Lucknow: When IAS officer Roshan Jacob took charge as the Lucknow district magistrate (DM) on 17 April, after serving DM Abhishek Prakash tested positive for Covid-19, the city was reeling under the second Covid-19 wave.
Jacob herself had only recovered just two days earlier but the city, recording 6,000 cases a day at a positivity rate of 50 per cent, was scrambling for beds, oxygen and treatment.
When Jacob finally relinquished charge last week on 2 June, to rejoin as the director of the mining department, Lucknow was recording 100 cases a day, with the positivity rate below 1 per cent.
In over a month, Jacob had managed to contain Lucknow’s spread, earning praise from not only Chief Minister Yogi Adityanath but also her peers.
Such has been her work, that even when DM Prakash rejoined duty on 27 April, Jacob continued to be the officer in-charge for Covid, after an order for her continuation was issued by UP Principal Secretary Mukul Singhal. She has since been appointed as the senior nodal officer through an order issued by the department for appointment on 15 May.
Jacob’s colleagues say that one aspect that really helped was her visiting patients admitted in hospitals and checking up on those in home isolation nearly every day.
“Roshan Jacob brought some major systematic changes that were needed to control the Covid crisis. She visited homes to ensure that help had reached,” said Bhuvanesh Kumar, Principal Secretary, Animal Husbandry, Dairy and Fishery department, who was appointed as senior Covid nodal officer during the same period.
“Roshan ma’am has been a guiding light; she has miraculously solved problems in Lucknow and we all look up to her. She would jump to action promptly and handle problems at their grassroots,” said a UP district magistrate who didn’t wish to be named.
Containing the ‘panic’ & strengthening grassroots aid
When Jacob took over, the city’s Covid response was an absolute mess — SOS calls were unattended, the district Covid centre was dealing with a logjam, hospitals were not updating figures on empty beds, patients were waiting five to six hours for a bed, there was a backlog of test reports and people were dying outside hospitals without treatment.
To handle the crisis, Jacob stepped up the efforts of the Rapid Response Team. The Rapid Response Teams are made up of personnel of the local Community Health Centres (CHCs). They are made up of CHC doctors, ASHA workers and auxiliary nurse midwives. They provide medical kits, visit houses of people in home quarantine, check on home isolation cases, and urge those symptomatic to get tested.
Jacob began joining the Rapid Response Teams visiting the homes of Covid positive patients and their primary contacts. Officials working with her said she even made it a point to visit Covid patients admitted in hospitals, every morning.
“Three hours of her over 12-hour workdays were spent checking up on patients. That’s how her mornings would start,” said an official.
Jacob told ThePrint that her mantra to handle the crisis was measures to “contain the panic”, which included even offering medical kits to those who were symptomatic but waiting for test reports due to the backlog.
“My solution to handle the crisis was to handle the panic in people by strengthening the home treatment protocol through the Rapid Response Team. I instructed them to speak to the patients offering words of peace,” Jacob said. “The idea was also that drug distribution should be more liberal. This way, the patient also finds some solace that ‘my treatment has started’.”
She then got rid of the “coercion” element in these teams. “I observed the manner in which the RRTs behaved; there was an element of coercion,” she said. “We had to ensure that it was not a punishment but a service. There’s no need to force or run after people for testing.”
The IAS officer also didn’t just limit herself to checking up on patients during RRT visits, but also made district command centre employees call them up for feedback. “They called up 600 patients every day to check on the behaviour of the RRTs,” Jacob said.
Further, Jacob also cancelled the barricading and sealing of houses of positive patients by the Lucknow Nagar Nigam through a written order.
The ‘Hello Doctor’
The officer also ramped up the ‘Hello Doctor’ system, a 24×7 tele-calling seva for those in home quarantine. This was in place during the first wave but had closed down later.
Jacob inducted 216 doctors — 150 Allopathic and 66 Homeopathic — into this system and divided them block-wise.
According to data accessed by ThePrint, between mid-April and mid-May, the ‘Hello Doctor’ fielded over 7,300 calls, for an average of 215 calls a day.
The IAS officer then streamlined bed allotment. She told ThePrint that when she visited ICUs of private and government hospitals, she realised that the bed positions shown on the government portal were erroneous, leading to a major bed allotment crisis.
“The command centre was operating on an excel sheet for bed allotments. I winded this up after joining and we started a public view portal. This shouldn’t be a secret between the command centre and the hospitals,” she said. “So, a system was devised that bed positions on the portal will be uploaded on the portal by the hospitals and the command centre will work on that data.”
Relaxing hospital admission norms, FIRs for overcharging
According to the officer, the provision of mandatory letters from chief medical officers (CMO) for admissions in private hospitals, in place during the peak of the pandemic, led to many dying while awaiting treatment.
Jacob spoke to senior administrative officials, and the norm was done away with in Lucknow on 22 April.
She also stopped the system of the Lucknow command centre sending requests to hospitals for beds, and instead personally began assigning patients to hospitals, depending on the bed status.
“She went to all private hospitals to get actual bed status. She also held meetings with senior doctors, informing them about complaints and to check behaviour with patients. Everyone knew that she would reach the spot if they didn’t show the truth,” one of Jacob’s colleagues, who did not wish to be named, said.
When Jacob had joined, the integrated command centre struggled with a logjam — calls lining up but patients unable to find a bed. “On one such day, there were around 276 calls made to the command centre by 3 pm but only one person would have got hospital admission,” a senior official said.
In the two weeks since the beginning of May, the Lucknow command centre is running on zero pendency.
Roshan also ordered lodging FIRs against hospitals for overcharging patients as some were found overcharging upto 882 per cent more than the government approved Covid-19 package of Rs 18,000 per day.
“People were really taken for a ride by these hospitals; it is a controversial area but it was the need of the hour,” Roshan said.
Managing oxygen in the district
To handle the oxygen crisis in the district, the IAS officer monitored oxygen tankers with help from the home department in real time, and also checked pipelines of hospitals for oxygen wastage. Lines with leaks were changed in two days.
Senior government officials said that Roshan’s intervention averted mass casualty due to lack of oxygen in the district in the last week of April.
“There was a night when patients from private hospitals had to be shifted to KGMU Lucknow due to an oxygen crisis. Also there was a huge chaos on the transportation of oxygen. With her intervention, two oxygen tankers with police escorts reached and we averted mass casualties,” a senior government official said.
“Jacob also improved the hospital administration and their management a lot, including availability of oxygen. It is because of her that Lucknow was able to handle the most critical period during the second wave,” Bhuvanesh Kumar, who worked closely with the IAS officer, said.
(Edited by Arun Prashanth)