Covid-19 Care @ SRM

• More than 5000 patients with COVID-19 were treated in the second wave of the pandemic.
• COVID-19 cases had a mortality rate of less than 1%.
• Dedicated selfless service by Frontline Warriors.
• There is no mortality among the doctors and nurses attending to COVID-19 patients.

Preparedness and watchful expectancy for the expectant third wave of COVID-19 with the paediatric, anaesthesia and intensive care teams.

The COVID-19 pandemic caused disruptions to the lives of all human beings.

In India, a total lockdown was ordered by the government on March 24, 2020, initially for 6 weeks and subsequently on numerous occasions.

SRM Medical College Hospital and Research Centre were identified by the Government of Tamil Nadu as one of the major hospitals in the Chennai zone to treat COVID patients.

We were tasked with preparing a 200-bed facility for COVID treatment. Accordingly, two wards were converted into COVID wards and six-bed ICUs, along with a COVID operation theatre, were established.

The ground floor of SRM Hospital was divided into three zones.

• Zone ‘A’ comprises (i) Casualty (ii) Fever clinics in adjoining areas.
• Zone ‘B’ for screening and entry of medical staff.
• Zone ‘C’ for screening and entry of patients attending various clinics.

Thermal scanning at entry points was mandatory. COVID prevention guidelines are thus strictly followed by all concerned inside the campus. An exclusive clinical pathway was developed for patients with suspected COVID from Zone ‘A’ to the COVID ward on the first floor with a 100-bed capacity. Donning and doffing arrangements were made, and thorough training was given to the doctors, nurses and health care workers. The remaining 100 beds were located on the second floor. A COVID ICU with six beds was established exclusively for COVID patients. The wards were made patient-friendly by providing a separate dining hall, a TV facility and two-way communication with relatives and friends via telelink. A few snippets of our activities as reflected in local newspapers are reproduced below.

In addition, innovative voice-to-text software has been installed on the computer inside the COVID ward with connectivity to a computer outside the ward, where case sheets are printed. This has been done to eliminate the use of paper records inside the ward to prevent the spread of the virus and also to avoid typing and contaminating the keyboard.

The patients were monitored round-the-clock by doctors, nurses and other healthcare workers. All the doctors, nurses and sanitary workers have been well-trained in the use of PPE, including donning and doffing.

A hospital administrative group was created with the Pro-Vice Chancellor of Medical and Health Sciences as Chairman and the Dean, Deputy Dean/Vice Principal, Medical Superintendent, Deputy Medical Superintendent, Chief of General Medicine, Nursing Superintendent, Administrative Heads of HR, Finance, Biomedical Engineering, Operations & IT. This committee met daily to assess the challenges faced by the hospital and plan remedial actions. By doing so, a coordinated action was initiated to control and manage COVID patients, as well as to protect all healthcare workers.

The Honourable Minister of Health and Family Welfare, the Government of Tamil Nadu, visited the hospital on April 16, 2020, and expressed profound satisfaction with the arrangements.

SRM Medical College Hospital and Research Centre was the only hospital in Tamil Nadu to be selected to conduct Phase I, II & III clinical trials of the indigenous vaccine, COVAXIN, developed by the Indian Council of Medical Research along with Bharat Biotech Ltd., Hyderabad. Dr. Satyajit Mohapatra, Professor of Clinical Pharmacology, was the principal investigator. While Phases I and II were completed in February 2021, Phase III is nearing completion by July 2021. COVAXIN has been cleared for emergency use. It has been administered to 50 million adults in India alone. Permission has been granted by the Biotechnology Industry Research Assistance Council (BIRAC), Govt. of India, to establish a clinical trial in our hospital for vaccination trials. Again, our hospital is the only centre selected for this purpose.

The second wave of the COVID-19 pandemic hit us like a tsunami in late March 2021, even as we were picking up pieces from the onslaught of the first wave. The second wave engulfed us with much more ferocity. Located on the outskirts of Chennai, Chengalpattu district reported the second-highest number of COVID-19 cases, next only to Chennai metropolis.

Several cases and variants with unusual presentations were encountered. The striking future of the second wave was a greater proportion of patients presenting with breathlessness and hypoxia requiring oxygen support. It was heartbreaking to witness young patients becoming breathless within minutes, with a drop in oxygen saturation levels leading to death. Indeed, oxygen was a ‘lifesaver’.

Owing to the fear and anxiety caused by the first wave, a vast number of people approached our hospital in the second wave. More COVID patients from other cities moved in as they were not finding a bed. More patients from rural areas came to our hospital as the pandemic spread far and wide. As more and more people became infected and fell sick, hospitals and health care centres became overwhelmed with patients who needed medical attention and lifesaving oxygen. The doctors and other Health Care Workers (HCW) who had toiled on in the first wave had become weary and tired. This was managed humanely by a rotation of the workforce, quarantining procedures, offering support, mental health counselling and individualistic interventions. With the sole purpose of serving fellow men and women, all staff members in our SRM Medical College Hospital continue to serve the ill and the needy.

The “Accident & Emergency” department was revamped, with the establishment of an additional emergency COVID ICU. Triage areas marked as ‘Orange’ and ‘Red’ are created and cordoned off.

All moderate-to-severely sick COVID patients are admitted to our hospital block. The hospital block is segregated into multiple areas: the COVID Wards (COVID Wards 1, 2, 3 & 4) for mild cases are housed on a separate floor, and the ‘Suspected COVID’ (Pro-tem) Ward is separate. About 600 patient beds are shared among these wards. The Intensive Care Units (ICUs) for very sick patients are converted to COVID ICUs with round-the-clock monitoring and supply of oxygen. Additional ICUs were created, taking the total number of COVID-19 ICU beds to 40. We enhanced our capacity to accommodate 200 patients who were positive with mild symptoms and did not need oxygen support in a separate ‘M’ Block (Medical Block), adjacent to the hospital. This block, an erstwhile hostel for students, which had been empty since the first wave, is being repurposed and converted into a medical facility in the shortest possible time.

Measures have been taken to optimize the use of liquid medical oxygen, which has become a precious and scarce commodity.

There is a huge need for ventilators, BiPAP and CPAP machines to deliver oxygen to COVID patients. We had, to some extent, augmented these by local purchases during the intervening period between the two waves of the pandemic. However, due to worldwide restrictions on transport and the breakdown of the supply chain, complicated by the surge in demand from every hospital, there is a shortage of life-saving oxygen concentrators and other essential equipment to fight the COVID-19 pandemic. With a predicted third wave, we have to double our efforts in this fight.

Immense help is received from our sister institutions and students worldwide in our fight against this virus. We would like to humbly acknowledge the support and appreciation of our kind-hearted donors, the Tzu Chi Foundation, Taiwan, -who at the time of this ‘once in a century disaster’ of the COVID-19 pandemic – are helping us. This keeps motivating us to do our best for our fellow human beings.

Oxygen Concentrator, Tzu Chi Foundation, Taiwan—Donation