The War Room

As the first wave of 2020 began to crest, my daily life as Medical Superintendent underwent a profound transformation. I was no longer just managing a hospital; I was being drafted into the strategic defense of an entire district. The “War Room” was no longer a metaphor—it was a physical reality located in the District Collector’s office in Wardha.

I found myself stepping out of the familiar, sterile comfort of my wards and into the wood-paneled, high-stakes nerve center of the district administration. It was here that the abstract guidelines from New Delhi and Mumbai had to be translated into survival strategies for the people of rural Maharashtra. I had the privilege—and the immense responsibility—of working closely with two dynamic District Collectors, Mr. Vivek Bhimanwar and later Ms. Prerna Deshbhratar. These were administrators who understood that in a pandemic, a bureaucrat without a doctor is blind, and a doctor without a bureaucrat is powerless.

The Advisor in the Ivory Tower

My role evolved rapidly from being a physician-administrator to becoming a key advisor for the district’s entire healthcare strategy. I spent more time at the Collector’s office than I could count, attending bi-weekly review meetings that often stretched into the late hours of the night. We were frequently joined via video link by the Chief Minister and senior health officials.

In these meetings, the atmosphere was a mix of exhaustion and adrenaline. We were tracking the movement of migrant workers, the availability of quarantine centers, and the terrifyingly slow arrival of testing kits. Working in tandem with the Civil Surgeons, Dr. Purushottam Madavi and Dr. Sachin Tadas, we had to build a unified front. Recognizing the need for a singular, disciplined protocol, I was appointed to chair the expert committee responsible for formulating the rules for Covid-19 diagnosis, prevention, and management for the entire Wardha district.

This committee brought together the best minds from across the region—physicians and anesthesiologists from JN Medical College and the Civil Hospital. Our task was to create a “Bible” of treatment that every clinic, private practitioner, and government facility would follow. It was a massive exercise in consensus-building during a time when everyone was panicking.

The Battle for Rational Therapy

The toughest part of my role in the War Room was not fighting the bureaucracy; it was fighting the “tsunami of irrationality.” Even as I sat in these high-level meetings, I was dismayed to witness the rapid spread of “panic prescribing” across the district. Driven by an understandable but dangerous urge to “do something,” many physicians were handing out drug cocktails that had no scientific basis.

As the chair of the expert committee, I had to be the “No-Man.” While other districts were scrambling to procure Favipiravir or Ivermectin, I stood firm. I stood before the Collector and the health officials and argued that we must not waste public funds on “magic bullets” that didn’t work. It was a lonely position. Private hospitals were under pressure from wealthy families to provide “the latest drugs,” and here I was, representing the largest hospital in the district, saying “No.”

At Sevagram, we made a conscious, collective choice: our treatment protocols would be dictated by high-quality global trials (like the RECOVERY and SOLIDARITY trials), not by pharmaceutical marketing or anecdotal social media posts. We admitted nearly 5,000 Covid patients over the course of the pandemic, and we steadfastly refused to use the controversial “magic bullets” that were bankrupting families elsewhere.

The Remdesivir and Steroid Protocol

The pressure regarding Remdesivir was perhaps the most intense administrative challenge I faced. The public viewed it as a life-saver, a “divine vial” that could snatch a patient from the jaws of death. The reality, as shown by the data, was far more modest: it didn’t reduce mortality or the need for ventilators.

While the rest of the country was seeing frantic queues and black-marketing of Remdesivir, Sevagram took a contrarian stand. From March 2021, we reduced our usage of the drug by 90%. We used it only selectively for a very specific window of patients. This decision saved our patients lakhs of rupees and spared them unnecessary hepatic and cardiac toxicity.

Our approach to steroids was equally disciplined. We knew from the RECOVERY trial that steroids were a double-edged sword: they were a miracle for hypoxic patients on oxygen, but a disaster for those with normal oxygen levels. We fought a constant battle against the “steroids for everyone” approach that was rampant in the community—a practice that, as I feared, would later contribute to the horrifying outbreak of “Black Fungus.”

A Public Stand for Evidence

My role in the district governance culminated in a very public declaration of our philosophy. In an interview with The Indian Express on June 9, 2021, I stated clearly that evidence-based healthcare was the cornerstone of Sevagram’s treatment. “We refrain from resorting to anecdotal evidence or promotional research,” I told the press.

Working with the administrators of Wardha was a testament to the power of a “War Room” that actually listens to science. We proved that in the face of a terrifying new disease, the most effective weapon we had was not a new drug, but the discipline of the scientific method. We didn’t just manage a crisis; we managed to keep our integrity intact while doing so.

As we moved toward the peak of the second wave, the “War Room” conversations shifted from drug protocols to something even more fundamental: the very air our patients breathed. The oxygen crisis was coming, and the governance structures we had built were about to be tested to their breaking point.

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