My Story of the Pandemic
-Dr. Anusha Rohit
Senior Consultant & Head of Department of Microbiology,
Chair – Infection control, Madras Medical Mission, Chennai
- THE PLOT, THE SITUATION AT LAB – WHEN THE PANDEMIC STARTED 18 MONTHS AGO
The management of Madras Medical Mission took a keen interest in how we functioned and responded well to the pandemic. The Hon. Secretary, Mr. M M Philip, first created a core team that included clinicians, administrative directors and infection control specialists. The key success of the core team was because we were ahead of the outbreak at every step. We met every day to discuss new suggestions and measures that needed to be instituted. Every suggestion that was put up by the core team was weighed in, the pros and cons evaluated and then put into action by the hospital management.
Planning and response
Before we got our first case of COVID-19, we trained all staff to handle patients – if brought into the Emergency – with multiple drills and training sessions. A sample collection kiosk was created that ensured staff safety in line with the Walk-In Sample Kiosks (WISK). We sourced and stockpiled PPE, including masks, face shields, and coveralls, and improved our supply chain. Every mask was tested. We felt in the pandemic, it was better to overdo our protocols and responses, thus keeping every healthcare worker safe rather than put them in any peril. We had not yet received permission to test in-house and hence we were outsourcing the test.
In-house testing services
We received permission to be a testing center on the 27th of April, 2020; but getting kits and consumables was the next herculean task ahead. In addition to the existing testing system that we
already had permission to test with, we procured a new point-of-care system that had obtained NABL certification and ICMR approval all in a span of 15 days. The lab staff was geared up for a long haul. More than 6 positions were created so as to avoid overburdening the staff. However, testing on many days went on till wee hours in the morning. We, in the laboratory, decided not to keep pending samples for the next day. So, we had to test on the same day. Using the point-of-care test, we could only restrict the number of tests in an hour. Further, there were challenges associated with data entry into the ICMR app and the pressure to complete the job on time without error. Eventually, we started having more personnel on the night shift and invested in another system to test. This eased the situation a great deal. Being in charge of infection control in the hospital, I had the additional responsibility of setting protocols in the clinical areas.
Phase I: During Lock-down
Our Outpatient departments (OPDs) were planned such that all of the OPDs were shifted to the block that had good ventilation and open windows. The intensive care units (ICUs), Operation Theatre, CATH-lab complex, and wards were in a building with Air Handling Units (AHUs). HEPA filters were placed at important ICUs and the staff were trained periodically. Very stringent measures were put in place as we saw that most hospitals had started Covid-19 care but many patients had no access to cardiac care, nephrology, and dialysis or deliveries. So we decided to concentrate on our strengths and provide that support to Chennai residents. All patients and attendants of patients undergoing a procedure during hospital stay were tested by RT-PCR. No visitors were allowed. All patients and attendants were tested by RT-PCR. A total of about 70,000 patients and attendants have been tested so far.
Phase 2: Post lockdown
As the number of cases started increasing, we opened a Covid-19 ward with 18 beds and 5 ICU beds on the fifth floor of the building with the set up of infrastructure like ventilation and exhausts and negative pressure ICUs being created. This facility not only treated mild to moderate cases of COVID-19 but also supported staff and their families who tested positive. Patient attendant waiting areas were made in the open air such that good ventilation is ensured when keeping their comfort in mind. Patient visits were slotted and overcrowding was avoided to the maximum. Hand hygiene and masking were compulsory. All ICUs and OT staff wore N95 masks and face shields. All other staff wore surgical masks. Sick Staff were sent to the fever clinic and tested and only allowed back to work if they tested negative.
Hand hygiene and masking were compulsory. Vaccination against Covid-19 had just begun and the hospital was immediately enrolled. Training and awareness programs on vaccinations were repeatedly conducted to encourage vaccination and allay fears of the employees.
The Delta Wave
When everything seemed to be just getting back to normal and we were reporting 2-3% positive patients per day. On one fine day, 17 people tested positive, which created panic. In fact, we got so worried after the fifth positive case that we stopped testing and ran controls in between the day. It was only later that we discovered that the 2nd wave had begun, caused by the dreaded Delta variant. We started clocking the increased number of healthcare workers testing positive too. Hence we had to retrain on masking and other COVID-19-appropriate behavior. For most hospitals, admissions in the COVID-19 ward are down and life is getting back to normal. But I take this opportunity to appreciate every laboratory technologist as the positives are lower but the number of tests have not reduced. We still do a lot of testing but thankfully the number of positives has reduced.
- THE ADJUSTMENTS IN PERSONAL, PROFESSIONAL LIFE
Life has become busier post-pandemic. We could not take a single day off and the pressure to give quick reports is still on. I have lesser time to spend at home and even at home, I am constantly bombarded with requests for early reports and coordination with the lab and the clinician constantly. However, on the up-side, the value of laboratory medicine is better recognized, and it is easier for people to understand the need for heightened infection control practices. I am also thankful that so many labs are now accredited to test for Covid-19 by RT-PCR. As an assessor for National Accreditation Board for Laboratories, I have done numerous online assessments. The NABL and ICMR have provided yeoman service to this country by recognizing the need for testing, providing quality testing in labs, and maintaining the need for quality testing through accreditation. It has helped the country be equipped for many more tests in the future too.
- EMOTIONAL BREAKDOWNS
The toll taken by this pandemic on the human mind is unfathomable. The whole process of testing and infection control has been a very emotional journey. However, the feeling at the end of 18 months is a relief. Relief that we have hopefully gone through the worst and we made it through… we did not have a single staff life lost to Covid-19. We have done well with vaccination too… both as a country and in our hospital. Covid-19 has changed us for good. Infection prevention has become everybody’s business.
4. ROLE PLAYED BY PEERS, FRIENDS, STAFF, FAMILY AS A STRONG PILLAR OF SUPPORT
At the outset, I would first like to place on record my thanks to my staff in the laboratory who have worked unceasingly throughout this pandemic and continue to do so. I would like to thank the hospital management for understanding our need as far as manpower and machine is concerned and helping us put it in place. I would also like to thank my colleagues in the hospital who abided by the hospital infection policy and helped in combating this outbreak. I am most grateful for the love, support, and understanding of my family, my husband, parents-in-law, parents, and sister. I have hardly spent time at home. Even when at home, I have constantly been in touch with the laboratory and the hospital. Their support has been immense. I could not have made it through in one piece both physically and mentally, if not for them.
5. SOMETHING EXTRAORDINARY ACTIVITY MAY BE A PRACTICAL INNOVATION / ARTICLE / TEACHING / WEBINAR / TRAINING THAT TOOK PLACE DURING THE PANDEMIC
The best part of the outbreak is that we realized that talks can happen online, audits can happen online and the need for travel can be reduced. I have been involved in a lot of teaching, training, and auditing online
6. ALSO A BRIEF ABOUT ANY STUDY / PAPERS THAT WAS PUBLISHED
- Paper 01: - During the 1st wave, we saw a huge increase in the number of cases of Covid-19 in the West compared to tropical countries. This is when I spoke to an air expert, Mr. Shankar Rajasekaran, and we came up with the paper
Anusha Rohit, Shankar Rajasekaran, Indrani Karunasagar, Iddya Karunasagar.
The fate of the respiratory droplets in the tropical v/s the temperate environments and implications for SARS-CoV-2 transmission. Medical Hypotheses 144 (2020) 109958 https://doi.org/10.1016/j.mehy.2020.109958).
- Paper 02: -During the 1st wave when little was known on variants and sequencing was not common, we noticed a sizable number of patients who tested negative for E gene but positive for ORF1A or N or RdRp gene. This led us to study the GSAID sequences and we came up with this paper
Kumar BK, Rohit A, Prithvisagar K S, Rai P, Karunasagar I, Karunasagar I.
Deletion in the C-terminal region of the envelope glycoprotein in some of the Indian SARS-CoV-2 genome. Virus Research. 2020.
DOI: http://doi.org/10.1016/j.viruses.2020.198222
- Paper 03: -The nephrology department saw a number of cases with different presentation. This was described in the next paper we wrote,
Abraham G, Rohit A, Mathew M, Parthasarathy R.
Successful automated peritoneal dialysis (APD) in a COVID-19 positive chronic kidney disease (CKD) stage5 patient with acalculous pancreatitis with NO detectable virus in the dialysate effluent, Indian Journal of Medical Microbiology.
https://doi.org/10.1016/j.ijmmb.2020.11.004
- Paper 04:- During the 1st part of the outbreak when there was shortage of masks, we also did experiments on extended use and reuse of masks. This study then happened to be published as
Anusha Rohit, S. Rajasekaran, S. Shenoy, S. Rai, I. Karunasagar, S.K. Dorairajan. 2021. Reprocessing N95 masks: Experience from a resource limited setting in India. Int. J. Infect. Dis. 104: 41-44.
Other than that, we published on antimicrobial resistance and the work from the lab that happened routinely.
- Paper 05:- Rohit A, Rani MS, Anand NS, Chellappa C, Mohanapriya P, Karunasagar I, Karunasagar I, Deekshit VK. Burkholdaria vietnameinsis causing a non-lactational breast abscess in a non-cystic fibrosis patient in Tamil Nadu, India. Indian J Med Microbiol. 2020; 38: 496-9
- Paper 06 :- Kesavelu D, Rohit A, Karunasagar I, Karunasagar I. Composition and laboratory correlation of commercial probiotics in India. Cureus 2020; 12(11): e11334. Doi: 10.7759/cureus.11334
- Paper 07 :- Carrara E, Alessia Savoldi , Laura J.V. Piddock , Francois Franceschi , Sally Ellis , Mike Sharland , Adrian John Brink , Patrick N.A. Harris, Gabriel Levy-Hara , Anusha Rohit ,Constantinos Tsioutis , Hiba Zayyad , Christian Giske , Margherita Chiamenti , Damiano Bragantini , Elda Righi , Anna Gorska , Evelina Tacconelli. Clinical management of severe infections caused by carbapenem -resistant gram-negative bacteria: a worldwide cross-sectional survey addressing the use of antibiotic combinations, Clinical Microbiology and Infection, https://doi.org/10.1016/j.cmi.2021.05.002
- Paper 08 :- Aditya, V., Kotian, A., Saikrishnan, S., Rohit, A., Mithoor, D., Karunasagar, I. Deekshit VK. (2021) Effect of ciprofloxacin and in vitro gut conditions on biofilm of Escherichia coli isolated from clinical and environmental sources. Journal of Applied Microbiology, 00, 1– 14. https://doi.org/10.1111/jam.15249
- Paper 09:- Tarun K Jeloka, Georgi Abraham, AK Bhalla, J Balasubramaniam, A Dutta, Gokulnath , Amit Gupta, V Jha, Umesh Khanna, Sandeep Mahajan, KS Nayak, KN Prasad, Narayan Prasad, Manish Rathi, Sreebhushan Raju, Anusha Rohit, Manisha Sahay, K Sampathkumar, V Sivakumar, Santosh Varughese. Continuous ambulatory peritoneal dialysis peritonitis guidelines – Consensus statement of peritoneal dialysis society of India - 2020. Indian J Nephrol 2021;31:425-34.
- Paper 10: - Shraddha Rani Modapathi, Anusha Rohit, Vankadari Aditya, Varsha Prakash Shetty, Akshatha Kotian, Mohanapriya, Praveen Rai, Indrani Karunasagar, Vijaya Kumar Deekshit. Comparative analysis of different methods used for molecular characterization of Burkholderia cepacia complex isolated from noncystic fibrosis conditions. Indian Journal of Medical Microbiology, 2021, ISSN 0255-0857, https://doi.org/10.1016/j.ijmmb.2021.09.012.
We also released our book that we were working on Abraham G, Rohit A.
“Handbook of Renal transplantation in Developing countries”. Oxford Clinical Practice Series, Edited by Georgi Abraham and Anusha Rohit, Oxford University press.