Mumbai: “An oxygen bed has just freed up, are there any requests for a bed?” Dr Divya Kaspe yells out as she cups a telephone receiver. There are 15 others around her, all manning phones. The team is in Room 4 of the Brihanmumbai Municipal Corporation (BMC) G North Ward office — one of 24 Covid war rooms set up around the city.
In response to Kaspe’s query, there’s frantic action in the room; the others start going through the register and scrolling through their phones to locate any requests for oxygen beds. One is located, following which Dr Kaspe, a doctor with the civic body, informs the hospital that’s been waiting on the other end of the telephone line.
This is a typical moment inside the Covid war rooms. In the past month, as the second wave of the Covid-19 led to a drastic increase in hospitalisations, these war rooms have become the designated link between Covid patients and hospitals.
ThePrint spent a few hours in the G North ward’s war rooms this Tuesday to find out how they’ve been coordinating hospitalisations.
Thirty three per cent of the G North ward’s population lives in central Mumbai’s Dharavi-Sion-Kurla pocket. It also includes areas like Dadar and Mahim.
According to BMC’s data, as of 27 April, G North ward had 5,731 active cases. The highest number of active cases were reported in Mahim (2,427), followed by Dadar (2,354). Dharavi, once a hotspot, reported 950 active cases.
Sixteen coordinators, doctors and medical students sit around a long table placed in the middle of the G North ward’s Covid war room. At least 10 landline phones, notebooks, mobile phones and two computers crowd the table’s surface.
In a corner sit two other coordinators, who meticulously go through the a list of home isolation patients, what they call a line-list. They call up patients and enquire after their symptoms.
A phone rings almost every other minute. Several of the calls are to place requests for intensive care units (ICU) and oxygen beds.
Dr Kajal Dhruv Soni, one of the doctors in the war room, explains the protocol.
If a patient or their relative calls the war room, the coordinators or doctors enquire about their medical history. This includes their blood saturation levels, their blood pressure and co-morbidities. In case the patient cannot access an oximeter, a healthcare worker is sent to their location to gather the data.
“The most important thing is their [oxygen] saturation. From that, we get to know if we need to give them an oxygen bed, or if they would need an ICU bed or ventilator … that depends on their oxygen level,” Soni said.
“If someone’s O2 levels is about 95 to 97 and if they don’t have any complaints, then it is normal. So we admit them in Covid Care Centres … there are three centres here. If their O2 levels are 94 or till 88-90, they’re mildly breathless. We advise them to be put on an oxygen concentrator,” she said, adding, “But if they are feeling more breathlessness, even when sitting down, they will need to go to an ICU.”
This is the concept of medical triage — a protocol the BMC has been following in allotting beds to various patients. Medical triage dictates that treatments be prioritised based on the severity of a patient’s condition.
Opposite to Soni, sits Akash Kadam, one of BMC’s coordinators. His eyes are glued to the computer screen in front of him, particularly on the ‘BMC Bed Tracker’ site. Only accessible to those within the civic body, the site has a real-time tracker for beds across various facilities in the city.
The beds are categorised under various heads — quarantine beds for suspected Covid-19 patients, isolation beds for positive patients, ICU beds, paediatric ICU beds, neonatal ICU, beds for pregnant women and others including those with dialysis and cancer.
These categories have further been divided into beds with oxygen and those without.
“Last month was stressful for everyone. We would work for 10-15 hours a day, over the shift. This was a priority for all of us, that the patient should get a bed. We were mentally prepared to do this … We try to get a bed for the patient,” Kadam said.
According to Manjula Chimbalkar, in-charge of the war room, the triage system has brought some improvement.
“Initially, when the requests used to come, we would allot the ICU beds, irrespective of checking if they need an ICU bed or not. Now it is not the same. If you need you will get it. You will get whatever you need. This has considerably balanced the situation,” she said.
A busy month
It was BMC chief Iqbal Singh Chahal who came up with the idea of ward-level Covid war rooms, which were started on 8 June 2020.
Like all other war rooms, it’s a 24×7 operation at the G-North ward, which functions in three shifts starting at 8 am. Currently, each shift consists of four doctors, four to five coordinators and data entry operators.
“When there was a sudden rise of cases, there weren’t enough people in the war rooms. So we had to immediately increase the number of staff,” Chimbalkar said.
Kadam added that in the past month, the number of calls have increased to over 1,000 per day.
“The situation today is very bad, people are not able to get ICU beds, and there is also a shortage of normal beds,” he said.
Most of the staff around the room can point to incidents wherein a patient they were in touch with succumbed to the disease in the past month. Soni recalls one such case.
“We were trying to get a patient to an ICU bed for 2 days … as is usual, we told them to go to the casualty ward of Sion Hospital. The patient had stabilised and came back after they were given oxygen and was monitored. We then called them at night, and then in the morning to follow up. That’s when we got to know that he had died suddenly.”
“The real challenge is when we get a lot of requests but there are no beds. We don’t know how to answer the patients. We keep telling them that we are trying our best … it isn’t so easy,” said Akhilesh Tiwari, a coordinator.
The BMC’s dashboard data from 29 April indicated that 9,667 of 11,147 oxygen beds and 2,814 of 2,887 ICU beds were occupied.
Lunch breaks are nondescript here. The staff eats whenever they can, sometimes in between phone calls. During these very short breathers, they also coordinate among each other about specific requests for beds or test reports. The war rooms also liaise with Covid testing labs to provide reports.
The last few days, however, have brought a ray of hope.
Kiran Dighavkar, BMC assistant commissioner and in-charge of the ward, said, “The number of cases has reduced drastically in the last two to three days. There was a time when we were getting 200-300 cases per day. But now the cases have been hardly 80-85. The big relief is that Dharavi has also reported between 20 to 30 cases in the last two days. Interestingly, though, we are still getting substantial requests for ICU and oxygen beds.”
“What you’re seeing now is nothing,” one of the coordinators, Mohammed Sikander Shaikh told ThePrint.
“We wouldn’t get a breather for even a few minutes one week back. But now, we are still able to talk and discuss things with each other. The number of cases has decreased in the past few days, that’s why,” he said before turning around to answer another call.
(Edited by Manasa Mohan)