COVID-19 Pandemic: A Perspective from Nephrology Resident

Dear Sir,

It was March 2020, coronavirus disease 2019 (COVID-19) has already wreaked havoc in China, Iran, and Italy. Other European countries and the United States had also started reporting cases in large numbers.[1] Meanwhile, in India, the clock was ticking. Hospital authorities were scrambling for resources. Residents had been continuing their daily work doing regular night duties, attending lectures, preparing for forthcoming exams, and carrying out their research projects. Suddenly, a nationwide lockdown was declared. Outpatient visits and admissions were curtailed, in-patients became apprehensive regarding their discharge. And then it happened, a patient on chronic kidney disease stage V (CKD VD), transferred from a different health facility after prolonged admission to ICU turned out to be COVID positive. Immediate contacts, including senior faculty members, resident doctors, nurses, and orderlies had to be ordered isolation. Our fight with COVID-19 had begun.

Our department of Nephrology caters to a large number of chronic kidney disease (CKD) patients who come for in-center hemodialysis, who are at high risk of contracting infections. Moreover, CKD patients and renal allograft recipients are immunosuppressed per se.[2] And finally, acute kidney injury (AKI) develops in approximately 50% of COVID- 19 acute respiratory distress syndrome (ARDS) patients.[3] The Ministry of Health and Family Welfare (Government of India) also issued guidelines regarding the posting of medical subspecialties in various COVID areas.[4] Armed with masks and face shields with a feeling of fear and agony, we marched into the battle against uncertainty.

Teams were created for COVID and non-COVID areas, with rotations and self-isolation post-COVID duties. Any patient presenting to the emergency with fever or cough or breathlessness was a suspected case and had to be examined with personal protective equipment (PPE).[5] COVID area duties were a different ball game altogether. Long working hours and wearing PPE were exhausting and excruciating. With restricted air-conditioning and fluid intake, we would perspire continuously and feel dehydrated. Donning and Doffing, were probably the two most used words in the last 3 months.

Our dialysis unit had to be curtailed. Run time was reduced from 24 h to 18 h with 6-h fumigation every night. Our dialysis nurses and staff had also been categorized, and manpower capacity was soon stretched to the limits. Dialysis in ICUs, including continuous renal replacement therapy, prolonged intermittent renal replacement therapy, and conventional hemodialysis, were still being done 24 × 7, but conducting emergency dialysis became a hectic task.

It was not just the patients that we had to deal with; many of our colleagues, resident doctors, nurses, and transcriptionists too contracted the infection. Kudos to them for rising like a phoenix and returning to the frontline soon after recovery. Sadly, the same cannot be said about the patients that we have lost, despite the best efforts in managing respiratory failure, the systemic complications of COVID 19 infection, and the renal injury.

Of course, interactive classes had to stop, but the anxiety doesn't end here; uncertainties on the final exam dates grip us in insecurities for our future. Online classes and clinical case discussions had shredded some pieces of positivity and hope to cope-up with our studies. It was also tough to keep up with the rapidly rising database of literature on COVID- 19. Life on the personal front has also suffered. Health care workers are the highest risk group for transmission of infection. For months now, people have been living away from their loved ones, elderly parents, and young kids. Not to mention the harassment of a few health care workers by a few insensitive neighbours.

It has been 3 months into the pandemic here in India. Fortunately, we are not yet running short of workforce and equipment. But the cases and deaths are rising daily. And we have already started feeling burnt out. Eagerly awaiting the sunrise!