By now, the world has witnessed the chaos, mayhem and turmoil along with the echoes of devastated pleas by the citizens of India, on account of the second wave of COVID-19. From shortage of oxygen cylinders to hospital beds, the struggle has been widespread. Latest data shows the death talleys of India has exceeded 329K.
During March of 2021, the number of daily cases grew staggeringly fast in Mumbai. They alarmingly hit a peak of nearly 10,000 cases daily in the first week of April, shattering all the previous records. Eventually, Mumbai cases stabilized to around 61 deaths per day by the end of April. As the scenario gradually improved for Mumbai, the same couldn’t be seen in Delhi.
After thorough analysis, the reasons Mumbai is indeed faring better than Delhi can be narrowed down to some major factors : caseloads, population, number of hospitals, maintenance of COVID-19 protocols, etc. But the key reason has been by far proper implementation of the triage system. Although both of the cities started off with the triage strategy- only Mumbai followed through adequately whereas in Delhi the concept of it merely existed on paper.
TRIAGE LEADING THE WAY
Triage is a sorting method by which patients are sorted into groups based on the severity of their conditions. Through this process, during times of war, devastating emergencies like 9/11 or Rana Plaza crisis, emergency rooms- priority of patients are decided by likelihood of recovery to make the utmost best use of limited resources. The main mechanism of “War Rooms” in India is currently based on the triage system. Originally, the triage process was developed in the 19th century during the Napoleonic wars by a French surgeon and military doctor when casualties were off the chart and evolved during World War I.
IMPLEMENTING TRIAGE DURING COVID
Let us delve into how the triage system has actually been put into work in the current war rooms. As mentioned before, the heart of the process is making the best use of limited resources. To do so the patients are categorized according to the severity of their conditions. The first priority is given to the patients who require immediate treatment due to their criticality but also have the best chance of recovering. Then come the patients who are in serious conditions but whose treatment can be delayed without risking their lives, in contrast to the first category. The third group consists of people who have minor casualties. The last category comprises patients that have barely any chance of surviving and the medical resources they require are simply not available. Unfortunately, this is the underlying reason so many hospitals have been turning away patients in the face of adversity, the pandemic has made medical frontliners make difficult calls like such to save as many lives as they can.
To ensure proper use of the triage process, 3 steps needed to be closely followed during the pandemic: data collection, data updating, and immense coordination.
These were handled by three groups of people in the war rooms: teachers, data entry operators and doctors.
A LOOK INTO THE WAR ROOMS
Teachers were responsible for calling up enlisted patients and recording details including their oxygen saturation, comorbidities, vaccine status, symptoms and what kind of house they inhabit. The last question may seem redundant but is how the front liner fighters decide who needs to be shifted in a government facility and who better remain at home. Based on their collected data, the data entry operators feed the data into the system. The database is then visible to the teachers and they get to see the number of available beds in the entire Mumbai in their dashboard, in real time. The doctors then decide what to do with the patients. As per the data at disposal, the doctors then start deciding who needs oxygen, who doesn’t, who needs to be hospitalized and who needs home isolation accordingly. Moreover, ambulances are sent for patients who need hospitalization. If their respective wards cannot accommodate them, they are instantly sent to an available ward based on the database’s information.
But the war rooms don’t solely depend on labs, they also get calls from people who suspect themselves of being positive are still waiting for confirmation reports. Besides, health workers and volunteers doing contact tracing in ground-level also add to the database. The war rooms remain active 24 hrs a day, 7 days a week in 3 shifts guiding patients instead of having them roam aimlessly in despair, credit goes to the real time database and relentless efforts of the trained front liners. Decentralising Mumbai into wards truly served the purpose in calming down the raging number of cases. Furthermore, triage centers are also being used to screen Covid-19 cases and break down into plan the next course of actions based on the severity of symptoms.
However, the scene has not been quite the same in Delhi. With a healthcare system bursting into seams followed by a myriad of delayed test results, no calls or follow ups from authorities for days- all fed into the collapse of Delhi’s disaster control plans. reflected in many people taking sick relatives from hospital to hospital without direction from authorities.
Amidst the deluge of cases, the sufferings have left people absolutely devastated. By the end of April, Delhi’s single day case spikes were overtaking Mumbai by nearly four folds. There has been a clear striking difference in terms of testing as well, while Delhi reported crossing 10 million tests in its 11 districts, there have been 5 million as per BMC. The numbers alone show the declining state of Delhi. Also, Mumbai’s “jumbo” field hospitals carry 40% of its present capacity, built during the first wave. Mumbai authorities made the wise decision of keeping it all set up whereas many cities closed shop on theirs.
Although both of the big cities realised headfirst that the triage system was crucial to weather the pandemic, only Mumbai followed through with protocols and procedures whereas Delhi fell short immensely, costing hundreds and hundreds of lives. Currently, Mumbai is being considered as a role model for not just Delhi but many other states due to their remarkable turnaround.
By Tasnuva Tasfia Puspita