From stadium to isolation centre to hospital: A jumbo fight against Covid-19 at Mumbai’s NSCI dome
The facility has a recovery rate of 76%; likely to play crucial role as cases surgeUpdated: Jun 28, 2020, 01:09 IST
Once a popular venue for sports and entertainment in the city, the National Sports Club of India’s (NSCI) stadium dome in Worli is now a full-fledged hospital for Covid-19. Since April, it has admitted more than 1,500 patients — including cancer patients, pregnant women, patients with comorbidity — and discharged 1,150 people, boasting of a recovery rate of 76%.
In April, NSCI became Mumbai’s first jumbo facility for the treatment of Covid-19. When the outbreak was in its early stages, the Covid centre at NSCI had a 518-bed quarantine centre for asymptomatic Covid-19 patients. Back then, Worli was a Covid-19 hot spot, with infection spreading through the congested locality of the close-knit Worli Koliwada.
Later, NSCI was converted into a dedicated Covid health centre (DCHC), with 200 beds equipped with oxygen.
A week ago, NSCI was converted into a dedicated Covid-19 hospital (DCH) with 10 modular intensive care units (ICUs) in movable containers as a first phase of an expansion plan, in preparation of a surge in numbers following relaxation of restrictions. It can now treat up to 528 patients.
With over 80 staffers — including 25 doctors, 50 nurses, an in-house senior gynaecologist and technicians — living on campus, NSCI is at present treating approximately 300 active Covid-19 patients.
Among them are 50 cancer patients, 10 pregnant women and four who are critically-ill. Six intensivists and anaesthetists are being roped in to look after the patients in ICU beds.
A surge in cases may pose a challenge to the medical staff.
Over the coming week, ICU beds will be scaled up to 37 in two phases.
The second phase will add 15 ICU beds in portable containers, and in the third, another 22 ICU beds will be added inside the extension of NSCI’s dome.
As a DCH, NSCI also has specialised zones for patients who require oxygen and those with cancer. It has units for families (depending upon availability) and pre-natal and post-natal care zones for pregnant women afflicted with Covid-19. (Pregnant women are shifted to hospitals for deliveries.)
Gastro surgeon and dean of the DCH at NSCI, Dr Rajeev Joshi said that since April, the facility has successfully treated 125 cancer patients.
ICU units in shipping containers
“It was not possible to set up ICUs in a stadium. Every time we had a critical patient, we had to move them to a hospital for an ICU bed. That is when we came up with the idea of ICUs in portable containers. We used shipping containers and converted them to ICUs,” said Dr Muffazal Lakdawala, Mumbai-based surgeon who conceptualised the facility at NSCI alongside Maharashtra’s environment Minister Aaditya Thackeray, who represents the Worli constituency.
A garden area within the NSCI compound now houses the ICU facilities. Each shipping container is accommodating two ICU beds, a toilet, and three entry points — one of which is reserved for doctors to maintain the negative pressure inside the container, as doctors are likely to frequent the room. Each ICU is equipped with ventilators, oxygen points, and variable monitoring devices. Before the ICU beds were inaugurated at NSCI last week, about 60 critical patients had to be moved to hospitals because they urgently needed treatment in ICUs.
Dr Joshi said, “All four patients on ICU beds at present were being treated at our quarantine facility. Over the past three days, since ICUs became functional, we were able to simply shift patients who required critical care to a unit within our premises. Our focus is to match these ICUs to ICUs in hospitals. “
Minimum contact facility
Aaditya Thackeray pointed out one of the remarkable achievements of the facility: “Not a single health care professional who started working at NSCI has been infected with Covid-19 over the past four months since the facility became operational [due to minimum exposure].”
Dr Joshi explained that NSCI is “a minimum contact facility”. “We are able to optimise the staff we have. Exposure time of doctors to the infection is limited so infection rate in healthcare staff is zero,” he said.
There is a no-contact swab collection cubical for doctors to take swab samples from patients for testing. While the doctor stands inside the glass cubicle, which has a separate exit, the patient approaches the cubicle from the other side accessing the cubicle from the quarantine facility. A resident doctor at NSCI who demonstrated the process to Hindustan Times said, “There are two small compartments with glove like extensions that the doctor can put their hands into, and collect the swab.”
Similarly, there are diagnostic cubicles with intercom systems for consulting physicians and patients to interact with each other, from either side of a glass partition.
Dr Lakdawala said, “This takes away the laborious task of treating Covid-19 patients. When we started the facility in April, we hardly had any doctors. We started with seven doctors and 24 nurses and I didn’t want to infect any of our healthcare professionals. So we conceptualised contact-less treatment. Hazmat suits are very laborious: You sweat, the lenses fog up, and sometimes you cannot talk to the patients at length, so doctors could not properly answer questions asked by these patients. So we came up with the idea of diagnosis cubicles.”
There are also two war rooms in NSCI to remotely monitor patients in ICUs and those in the quarantine facility inside the dome. Dr Joshi said, “We can zoom into a patient at the quarantine facility and if we see signs of restlessness or discomfort, the doctors can attend to the patient. The war room for monitoring ICU patients also shows their vital parameters at all times. The healthcare staff is watching the monitors in both war rooms.”
With authorities expecting a surge in cases following the next round of relaxations, the facility at NSCI is expected to play an important role in Mumbai’s fight against Covid-19.
Delhi government had sought help from BMC
The Delhi government had reached out to the BMC for insight into how they converted stadiums in Mumbai into isolation centres, Covid care facilities
Iqbal Singh Chahal, BMC chief, had said, “Top officers from Delhi have approached me to help them with construction of Mumbai-like jumbo facilities in Delhi.”
Maharashtra cabinet minister Aaditya Thackeray, who has monitored Mumbai’s Covid-19 bed augmentation plan, had said the city increased its municipal hospital beds from 400 to 5,000 in about a month.