11.35pm: 43, female. Cough, fever for 3 days 11.35pm: Sharing her CT scan. Can radiologist look n help in severity grading? Seems mild to mod covid.
Shridhar Singh wasn’t sure if the woman sitting across the table from him had covid-19. The orthopaedic surgeon at the government hospital in Jammu and Kashmir’s (J&K’s) Budgam district sent his query and the CT scan on COVID CLINIC I, a WhatsApp group of over 250 doctors from J&K and Ladakh.
The woman had complained of a constant headache and had a runny nose. The rapid antigen test was negative. But Dr Singh wasn’t convinced. He ran a CT scan, which seemed to indicate a mild infection, but as a doctor whose speciality is the musculoskeletal system, he wasn’t completely confident of his reading of the lungs. So, he consulted the WhatsApp group. The reply came within 30 seconds.
11.35pm: CT SEVERITY SCORE IS 10...MODERATE CASE
A RT-PCR test confirmed the patient indeed had a moderate case of covid-19.
COVID CLINIC I has become the go-to helpline for doctors in J&K, who have been without high-speed internet for more than a year and feel a heightened need for connectivity while treating a new disease. It was created by a group of doctors on 15 July as an active community of medical experts to inform, update and help each other deal with queries, doubts and the crisis brought on by the pandemic. One moment, a physician in Pulwama is asking if Favipiravir can be used for covid-19 pneumonia, the next, a Srinagar-based cardiologist is sharing an article on how covid-19 ravages the body. This is followed by a query from a Leh-based pulmonologist about whether to recommend home isolation or hospital admission for a case. Minutes into the WhatsApp group, you know you are in a war zone, fighting an invisible enemy—but with lifelines of support from afar.
The medical community has come to depend on such WhatsApp and Telegram groups and Zoom webinars for updates on the latest research and medical developments during the pandemic. Unlike medical experts in other regions who are able to monitor real-time global breakthroughs, and share the treatment responses of patients, front-line workers in J&K are engaged in a more complex battle. Ever since Parliament effectively revoked Article 370 of the Constitution and turned it into a Union territory last year, J&K has been living on 2G.
“We have broadband at home but when we are at work it’s all 2G. That’s why the WhatsApp solution came into being,” says Nasir Shamas, one of the doctors who came up with the idea of forming COVID CLINIC I and COVID CLINIC II, another group formed to expand the network since WhatsApp doesn’t allow more than 256 members on a group.
Besides treating those hospitalized, the doctors also use WhatsApp to address people’s concerns through direct phone calls and WhatsApp messages.
“The combined effort of all doctors has helped us keep up the fight,” adds Dr Shamas, a consultant physician at Srinagar’s Jawahar Lal Nehru Memorial Hospital covid-19 facility.
The groups are especially useful for junior doctors or those from different fields who may not be fully equipped to diagnose whether the patient in front of them is infected with the virus. “We all started preparing for the virus early March but you can’t increase medical capabilities in a span of five-six months. You can’t expect an anaesthesiologist to quickly shift to taking care of patients on ventilators. It takes years. For an ortho like me, sometimes it becomes very difficult to figure out if a patient has covid. This is where COVID CLINIC comes to my rescue,” says Dr Singh.
These groups are like a “virtual classroom”, explains Seema Hamid, who has been part of COVID CLINIC I from Day 1. “We share whatever information we receive from fellow doctors. If I speak to a doctor in Delhi or the US, I will share it in the group so that the members know about it and they share it with people outside,” adds Dr Hamid, the medical officer in charge of the urban primary health centre in Sangam, a rural cluster of 4,000 people near Srinagar.
There was one occasion, for instance, when two patients tested negative for covid-19 in a rapid test. Unconvinced, Dr Hamid turned to the group for help. “I had just recovered from covid myself and I wasn’t sure. They suggested another test and eventually results turned out positive,” she recalls. “It’s during these moments that you realize you are not alone despite being so far from each other and not being able to see each other’s faces.”
“When you see a patient who is breathless, you try to give them oxygen. But when even that doesn’t work, what do you do? You lack experience and you don’t have the signal on your phone to google or video-call your senior. You feel helpless. That’s when these chats help,” explains Dr Hamid.
WhatsApp networking, along with government efforts and initiatives by mohalla communities to raise funds for medical supplies like ventilators and create awareness about the virus, seems to have had an impact. Despite a surge in mortalities and number of positive cases in J&K, the recovery rate in August jumped to 70%, from 60% a month earlier. Till 31 August, of the total 37,698 cases, 29,015 people had been cured and discharged.
A strong community also helps in dealing with the mental stress that comes with fighting the pandemic—particularly if front-line workers cannot see the faces of friends and family even on video-call at a time when India is reporting the world’s second highest number of novel coronavirus cases, and J&K itself has been recording more than 1,000 cases daily over the past week.
About 300km from Srinagar, in Jammu’s Doda district, a young MBBS doctor at a government hospital, who doesn’t wish to be named, says he has been struggling with the influx of patients for the past few months. He’s among the six doctors at a hospital that caters to a population of about 100,000.
“We see so many patients every day, there’s a strong possibility we might miss something,” he says. “Our WhatsApp group is helping us but fast and stable internet would have allowed us to stay connected with them over a video call and that would have ensured a better diagnosis.”
The added stress of exposing his two young children at home to the virus also keeps him awake at night. “When I reach home after my shift, I see them waiting for me at the door and I can’t even hug them. It’s heartbreaking,” he says.
It’s during such moments that the doctor community on the two WhatsApp groups helps bolster morale. “Knowing that there are people with me all the time and they are facing similar challenges gives me strength,” he says.
For Dr Singh too, the nights are difficult. “My family is in Delhi. Most of the time, the net connection doesn’t support video calls,” he says. “We are fighting something we have never ever seen and it’s not even visible. Is it too much to ask that we at least see each other’s faces?”