Dr. Muffazal Lakdawala, Founder Of The Digestive Health Institute, Helmed Mumbai’s First Jumbo Covid Isolation Facility At National Sports Club Of India’s Dome In Worli

I ACCEPT THIS AWARD ON BEHALF OF A LOT OF PEOPLE: THE BRAVE NURSES WHO RISKED THEIR LIVES AND WERE ALL UNTRAINED, NOT EVEN QUALIFIED. I STARTED WITH A GROUP OF 24 NURSES WHO HAD NOT CLEARED THEIR NURSING COLLEGE, AND ALL THE DOCTORS, PHYSIOTHERAPISTS WHO BECAME DOCTORS DURING THIS JOURNEY. A SPECIAL THANKS TO MR. ADITYA THACKREY BECAUSE WITHOUT HIS SUPPORT I WOULD HAVE NOT BEEN ABLE TO MAKE THE NSCI DOME FACILITY INTO WHAT IT IS. HE BACKED MY WILD IDEAS FROM ICU CONTAINERS TO EVERYTHING ELSE AND WE KNOW THAT WITHOUT POLITICAL BACKING IT IS VERY VERY DIFFICULT, AND ALSO MUNICIPAL COMMISSIONER IQBAL CHAHAL, I THANK THEM ALL. BUT MOSTLY TO ALL THE PATIENTS WHO KEPT A SMILE ON THEIR FACE THROUGH ALL THE DIFFICULT TIMES THEY FACED.

I had a few things when I started this journey: the first, to drive away fear because fear was the one thing killing more people than the actual disease. It was straight out of a movie: the sirens would blast the moment you came to know you are positive. In March, and early April, we were so scared.

The next thing was stigma. The municipal officers would come, the ambulance would take you away from your family, you didn’t know if you would be alive, come back and see them or probably you would never see them again. The myth was that if you are 60+ or diabetic, there are very few chances that you would survive. The other myth was: let’s start inhaling steam, start all kinds of hot gargle. Now, we know that in the hot climate, hot gargles and steams have
done little to save lives. If at all, they have managed to probably clear out your nose so you can breathe well. That is the extent of the curative effect.

I had to think out of the box. I told the Municipal Commissioner G South that the NSCI dome is a great facility to convert because we will soon run out of hospitals and we will not have any space. He asked if I could do it and I said, give me five days.

We divided it straight up into sections where one was for ladies and one was for gents, one was for old people and one was an isolated section for those at higher risk who needed oxygen. And, because NSCI already has hi-tech cameras, I could zoom into the finger of the patient and point out their pulse and oxygen. That is how our journey started and we started to save a few lives.

There was not too much money, so I thought of simpler measures. I read autopsy reports of about 50 patients from Italy and it said that what was killing people was tiny little blood clots. So, I put all of the diabetic patients above 50 years of age on blood thinners. And that Rs. 350 injection which I got with the help and support of lot of Rotarians like yourself and a lot of other CSR initiatives. That is why our mortality rates were shockingly and exceedingly low.

I promised all the 24 nurses that joined along with a group of seven doctors to manage 500 patients, that I will be the first one to get infected of Corona, if at all, I will protect you completely. In the beginning, I was going in wearing a PPE suit for 10 hours and it was extremely difficult because I used stringent guidelines. I would not allow anyone to go and take a bathroom break, no one was allowed to drink water, coffee, nothing. So the team was in PPE suits and even 10 minutes is torturous because at that time, we wore PPE suits that came from Taiwan and these had a PSM that was more than 200. Now, of course, it has come to 60s and 90s which are more breathable. At that time, these were not available. So, when you came out, there was a process of donning and doffing, and for doffing we created a buddy programme. I told two people to come out together so that one would observe the other remove the PPE because sometimes you make mistakes and the steps are not looked after. I can proudly say that these tiny little steps ensured that not a single doctor or nurse was infected in the five months I ran the NSCI dome. I am much more proud of that because if we had lost even one health care professional at this time, the morale of the entire team would have come down and, as it is, we didn’t have too many people to fight this war with us.

The other thing I did was to make a contact space. So, I first thought of putting the doctors in a separate space and patients in a separate space. This being a centrally air-conditioned space, it was impossible to actually do so. What happened was that when a doctor went in a PPE suit, he was as it is anxious, sweating and had his glasses fogging, his screen would be foggy, he would be irritable, the nurses would be irritable, and the patients didn’t have much time with the doctors. We had two doctors watch about 500 patients at six-six hour shifts with four nurses. It became difficult to personalise attention. We thought we would concentrate all our resources on those who are serious, those who needed complete care and that is where we started using hand wearable devices. We used IOT devices where the thing would come on my phone or computer screen and I could tell whether the patient’s saturation levels are dropping and we would move that patient, zoom in, get that patient on oxygen and save their life.

Then, because NSCI was not a hospital, I set up the ICUs in shipping containers, I also thought of how to reduce the contact time because that is where the maximum aerosolization of virus would spread. So, I thought how do I reduce this contact time between the doctor and the patient. First, I created oxygen coats so the patients could bathe in the oxygen, the other idea, I was actually castigated on Twitter from some people who actually didn’t know medical science as to why I was suggesting these jumbo massive cylinders to come up because when they asked the BMC engineers at Nair, KEM, Sion to begin with, how much oxygen you need? They said 5-8 litres and I said I need 60-80 litres per minute per patient. So, they though it was completely crazy. They were massive jumbo oxygen cylinders and now, we don’t know, many are saying that India is importing oxygen from abroad because we don’t have enough to save lives.

Then we had BKC, NESCO and various other facilities because I set up a guideline for these facilities and I became more of an advisory, I have a lot of young doctors, braver than me and I think the bravest of all were the nurses because they were going every single day wearing these PPEs. I have girls, young girls, actually throwing out in the PPE, some fainting on our hands, all this drama and action has happened while we were at the NSCI dome.
The other thing I noticed was that if you displaced fear, you managed to save, the irony is that in the five months that we were there, we went in everyday, fearlessly roaming around, people came in wearing masks and shields and gloves and everything, eventually people realised that though it was corona patients it was not much of a problem. We were walking around as if it is all common. We used to wear our masks but that was it. I never wore gloves; I was always against wearing gloves because unless you were touching patients physically it was no point wearing gloves. It was a false sense of security. I would rather sanitize my hands insanely often.

The other thing was keep up team morale. We would organise many things where you keep pepping up the members who were a little down and it then almost became like a family and I must thank all these people for being a part of this journey because while we were there, we were great.

We must thank the police officers because there are so many who succumbed to this disease, a lot of BMC officials too. All came out very bravely right in the front. I remember the first time we had the cyclone, we had 260 patients to be shifted out of BKC because they feared that the tents might be blown away due to the velocity of the wind and within three hours, we accommodated 260 patients in the NSCI dome. We stayed up whole night to make sure that every one was comfortable. The other tough time we had when the first rain hit the city and Mumbai was flooded out.

The wind velocity blew out the entire covering of NSCI and we had electricity disruption with 16 ICUs being treated. I stayed up the whole night to ensure we don’t have to shift any of these patients, we temporarily made oxygen available for 16 beds inside the dome and moved them there till morning, till we had back up. Another time was when two or the electricity servers (lines, board) blew up on us and the entire dome was going on only one and we were wondering what would happen if this closes up. So, we had 20,000 litres of diesel coming in the NSCI for the generators to run smoothly till the morning.

I also thank my wife, she was five months pregnant when I jumped into this fight and I didn’t even ask her if I could go or not, and she delivered when I was in the ICU. The other two people I’d like to thank is Dr. Nita because she came on board and we took all the pregnant ladies and we became the first CC2C facility taking everyone from two months pregnant to nine months pregnant because there was a lot of discrimination against them initially. Then, Dr. Arjun and Dr. Pankaj from the Tata hospital. Initially, nobody was ready to take on the cancer patients, so, I said would you like to join hands? So, they would come in everyday, they have treated over 300 cancer patients while they were at NSCI without even one mortality and I think that was some kind of record. Thanks to the Municipal officials who stood shoulder to shoulder in this fight going in all nooks and corners of the city, in the cramped slums.

And to say, what differentiates doctors here and the doctors abroad? It is the heart! Most doctors here have the heart and they would be ready to risk their lives to save yours and that is what we stayed on to do.

ROTARIANS ASK

What are the after-effects of COVID-19?
Covid not only kills in an acute phase but actually causes harm in a longer term. A lot of people were scared of getting reinfected. Now we do know that is happening across the world but it is extremely miniscule and people who are getting re-infected are probably not dying because of the Covid infection. There are rumours but don’t believe them. Now the Covid long term sequelae, it has sequelae like fibrosis of the lungs, so, we monitor these patients very closely. The one thing that can save you is steroids, during the acute phase of COVID-19. Then, people have died out of sudden heart attacks or had neurological problems suddenly within a month. So, we do D-Dimer test, to figure out the capability of your blood to clot. So, if your D-dimer is on the higher side, I would recommend either inject a blood thinner or an oral blood thinner close to 21 days a month. This will prevent a long-term sequela. Physiotherapy and yoga will help too.

Are obese people at higher risk of COVID-19 infection?
Obesity is a big killer. It is the mothership of all diseases and has been proven in COVID-19 times through worldwide statistics. So, yes, obese people have higher risk.

Indians seem to be less prone to Covid-19, given all the challenges, is there any scientific reason? In India male group is affected more than the female group. And the age group 50-65 is most vulnerable. Your comments.
The fatality rate in India is much lower, I do believe it. I think what we must realise that many of the slum’s population has been exposed to some form of corona virus, because we do know how they stay and maybe that has given them some form of innate immunity to fight corona. I don’t have any medical proof for it, it is my personal thought. It is not about age, but the genetic pre-disposition. We have acted early, and we have got ourselves prepared. About men and women, men are affected more that just shows that the Indian women are immune to anything.

We lost a lot of people in the early months because we were not giving blood thinners and we started using them much before WHO recommended it. It depends when you initiate the treatment. I would say, use pulse oximeter as your new stethoscope. Keep it at home. I feel there are three phases to corona, the first 10 days; where there are hardly any symptoms, you have started taking medicines, the second 10 days: it is the most to worry about, either it will decide that you go home and live happily or you go to the ICU or worse and the last 10 days if you have been in an ICU, you can either make it out or never. The second course decides everything. So, be careful from the 8th-10th day of corona.

Are children the silent carriers? And now with everything opening up, what care should we take?
Yes, children are silent carriers because they are majorly asymptomatic. They inter-mingle with one another, they can’t wear their Disney character masks all the time and, also, how often can you sanitize a child’s hand. So, be vigilant, don’t let your guard down. We have about six months left, and while we are there let us treat everyone as if they are COVID-19 positive and take all precautions.

Let’s not hug, keep social distancing, you can invite people home but don’t stick to one another, don’t share drinks, try and be in open spaces with cross ventilation rather than AC rooms, don’t wear masks while running outdoors, keep distance, when someone is coughing we go away but a person who will infect you is someone who is breathing heavily, or shouting. So, try and use these few basic rules, protect our old ones, make sure you sanitize and when you come home have a shower. Soap water does wonders, you can order from outside as much as you want but make sure that when you take out the food from the box, wash your hands and then touch the food. Don’t touch your face, as much as possible, and keep a sanitizer with you and wear a three-layer mask. That’s it!