LACKING: Covid-19 patients found lack of adequate attention with even nurses and doctors unwilling to attend to patients. There were only two toilets and the level of hygiene was appalling

A Covid-19 victim compare his experience of home isolation, his stay at the Covid-19 centre, the ESI Covid-19 hospital and private Covid-19 hospitals. He reveals that there are no oxygen facility in Covid-19 centres and hygiene and caring is lacking at the ESI Covid-19 hospital in Margao.

The day after Ganesh Chaturthi, I received a call that my father-in-law (whom we call Baba) seemed to have cold and general weakness and that he looked to be pale and emotionally drained. This was the first year that neither his son from Pune nor his daughter from Panaji visited for Chaturthi at their Nerul-Candolim House. Panic struck us wondering if this could be the dreaded Covid. But we could not afford to stay isolated from this! We had to visit him and take him to the doctor if need be.
So, Sweta and I went to Nerul to visit him wearing N-95 mask and a face shield. As per advice from doctor friends, this was the basic gear we had to wear. We were advised to see that the patient also wore similar gear and that we could drive him down to a hospital for check-up with car windows rolled down. But this was tricky as due to the rains, we would not have been able to keep windows open all the while. But yes, even if the windows were closed, so far as we wore N-95 masks and face shield, did not touch our face, sanitise hands regularly and have bath once home, we would be good – was the general advisory.
We brought him to see a doctor who advised to get an x-ray done before consulting him. The x-ray was normal. He checked him and also some routine Blood tests were done in his clinic itself; his random sugar levels were pretty high. But he didn’t advise for a Covid test and we were kind of relieved. The next day, the blood reports came in and were pretty much normal.
But that evening, we got the news that Sweta’s cousin who had returned to Margao after Chaturthi, had fever and was tested positive for Covid along with his wife and daughter. This made us a little nervous and we decided to test all. Nerul house is occupied by Baba (83y), his brother (Kaka-73y), mother-in-law (Mumma-75y), and a house-keeper family of 3 (28M, 23F, 2M). The same night, Baba’s brother (we call him Pappa) who stays in Panaji also started showing signs of fever.
The next day, we asked the house-keeper to drive with Baba, Mumma & Kaka while Sweta and I drove in another car. Since all the residents of the Nerul house were together, it would be appropriate to get them all in one car while we took another. Again, N-95 masks and face shield was worn the entire journey. We went to Ponda District Hospital for testing since my friend heads the Pathology lab there. Interestingly, Baba tested negative on antigen test, while the other 3 tested positive. The house-keeper testing positive was a big surprise as he was totally fit with absolutely no symptoms. Baba tested positive on the RT-PCR test. Same time, Pappa and his grandchild were taken for testing at Panaji UHC and detected positive on antigen test. The next day, the remaining family of 4 in Panaji also tested positive on antigen test. The house-keeper’s family was also tested as per protocol (contact tracing) and they too tested positive. So, now we were looking at 15 cases- 6 in Nerul, 6 in Panaji and 3 in Margao.
Sweta decided that she should stay in Nerul since 3 of them were elderly (above 73 years of age). I would stay around to assist and aid in the logistic support. It was a plunge she took, fully aware the risks involved. We were receiving calls from Health officials and doctors and family advising us on our next line of action. Although we were experts on Covid (thanks to WhatsApp and Google), the practical reality on the ground was way different. The ground had shaken beneath our feet! This was one of the biggest explosion of the virus on the Bhobe family.

We had known Covid to be mild and that it is best treated at home with normal set of medicines like MultiVitamins with Zinc, BComplex and the likes. There is no actual medication for Covid. You only have to help your body to fight this virus with immunity boosters. So, we applied for Home Isolation. But due to the age factor, we were considering the option of Hospitalisation. It wasn’t an easy decision to take when you learnt about the issues with the hospitals. That night was crazy! Baba’s oxygen readings dropped to 93 and we began to get calls from all around to shift him immediately to the hospital. This was around 11:30 in the night and Baba was sleeping peacefully. They said that the oxygen levels can suddenly drop down to 80 things can get critical because of his age factor.
We explained to the doctor that though he was 83, he has a healthy life. He drives himself to Panaji, climbs two floors and works in office as an Advocate/Notary, comes back home and waters his garden for almost 2 hours and also visits his salt pan to oversee the work there. For an 83-year-old, he was much healthier than me. To wake him up from sleep and take him to hospital in the middle of the night would only add stress and could lead to other complications. We had to take a calculated decision and lucky for us, that decision did not backfire on us. Sweta checked his readings once again before we slept and his oxygen level had climbed up to 95 and we were relieved. The next day we decided to take them to the hospital.
But which Hospital? This was on the 27thAugust. Government had recently opened some wards in GMC and a few private hospitals were allowed to operate some beds for Covid cases. We had hardly any choices in front of us since almost all the hospitals were fully occupied and there were no beds available. But the research at that time about the hospital facilities is something you would like to know.

Pvt Hosp 1:

Good facilities, good doctors. But VIP patients were admitted and these VIPs didn’t want to share their “twin sharing” room with anyone. Hence the hospital capacity was down to half. Further, 10 of their staff were infected with the virus and they had to take hostels to treat them. Another feedback that I received from a friend who had shifted his mother there was that the hospital gave him an estimate before admitting and it was as follows: “10 lacs with ventilator and 8 lacs without ventilator”. He eventually paid 6.5 lacs for 13 days of hospitalisation without ventilator.

Pvt Hosp 2:

They were not having enough staff and a doctor who got admitted actually took two of his nurses to the hospital. And they were admitting only mild cases.

Pvt Hosp 3:

Only mild cases were being admitted. Speciality doctors unavailable and they had only 2-3 ventilators and all in use. In case of critical conditions that may develop, they would shift the patient to other hospitals. At that time who knows if beds would be available or not!

Pvt Hosp 4:

not yet started operatio. And among these private hospitals, there were no beds available. Tried with all high-end connections, but we were not able to secure a bed with either of these.
Now the only other option left was GMC since it would have all the necessary doctors and equipment for any co-morbidity. ESI was an option but it wasn’t meant for co-morbidity issues. SDH in Ponda was meant for only gynaec related Covid cases at that time. All the other Covid Care Centers were meant to be used as Isolation centers and not necessarily for treatment for old age and co-morbidities if any.
We visited the CCCR unit of GMC for medical advice. The casualty department (CCCR) was very well maintained. Doctor on duty was extremely polite and good to talk to. We got an x-ray and a CT scan done. And the parameters were all normal. But due to age factor, the doctor advised us to admit all 3 of them. But where are the beds? We tried frantically to find a bed, but we could not manage one. We were advised to admit them in the Casualty itself. We opposed this since there would not be any doctor to monitor our patients. As a matter of fact, the doctor in the Casualty asked the nurse to fetch some medicines from ward 148. We could not just admit them to casualty which didn’t have the necessary facilities except the fact beds were available.
So eventually, they asked us to admit Baba in ward 148. But when we went there, this ward was overflowing with patients. There were some on the bed, some on stretchers, some on the floor and some on wheel chairs. And the commotion around the place was just like a busy railway station. We had rather keep Baba at home than admitting him here. Finally, we managed to get a bed in ward 146 which was much better than ward 148. With just a N-95 mask and a face shield, we were in GMC for almost 7 hours, running from one place to the other, a very stressful day where we must have interacted with almost a hundred Covid positive patients.
After admitting Baba, Sweta drove Mumma and Kaka to Nerul and I was left thinking on my next move. Being in the hospital with so many confirmed patients all around, it was difficult to even think of going home to my mom, aunt and daughter and I was not willing to put them at risk. So, I holed up myself in a room away from home, yet accessible enough to reach out for any help at any given time.

PROTECTION: The patient and his family from Nerul took all the precaution while travelling to the Ponda district hospital including wearing a N95 mask and face shield (the mask cost Rs 10 and the face shield Rs 250)

Interesting to note here that although I had a negative certificate, my Arogya Setu app was showing RED – “As per ICMR, the person with this phone number is Covid-19 Positive”. I was taken aback and wondered how the app could say I am positive. Then I realised, that I had given my mobile number during the testing and hence it would show that the number is of a positive patient. What happens at the testing? There are two types of tests done in Goa. Antigen and RT-PCR. Let me give a brief info on the tests. You need to give your details and your Aadhaar card for verification. OTP is received on your phone for registration for the testing.
Antigen test: A Nasal swab is taken for this test. Healthcare workers use a double sized ear-bud kind-a-thing to take a nasal swab. This test gives you results within half an hour but sometimes a false negative is reported. A positive report on Antigen test means the viral load is pretty high.
RT-PCR test: A throat swab is taken for this test. Similar to that of nasal swab, they take a swab from your throat. This is more accurate testing as of now and even milder cases of Covid are reported by this test.
So, what had happened was that since I had given my number during the testing of all 6 of us, and while 4 were reported positive, the Arogya Setu app was showing the number to be positive.
While Baba was administered good treatment at GMC, Mumma was doing fine at Nerul while Kaka kept having fever on and off. After 5 days, Baba was set to be discharged from GMC. Sweta came to GMC with Kaka for consultation. They advised that the fever could be managed at home with paracetamol and that he need not be admitted. While Baba was discharged after treatment in GMC and after 5 days. I tested myself again before I came home and fortunately, I tested negative.
Sweta also tested negative even though she continued her stay at Nerul. As per protocol, she had to test herself after 5 days of contact. We were happy that she managed to stay negative staying with 6 positive patients and in the house that infected 15 people. It sure takes a lot of courage to jump into the fire and stay unharmed.
It’s important here to know what Covid symptoms are and when you are advised hospitalisation. To the best of my knowledge and to what I gathered from all my interactions, a symptomatic patient is different from a person having symptoms. Confusing right? So, let’s look at the two carefully. When you are affected with Covid, you are bound to get fever, cold, sore throat, headache, weakness, lower oxygen levels, loss of smell and loss of taste. These are “Indications” of Covid. Like when you have cold, you will get some fever, runny nose, etc. similarly, these indications will tell you that you are Covid Positive. Then what symptoms does a symptomatic patient have?
If you have either of these 3 symptoms, then you are a symptomatic patient who needs immediate hospitalisation.

  1. 102 and above fever that does not settle down with a paracetamol. So, if you have fever, say 101.5 or so and it comes down after you have taken a paracetamol, then it is not a symptom and not a point of worry.
  2. Your oxygen levels may even drop down to 85-90. But if you are gasping for breath, then you have to visit the hospital immediately.
  3. Weakness to the effect that you cannot even get up from your bed and go to the washroom.
    In such cases only, you are referred to a hospital. Or if you are above 60-65 years of age and have co-morbidities, then you have to get medical attention. Or else, 17-day Home Isolation with the regular immunity booster medications, homemade remedial measures like steam inhalation, gargles and “kada” are advised. An oximeter and a thermometer are necessary to monitor your oxygen levels, pulse rate and temperature 3 times a day.
    Since Kaka was still having fever, doctors advised to check him for Malaria or Dengue. For a Covid Positive patient, not many labs do the testing. Doctor at PHC Candolim referred us to Asilo Hospital where they have set up a special clinic for Covid patents. His blood reports were normal but his fever didn’t seem to come down. Next day, we again took him to GMC at CCCR and got an X-ray done. By this time, his oxygen levels also were dropping to 92-93. Same time, Pappa was brought to GMC for an X-ray since his sugar levels were increasing. Both brothers’ X-ray showed patch of Pneumonia and with their other parameters not showing normal levels, both were asked to be admitted.
    This time around, the Government had made more beds available and ward 122 was made available to them. They got to stay in one room (twin-sharing) and being together made a lot of difference. This room was at par with any private hospital and the treatment they received was par excellence. Meals were supplied to them at the room and they both mentioned that the food was of very good quality.
    One night at home, Baba suddenly reported low oxygen levels again. We had a spare oxygenator with us which was being used by a relative for her asthma. We had shifted this to Nerul few days earlier. Sweta administered oxygen to Baba through this oxygenator for 5 minutes, and she was successful in assisting Baba to bring back his oxygen levels to 96. 9 days later, Pappa was discharged from the hospital and another 2 days later Kaka was discharged too. The 17-day mandatory Isolation period was over now and it was home-coming for Sweta. But we decided to opt for a test so that we can be doubly sure to break this chain. Unfortunately, Sweta tested positive on RT-PCR test with a CT Value of 33. She decided to go back to Nerul instead of coming home and her 17-day Home Isolation is currently going on. Although she had managed well early on, there were instances when she had to administer oxygenator, do sponging, check sugar levels – all this in close proximity to a positive patient. And the virus managed to infect her.
    Now waiting for the 2nd October when Sweta, our Brave Frontline Covid Warrior completes her Home Isolation and returns home.
    I would like to mention here, the selfless service that the frontline Doctors and Healthcare workers are putting in. We had a tough time wearing N-95 mask and face shield for 7 hours. Imagine the plight of those with PPE kits. While we plunged in to take care of our relatives, these doctors and healthcare workers do it for those unknown to them. Frontline workers are working under immense pressure and the fear of taking the virus home to their family and friends. The least we can do is to give them give them protective gear, and an environment to work at the safest possible level. And Government has to step up and provide this. While we as individuals, should try and maintain social distancing, wear masks, and stay home unless really required to step outside and help our bit in educating others.
    We have been interacting with a few doctors and healthcare workers. They have their own stories, their own worries at home. While one of the doctor’s wife was hospitalised for dengue, another healthcare worker had his father admitted for CVA. Another doctor is worried while going home every day since her father is an asthma patient and her sister is pregnant. We really need to applaud the selfless service during these unprecedented times of all these brave hearts. I recount this healthcare worker at GMC who took Baba on wheelchair from one ward to the other. She was wearing a PPE kit and totally exhausted. We offered her a tip for her help, but to our surprise, she refused. A big salute to these selfless dedicated workers.
    We would like to thank family and friends for help from time to time. And special thanks to Hon. Health Minister Vishwajit Rane and Hon. Minister Michael Lobo for their assistance. I would like to share that HM called me up after I complained about the facilities at ward 148 in GMC and he told me that he will convert more wards in GMC for Covid treatment. In just under 4 days, new wards were ready. Thanks also to Nandan Kudchadkar, Manoj Caculo & Dattaprasad Kamat for their support. Thanks also to Manguirish Gadkar, Andrea Marques & Satyen Nagwekar with whom we have been co-ordinating.
    The system put in place for Home Isolation works efficiently. Doctors who are treating the patients over the phone are very polite, calm and respond to messages and calls any time of the day. We are very happy with the set of doctors with whom we have been co-ordinating with daily reports. These Frontline Covid Warriors deserve a special mention. Dr. Radesh Kerkar, Dr. Diksha Divkar, Bro. Madev Mandrekar and Dr. Savita Naik- you all are amazing human beings. Thank you for all the help.
    The set of IMA doctors team of Dr Astrid Monteiro & Dr Pravin Varghese who were assigned to us have been very helpful and prompt. Special thanks to doctors at GMC, Dr. Gauri Naik, Dr. Rachita Gupta Velho, Dr. Pranav Nadkarni, Dr. Hardik Patel, Dr. Anar Khandeparkar, Dr. Kedareshwar Narvekar & Dr. Sanjay Sardessai. Thank you for treating the three Bhobe brothers. Thanks to Dr. Dwen Dias with whom we have been discussing all aspects including protocols, safety and other concerns. The testing team led by Dr. Amey Kavelkar is very efficient. Thanks also to the Dean of GMC, Dr. Shivanand Bandekar for the facilities at GMC. On behalf of the Bhobe family and from us, I acknowledge your sincere efforts and thank you from the bottom of my heart.

Coutersy from facebook post

(By Siddha Sardessai)

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