Mumbai: As Maharashtra battles the second surge of Covid-19 pandemic, doctors and administrators have help at their fingertips — a set of 11 phone numbers that they can dial any time of the day or night to seek expert guidance on a particular case or on general treatment protocal. A call, or message, to any of these numbers is guaranteed to bring prompt and detailed advise.
On the other side are doctors — from varied backgrounds and expertise — who are part of a taskforce that was constituted in April last year when the first Covid wave had brought Maharashtra, particularly Mumbai, to its knees.
The 11 doctors, whose mobile numbers form the helpline contacts that have been shared with the medical and administrative fraternity, are among Mumbai’s most well-known and senior physicians, and were handpicked by Maharashtra Chief Minister Uddhav Thackeray to be a part of the Maharashtra Covid Task Force.
Since then, they have helped the state bring down the Covid mortality rate and helped devise dynamic testing and treatment protocols to handle the crisis.
From rational use of oxygen to cutting down on the indiscriminate use of medicines like remdesivir, used in Covid treatment, these doctors have played an important role in the way the disease is being treated in Maharashtra. Their individual and collective specialisations have also helped the state in handling Covid patients with comorbidities.
The team meets virtually once a week to discuss the most pressing and immediate concerns and hand over their suggestions to the state government in the form of an advisory.
That apart, they are also in touch with district administrations and guide healthcare workers treating patients as and when required.
Nidhi Choudhary, collector of the Raigad district, told ThePrint, she that too has contacted the taskforce multiple times and has always received an immediate response.
“Some doctors were prescribing steroids after treatment, so I contacted Dr Shashank Joshi [a member of the taskforce] recently to ask if it is advisable. His response was prompt and elaborate. He first asked about the case history, symptoms and so on, and then gave his opinion. Our district civil surgeon has also contacted the task force through video conferencing on a number of occasions for guidance,” she said.
The biggest contribution of the taskforce has been coming up with an ‘evidence-based treatment protocol’, which keeps evolving as needed. It has also helped popularise the ‘six-minute walk test’, to monitor an individual’s oxygen level, to decide on the course of treatment, and the ‘chase the virus’ policy, as part of which door-to-door checks were conducted to measure the oxygen saturation in people.
Also read: India’s oxygen emergency is more logistical
Maharashtra’s Special 11
The members of the task force bring with them both public and private sector experience and varied specialised knowledge, to deal with those with co-morbidities.
The team is headed by Dr Sanjay Oak, who till last November was the chief executive at Prince Aly Khan Hospital. Dr Oak has also been the dean of the civic-run King Edward Memorial Hospital and worked with the Brihanmumbai Municipal Corporation (BMC) for 23 years. Dr Praveen Bangar of KEM Hospital is the convenor of the taskforce.
Others on the panel include Dr Rahul Pandit, director, intensive care at the Fortis Hospital; Dr Khusrav Bajan, head of emergency medicine at PD Hinduja National Hospital; Dr Kedar Toraskar, director of critical care at Mumbai Central’s Wockhardt Hospital; and Dr Nitin Karnik, intensive care specialist at Sion Hospital.
There are also experts on infectious diseases on the team, such as Dr Om Srivastava of Jaslok Hospital and Dr Vasant Nagvekar, an expert on internal medicine. Then there’s Dr Shashank Joshi, diabetologist and endocrinologist at Lilavati Hospital; Dr Zarir Udwadia, a consultant chest physician attached to the Hinduja Hospital and Research Centre and Breach Candy Hospital and Dr Zahir Virani, nephrologist at the Prince Aly Khan Hospital.
The taskforce reports to Chief Secretary Sitaram Kunte.
Speaking to ThePrint, Dr Pandit said having doctors with different specialised knowledge has helped immensely.
“You need to have a multi-speciality task force so that everyone brings a niche expertise to the table, to form worthwhile protocol…If I say the task force has to have 100 per cent unanimity, that’s not fair, because everything will have pros and cons and those need to be discussed. Because unfortunately in medicine 2 plus 2 is never four,” he said.
Every Monday, the taskforce meets for a video conference for over two-three hours, to discuss the most recent medical issues arising out of the pandemic. At the end of every meeting, Dr Oak summarises the discussion in the form of an advisory, which is then handed over to the state government.
The taskforce also has regular interactions with district collectors, representatives of the Indian Medical Association, local civic officials and doctors at the local level.
“The advisories that we give every Monday are related to the issues that the state may be facing at that point of time. For example, three weeks ago, when there was a severe shortage of oxygen, we came up with an advisory on how to rationalise the use of oxygen,” said Dr Joshi.
Everyone on the panel realises the importance of the work at hand, and neither illness, nor personal loss, have kept them away from their duties.
“Not a single member has missed more than one meeting in the past one year,” said Dr Bajan. “Our guidelines have been circulated to all DMER centres (the Directorate of Medical Education and Research). Through many, many Zoom meetings we have discussed and guided younger doctors across Maharashtra. In case they want to discuss any case, we have been there to guide them.”
“Seven of the eleven of us have had Covid at some point of time. Some of us have also lost our loved ones. But, we as well as the entire healthcare fraternity, have put our lives aside for this,” Dr Bajan added.
Bringing down the mortality rate
When the team was newly formed, the first challenge before the 11 doctors was to reduce Maharashtra’s mortality rate, which was nearly 7.5 per cent then. This they were able to bring down to a little over 3 per cent by the beginning of June, by drawing up a proper treatment manual to help decide on things like when to hospitalise a patient and when to allow home quarantine and how to treat patients with comorbidities.
Dr Joshi said, the mortality rate is much lower now than in the early days of the pandemic because doctors have a better understanding of the treatment protocol.
According to government data, Maharashtra, which has so far recorded 49,39,553 Covid positive cases, currently has a mortality rate of 1.5 per cent.
Dos and Don’ts
“What we have recognised in Covid care is that we should identify those in need of hospitalisation early. [For this] we were able to popularise the six-minute walk test,” said Dr Joshi.
The test involves monitoring the oxygen levels of an individual with Covid symptoms before and after a straight six-minute walk on an even surface without a pause. The individual is considered healthy if the oxygen level does not drop after six minutes.
The treatment protocol has been updated from time-to-time.
“Covid was an unseen danger and we have followed evidence-based guidelines. We evolved from treatments like the use of hydroxychloroquine and azithromycin and thrown them out of the protocol completely. These exotic drugs don’t help. What helps is early reporting and timely hospitalisation,” said Dr Bajan.
The doctors have also advised that remdesivir is not a life-saving drug and that its “rampant and irrational use” should be stopped.
Talking about how the taskforce guidelines have helped, Nashik District Collector Suraj Mandhare said, “They gave us exact norms for how to administer oxygen and when to opt for remdesivir. Sometimes, patients make demands and if we, as administrators, try to rationalise resources we are questioned and criticised for having no medical expertise. But when the task force lays down guidelines we can quote them, saying here’s a learned, respected person giving these norms.”
Mandhare said, he gets to interact with the taskforce once in 15-20 days.
The taskforce was also responsible for tailoring the guidelines of the Indian Council of Medical Research (ICMR) to the localised needs of Maharashtra’s densely populated cities.
For instance, said Dr Joshi, the taskforce helped in formulating the ‘Chase the Virus’ policy. “We checked oxygen readings door to door and filtered out the population with low saturation levels,” he said. The policy was launched as part of CM Uddhav Thackeray’s ‘My family, my responsibility’ campaign in September last year, with the aim of checking the health status of Maharashtra’s entire population.
The eleven doctors find their phones buzzing at any time of the day or night, with doctors and government officials looking for guidance on what to do in a particular case.
Some calls for help are basic and short, while others need a longer conversation, but at the end of the day, taskforce members said, doctors just need the assurance that they are taking the right calls while tackling an unpredictable virus.
“For instance, in one case, an at-term pregnant woman was struggling to breathe and was on ventilator support. I suggested a C-section and both the mother and the baby turned out to be fine. These are tough calls to take and the doctor at the other end just needs some validation,” said Dr Pandit said.
“In the end, it is all about touching lives. As many as you can.”
(Edited by Poulomi Banerjee)