearing PPE Kits without a sip of water or being able to pee does take a toll on the physical as well as the psychosocial aspect. 


These sometime go deep especially for the female doctors, nurses and other healthcare workers as they have no other option but to use diapers and sanitary pads inside the PPE during menstruation. According to reports, almost 30% of doctors in India have started developing skin allergies due to prolonged use of hand gloves. 


According to Centers for Disease Control and Prevention (CDCP), formerly known as the Centers for Disease Control (CDC), there can be some long term side effects due to prolonged use of PPE like headache, increased pressure inside the skull, nervous system changes (e.g., increased pain threshold, reduction in cognition – altered judgment, decreased situational awareness, difficulty coordinating sensory or cognitive, abilities and motor activity, decreased visual acuity, widespread activation of the sympathetic nervous system that can oppose the direct effects of CO2 on the heart and blood vessels), Increased breathing frequency, Increased ‘work of breathing’, which is result of breathing through a filter medium, Cardiovascular effects (e.g., diminished cardiac contractility, vasodilatation of peripheral blood vessels) and reduced tolerance to lighter workloads among others. 


There were days when my fellow doctors tested positive and were taken to the ICU as their situation deteriorated. Parents are always worried about our health and they keep a check on me every day. Ultimately it is the passion for the profession which keeps our feet running. 


In a nutshell, I put forth a humble request to the general throng, to try and take due precautions to prevent COVID from occurring rather than finding a place on the other side of the coin taking treatment. Only the masses can prevent it. It is only with mutual cooperation and congruence of thought between healthcare workers and public, we can bring an end to this pandemic.


(The author is a 2nd Year Post Graduate Resident at the Department of General Surgery at GMCH. The views expressed in the article are his own.)
 

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