|LETTER TO THE EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 145-147
“There’s always a First Time”: My experience in COVID ICU as “Corona warrior”
Amol Bansal, Lalit Gupta
Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi, India
|Date of Submission||21-Jun-2020|
|Date of Acceptance||04-Jul-2020|
|Date of Web Publication||29-Aug-2020|
Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bansal A, Gupta L. “There’s always a First Time”: My experience in COVID ICU as “Corona warrior”. MAMC J Med Sci 2020;6:145-7
Coronavirus disease (COVID-19) also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is caused by a novel coronavirus strain. Although first case was reported from China in November 2019, India reported its first case on 30 January 2020. Since then, India has peaked in Asia in terms of total number of cases reported so far.
My hospital, Lok Nayak hospital, was selected by state government as the largest COVID Hospital and given the Herculean task of managing a totally new and unknown pandemic disease. When our institution was gearing up day and night with preparations to fight the pandemic, with the Corona Infection, department of Anaesthesiology, took a lead from the front in performing multidimensional roles as experts in emergent airway management, acute and intensive care, and perioperative anesthesia both compassionately and strategically. It was a totally new and challenging experience for all of us with mixed feelings of fear, anxiety and pride in dealing with such a highly contagious disease. Our skills and acquired knowledge were tested with a significant risk to our own health. I knew that I could be asked any day to report in the COVID ICU and believe me, I was going through emotions like a soldier who is sitting in his base waiting for orders from seniors to report on the war front. I will be lying if I say I was not frightened, but at the same time I was equally excited to have a first-hand experience of dealing with a disease which not only medical fraternity but the whole mankind has never seen or heard of. The adrenaline inside me was rushing to get a badge of Corona Warrior, and finally the day came when I saw my name on the roaster of COVID ICU.
The responsibility was not easy both on and off the work front. Out of all the Corona positive case, less than 10% get into critical condition and I have to deal with these cases only as being an Anaesthetist, I was primarily responsible for ICU patients. Off the work front, also the challenges were no less. I had to leave my family alone for indefinite time. I even did not tell my landlord regarding my duty as I was afraid they might get frightened and could ask me to vacate the flat. My parents were very frightened, but equally proud of me.
The real time condition of COVID ICU was very different from what I thought of or as compared to the normal ICUs, where I have been working since last 5 years. The ICU was full of only COVID patients, each being allotted a separate cubicle under different category like suspected, negative and confirmed ones. The hospital and administration had provided sufficient safety equipments like personal protection equipment (PPE) kits, N95 masks, surgical gowns, shoe covers, etc., but the real issue was to work continuously with those PPE kits. With temperature, touching 40°C and centralised air conditioners not allowed inside the COVID wards, my body was full of sweat in first couple of hours only. However, nothing can be an excuse to be careless in such a situation where not only patients, but also my teammates and myself can be infected by slight mistake or carelessness. Therefore, I continued working with the PPE kit and asked my colleague to follow all the guidelines. One more problem with working with PPE kits was communication. Everyone with PPE kit, N95 mask and face shield has to literally shout in order to pass instructions directly or on call and that was really exhausting.
Corona does not have any effective cure at this moment. As someone has said that, the fear of death is worse than death. All over the world, Corona has emerged as such a huge pandemic that everyone is frightened of it. However, if we see the statistics, the mortality rate from Corona is just between 2-4%. When I talked with some of the patients in my ICU, they were so frightened and assuming they will not live for long. I had to counsel them that with proper safety and treatment, they will get alright in few days. They should maintain physical distance among themselves and with other Corona patients or with the ones meeting them. As our honourable Prime Minister has aptly said we need to increase the physical distance but decrease the emotional distance.
Another experience, I would like to share here is with a young corona patient with age around 35 yrs. That man was so confused that how he can have Corona. Most of the people have misconception that young people or people who are healthy are not by COVID - 19 affected. However, the fact is that Corona Virus can enter anyone’s body. It is just that people with young age or healthy lifestyle recover quickly or may not have any symptoms as their immune system is strong. People belonging to extreme age group of those having other comorbid conditions like diabetic, hypertension are at high risk as compared to other age groups. As you all know, the number of COVID cases in our country is on the rise with the media buzzing with ‘breaking-news’ and ‘latest updates’ on new cases, and mortality statistics every minute! Anything and everything related to COVID gets a highlight while the common, usual communicable and non-communicable diseases continue to contribute their part on death toll!
I gradually got used to the environment and handling COVID patients in a better way in a couple of days. In the absence of a tested drug to cure COVID-19, we used combination of drugs as specified by our Hospital Policy with remarkable successes. We even managed many patients without intubation when their arterial oxygen saturation (SpO2) was around 80% and after prone positioning, oxygen supplementation with non-rebreathing masks (NRB) and High Flow Nasal Oxygenation (HFNO), the SpO2 dramatically improved from 80% to more than 90%. Oxygen therapy is recommended by the World Health Organization (WHO) and center for disease control and prevention (CDC) as the first line therapy for treating COVID-19 induced respiratory distress and hypoxia., Many times, We had to intubate the patient with so many what-if questions running in the back of mind like ‘What if it turns out to be a difficult intubation? What if we get exposed?’ However, we always proceeded with a sense of utter responsibility. In the final week of my posting, COVID-19 patients started coming in large numbers. This was particularly due to increased testing. However, by that time we were also prepared to handle the situation in a much better way.
One thing, I really want to appreciate was the handling of this pandemic by both Central and State governments as a team. At no point, I felt the lack of PPE kits or any other facility. My accommodation was well arranged in a hotel with in room meal services. I felt proud when I saw Indian Air Force helicopters showering rose petals over my hospital. Now when my shift of 14 days was over, I stayed in the hotel for 14 days in isolation. During these 14 days, I underwent mandatory COVID-19 testing to check if I had been infected or not. This 1-month experience has given me a lifelong experience. The life was challenging during this 1 month and it was equally challenging for all those associated with me including my family.
Meanwhile, social media continued to do what they are best at − create fear and mistrust among the common person, as usual, in the name of sting operations! What they fail to show is the “hundreds of thousands of” health care workers who are away from their families and taking care of the sick and the needy, the emotional agony that they go through every passing minute with the growing uncertainty ahead! It should be understand that most of the public as well as private sector hospitals have been functioning with less manpower all these years and this pandemic has just opened up the eyes of the media! The society can participate by showing faith in the medical fraternity so that they can deliver the best possible care to the needy patients.
I am sure this pandemic will be over in few days or months, but this one virus has given us many lessons. Lesson to keep ourselves clean, wash hands regularly, and maintain social distancing. It has taught us that humans only damage the environment and it is our responsibility to keep our environment clean. However, one thing is sure that we need a better preparation to handle such situations in future. We need proper training to be provided for junior staff like security guards, ward boys, and nursing staff regarding COVID duty and what safety measures they have to take to protect themselves. India has done really well in becoming independent in terms of N-95 masks, ventilators and PPE kits but we still need more beds in ICU. If we have to win this battle, we need collective efforts from the grass root level up to Apex ICUs with proper awareness in general public. Last but most important thing is as a society we need to be more responsible and follow government guidelines regarding lockdown and social distancing. Then only we will be able to break the chain of transmission.
My inner anger, expectations and fleeting emotions are auto-cooled by my drenching sweat within my PPE while writing this letter! Doffed and headed for a shower pondering, ‘This too shall pass!’
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Farias E, Rudski L, Zidulka A. Delivery of high-inspired oxygen by facemask. J Crit Care 1991;6:119-24.
WHO. Clinical management of severe acute respiratory infection when Novel corona virus (2019-nCoV) infection is suspected Interim Guidance. WHO/nCoV/Clinical/2020.3 January 28 2020.
CDC. Interim infection prevention and control recommendations for patients with suspected or confirmed Corona Virus Disease 2019 (COVID − 2019) in healthcare settings. 2020.