Gangtok: “That morning, I had prepared traditional Sikkimese food in the hope that I will have it for lunch after coming back home; it may be rotten by now,” said one of the health workers who first attended to the lone COVID-19 patient of Sikkim currently undergoing treatment at STNM Hospital’s isolation ward.
Another expressed concern that her pets might be hungry, yet another said that she had planned to go out that day.
These are some of the stories that are now coming out from the 31 health workers, including sanitary staff, doctors, nurses and technicians, catering to the patient in STNM Hospital, which is now a devoted COVID-19 hospital in Sikkim.
“It may have been my destiny to reach early on May 23, as my early response with the doctor concerned saved others from being directly being exposed to the patient. I was not scared, but others were. They were crying on hearing that they would be the first lot to handle the COVID-19 patient,” said a nurse in the isolation ward.
A doctor, who wished to remain anonymous, said, “Patient is fine now, he has no symptoms. A second test was also conducted on him and it shows that the viral load is less now. We have stopped on hydroxychloroquine, as his viral treatment has now ended. It is only the symptomatic treatment that is being given to him. He underwent five days of flu medicine, but will be taking the medicine for another five days. Another test will follow on the 14th day from the time he tested positive.”
“We could not have asked for a better first COVID-19 positive patient, he is patient, abiding and his cleanliness routine is even better than ours. We have put him under surveillance for the full stretch of 24 hours, disinfection and cleaning is conducted every three hours of the whole ward, and we maintain a strict surveillance on his movement and with whom or what he is coming in contact with,” said another health worker said.
The patient is currently on oral medicine, and is on a high protein diet, which he is being provided through eggs and paneer. Overall his food requirements are handled by the hospital catering staff. None of them come in contact with the patient. Food comes in aluminium foils and plastics which are disposed of immediately after eating. No other utensils are being used. Even if it is just drinking water to be provided to the patient, then we have to go in three layers of clothing with PPE suits, the health worker said.
On the spread of the virus to his fellow inmates at the Ravangla quarantine facility where he was initially based, the health workers said that the patient maintained strict discipline even there; hence, the primary contacts and health workers have tested negative. “He came to the hospital wearing an N95 mask, so he was cautious in his approach. He feels that he may have got the virus during the bus journey from Delhi to Siliguri. They made a night halt in a roadside lodge, that could be the place where he got the virus. In Delhi, it appears he was staying in a hostel with a common mess hall but with individual toilet facilities,” the staffer said.
The hospital is currently functioning with OPD but there are restriction on new admissions, as patient enrollment is already happening in CRH Manipal. On the day the positive case came to light, there were 280 in-patients, the same has been substantially reduced, informed a health worker.
“If we have to visit the patient, then all of us in the isolation ward do it collectively. We give him food, water and take care of all his requirements, from his phone to his need for books. He is alone in the isolation ward, with three doors sealing him afar. We are in contact with him throughout from the intercom service,” he said.
The health workers at his disposal have counselled him well about the stigmatization that could follow, so he is using the phone but not sharing information about his treatment.
Meanwhile, health director general Dr Pempa Tshering Bhutia said all the primary contacts have tested negative. All of them who were brought to STNM have been sent to a special quarantine facility in East Sikkim district for further observation, but they seem to be out of danger and transmission of the virus, he said.
The positive patient was in the triage level when he was identified as positive, among the four levels of the hospital devoted for COVID. “It was the confirmatory test that came as positive that put us all in frenzy. There was denial at first, following which many nurses started crying with the thought that they were the first to respond and exposed to the patient. It took us hours to shift the patient to the isolation ward. Everywhere he had been or was being taken to had to be cleaned and disinfected,” said another health worker.
There were six nurses and three doctors who were directly exposed to the patient, which later grew. Including the cleaning staffs, there are now 31 who are currently devoted to the lone patient, informed the health workers.
“On May 22, the test had come through as positive on TrueNat and upon that a confirmatory test carried out under the supervision of doctors and nurses. We expected it to be negative like other times, but this time RT-PCR from NBMCH in Siliguri, confirming of the same being positive,” said a health worker.
“It was supposed to be my last day in the isolation ward. Prior to the positive patient, we were conducting dry runs, supervising other nurses and doctors on the various guidelines, but when the first case came through, I was there. I was supposed to return back to my ward after that day but it has been a great experience to be the ones to respond to the first COVID positive case. I was not scared to be honest,” shared another health worker.
It has been a week since they were exposed to the patient, now. “14 of us had our sample tests conducted on Thursday and the result came through as negative on Friday, following which we have been given a hotel for quarantine for next 14 days. Test for the remaining 17 will be conducted on Friday. The ordeal for us everyday since exposure has been reaching to isolation ward to our single sharing or in one case double sharing room, at the adjacent annexure building. Between those two commutes, we take a shower once at the hospital and take another after reaching the room. We cannot come close to any of the other staffs at the hospital and have very less idea about what is happening outside of the top four levels of the hospital and the annexure building where we are staying,” said a health worker.
Some exceptional work in the hospital is being carried out by the sanitary workers to keep the premises clean. “If they don’t work, then there is chance of virus spread, so they must all be equally appreciated, as they are getting more exposed to the patient than the doctors and nurses. They were part of the ‘One Family One Job’ recruitment who despite waiting for their two months of salary currently, are working with all their heart. They are at the risk of virus spread through air particles from coughing, talking as these are air particles or drops we let out while sneezing and coughing which may linger around in his clothes and his wastes,” informed sources.
On the quality of the PPE, the only barrier between the patient and health workers, a health worker said, “We cannot complain on the PPE as many of us are using them for the first time, apart from training. There are two types of PPE that we have, one is thicker and heavier, the other is thinner and easy with mobility. It gets really hot inside the PPE, and to add the twin layers of masks, one surgical mask and the other N95 masks, result in more intake of carbon dioxide, making us easily fatigued due to lack of oxygen. I had never worn gumboots before, so can’t comment if it was comfortable or not.”
However, the health workers complained that the management on the hospital’s part with the first COVID case could have been better. “Being the first group, we had to set many things that were not considered during our training. There was no room for complaining as it was a life and death kind of situation during the initial rush. But, when the second group of doctors and nurses come, they will feel at ease, as all the work has been laid out for their ease. But, they must also not compromise on quality, treatment and the availability of safety equipment, as that could put them in threat of virus spread,” informed the health worker.
With the health workers or the first batch eyeing their quarantine from Saturday, two health workers will hand over all the responsibilities to the next batch. “I am a bit worried about facing the crowd after being in isolation for over a week, there are fear of stigmatization as well. But since our work is done now, we will be away from the hospital for at least 28 days and around 2-3 months before we have to cater to another COVID positive patient,” said the health worker.