A tertiary care system response to COVID-19 in a resource limited setting: a 6-month experience
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20210254Keywords:
Leadership, Process, SARS-Co-V2, Screening, Tertiary care system responseAbstract
Kerala recorded the initial cases of COVID/SARS-CoV-2 in India and managed to successfully contain it initially through its public health system. As the number of cases increased, the private sector also needed to be prepared. Here, we describe the preparedness and response of a tertiary care system in the nonpublic sector. The Health system response and preparedness consisted of establishment of leadership and infrastructural modification; screening-fever clinic, inpatient admission pathway, dynamic screening strategy training; developing protocols for emergencies and review visits of patients requiring dialysis and chemotherapy. Other priorities included maintaining supply chain of PPE, other essentials such as antivirals and establishing tele consultation. A strong leadership spearheaded infrastructural developments, meetings and troubleshooting every day to adapt to the changing epidemiological and clinical scenario. The Fever clinic was the designated area for consultation of patients with positive symptoms complex and epidemiological risk factors. In early March the screening strategy focused on the presence of a combination of epidemiological and clinical risk factors. As the number of contact cases rose, the focus shifted to identifying any of the defined epidemiological risk factors among persons reaching the hospital. The challenges included redesigning a patient movement pathway, deployment of human resources from their regular work to the screening activities, training of the repurposed human resource, procurement of good quality PPE, coordinating among the specialties, ensuring psychological support etc. The implementation of a timely COVID screening strategy aided our tertiary care centre to provide health care to all patients during the pandemic seamlessly.
References
Udhaya KS, Thirumal KD, Siva R, George PDC. Kerala, India’s Front Runner in Novel Coronavirus Disease (COVID-19). Front Med. 2020;7.
Sadanandan R. Kerala’s response to COVID-19. Indian J Public Health. 2020;64(6):99.
Sreedharan S. Analysing the Covid-19 Cases in Kerala: a Visual Exploratory Data Analysis Approach. SN Compr Clin Med. 2020.
Menon JC, Rakesh P, John D, Thachathodiyl R, Banerjee A. What was right about Kerala’s response to the COVID-19 pandemic? BMJ Glob Heal. 2020;5(7):e003212.
World Health Organization (WHO). Everybody’s business. Strengthening health systems to improve health outcomes: WHO’s framework for action. WHO. 2007.
Cavallo JJ, Donoho DA, Forman HP. Hospital Capacity and Operations in the Coronavirus Disease 2019 (COVID-19) Pandemic-Planning for the Nth Patient. JAMA Heal Forum. 2020;1(3):e200345.
Toner E, Waldhorn R. What US Hospitals Should Do Now to Prepare for a COVID-19 Pandemic. Clinician’s Biosecurity News. Available at: https://www.centerforhealthsecurity.org/cbn/2020/cbnreport-02272020.html. Accessed on 1 April 2020.
Grasselli G, Pesenti A, Cecconi M. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy. JAMA. 2020;323(16):1545.
Iyer S, Subramaniam S, Ravikumar B. Recommendations for Safely Performing Major Head and Neck Surgery During the COVID-19 Pandemic: Experience with Implementation of a Workflow. J Maxillofac Oral Surg. 2020.
COVID-19 Oubreak Control and Prevention State Cell Health and Family Welfare Department Government of Kerala. Advisory on Recording and reporting of COVID tests. Available at: https://dhs.kerala.gov.in/wp-content/uploads/2020/ 06/ADV-1.pdf. Accessed on 3 September 2020.
Hospital Infection Control Committee Trivandrum Medical College and ICT State PEID Cell. COVID-19 Infection Prevention and Control Manual. Trivandrum Medical College. Available at: https://dhs.kerala.gov.in/wp-content/uploads/2020/ 04/covid_16042020.pdf. Accessed on 3 September 2020.
Health and Family Welfare department Government of Kerala. Revised guideline on Covid-19 testing and Quaranine/ Isolation. Available at: https://dhs.kerala.gov.in/wp-content/uploads/2020/ 06/Revised-Guideline-COVID-19-Testing-Quarantine-Isolation.pdf. Accessed on 3 September 2020.
COVID-19 Treatment Guidelines for Kerala State.; 2020. Available at: https://dhs.kerala.gov.in/wp-content/uploads/2020/08/COVID-19-Rx-Guidelines-15th-August-2020.pdf. Accessed on 3 September 2020.
George M. Fever epidemics and fever clinics. Contrib to Indian Sociol. 2011;45(3):373-97.
Wu X, Zhou H, Wu X, Huang W, Jia B. Strategies for qualified triage stations and fever clinics during the outbreak of COVID-2019 in the county hospitals of Western Chongqing. J Hosp Infect. 2020;105(2):128-9.