ZN: Your hospital has recorded the lowest fatality of admitted patients in Level III healthcare. How low has it been?
NNS: Our total admissions from March 2020 to March 2021as per our Medical Records Section is 2137 patients. During this period, 167 of our admitted patients died.
The mortality rate as per these numbers is 7.8 percent.
This year, it has been different to a great extent, from March onwards I am saying. Our admissions shot up. From March 2021 till date, we have already admitted 817 patients, that’s like one third of the entire Wave I. Of these, we unfortunately lost 45 patients- just 5.5 percent of our admissions, the rest recovered well.
However, the mortality rate of patients at Chest Diseases Hospital has been much lower than what was recorded at other hospitals.
Overall, if we look at the data holistically, first and second wave combined, we have had 2940 patients with us ever since the pandemic struck. Among these, we had 212 people who did not make it and lost life. The overall fatality at our hospital is 7.2 percent. We feel we have done well in terms of saving lives.
ZN: Was there a difference between mortality in the first and the second wave?
NNS: Yes, in second wave the mortality in our hospital was less. Apart from our better understanding of the disease, the lower fatality across hospitals could be due to a number of reasons. The virus mutation is also one of those reasons. Although it has a high transmissions rate, the mortality over all was lower compared to the previous predominant strain.
Moreover, we had very good outcomes in patients despite the fact that we were receiving very sick patients referred from across the districts. These patients had severe, often critical COVID disease.
ZN: What is it that you did differently that according to you helped save more lives?
NNS: The department at the outset volunteered to take up the challenge of being at the forefront fighting COVID. The senior consultants at this Hospital were the first ones to go into the wards and personally examine the patients. I am talking of March last year, when there was so much fear and taboo that the manner in which patients were admitted made it look like as if he or she was in a detention or a Cell. Our approach gave confidence to our junior doctors and they never looked back since then. The aggressive handling of the disease and personalized, real time treatment of patients by our teams, I feel, set us on a solid ground thereafter.
We formulated different social networking groups where all the information vis-à-vis clinical condition, investigations, plan of treatment regarding patients was shared among all the consultants, before and after completion of rounds. All the cases were and are discussed and a consensus on treatment plan reached to. Ours is a team approach, totally.
ZN: What teams are we talking about here?
NNS: I don’t know how it is at other hospitals, but we have made sure that the patients admitted with us are seen every day by doctors, which includes consultants. Not just their disease part, we try to address their mental well being. The patient, if there is a need, is counseled by an expert and their confidence is boosted. This way, we can hope for a more rapid and better recovery. The anesthesia department which takes care of ventilated patients in ICU and the radiology department plays its role in diagnostics.
We have extremely efficient and cooperative paramedical, technical and nursing staff. You see, a doctor alone cannot treat and save patients. It needs so many systems to work in tandem at multiple levels. It takes support of our sweepers who go into wards every day to ensure safe and hygienic conditions for patients, it takes support of our drivers who ferry patients to and from the hospital, make sure the staff reaches on time. Everyone has been working with zeal and dedication in extremely difficult circumstances.
ZN: What has been the treatment protocol at CD Hospital?
NNS: Although we still don’t have definitive treatment for COVID19 but all the experimental therapies which were found useful in research studies were used in the patients after their consent. Drugs like antibiotics, steroids, anticoagulants, antiviral, anti inflammatory drugs were provided free to cost to the patients. It was possible due to the tremendous support from the Government, from Financial Commissioner Health and Medical Education Atal Dulloo and our Principal GMC Prof Samia Rashid, known for her dedication. J&K Government augmented our staff and upgraded our oxygen capacity, machinery and equipment and put us in a safe position to tide through the worst part of the pandemic.
ZN: How can we reduce deaths in other hospital settings where mortality as high as 20 percent has been recorded?
NNS: We need to see whether the facilities are adequate for the number of patients they are admitting, including manpower. We need to start from the grass root level. We need to test all contacts and suspects at the earliest and isolate them to prevent the spread. Once someone is positive he needs to be counseled.
ZN: Many patients have died within days, sometimes within hours of reaching hospitals. How can this be changed?
NNS: This can be done by identifying the high risk patients and putting them under observation in COVID care facilities and initiating treatment early to prevent progression of disease. The health care workers of the periphery have to strictly check whether those that are allowed home isolation have adequate isolation facilities at home. High risk patients, who are more susceptible to progress to severe disease should be shifted to COVID care facilities where they can be more closely observed and early intervention may be done if any signs of progression of disease are seen.
ZN: What other specialties do you think are going to make COVID19 care more effective?
NNS: COVID, we have realized over the time, is a multi system disease and needs intervention of multi specialties like cardiology, nephrology, neurology in order to provide optimal care to the patients.
Many a times it is not possible to have all these specialties under one roof. The problem is more complex in peripheries. Here, in Srinagar, we have almost every category of specialist around, and can be called. But we need to work out a system that these doctors are available for critically sick patients, those with severe disease in every hospital. We need more accountability and multi-dimensional approach to the disease.
ZN: How will you sum up your experience with the pandemic from Day 1 at CD Hospital?
NNS: It has been and continues to be a learning process. We are learning new aspects of diseases and patient care every day.
I would say that it is too early to claim triumph over the virus and the pandemic. The virus is changing and the mutated strains could behave differently than what we have seen. In addition, there is a risk of complacency by public regarding COVID19 appropriate behavior. A high percentage of our population is at risk because they have not gotten themselves vaccinated. We need to keep the guard up. We need to keep discussing the disease and research about how we can handle it better. We need to keep improving our systems. We need to vaccinate everyone. We need to be ready, all of us, at every level. It’s not over yet.