Year : 2020 | Volume
: 13 | Issue : 6 | Page : 595--597
Institutional quarantine center of North Bengal Medical College: A novel concept
Department of Community Medicine, North Bengal Medical College, Siliguri, West Bengal, India
Department of Community Medicine, North Bengal Medical College, Siliguri, West Bengal
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Ghosh N. Institutional quarantine center of North Bengal Medical College: A novel concept.Med J DY Patil Vidyapeeth 2020;13:595-597
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Ghosh N. Institutional quarantine center of North Bengal Medical College: A novel concept. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2021 Jan 20 ];13:595-597
Available from: https://www.mjdrdypv.org/text.asp?2020/13/6/595/300137
“People felt lost in crowd, now feel connected in isolation/quarantine”
Since the advent and spread of COVID-19 globally and confirmation of human-to-human transmission by the World Health Organization, various strategies have been formulated in unison all over the world to contain the threat and tide over the crisis. With high infectivity and Ro (basic reproduction rate) of 2.4, it is now known that asymptomatic carriers are the main source of transmission. Hence, isolation of the symptomatic exposed and quarantine of the asymptomatic yet exposed with periodic testing is being implemented with rigor to attain desirable outcomes.
For those not able to adhere to home quarantine criteria like people having workplace away from their hometown or other conditions and contacts of COVID-positive cases, provision of state quarantine facilities was made. Government identified few hotels and lodges for the quarantine facility and it was made functional with all essential amenities being provided at government's cost. Few paid quarantines were also identified. However, in a country like India, it started overflowing soon and complaints regarding basic facilities also heaped up, which is uncalled for, considering it being a crisis situation like never before. More and more institutions were roped in for the government quarantine centers. Circumstances need to be dealt with patience as health care workers are risking the lives to control the dreaded pandemic.
In this context and under such challenging circumstances, North Bengal Medical College (NBMCH), a rural tertiary rural medical college located in foothills of Himalayas, struggling with manpower and logistic issues, opened its own institutional quarantine center at a distance of just 500 m from the college. It was opened strictly adhering to the government guidelines. The center was created in a facility hired at institution's expense and personally supervised by institutional head, medical superintendent cum vice principal, institutional rapid response team members, and the Institutional Quarantine Committee. Administrative challenges faced were mostly during setting up and making the facility operationally feasible alternative to the state-run institutional quarantine centers as this is the only one in the entire West Bengal. There are no financial implications to the study. The rooms were personally inspected, sanitized, cleaned, and reoriented appropriately for quarantine. Meals, drinking water, and other essentials such as medicines and emergency provisions were made available with college support round the clock. Two trained nursing staffs and two guards are also appointed for smooth functioning. Nursing staffs wearing adequate protective gear took clinical notes of all residents and maintained records. It was visited by college authorities at regular intervals. A Greenzen Bio vehicle with dedicated garbage collector was designated to collect and dispose wastes regularly. The facility is a residential complex having 30 rooms with a sprawling garden located safely with residential building and shops all around.
Standard operating procedures and guidelines issued by governments (state and central) from time to time were followed regarding admission to and discharge from quarantine facility. At the time of discharge, an institutional quarantine certificate was issued along with report of being COVID-19 negative. It is one of its kind in entire state and no other medical college has yet it's own institutional quarantine Center. It is one of its kinds in West Bengal. Hence, when one doctor tested positive while coming from Kolkata, the government bus carrying all the 27 senior doctors could be quarantined together at a place. Such a place is difficult to arrange in Darjeeling district due to the geographical terrains and its limitations. Moreover, the doctors did not have to stay with general population and could stay under ambit of North Bengal Medical College and Hospital (NBMCH) directly and very near to it. Hence, in other medical colleges, their staffs have to be quarantined with general population. However, as every endeavor comes with its own challenges, this also stands no exception.
The center is spacious and comfortable and was earlier used to host various functions. Local people were initially reluctant to give away the building for the Quarantine purpose but later relented readily after explaining the benefits and implications. The center required regular cleaning, sanitization, record maintenance, timely supply of meals and water, waste disposal management, attending to any emergency calls or needs of boarders, arranging on site specimen collection for testing, and a dedicated quarantine team for its overall smooth functioning. It was all arranged with support and approval of District Magistrate, Darjeeling district, after hours of meticulous planning and dedicated work. Health care workers of various cadres like doctors, nurses, paramedical staffs, Gr.D Staffs working in the college were eligible to stay there. protocol or got inadvertently exposed. Screening clinic and isolation wards running successfully in NBMCH bore the maximum brunt of inadvertent exposure to COVID suspect or positive cases and often got sheltered in the institutional quarantine center to tide over crisis as majority of the on-duty health staffs lived in lodges and hostels.
Just 15 days back an unfortunate incident occurred. A team of 27 senior doctors travelled from red zone of Kolkata to NBMCH in a government provided bus. One of them was tested COVID positive on arrival day when all travelers were being tested before joining duties. The college authorities were quick to respond and they were all stationed in the quarantine center after briefing them the cause and patiently explaining them hazards of living in a lodge where other people were also staying. Apart from supplying all essentials, regular visits were done by college authorities.
However, unfortunately when the grave news was disclosed the usual phases of anger, denial, frustration occurred. Finally they accepted the news. Though from the same college due to panic and fear they complained uncomfortable stay. They expressed dismay over not being able to stay in their comfort zones of the private lodges as they hosted other boarders as well. They cited sense of insecurity and confinement. Moreover, moving into the government quarantine facilities with general population at places which were located more than 15 km away from college was also not a feasible and acceptable option by the senior medical professionals leaving apart the fact they were yet to be ready for a move-in arrangement of the doctors overnight on an emergency basis.
Authorities realized that trauma and fatigue of the 12 hour long night journey and the sudden course of events was the reason for initial hiccups. However they finally complied and accepted the institutional quarantine center as the quarantine stay arrangement for 14 days. Alternate arrangements were sought. It was reasoned and reinforced along with district authorities that all the criteria set for 'home quarantine' could not be met in a private public lodging. Local civil authorities were summoned to seal any broken crevices and fix the doors and broken windows if any in the Bhavan, as complained. Situation resolved amicably and the usual testing and quarantine protocol for a primary contact of positive cases were followed. The infrastructural issues were tried to be sorted to the best of abilities in these tough times.
The article reinstates that during these COVID-19 times, any new modality is a double-edged sword, yet the arrangement needs to be made depending on the perceived benefits rather than evidence-based medicine. Very few medical colleges in South India, especially Vellore and Kerala, have their own such set up (unpublished). Thus, this novel challenging endeavor of having an institutional quarantine for dedicated health-care workers near to the college was taken up with zeal and enthusiasm. Notwithstanding the limitations, the center is still functional and helps even the district authorities to send their health-care staff for quarantine at this center. As COVID is an unprecedented situation, it calls for team work. Finding solutions to emerging problems has to be done by hand holding with more dedicated time and effort of all stakeholders. It was seen and reiterated that faultfinding attitude and punitive actions has to take a back seat. At these tough times and grim situations collective participatory compliant approach is needed to strive for improvement as a team. An able leadership and guidance are need of the hour.
It is a novel concept in West Bengal where a rural tertiary medical college has its own quarantine center which is manned by its own staff and funded by the college. Due to the strategic location near border and in foothills of Himalayas it caters a huge population burden who reside in remote difficult terrains. Darjeeling district administration has its own unique set of challenges due to the geographical distribution and COVID 19 pandemic has increased the constraints manifold. Hence a sudden need of residential space for 25 doctors would have been very difficult to arrange for them at one night notice. As doctors working in NBMCH often stay in lodges since their families stay away in Kolkata at a distance of more than 600 km, their residing in lodges was also not operationally feasible. This center came to the rescue as it caters all tiers of health care workers of the college along with catering district officials as well. Thus the anticipated benefit was proven beyond measure at time of this antecedent crisis.
NBMCH has a dedicated team with leading clinicians as eminent leaders who work round the clock ensuring smooth functioning of the rapid response team when motivating other health-care staffs in the process. Equipping the quarantine center with more modern facilities, liberal funding, giving more autonomy to college authorities, and sealing the identified gaps will help in creating a state of art institutional quarantine center for NBMCH. This model may be replicated in other medical colleges at state and national level. Such centers will be a moral boost to the health-care workers who are risking their and their families' life every day. The team spirit and ownership of the concept will motivate the institutional COVID-19 team to further formulate user-friendly strategies since it is anticipated that the facility will be needed by one and all health-care working staffs of any institution at some point of time or other.
Authors acknowledge the support of the college authorities who are proactively fighting the COVID-19 pandemic and thank Professor (Dr) Arun Sharma, University College of Medical Sciences, New Delhi for his support.
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