Inside the war room leading TN Covid fight

Published on May 17, 2021 12:38 AM IST

Chennai: “Can you tell me his oxygen level? What percentage of score does his CT scan say?” Dr Devishree Bhaskar asks a patient’s attender on the other side of the phone call

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HT Image
ByDivya Chandrababu

Chennai: “Can you tell me his oxygen level? What percentage of score does his CT scan say?” Dr Devishree Bhaskar asks a patient’s attender on the other side of the phone call. She then tells her colleague Dr Sharanya Shankar, who is seated next to her, “The patient’s oxygen saturation is 80. They haven’t taken an RT-PCR test or CT-scan. What shall we do?”

The duo are part of the morning shift inside Tamil Nadu’s Covid-19 war room that functions round-the-clock to find oxygen and ventilator-supported beds and ambulances for Covid-infected patients. The two doctors discuss that since the patient is already at a primary healthcare centre, he can get an RT-PCR test done while waiting for an oxygenated bed. The family responds by saying that they will try arranging for a bed on their own and will ring back in case they cannot find one. Dr Bhaskar goes on to list him as a priority patient requiring an oxygen bed in the internal dashboard.

Inside the Covid war room, the foremost important job of doctors is to triage a patient. “A lot of requests come in out of panic… people just want a doctor to reassure them,” says Routbitha David, a public health consultant who started heading the social media team, at the war room, just a month after returning from her education in public health from the London School of Economics. “Since every request is treated as urgent, we prioritise depending on the patient’s condition,” David adds.

Amid a vicious second wave that is provoking the public health system in Tamil Nadu to crumble, people struggle to find beds with oxygen and intensive care units (ICUs) on time.

The war room initially began as the Unified Command Centre, a nerve centre for better coordination, on April 30 but the newly elected chief minister M K Stalin recently renamed it as Covid-19 war room.

The room is located on the seventh floor of the national health mission (NHM) building inside the Chennai campus of directorate of public health (DPH). It could be mistaken for a co-working space where people mostly analyse data from giant screens, speak over the phone and walk stealthily to share important details with their colleagues.

For each shift, there are at least 50 staff members who are supported by several other teams located elsewhere such as IT, oxygen maintenance, etc.

The panic on the phone lines, the speeding ambulances and mad rush at hospitals doesn’t trickle down inside the room which is meant to address the chaos outside. Although, there is a sense of urgency, grief as well as hope here. The loudest sounds that are heard here are those of the pedestal fans kept for the staff as the city reels under the scorching summer.

Families of patients try to seek help through various means - the 104 helpline (located elsewhere), social media such as by tagging @104_GoTN, the official government handle on Twitter, in their messages, or updating forms on the war room’s official website with patient details.

Three giant LCDs erected inside the war room presents live data and pie charts on the total number of requests received for beds, oxygen, ICU plus ventilator, number of requests looked into by the triage team, number of deaths, among others. Ever since its inception till Friday afternoon, the war room received a total of 17,862 bed requests, of which 1,447 required either oxygen or ventilator ones, 8,331 did not require any beds, 140 were under process and one request was pending.

The request along with details of the patient and contact of attenders are updated on the internal dashboard. After which, doctors call the patient and triage to decide if they require home isolation, a care centre or hospital depending on the severity of their symptoms from mild-moderate to severe.

If a bed is required, they raise an alert on the dashboard, and the bed allocation team takes over. This team also comprises medical professionals who are a mix of medical professors and insurance workers under the chief minister’s comprehensive health insurance scheme who have been temporarily routed for this job. As per the scheme, medical treatment, including Covid-19, for ration card holders in government and private hospitals is covered by the state government.

This team is further divided to allocate hospital beds in private, government and government medical colleges. Bed availability is dynamic and also updated on another government website for the public.

“If the patient can be stable for a couple of hours, we let them know about the availability. If it’s critical, we also call the hospitals and tell them not to delay admission,” a member of the bed management team who is a professor at the Rajiv Gandhi Government General Hospital (RGGGH), the biggest public hospital in Chennai, says on condition of anonymity.

If a patient at the helpline is in a critical state, doctors raise Code Red. For instance, a 33-year-old man’s wife called 104 when his saturation was 55 and they were home. “I raised Code Red. We arranged a bed in Stanley hospital and sent a 108 ambulance -- all within 15 minutes,” Dr Sharanya says. Subsequently, an internal email from an official ID and a call from the war room goes to the hospital where there is availability. “This is to ensure no one from outside misuses Code Red. We have had that experience too,” says Dr Darez Ahmed, former director of NHM and an IAS officer who has been deputed to head the war room.

But what happens where there is no ICU available? “When the patient is sinking, we initiate Code Red, which is a stabilisation protocol. Hospitals have to accept the patient, they may not be able to reserve a bed immediately but they will stabilise the patient in a bay by intubating or resuscitating until they assign a bed.” No more than one Code Red is invoked at a hospital per day to not over burden a facility.

In cases of Code Red or when the patient requests an ambulance, the ambulance team of an emergency management executive and emergency technician contacts the state’s 108 ambulance service. They liaise with ambulance drivers and guide paramedics in case the patient’s SPO levels drop. Compared to the shortage of beds, ambulances are aplenty. In real time, a map shows that 245 ambulances are moving across Tamil Nadu while 995 are available. The GPS tracking of ambulances is an additional indicator to help understand the rush on the ground besides bed availability. More than 40 ambulances were found clustered in Chennai’s Madras Medical College (MMC) while only two were at the government Stanley hospital. “I’ve informed the bed allocation team to reroute further requests for critical admissions from MMC because of the ambulance traffic,” L N Vasantharaj, the emergency management executive, tells Ahmed.

Once a request has been seen through, until the patient is admitted, a volunteer team located elsewhere is assigned to follow up with the family to ensure their needs are met as well as escalate further complaints. “This system helps us assist the patient even after their hospitalisation,” says David. A job alert was issued for such volunteers and they received an overwhelming response of 6,000 applications for a 500-member team.

On Friday night, Stalin along with his bureaucrats, came to the war room to oversee its functioning and also returned a call for a request and allotted the critical patient a bed at RGGGH.

Besides arranging for medical help, the team also deals with losses, and angry and wailing families everyday. A man lost his 70-year-old mother just 10 minutes after he reached out to 104 for help. She had comorbidities and an SPO2 below 50. “Some families yell at us or get upset. But the son said it’s alright, my mother was old while so many youngsters are continuing to die,” Sharanya says. “Even amid a loss, he was thinking about the suffering of others across the country. That’s the kind of sentiment that brings us together in this work.”

On Sunday, Tamil Nadu recorded 33,172 cases, taking the overall tally to 1,598,216. With 311 deaths in 24 hours, the overall toll rose to 17,670.

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