“Can you tell me again how you are related to the patient?” Sangeeta Patil of the Malpa Dongri municipal school, one of the 50-odd teachers staffing the Covid-19 war room in Mumbai’s K-East ward, repeats herself over the telephone.
It is a couple of hours into her shift and Patil, tasked with making follow up calls to patients in home isolation, has just been informed of a patient’s death by a relative. How can that be, she asks a colleague. Only three days ago, she had spoken to 53-year-old Prakash Jagdale. He had no symptoms then, and today he is dead. Patil is visibly shaken.
Around her, a call centre-like humdrum belies the desperation and panic on the other end of the phone calls. “We do show urgency, but there is a thin line between urgency and panic,” said Dr Prachi Jadhav, in-charge of the war room. “We have all been trained to be calm and speak with clarity to the patients and their relatives. Our job is to guide them on next steps.”
One of the key learnings from the early months of the pandemic for the city’s civic body, Brihanmumbai Municipal Corporation, has been that strict triaging of patients is essential to ensure the best use of resources. ‘Triage’ is the process of determining the priority of patients’ treatments by the severity of their condition or likelihood of recovery with and without treatment. The primary job of the Covid-19 war rooms, one in each of the 24 wards of Mumbai, is that of triaging. Here is how it works.
An all-Mumbai BMC bed tracker dashboard provides realtime updates of bed availability across hospitals and Jumbo covid facilities under various classifications: patients who are Covid-19-positive, further broken down into those who require oxygen and those who don’t; suspected Covid-19 patients, also broken down into those who require oxygen and those who don’t; patients needing admission to Intensive Care Units, paediatric ICU, neonatal ICU; pregnant women; those needing dialysis, and so on. These categories are further broken down, facility wise. Each facility is tasked with updating the numbers in real time.
Every day, all 24 war rooms receive the list of Covid-19 positive people in their respective wards from the Indian Council of Medical Research, which gets reports from all labs, government and private, that are conducting RT-PCR tests. They also receive calls from people who have Covid-19 symptoms and are still awaiting confirmatory tests or test reports. Health workers doing contact tracing on the ground also feed in data about those showing symptoms.
The war room staff are primarily BMC school teachers, many of whom come from as far as Palghar, Vasai and Virar, mobilised for Covid-19 duty. They are supported by data entry operators and doctors. The teachers call each person on the list and record all details including oxygen saturation levels, symptoms, comorbidities, vaccine status and the type of house they live in. The last data point helps in deciding if home isolation is indeed feasible, Jadhav said.
The doctors in the war room use this data to begin triaging and liaising with hospitals and Covid-19 facilities within their ward. In case of bed unavailability in the ward, the doctors contact other ward war rooms using the information displayed on the dashboard. Ambulances are then dispatched to move the patients for whom the doctors have recommended hospital admission.
Jadhav has been handling affairs at the war room for K-East ward, which comprises the suburbs of Andheri East, Jogeshwari East, and Vile Parle East, since May last year. To her, the pandemic feels interminable. Many in the team have worked weeks on end without a break, she said. And while set protocol and processes help to keep things running, the shortage of medical facilities had been felt acutely when cases surged dramatically for a few days in March. On an average, the war room was fielding upto 2,000 calls a day, she said.
Dr Nilesh Tiwari, entrusted with keeping record of and dealing with airport cases – the Mumbai airport is part of the K-East ward – and ensuring enforcement of hotel quarantine protocol said they are keenly aware that sometimes their best effort may not be enough, but the learning curve has been steep and every individual in the war room has stepped up to the challenge.
The war room reports to Dr Urmila Patil, the medical officer of health for K-East ward. Patil insists that the two BMC and six private hospitals in her jurisdiction have for the most part been adequate. “But last Sunday we faced a crisis situation at one of the private hospitals,” she recalled. Five patients at the hospital were on BiPAP machines that deliver non-invasive oxygen support, but the hospital started running out of oxygen. “I got a call saying my patients will die if I don’t get oxygen.”
Unable to procure oxygen immediately, Patil’s team looked for an alternative hospital. “We figured that Seven Hills (a BMC-run hospital with 2,000 bed capacity) had oxygen but no vacant beds, so we moved the five patients with their BiPAP machines, each one accompanied by the attending nurse, into ambulances and rushed them to Seven Hills and transferred them onto a regular bed,” she said. “All five are fine now.”
Patil’s mobile phone rings incessantly. Before the ward war rooms became operational, it was her number, as the medical officer of health, that was circulated widely. “So everybody, from the Commissioner down to the last person in the ward, called on this number,” she said, throwing her hands up in mock frustration as the phone rang again.
It was a member of the contact tracing team, one of the many across the 12 health posts or Arogya Kendra, calling with feedback. Feedback from team members with on ground experience she says, has proved helpful in establishing and tweaking protocol. “We are learning as we go along,” she said.
Not all patient information can be gathered by making calls from the war room. K-East ward is made up of 60-70% slums. Those living here are unlikely to have access to thermometers, let alone pulse oximeters. The health posts are assigned to record vital parameters like oxygen saturation levels and temperature of suspect and confirmed Covid-19 cases in these areas.
In the months of May and June last year, K-East ward was one of Mumbai’s top Covid-19 hotspots. The cases were predominantly from the slums. As a result, the 25 quarantine centres in the ward were fully occupied. Approximately 5.5 lakh people live in these overcrowded spaces.
Presently, Patil says, buildings and high-rises have more cases. Hinting at a lack of cooperation from people living in the containment zones in some of these buildings, she remarked: “Enforcement of protocol in sealed buildings and containment zones is not easy, we can put up boards, provide requisite information but people also have to take some responsibility for these measures to work. “
While Covid-19 cases in Mumbai have shown a marginal decrease over the last few days, the pre-monsoon period comes with its own set of public health challenges for the city. Urmila Patil, whose remit extends to monsoon preparedness measures, is confident the lessons from battling Covid-19 over the last year would prove useful in dealing with them.