Surveillance and testing, field hospitals, health corps, a human touch and awareness drives can help stem the current wave of COVID-19 in India
The second wave of the novel coronavirus disease (COVID-19) pandemic has brought India to its knees. Thousands have died and there is chaos and turmoil throughout the country.
The Union government led by Prime Minister Narendra Modi has come in for harsh criticism for its handling of the crisis.
The government will have to abandon its traditional patient centered care approach in order to stem the contagion. Instead, a community-centered approach will have to be adopted.
Surveillance and testing
Contact tracing needs to be done aggressively to identify case surges. Innovative ways including tests on sewage water, currency notes and blood bank samples for antibodies have to be explored.
The RT-PCR testing strategy needs to be planned properly. The patient triage algorithms have to be formulated according to the surge. The kits must be acquired from low surge states.
Abundant supplies of test swabs and reagents have to be stocked. Also, pooled testing has to be done. Vulnerable symptomatic seniors, pregnant women, co-morbid patients and infants have to be tested.
Caregivers and inmates of disabled facilities, old age homes and long-term facilities have to be tested. The asymptomatic patients should be advised to isolate mandatorily. Mobile and drive thru testing units have to be used.
Media, both in India and abroad, is awash with heart-wrenching scenes of overwhelmed hospitals turning away patients. The Union Health Ministry should do a reality check of the hospitals and nursing facilities and study the prospect of setting up field hospitals.
The inventory of all available medical equipment including ventilators, monitors, oxygen, swabs, testing kits, serum and pathological labs, biomedical devices, personal protective equipment, emergency beds, intensive care units and ambulances should be meticulously prepared at the district level.
A roster of all medical professionals including doctors, pulmonary specialists, surgeons, nurses, lab technicians, paramedics, retired doctors and nurses, dentists, AYUSH practitioners, veterinarians, mental health professionals, ASHA, social and health workers at the district level has to be prepared.
A district command centre and a central warehouse housing all the equipment has to be set up at an accessible place.
The government should expand existing hospitals and set up field hospitals by leveraging railway coaches, schools, stadia, hotels and function halls. The field hospitals should be set up away from thickly populated settlements.
The government needs to design the template and inventory needed for a 100 beds block and increment it in multiples according to the requirement.
This model should to be implemented wherever necessary. The action plan should involve setting up a sterilised area, ambulance accessibility, medicines, water, diagnostic labs, waste and biomaterial disposal, WiFi and administration support.
The hospitals should work with a designated parent hospital. The quantum of doctors, nurses, specialists, junior doctors, attendants and support staff needed should be determined per block.
This template has be repeated for planning multiple blocks, scaled and shared across the country. A similar template can be prepared for isolation facilities for mild cases.
Major railways stations have to be designated and isolation coaches stationed. The platforms have to be sanitised and biomedical waste disposal done according to protocol.
Passenger trains have to be kept away from these stations. Mobile bus clinics with medical strike teams should be sent to the areas with high incidence of infections for assessment.
A pool of workers, civilian and army engineers should be enlisted for constructing the field hospitals. The knowledge of construction must be documented for future use.
A Health Corps like the National Cadet Corps with rapidly trained volunteers should be created immediately.
The Corps should consist of retired doctors and nurses, medical graduates, students of medicine, pharmaceuticals, AYUSH, nursing, dentistry, veterinary science and biology, healthcare workers along with IT workers and other youth.
The Corps should act as the public face of the government response and a bridge between the COVID-19 patients and the medical providers.
The Corps should be trained in concepts of primary response and preliminary triage (process of determining patients’ treatment). They should help the medical professionals without interfering with their duties.
The Corps should also be given the task of organising the test results, tracking and contact tracing. The IT experts must be deployed to help with software tools.
The Corps should help mobilise and organise resources like PPE and equipment and disinfectants. They should work with self-help groups, home volunteers, small and medium companies to help bridge the gap of PPE at the local level.
The Corps have to be rewarded for their service by the way of honorariums, academic credits and public recognition.
Human touch and awareness
Innovative ways to communicate and assure the patients have to be explored given that the masks, PPEs and loud noises hinder effective communication.
Music, hand, facial and eye gestures, video communication should be looked into. Mental health counselors and social workers should be on site. The doctors and hospitals should show their ‘human face’ in the suffering and not treat patients as statistics.
Parameters like the rise in infections among healthcare workers, conversions of quarantined into positive patients, 14-day decline in positive cases, outbreak of seasonal epidemics, and availability of facilities in hospitals in case of a subsequent surge should be considered before relaxing restrictions.
Messages urging people to take measures and to remove the stigma regarding COVID-19 patients have to penetrate deeply. Buses, trains, government offices and public areas have to painted with messages and mass media used to constantly remind people.
Reverse migration of workers should be discouraged until the situation improves. The home states have to provide them alternate jobs for the time being.
A victory over the pandemic is only possible with a community-centric effort and government support. Health infrastructure should be ramped up with a human face and the public should co-operate to reduce the stress on hospitals by taking measures. Let no patient be left behind in this fight.
Views expressed are the authors’ own and don’t necessarily reflect those of Down To Earth
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