FATAL: It is the lack of oxygen supply which causes the increasing number of fatalities, the Monday, May 3 score being more than half-a-century
By Rajan Narayan
The biggest crises that is facing covid patients and doctors treating them is the severe shortage of oxygen. The need for three crore litres of oxygen would not have been necessary if test results came earlier . Unfortunately, the new mutant hits the lungs within 48 hours like Falciparum malaria– this is what increases the demand for oxygen. All Goans should get themselves tested the moment they feel any of the covid-19 symptoms, and guided by their doctor treatment should start even before test results come in and hospital admission is necessary….
ON Sunday, May 2, I received a desperate call from Retd Commodore S Bhatia who has set up the covid-19 website. Which has far more reliable information than the Chief Minister Pramod Sawant’s website! The CM’s website does not open most of time. And the position of Covid-19 beds in various hospitals is totally feku. As a friend of Commodore Bhatia, Mr Bhera, discovered.
Mr Bhere reported to GMC after having tested positive. He was send to the South Goa District Hospital (SGDH) in a covid-19 ambulance. His daughter had to go to Margao to look after her father by bus as she was not permitted to accompany him in the ambulance. She had to wait for almost six hours before her father got a bed with an oxygen delivery facility at the SGDH.
GASPING FOR BREATH
ANOTHER friend, working for a pharmacy attached to the Campal Clinic, called up in even greater desperation. The mother of a very close friend of his had reached the pneumonia stage of the covid infection. He worked for a pharmacy attached to a small local private Panjaji hospital which does RP-TCR covid testing. The friend had a chest CT scan done for the 60-year-old mother of his friend.
The CT scan showed fluid accumulating in her lungs. When they went to the GMC they were directed to the North Goa District Hospital (NGDH) which has replaced Asilo. Here again they waited for several hours to get a bed attached to an oxygen facility.
The state government claims that it has set up covid-19 centres at various places including the Shyama Prasad Mukerjee Stadium and the Fartorda Stadium. But this is so much waste of time and money if the beds do not have oxygen facilities. There is not even a CT scanner to check if the patient is in the critical stage of the infection.
Even the SGDH does not have a CT Scan machine and patients are sent to the old Hospicio, which mercifully is still functioning.
YOUNG DOC TRAUMATISED
AT the SGDH, a-22-year old who had finished her MBBS, but is now serving her bond period, has been posted in the covid ward. Before the MBBS degree is given physically to those who pass the exam they have to serve a year as an internee doctor in a government hospital for a token salary of Rs60,000. This 22-year-old I spoke to is very angry with the government.
She confided to me to come and see the ground reality in the hospital. Come and see how many patients are gasping for breath for want of oxygen. See for myself the acute shortage of Remdesivir which is prescribed in critical stages only to see if it makes a difference. Come and see how patients are dying every day. After 72 hours of duty when she gets a break she is totally traumatized naturally. Every shift she sees 20 to 50 people dying. She sees relatives pleading for oxygen for their mother, brother, sister, etc. She cannot do anything as oxygen may not be produced from thin air.
Which is not strictly true because if you have a concentrator you can literally create oxygen from the air in the atmosphere. But there are no concentrators available at any of the covid facilities though they cost as little as Rs 24,000 plus to a maximum of Rs2 lakh for sophisticated versions.
If non- resident Goans and people of Goan origin want to help, they may donate these oxygen concentrators to the right places to save hundreds of lives. But send it to the Red Cross or reliable NGOs like Caritas (an NGO run by the church worldwide). Don’t sent it to chor businessmen in charge of the covid centres because they will allegedly sell them at four times the price to private hospitals!
WE already have the example of the Manipal hospital offering vaccinations for the 18 years plus youth at Rs1,360 per dose from Monday, May 3 as was promised by the government. Except that the government is not providing the free vaccines promised because it has not received its stocks from the Serum Institute of India in Pune. Uncertainty over when the 5.5 lakh doses will reach Goa to vaccinate people between 18-45 years of age has become more uncertain after Serum Institute boss Adar Poonawalla fled to London fearing threats to his life or so he been reportedly heard saying.
The Serum Institute is the largest producer of vaccines in the world. It can produce more than hundred million doses of vaccines a month. But what does poor Poonawalla do if he gets threatening calls from Shiv Sena which is demanding that Maharashtra should get priority because the Serum institute is located in Pune? Poonawalla get calls from the country’s Home Minister Amit Shah demanding that preference be given to the BJP-ruled states, particularly Uttar Pradesh. Which is witnessing a huge spike in cases because it foolishly decided to go ahead with the mega Kumbh Mela when millions of Hindus go dip themselves in the holy river Ganga.
It is not just politicians alone who have been threatening Adar Poonawalla. Top industrialists close to Modi are demanding vaccines immediately for their several lakh employees, just like Babush Monserrate demanded that his son Rohit be the new mayor of Panaji and he should be vaccinated immediately before the tikka scheme for the over 18 years old kicked off on May 3! The wealthy can pay any price for their vaccines and not even pay.
As it is the Serum Institute is being threatened by Europe and several other countries for not delivering the vaccines they have long since paid for. There was a fire in the institute’s complex where they were planning to expand vaccine production. The United States suddenly stopped sending the raw material needed to make the vaccines on the principle that it had to attend to its own citizens on a priority basis. Never mind that the US has stocked up on huge stores of vaccines for the future!
To further complicate issues some countries in Europe who are alleging that the AstraZeneca vaccine, as it is called in Europe, is responsible for triggering off blood clots post vaccination of patients. Some countries have banned the use of this vaccine.
No willing to be bashed up or killed Adar Poonawalla of the Serum Institute of India has fled Pune to join his wife and children. Though he claims that vaccine production is in full swing some reports say he may relocate his production facility to the UK. May be because of the pressures that vaccines manufacturers in India face; Microsoft chief Bill Gates has publically stated that the technology for making vaccines may not be transferred to governments of any developing nation.
Under the circumstance we will be left with the one choice of Covaxin, the only vaccine approved by the World Health Organisation (WHO) but which is not a very popular choice with many. Clearly, it is a case of “ghar ki murgi dal barabar.” We do not know who will get the Sputnik vaccines donated by Russia to India.
THERE are only two solutions to containing the deadly spread of the aggressive double or triple mutant virus infection that is alarming everyone including the medical community. Now India has the distinction of being responsible for 40% of covid-19 cases worldwide and 60% of deaths. The situation is complicated by ego issues and petty fights between our politicians.
So much so the High Court of Delhi had to order the Central government to provide Chief Minister of Delhi Arvind Kejriwal the oxygen quota he had been allotted for patients in Delhi. Amongst those who died reportedly for lack of oxygen is father of the famous TV anchorwoman Barkha Dutt. In Goa there is continuing differences of opinion between Health Minister Vishwajit Rane and Chief Minister Pramod Sawant.
Rane wants the Navy, Goa Shipyard and MPT to supply covid centres with oxygen. The CM claims that he has visited all the government facilities and there is no shortage of oxygen. But the Goa Association of Resident Doctors (GARD)’s doctors who’re treating covid patients 24×7 insist keep reporting there is desperate shortage of oxygen.
In the GMC ICU wards oxygen is piped with connection at every bed. If something goes wrong with the main oxygen tank or anywhere along the pipeline the oxygen continuity is disrupted and even 30 seconds may make the difference between life and death for a patient. A senior doctor in charge of over 150 covid patients shares his frustration and helplessness. How many patients can a doctor give manual resuscitation?
Clearly patients are uneducated in this pandemic to the seriousness of mutant virus when the only solution is not to wait but to get tested quickly and even more quickly get to a doctor who knows how to prescribe for the infection from day one of the symptoms of fever of 101 degree with other symptoms present.
There is mild covid infection and the serious covid infection which rapidly leads to pneumonia if not treated with blood thinners and steroid medication right away even before test results come in. Home quarantine patients need to be in touch with their GP constantly. Patients may even go to a radiologist to get a chest scan done to check if pneumonia has got into their lungs. This is when the oxygen levels in blood start fluctuating and go below 87, which is crisis point in need of hospitalisation.
Unfortunately, in the case of the new deadly so called Indian double mutant viral infection there are no symptoms of sore throat or a running nose – apparently the infection directly targets lung tissues and so breathing difficulties commence. Which is why instead of waiting for delayed test results a patient must be checked and put on the right medication if need be. Ideally test results should come in within eight hours.
Neither State nor private hospitals and labs have the capacity to do RT-CPR testing for more than a thousand people a day. While at government centers a queue may be 5,000 strong. So much so government has stopped testing for only travel purposes. We are talking about the RT-PCR testing here which is the gold standard for positive or negative patients.
The double mutant virus variant is far more infections and by now experienced doctors say there is the danger of the entire family catching this infection which progresses rapidly. That is why if anyone experiences symptoms of high fever they should not wait but start taking the prescribed medication immediately. The incubation period for the new virus is less than 48 hours. Which is why if you get the test reports on the 7th day may already be in a critical situation needlessly.
SHORTAGE OF BEDS
THERE is no point in running around looking for hospital beds with an oxygen facility. Even if the government has directed all private hospitals to reserve 50% of their beds for covid patients. This amounts to reserving 720 beds across the state. But this is not going to solve the larger problems of prompt treatment and oxygen supply at the right time to the right patient. It is imperative that additional labs are set up to confirm infection within eight hours and not the week long to ten days it takes presently.
Which is precisely what Commodore Sashikant Bhatia, a retired naval officer, is attempting to do. Instead of the Navy opening up its hospitals and making available its doctors to the civilian population, he has suggested that they can do put up testing facilities. According to a senior pathologist the cost of putting up a testing centre for RT-PCR is around Rs75 lakh! If you lease the testing centre instead of buying it you get the lab and the qualified staff.
The extremely enterprising and hardworking Commodore Bhatia got the Governor of Goa and Maharashtra, Bhagat Singh Koshyari, to speak to the Flag Officer Goa Area (FOGA), Rear Admiral Philipose G Pynumootil, to do the needful. I understand that there was a meeting between the FOGA and the CM. I hope that the Navy and Army will do the needful at the earliest.
Even the army can be of great help because Goa is the headquarters of the Signals Regiment which can take over the control room and provide real time details on the availability of covid beds, oxygen ventilators, etc, just like the Tata Consultancy Services is doing in Mumbai. In contrast in Goa you have to keep shuttling between GMC, South Goa District Hospital, North Goa District Hospital and the corporate hospitals including Healthway, Manipal, SMRC and Victor Apollo.
If you are willing to pay the price you may get your travel test done at the Miramar Residency courtesy Victor Hospital for Rs1,400 and Manipal Hospital for Rs1,200.
IF YOUR test comes on time there may be no need to hospitalise a patient. Even if the patient’s home does not have a separate bedroom with attached bathroom, early symptoms can be taken care with medicine and physiotherapy. But the head of the family or whoever is in charge should ensure that the patient under home quarantine does not go out loafing like many people in Margao did during the recently conducted civic elections.