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The Story of India's First Makeshift ICU: A Journey of Pain and Gain During the Second Wave of COVID-19
The COVID-19 pandemic shook the world in every possible way—mentally, socially, and economically. The first wave instilled deep apprehension, amplified by the media, leaving people shattered and locked in fear. However, it was the second wave that truly tested the resilience of India's healthcare system, bringing hospitals to their breaking point.
The Beginning: A Call to Action
At the time, I was leading the Emergency Medicine Department at Aster MIMS Calicut. Our emergency department had 35 beds, including a 10-bed Acute Care Unit (ED ICU). The Medical ICU (MDICU), under the able leadership of Dr. Mahesh, had 30 beds dedicated to critical care with ECMO facilities. The hospital's COVID-19 surveillance team, led by Dr. E.K. Suresh Kumar, ensured strict adherence to protocols and guidelines.
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| Dr Mahesh and Dr Suresh Kumar EK |
In April 2021, warnings from the national government indicated an impending second wave—one that would be stormy and overwhelming. Our team at Aster MIMS took proactive steps, reserving 50% of MDICU beds for COVID patients and setting up First Line Treatment Centers (FLTCs) in hotels and hostels for milder cases. However, as we braced for impact, we knew these efforts might not be enough.
Then, I received an unexpected phone call from Dr. Azad Moopen, our Chairman. His words were direct and urgent:
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| Dr Azad Moopen |
"Venu, I have a suggestion. I’ve seen makeshift ICUs and field hospitals in war zones. The second wave is coming, and our current ICU capacity may not be sufficient. If we set up a makeshift ICU in a car park or another suitable location, it could save lives. Would you take the lead?"
Hearing this concept for the first time, I immediately recognized its potential. It was novel, urgent, and necessary. Without hesitation, I responded:
"Yes, sir, we will do it. I will lead this effort with pleasure. We have a very supportive CEO here. Please ensure the final approval, and we will make it happen immediately."
Building the Makeshift ICU: A Race Against Time
Within 30 minutes of my conversation with Dr. Azad, our CEO, Mr. Farhan Yaarsin, arrived in the Emergency Department with key personnel—Mr. Liju, our chief of projects and engineering, and Mr. Aneesh, head of biomedical services. The plan was set into motion at lightning speed.
| Team leads - Mr Farhan( CEO), Mrs.Sheelamma (CNO), Mr Briju Mohan ( Group HR Head), and Mr.Liju( Project and Engineering Head |
We identified the ideal site for the makeshift ICU, ensuring it would include: |
- 10 high-end ICU beds equipped with ventilators, monitors, ABG machines, HFNC devices, BiPAPs, and other essential COVID-management equipment.
- Dedicated rooms for donning and doffing PPE, Audio-visual controlled counseling room, and utilities to maintain strict infection control.
- A fully air-conditioned setup to ensure patient and staff comfort.
Mr. Liju assured us the ICU would be operational within a week, while Mr.Briju, our HR head, expedited the recruitment of additional emergency physicians, nurses, and EMTs. Simultaneously, we launched advanced COVID-19 training programs for our existing staff, covering intubation, ventilator management, prone positioning, and crisis communication.
Within just one week, we established three Acute Care ICU units exclusively for COVID-19 patients—10 beds in the ED ICU (Acute Care 1), 10 beds in the makeshift ICU (Acute Care 2), and 10 beds in the adjacent mosque prayer hall. By the time Kerala was hit by the second wave, we had already created 30 additional ICU beds. It was a historic achievement.
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| Residents received advanced training prior to the make-shift ICU launch |
Expanding Capacity: Meeting an Unprecedented Surge
As patient inflow surged, Mr. Farhan quickly initiated the construction of two additional makeshift ICUs, increasing our capacity by 70 more beds. In total, we created 100 ICU beds in makeshift facilities, an unprecedented milestone in India’s pandemic response.
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| Make-shift ICS under Emergency Medicine department |
Every day, I began my rounds at 8 AM and worked late into the night, clad in PPE that was physically and mentally exhausting. But looking into the eyes of our patients—filled with fear and helplessness—gave our team the strength to push forward.
Despite strict protocols prohibiting bystander visits, I made a difficult yet humane decision: I allowed relatives, in full PPE, to see their loved ones. The impact was profound, reducing distress and bringing emotional relief to both patients and families. I also introduced music therapy, which showed remarkable psychological benefits in stabilizing some critically ill patients. I used to counsel bystanders in the briefing room, and I took at least 15 minutes for one patient, consoled them, and met them daily. This strategy worked well. My team also followed the same strategy.
Truenat's COVID-19 screening machine was operated by our EMTs in the ED. This helped to speed up the testing and decisions  | |
The Mental and Emotional Toll
The work was relentless. The sorrow of losing patients, the helplessness in the eyes of their families, and the daily trauma of death took a mental toll on us. Our Emergency Department became a hospital within a hospital, operating with nearly 300 personnel, including doctors, nurses, ambulance crews, and security teams. At any given time, 5–8 ambulances lined up outside, waiting for a bed to become available.
Dr. Vineeth Chandran, my consultant colleague, once asked me,
"Can the Emergency Department handle this burden alone?" My response was clear:
"No one knows where this will end. But we know the science. Let’s join hands and lift this together."
Our emergency medicine team, including Dr Vineeth Chandran, Dr. Vineeth N, Dr. Sivaraj, Dr. Rashad, Dr. Faisal, Dr Abhiram, Dr Alex Antony, Dr Aboobacker, Dr Swaroop, Dr Honey, Dr. Noorjahan, Dr. Veena, Dr. Bindiya, Dr. Sajina, Dr. Sameeh, Dr. Amit, Dr. Arshad, Dr. Neethu, Dr. Kamal, Dr. Shaheem, Dr. Deepak, Dr. Sasha, Dr. Nadia, Dr Aventika, Dr Vernas, Dr. Anjana, Dr. Jumeena, Dr Sujith and many others, worked tirelessly. Mrs. Nirmala Thomas, our nursing supervisor, ensured seamless operations, while Mrs. Sheelamma, our CNO, provided unwavering support. CFO Arjun also played a critical role in securing resources.
Until the second wave, intensivists were considered the backbone of critical care, but we proved that emergency medicine specialists could rise to the occasion and lead ICU-level care in a crisis.
A Family on the Front lines
On a personal level, my family was deeply involved in this mission. My wife, Dr. Supriya, a sonologist, supported me in every way possible. My daughter, Dr. Neethu, an emergency medicine resident, and my son-in-law, Dr. Kamal, also an emergency medicine resident, stood beside me, serving tirelessly on the frontlines. Three out of four members of my family were actively treating critically ill COVID patients—each of us knowing we might not see the next morning.
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| With Family |
We, too, contracted COVID-19, along with my team members. But thankfully, our symptoms were mild, allowing us to continue serving those in desperate need.
Recognition and Legacy
The success of our makeshift ICU gained international attention. The American College of Emergency Physicians (ACEP) International Journal published our story, with special thanks to Dr. Kate Douglas, Dr. Sweta Gidwani, and Dr. Kevin for documenting our journey so vividly.
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| Dr.Kate Douglas,Dr Sweta Gidwani, and Dr Kevin Duvey |
ACEP story link
What we achieved at Aster MIMS Calicut was more than just a temporary solution. It was a model of resilience, innovation, and teamwork—a blueprint for future crisis management in India. The makeshift ICU concept saved thousands of lives, proving that visionary leadership, rapid decision-making, and a committed emergency medicine team can turn the tide during a catastrophe.
Even today, when I reflect on those dark days, I feel immense gratitude for the unwavering dedication of my colleagues, the courage of our patients, and the trust placed in us by our leadership. We fought together, we suffered together, and in the end, we created history together.
This is not just a story of pain and loss. It is a story of hope, courage, and the power of human resilience—a testament to the fact that, even in the face of overwhelming adversity, we can find ways to save lives and make a difference.
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| A period of extreme agony ....We can't forget ... |
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