Resources to Meet Patients Needs During the COVID-19 Pandemic
Article by Dr. Nachiket Mor, PhD
In this hard time of pandemic it is difficult to cope up with the newly generated information and treatment modalities of the novel coronavirus. For frontline workers, who are saving the country without thinking about their well being it is challenging to find a reliable source to depend on in this medical world full of hoax news.
Here is a summary of the article on resources available to help primary care providers (PCPs) by Dr. Nachiket Mor. He was a member of the Planning Commission’s High-Level Expert Group on Universal Health Care, the Primary Care Task Force of the Ministry of Health and Family Welfare. He helped create a new model for comprehensive primary care, pioneered by SughaVazhvu Healthcare in remote rural parts of Tamil Nadu. His current work is principally focused on the design of national and regional health systems.
He shared his valuable views for primary care providers as they seek to address the needs of their patients during the current COVID-19 pandemic. It is not meant to replace clinical judgment or specialist consultation but preferably to strengthen clinical management of patients and to provide up-to-date guidance and sources to rely on.
Standard Operating Procedure in Primary Care
- Tool for initial risk assessment for COVID-19: https://coronavirus.heallify.com/, low-risk individuals advised to remain at home and follow Home Quarantine guidelines by MoFHW
- An emerging best practice adapted from China is to stream patients into 3 categories:
a) Those with fever went to a specialized Fever Clinic which is physically separated from rest of the facility and even be a distance away;
b) Those with cough, cold, runny nose, sore throat, anything that could be a viral Upper Respiratory Tract Infection (URI) go to the main facility, but are seen by a provider who only sees such cases and is kept physically separated from the rest of the patients; and
c) All the other cases are seen by their regular providers.
This minimizes the risk of transmission but also ensures that regular patients, particularly those with other infectious (like Tuberculosis) and chronic (like Cardio-Vascular Disease) conditions continue to receive the care and medicines that they need promptly.
(ii) Safety Precautions in the Clinic:
- An unwell patient with relevant symptoms should be identified and immediately placed in a room away from other patients and staff.
- If COVID-19 considered possible when consultation is already in progress, withdraw from the room, close the door, and wash your hands thoroughly with soap and water.
- The patient should remain in the room with the door closed. Belongings and waste should remain in the room.
- The patient and any accompanying family should remain in the room with the door closed while they are remotely assessed by a clinician in the practice.
- If following remote consultation the patient needs face-to-face assessment, wear personal protective equipment (PPE) in line with standard infection control precautions.
(iii) Notification & Home Quarantine:
The MoHFW, GOI, has issued detailed home isolation guidelines on Notification of Cases, and Home Quarantine of contacts. Following the guidelines, all suspected cases of COVID-19 will need to be rapidly isolated in designated health facilities and all contacts of such cases will need to be quarantined at home.
Personal Protective Equipment (PPE) for PCPs
- The National Centre for Disease Control (NCDC) of the Ministry of Health & Family Welfare, Government of India, has recently issued detailed guidelines for Infection Prevention and Control in healthcare facilities.
- WHO has issued detailed guidance on the rational use of PPE for COVID-19 which includes the use of medical mask, gown, gloves and eye protection (goggles or face shield) for healthcare workers providing direct care to COVID-19 patients
- Hand Sanitizers: WHO recommends using an alcohol-based hand rub for routine hand antisepsis in most clinical situations, provided that the hand rubs meet recognized standards for microbicidal efficacy (ASTM or EN standards) and are well accepted/tolerated by the health-care workers.
Emergency Clinical Management of COVID-19 Patients by PCPs
The Chinese CDC suggests that the severity profile for COVID-19 patients will be in the shape of a pyramid as shown in figure indicating that, total number of patients, almost 80% could recover at home with mild to moderate illness and, of the balance 20%, 75% could be treated for breathlessness and hypoxia using oxygen therapy in primary care settings, and only 25% of them, may need hospital-based intensive care or mechanical ventilation.
“The central role of oxygen therapy should be emphasised, oxygen supplies and delivery systems secured, and guidelines for sustainable and appropriate use issued”, according to Dr. Nachiket Mor.
(i) Therapeutic Options for COVID-19 Related Severe ARDS are:
Hydroxy-chloroquine is found to be effective against coronavirus in laboratory studies and in-vivo studies. Its use in prophylaxis is derived from available evidence of benefit as treatment and supported by preclinical data.
Mental Wellbeing of PCPs
i) Indian Association of Clinical Psychologists: “In view of the CORONA-VIRUS outbreak, extend the support in the form of providing Psychological counseling and Psychological First Aid to those who need it throughout the country. To facilitate the same, this list of volunteers is provided in public domain to utilise psychological services i.e tele-counselling. The list is functional during the COVID-19 epidemic.” according to Dr. Nachiket Mor.
ii) The Banyan Academy of Leadership in Mental Health: A research and teaching institution (www.balm.in) closely affiliated with The Banyan, which also offers teleconsultation services for both PCPs and their patients, in multiple Indian languages, including English, Hindi, Tamil, and Malayalam.
Tele-Consultation Guidance for PCPs:
Telehealth services could provide valuable support at this time both directly to patients and to PCPs according to an article published by Dr.Nachiket Mor. Here is the link to the telemedicine guideline provided by The Medical Council of India.
i) Remote Consultation by PCPs
Given the need for infection control and patient's inability to travel to their primary care facility, it may also become necessary for PCPs to consult, even with their regular patients, over the telephone or a video connection on COVID-19.
Training & Education Resources for PCPs
- Visit https://covid19.plexusmd.com/ for Certificate Course in Management of Covid-19 for Medical Professionals by the health and family welfare department, Government of Gujarat in association with PlexusMD. There are Comprehensive online training modules for Covid-19 for Doctors, Nurses and Healthcare workers worldwide completely free for all the participants.
-Noora Health (Patient / Provider Resources): Noora Health have built out a number of COVID-19 specific capabilities.
- Intelesafe: InteleSafe is an app and a website that currently provides critical resources for PCPs to stay safe while on the job, WhatsApp helpline (+919825989750) for PPE questions, and a mental health counseling helpline for healthcare providers (www.intelehealth.org/mental-health-consult).
- Introductory Course on COVID-19 from WHO: This open-access course provides a general introduction to emerging respiratory viruses, including novel coronaviruses, and comprises the four modules.
- Government of India Resources
- AIIMS, New Delhi 24x7 helpline for PCPs (+919971876591)
- Ministry of Health and Family Welfare,GOI Official Website (MoHFW)
- Government of India WhatsApp Helpline for the General Public:+919013151515