Holding Down the Fort

I was thinking about taking a long hot shower but the crowd gathered outside made me change my mind. I jumped out of the shower, wiped myself with a sterile towel and ripped open a sterile protective kit that looked like an astronaut’s suit. It was white with red lining around the edges and came in a single piece. I had to work my way into it with both feet in first and then the arms. A new sterile pair of protective eyeglasses looked stylish to me and I thought maybe I should ask the nursing in-charge for a pair to wear on my motorcycle.

As I moved from the shower to the dressing area, I could already hear a crowd of impatient patients arguing with the nursing staff. As I entered the waiting area there was a momentary pause. One of the younger patients gave me a frightened look, turned to her mother and pulled her into a suffocating embrace. I handed out masks to all of the patients and their attendants and asked them to remain calm. I then handed them questionnaires to fill.

Flu season was taking its toll. The number of flu cases had increased since November and a surprisingly large number of people were testing positive for the H1N1 virus. In addition to that, regular seasonal flu, which hits around October-November, was creating confusion among the inhabitants. We were receiving almost 30 to 70 patients daily from various nearby centers.

We could not sample all 70 every day, so the team came to a consensus that we would only sample those who have the symptoms of the virus, which in itself was a difficult task. All kinds of flu have the same symptoms. Ultimately, we landed with approximately 20 to 30 swabs per day, much to the dismay of the virologists, who had collected in the hospital with their kits so as to limit themselves to the labs for real time PCR.

The child was still holding on to her mother when I asked her to open her mouth for the throat swab. Instead, she coughed out a secretion over my astronaut-suit, but I was lucky that I was able to get the sample. When I went in again for the nasal swab, she screamed as if I was some kind of psychopath trying to kill her. After I had dispatched her sample to the lab, I realized that I would be taking 10 more of those in the morning.

A group of students from the engineering college nearby were also there, trying to talk their way through the security guards. The intelligent people at the college had decided to go ahead with their annual fall festival despite the national Indian warning against large social gatherings. Approximately two to three thousand interstate visitors gathered around the college premises to make the festival a great success. The next day they suddenly realized that quite a few of them had become febrile. Obviously too late to limit the spread. Consequently, this group of students landed in the isolation wing of the hospital for screening. I asked them to wear masks, remain calm and stop talking among themselves.

Among the ten males only one looked sick enough for me to intervene. So I decided, after consulting with my infectious disease specialist, to send only the specimen of that particular individual. We gave symptomatic treatment to those who had some of the symptoms but decided not to sample them. Most of them were there simply because they were panic stricken.

There were a few couples with sons and daughters who had fevers and running noses. They were the braver ones. They wanted to do things right so were compliant and calm when I sampled their children. Mothers were anxious. Their weary eyes were always involuntarily asking me for instructions. Their concern was well-founded as a seventeen year old girl became the first mortality in the union territory after four months of the pandemic. That was a first for us, so for children, the policy was simple: if they were sick, we admitted and sampled them.

The student from the engineering college tested positive. He was admitted in the ward and we started him on the medicine (Oseltamivir; popularly known as Tamiflu) as he was showing signs of deterioration. Fortunately for him, his condition improved within three days of medication and we discharged him on the fifth day.

This flu had consequences for the residents of the hospital that were hilarious for me. Every day five to eight residents would think they had caught the flu. We seriously discouraged thoughtless specimen collection but however hard we tried, two or three residents would convince us for a screening, only for everyone to test negative eventually.

For Chandigarh, this pandemic has come late. No chaos so far. Schools have closed down for the season. The engineering college has closed down until further notice. Many patients are on treatment and home isolation. Innumerable contacts are on prophylaxis. There have been four fatalities. There are only two residents (including me) to tackle all the patients, with one infectious disease specialist and emergency medicine specialists as our back up. The whole union territory health department and their nodal officers are there for bureaucratic back up. Not to mention the efficient virologists who dig out the H1N1.

As for us two residents, we are both geared up. Well protected. Without prophylaxis, trying to hold the fort till the enemy gives up.