My COVID - 19 Story: A Tale of Despair and Hope 👨🏻⚕️
Musings from a frontline COVID warrior at the peak of the pandemic.
Hello, and welcome to Reflections. I'm Sanuj, a physician. I write insightful posts about health, wealth, family and other interesting topics. If you're new here, you can learn more about Reflections in the about page. If you would like to read more, hit the subscribe button below to catch my weekly posts and join a growing list of readers around the globe.
It was December 2019. Christmas cheer was brought short by news of a deadly virus that caused breathing difficulties and deaths in China. The virus was called SARS CoV - 2 and the disease was COVID - 19 which later became a pandemic. The world was taken aback by the impact of this sudden and devastating disease. Lockdowns were declared worldwide, and curfews were set in place. Terms like ‘social distancing’ and ‘masking’ became part of daily vocabulary. Doctors, nurses and paramedical staff who had to quickly adapt to new protocols, often with limited information and resources, were overwhelmed by the sheer patient load, patient deaths, and lack of knowledge on this new and previously unheard-of disease.
People walked on isolated streets, alleys and main roads of the biggest of cities wearing masks and hunting for essentials that were running out swiftly. It was a scene taken straight out of a post-apocalyptic movie. Never in our wildest dreams had we have imagined this to happen for real. Was this the end of humankind? In hindsight, it thankfully wasn't.
The impact of the COVID -19 pandemic still continues to plague us today. Breathing difficulties persist, economies are still recovering from the shock of lockdowns, inflation rose to sky high levels, and jobs were lost en masse.
Pain and Resilience
My days doing COVID shifts brings back memories of pain and resilience. The pain suffered by patients and the resilience of healthcare workers. People, both old and young, in critical states, awake one day were not to be seen the next day. Their beds were occupied by other critically ill patients in no time. There was a long queue of patients waiting for a hospital bed. Add to that dwindling healthcare resources, and you had one of the worst times for hospitals the world over.
I remember one particular young man in his mind thirties who was present during one of my shifts. He had been in the hospital for about 2 days. I could see only his head and his eyes. The rest of his face lay covered with a non invasive ventilation mask. He was awake but his blood parameters and oxygen saturation weren't promising. Two days into my shift and he was not to be seen anymore. I enquired about him, expecting the worse. I was given the terrible news.
The hospital staff, including doctors, nurses and the paramedical team were stretched to their limits. We faced shortages of critical supplies, including ventilators and medications. We often worked long, grueling hours, with many forgoing days off to meet the demands. The N95 masks were sometimes of poor quality and looked liked white coconut shells. Their elastic bands caused bruises and scars on the face after prolonged use. The burnout was real, and the emotional toll was extreme.
Although we were thankful to have biohazard suits, unlike many other centres, they were the least bit comfortable. It felt like we were getting cooked inside it. The elastic bands of the N95 mask only added pain to the existing misery. Many of us fell sick. Our colleagues and counterparts were brought under our care. We hoped and prayed that they'd be alright and would get discharged without any complications.
The patients got to see their relatives once a day in a personal protective equipment. The staff at my hospital were empathetic and compassionate. They arranged video calls with patient relatives while they were in isolation. This had a positive impact on many of the patients who felt motivated to get well soon and go back home.
Our major challenge during the initial days was the absence of medical literature on the disease. Treatment was symptomatic. The clock was ticking, deaths were rising. Children, adults, and elderly were all affected although the brunt of the disease was borne by those immunocompromised by chronic illnesses. Patients on non invasive ventilation with tight fitting masks had a free fall in their oxygen saturation numbers when it was removed during feeds. Pressure ulcers formed over the bridge of the nose as a consequence of wearing those masks. They needed it to keep them alive. Removing it to allow the ulcer to heal was a life threatening option. They required intubation and mechanical ventilation (assisting breathing artificially). But we were short on ventilators. Some would get a ventilator in 1 or 2 days while others passed away waiting. There was no option to refer. All hospitals were occupied and working beyond capacity.
During one time, the load on the oxygen supply in our hospital was so much that we were going to run out of it in less than a day. Our hospital had built a new facility which was not officially commissioned but was partially ready and had a central oxygen supply. Overnight, we shifted out several patients one by one in ambulances to the new facility. This reduced the stress on the oxygen supply and hundreds of lives were saved. It was a divine act of providence at a time of dire need, and we were thankful to God for the same.
The Emotional Toll
I remember the first COVID -19 patient at our hospital, a middle-aged gentleman. He was isolated alone in a single room. Fear gripped the hospital staff and the government as we were unsure how to evaluate, treat and discharge the patient. There were absolutely no protocols in place at the time. We wore biohazard suits to enter his room, talk to him and to administer medication. He continued to remain COVID-19 positive for days, followed by weeks and later months. He was the only case in our area at the time and everyone including the authorities wanted to isolate and keep him inside till his test result came negative. There was genuine anxiety and worry among us. Would we be accidentally carrying the virus back home to our families? Are we putting off the biohazard suit without contaminating ourselves? How long will the patient remain positive? Is he going to be alright not seeing his family and friends for months now?
The patient was given the best care possible but he lived in a prison, masquerading as a hospital with healthcare workers in place of prison guards. Uncertainty loomed about the impact of this disease on the patient and on his treating team. He had a room, a bed and food served to him daily as is done for every inmate in prison. The doctors and nurses tried their best to keep him comfortable. But the solitude brought loneliness and depression ensued. We had to call in the psychiatry team to help him tide over the emotional crisis.
Later, when the disease became more widespread, it was found that after disease resolution, the SARS CoV - 2 swab test can continue to remain positive for many days. Retesting after recovery and prior to discharge was thus, dropped from the management protocol. Our first patient was finally discharged after three and a half months of isolation in the hospital.
The rest of the pandemic with its many peaks witnessed the deaths of many. We struggled to find a cure or a vaccine to prevent this infection. As healthcare workers, we often deal with deaths. But never at this scale. Every day patients passed away. Some couldn't even reach a hospital, some couldn't reach the isolation ward from the emergency department, and some couldn't get access to a ventilator when they needed one. The whole state of affairs was terribly sad.
Innovations in Medicine
Lockdowns brought the world to a standstill. People with chronic diseases including cancers were worst affected. Access to cancer care was a challenge as no form of public transport was available at the time of lockdown. Those with chronic illnesses from far away places couldn't review for their follow up and replenishment of medication.
This urgent need to reach out to healthcare access for non acute conditions paved the way for telemedicine. It had its cons as the method of treatment was definitely sub standard in comparison to actually seeing and examining a patient. But it would have to do for the time being. The silver lining was that patients could now connect with their doctors, bring up their concerns and clarify their doubts. Test results and medications were exchanged online.
Amidst the pandemic and while battling it, healthcare workers and scientists researched for a cure. Several drugs were studied, various vaccines were tested. Supportive therapy to prevent breathing problems and critical illness were discovered. New vaccines were accepted for emergency use to put an end to the pandemic. Some worked, some not so well. Vaccine prices were slashed and they were distributed globally, freely in many countries, although developed countries took their time to supply it to developing countries. It wasn't a cure but it provided some level of protection against serious infection and death - light at the end of the tunnel. However, no good deed goes unpunished. Misinformation spread globally and people lived in such great fear that any news that brought hope was believed to be true, despite the contrary. False hopes of cure, pushing traditional non evidence-based medicines and publishing unethical research in reputed medical journals were just the tip of the iceberg.
A significant breakthrough was seen in how medical research was shared with the scientific community. Most medical journals charge hefty prices for subscribing and reading research articles including practice changing updates and guidelines. For healthcare workers in low and middle income countries, these journals become unaffordable and hence, they find it difficult to stay up-to-date with the latest medical developments. But this time, medical journal publishers decided to keep all COVID related articles absolutely free. In fact only COVID related articles were getting published during the peak of the pandemic. Medical literature related to COVID -19 was now available for free. A miracle in the medical community.
Are we prepared for another pandemic?
The world eventually moved beyond the peak of the pandemic. Economies have shot back up and life is (almost) back to normal now. In fact, we may have already forgotten about those dreadful days from the past. The name COVID-19 no longer instills fear. It's just another viral illness today despite its multiple variants. But we can't remain complacent. We don't know when the next pandemic will hit. We can't lose precious lives again.
The endurance of healthcare workers during the peak of the COVID-19 pandemic was nothing short of extraordinary. Their sacrifices, resilience, and unwavering dedication provided a critical line of defense against the virus and saved countless lives. Investing in healthcare infrastructure, ensuring adequate resources, support for healthcare workers, and prioritizing mental health will be essential in building resilience for future public health emergencies. At the same time, we must ensure that there is equity in healthcare. One life is not more valuable than the other. The rich and the poor should have access to quality healthcare. We are divided by many physical and cultural attributes externally, but let us not be divisive internally.
As we reflect on how we survived the pandemic, let us honor the contributions of healthcare workers, also known as COVID warriors now. We must also ask ourselves the question: are we ready to face another pandemic? A deadly virus may spring up anytime and may be out of our control. We can be prepared if our governments prioritise health and nobody is left to perish in want of access to healthcare resources.
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Music for the Soul
When I wrote this post, I was reminded of this beautiful soothing score that gives you a sense of hope, composed by Alan Silvestri for Forrest Gump. If you are a soundtrack fan and like instrumental music, you'll enjoy this.
What a captivating post. Thank you for your service 🙏🏿