At the reception desk of the administrative block of Government Medical College Hospital, Ernakulam , you are asked to disinfect your hands using a sanitiser. On the wall across from the desk is a white board screaming out the word of the day, ‘Alert’ in English and ‘Jagrata’ in Malayalam.
At the other end of the lobby is a wide glass door, behind which a white curtain running across the small courtyard leading to a towering seven-storey building segregates two sets of people, all wearing face masks. Some are seated in chairs, while a few stand around having animated talk over their phones. A few desks with people in personal protective equipment (PPE) are seen in the portico and inside its opaque glass doors. It houses the largest isolation facility in the State for symptomatic suspected COVID-19 cases and confirmed patients.
Over the past two days, there has been a rush of inbound travellers at the Cochin international airport, mostly from the 13-affected countries bracketed in the high risk group, who were ferried to the isolation facility in sanitised ambulances driven by men in PPE for swab collection and screening.
KOCHI, Kerala, 12/03/2020 : The way to the COVID19 isolation facility behind the Administrative block of Ernakulam Medical College has barricades with signages and a sanitised environment. While the 30-room isolation facility in the seven-storey structure has almost 29 in patients including three confirmed cases, scores get screened at the triages every day. Photo : Thulasi Kakkat/The Hindu
Segregation
“In view of the rush, we segregated patients into high- and low-risk categories based on symptoms (or lack of it), history of illnesses and travel history. It was a need-based stratification based on which admission was done, with the rest being advised mandatory home quarantine. We have set up primary and secondary triages,” said Dr. Ganesh Mohan, in charge of the isolation facility and assistant nodal officer for COVID-19 control.
There are also secondary contacts and symptomatic home-quarantined people brought to the facility.
Dr. Mohan had taken the lead in setting it up a year ago to isolate suspected Nipah patients and it was being used to house the library and office quarters.
But, 49 days ago, when the first wave of COVID-19 hit the State in the form of Malayali medical students from China (they have since been cured of the infection and discharged), the medical college hospital led by Principal Dr. Thomas Mathew sprang to action to create an advanced isolation facility.
From the primary triage, symptomatic and sick people from highly affected countries are sent inside and their short history is recorded. The triages and the isolation area – with 30 bath-attached rooms across the third, fourth and fifth floors – have doctors, staff nurses and attenders working round the clock on four-hour shifts. All floors are under CCTV surveillance, with freshly drawn oxygen lines to meet emergencies and the patients are allowed to carry their mobile phones and are served food (often of their choice) and clothing.
The three-year-old patient here gets to enjoy his favourite pasta. “When separate groups of Americans and Russians were admitted here, we managed to get them their choice of food, too,” says a doctor.
KOCHI, Kerala, 12/03/2020 : Inbound travellers from high-risk COVID19 affected countries waiting at the triage of Ernakulam Medical College at Kalamassery for medical screening for any infection, ailment or symptoms on Wednesday. Photo : Thulasi Kakkat/The Hindu
Nerve centre
The nerve centre of the facility is a well-equipped, busy access-regulated control room in the admin block manned by house surgeons. “Continuous monitoring of the isolation building is done from here,” says Dr. Mohan. This is from where daily reports are sent to the government.
Its walls dotted with continuously updated white boards showing patients’ details, including bio, condition and treatment, doctors and nurses on duty, ambulance availability, screening details, stock of medicines, protective gear and related material besides videoconferencing facility, the control room is a hive of activity. Everyone makes it a point to sanitise their hands almost obsessively.
“This is what’s going to save you,” says Dr. Fathahudeen, head of the department of pulmonary and critical care and nodal officer for COVID-19, who walks in for a brief discussion, pointing at the hand sanitiser.
While the patients are taken in through the front entrance, the staff use the back entrance. There’s a donning room where they are assisted to put on the PPE and they use an elevator different from the one used by patients. The entire space is disinfected every now and then.
“You can’t eat or drink anything when you have put the PPE and you sweat profusely as the area cannot be fully air-conditioned. But they don’t complain. Nipah made them strong and they are cool,” says Dr. Fathahudeen.
Once the duty hours are over, they go to the doffing area to remove and set away the PPE for safe disposal. “This is done with even more care and then they walk down the fire escape stair so that they don’t mix with the staff arriving for duty,” adds Dr. Mohan.
Doctors have regular conversations with the patients in the isolation unit to keep them in good spirits.
The facilities
Oxygen lines, cylinders and echo machines are available on all isolation floors. There are two ICUs, but there could be two more. Samples collected at the triages are priorty-marked and rushed to National Institute of Virology, Alappuzha, in viral transport mediums several times a day.
If 75 samples were sent on Tuesday, it was 49 on Wednesday. Similarly, everything used in the isolation facility is segregated, marked, coded and disposed, with the help of Indian Medical Association.
“Barcoded to trace them back to their source,” says a doctor. “The ambulance crew and the support staff are all trained and fully geared to do the work assigned to them. Doesn’t it show the strength of the public health system,” asks Dr. Fathahudeen.
A PPE costs ₹300 and PPEs worth over ₹30,000 are used daily. Add to that other expenses, including patient requirements and it is all on the system, adds another doctor. A fresh desk for contact tracing is also being added.
With the facility working almost to its capacity, more isolation centres, both in private and government, have been set up in the region for admitting symptomatic patients arriving from high-risk countries. “Ours is a world-class isolation model which has been commended by doctors from AIIMS and the NCDC as well, and therefore we need to ensure that only those requiring in-patient care are admitted here,” says Dr. Geetha Nair, medical superintendent in-charge.
“Active participation of private hospitals is also needed to meet exigencies,” they all point out. What if one of you gets infected? “Well, it’s been 49 days and we have taken utmost care to follow the protocols ourselves. We have even devised some on our own,” says Dr. Mohan, pointing to a chart.
