We all are aware about the day to day spreading of coronavirus in India, and thousands of people are dying every day. The health system has completely collapsed, and the government and the system has failed to tackle the situation. Due to this, it becomes difficult to get covid bed in Delhi, but Mumbai handled the allocation of the beds very well. If other cities also adopt Mumbai’s model to fight corona and to allocate beds for covid patients, then the situation can get better.
So, let us see how Mumbai provided the facility of hospitals and doctors to all the needy?
A few days back, Mumbai recorded more than 10000 cases per day. And it was crucial to control the situation. To handle the situation, Mumbai adopted a process called triage.
Just think in this way, you are a doctor and you have two patients in front of you, one is 30 years old, and the other is 70 years old infected with the same disease, whom do you choose? In this situation, triage comes in.
Triage is the process of sorting people based on their need for medical treatment. This process is carried out in emergency rooms, during disasters, and in wars. We use triage when there are limited medical resources, and we have to decide who should get those resources.
It’s believed that this system was developed in the 19th century during the Napoleonic wars when the casualties rose dramatically. Dominique-Jean Larrey formulated it. The triage system evolved after World war I. Triage makes sure that the resources are being used on people who need them the most and have the best chances for survival.
For example, those who have the best chances of survival are in the highest priority. Second, are those for whom treatment could be delayed without risking their lives. Those who have minor injuries, come in third place. The fourth-place consists of those, whose condition is severe, or there are not enough resources available to treat them, or their chances of survival are least.
How Mumbai managed it
For a reliable triage system, we require data collection, data updating, and immense coordination. Brihanmumbai Municipal Corporation, BMC, predicted earlier that a triage system is essential to weather the pandemic. Hence, the BMC created 24 war rooms, one for each ward in Mumbai.
Every war room receives the list of COVID-19 positive patients from the private and government labs that are conducting RT-PCR tests. Twice daily, the testing labs have to inform the BMC about the positive reports. The war room finds out if a person tests positive before the person himself/herself. With this information, the war rooms create a list of patients before calling them individually.
The war rooms don’t depend solely on the labs. They also receive calls from people who have symptoms of COVID-19 and are still awaiting confirmatory reports. In addition, health workers do contact tracing on the ground also feed in data about those showing symptoms.
Working of War rooms
There are three groups of people in a war room.
- First are the BMC school teachers who are responsible for making calls.
- The second is the data entry operators who feed the data into the system.
- The third is the doctors who decide the line of treatment for patients.
The teachers call each person and record details including, oxygen saturation levels, symptoms, comorbidities, vaccine status, and the type of house they live in. Information about the house helps in deciding if the patient could be kept in home isolation or does he/she needs to get shifted to a government facility.
The data entry operators fill this information in a database, and the teachers see the dashboard filled with the information. They are shown the bed availability of the entire Mumbai. The teachers and data entry operators are responsible for collecting and filing this information.
Now comes the responsibility of doctors. Based on the data, the doctors prioritize patients- who need a hospital bed and who doesn’t; who needs oxygen and who doesn’t. Then they start coordinating with government hospitals about COVID-19 facilities. Ambulances are dispatched for the patients requiring hospitalization. If there’s no bed available in the patient’s ward, the war room allocates a bed in different wards.
The role of the triage center doesn’t end with dispatching ambulances for critical patients. The center constantly monitors patients with mild symptoms to ensure that their condition doesn’t decline. Teleconsultation helps in doing this work. The doctors monitor patients through a voice call or video call.
Benefits of the triage system:
There are three benefits of the triage system:
- First, since the war rooms have enough information, they can guide patients.
- Second, it makes people less anxious as they don’t have to run from one hospital to another.
- Third, it helps in controlling the virus. Like the BMC chief said, “a single patient could have infected 200 more in his/her hunt for hospital beds.”
But this system will only work if, instead of approaching the hospitals, patients go through war rooms. This is why BMC has ensured that only War rooms can allocate beds. But this doesn’t mean that a patient with a critical condition won’t be allowed inside a hospital without going through a war room; or that they can’t approach private hospitals.
Private hospitals don’t come under BMC’s jurisdiction. But the BMC has ensured that the critical patients must be admitted even if they haven’t called a war room. But the hospitals have to inform the war rooms immediately so that the dashboard can be updated. The system’s peculiarity is that the responsibilities are distributed at the ward level instead of the city’s command center. And this makes the process quicker.
Due to this system, as Chennai’s commissioner explained, patients aren’t helplessly waiting on the streets for treatment. And that is what exactly is happening in Delhi.
Situation in Delhi
Delhi established the triage policy in April 2020. And the government asked to provide facilities to all patients within one hour. The procedures of the policy in Delhi and Mumbai are the same. Once a patient tests positive, he/she is either hospitalized or kept under home isolation. During home isolation, a district team monitors the patient, and if their condition worsens, they would be taken to a hospital. The district medical officer arranges an ambulance for them. But the policy exists only on paper.
Triage is not a perfect solution but during a pandemic, it ensures that the medical resources are being used efficiently. Mumbai has shown significant progress due to this. This is how Mumbai’s model to fight corona saved many lives.