COVID-19 PANDEMIC

COVID-19 PANDEMIC – a portfolio on the current situation with close correlation to ethics, attitude and communication among healthcare professionals

 

WHAT ARE CORONAVIRUSES?

Coronaviruses are a large family of viruses that can cause animal or human illness. Several coronaviruses are known to cause respiratory infections in humans ranging from common cold to more serious diseases such as Middle East Respiratory Syndrome (MERS) and Extreme Acute Respiratory Syndrome (SARS). The most recent coronavirus discovered triggers the COVID-19 coronavirus disease.

CASE DEFINITIONS:

Suspect case

  1. A patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath), AND a history of travel to or residence in a location reporting community transmission of COVID-19 disease during the 14 days prior to symptom onset.

OR

  1. A patient with any acute respiratory illness AND having been in contact with a confirmed or probable COVID-19 case (see definition of contact) in the last 14 days prior to symptom onset;

OR

  1. A patient with severe acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath; AND requiring hospitalization) AND in the absence of an alternative diagnosis that fully explains the clinical presentation.

Probable case

  1. A suspect case for whom testing for the COVID-19 virus is inconclusive.
  2. Inconclusive being the result of the test reported by the laboratory.

OR

  1. A suspect case for whom testing could not be performed for any reason.

Confirmed case

A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms

 

15TH APRIL.

According to WHO’s April 15 updates, globally, there are 18,48,439 confirmed cases and 1,17,217 deaths.

In the past 24 hours no new country / territory / area recorded COVID-19 incidents.

WHO has issued a strategic preparedness and response plan revised to overcome COVID-19. The document takes what we have learned about the virus so far, and translates it into strategic action.

The first UN solidarity flight has departed Addis Ababa carrying vital COVID-19 medical supplies to all African nations. WHO cargo includes one million face masks, as well as personal protective equipment, which will be enough to protect health workers while treating more than 30 000 patients and laboratory supplies to support surveillance and detection.

There is no evidence that oral poliovirus vaccine protects people against infection with COVID-19 virus. A clinical trial is planned in the USA, and WHO will evaluate the evidence when it is available.

Health workers are at the front line of the COVID-19 outbreak response and as such are exposed to hazards that put them at risk of infection. Hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence. This document highlights the rights and responsibilities of health workers, including the specific measures needed to protect occupational safety and health.

 

16TH APRIL

In the past 24 hours no new country / territory / area reported COVID-19 cases.

Speaking at yesterday’s COVID-19 media briefing, WHO Director-General Dr Tedros stressed that our “commitment to public health, science and to serving all the world’s people without fear or favour” remains absolute.

WHO has released a substantial update to its COVID-19 dashboard, offering better data visualization.

Drinking alcohol does not protect you against COVID-19: existing rules and regulations to protect health and reduce harm caused by alcohol such as restricting access, should be upheld and even reinforced during the outbreak.

WHO has developed interim guidance for laboratory diagnosis, advice on the use of masks during home care and in health care settings in the context of COVID-19 outbreak, clinical management, infection prevention and control in health care settings, home care for patients with suspected novel coronavirus, risk communication and community engagement and Global Surveillance for human infection with COVID-19.

In India, WHO is deploying its national polio surveillance network and other field staff to help with the COVID-19 response.

 

17TH APRIL

The number of confirmed cases reported globally exceeded 2 million.

During Ramadan the WHO issued guidelines on public health for social and religious activities and gatherings. The guide also provides advice as the COVID-19 pandemic continues to improve mental and physical health.

The WHO has given advice on issues in the sense of COVID-19 changes to public health and social initiatives.

The Chinese authorities have informed WHO that as cases have declined in China and the strain on the healthcare system has eased, a multisectoral team was established in late March 2020 to perform a comprehensive review of COVID-19 data in Wuhan, Hubei Province. Information from a variety of sources was reviewed, leading to duplicate cases being removed and missed cases added. Following this review, the total number of cases in Wuhan increased by 325 and the total number of deaths increased by 1290.

As of 11 April 2020, 167 countries, territories and areas have implemented additional health measures that significantly interfere with international traffic.

Worldwide, as millions of people stay at home to minimise transmission of severe acute respiratory syndrome coronavirus 2, health-care workers prepare to do the exact opposite. They will go to clinics and hospitals, putting themselves at high risk from COVID-2019. Figures from China’s National Health Commission show that more than 3300 health-care workers have been infected as of early March and, according to local media, by the end of February at least 22 had died. In Italy, 20% of responding health-care workers were infected, and some have died. Reports from medical staff describe physical and mental exhaustion, the torment of difficult triage decisions, and the pain of losing patients and colleagues, all in addition to the infection risk.

 

18TH APRIL

Health-care systems globally could be operating at more than maximum capacity for many months. But health-care workers, unlike ventilators or wards, cannot be urgently manufactured or run at 100% occupancy for long periods.

It is vital that governments see workers not simply as pawns to be deployed, but as human individuals. In the global response, the safety of health-care workers must be ensured. Adequate provision of PPE is just the first step; other practical measures must be considered, including cancelling non-essential events to prioritise resources; provision of food, rest, and family support; and psychological support.

Presently, health-care workers are every country’s most valuable resource.

With the world’s focus on coronavirus disease 2019 (COVID-19) outbreak, Semida Masika, the last person in DR Congo reported having Ebola virus infection and discharged from treatment after her recovery on March 4, is a good news tale getting much less coverage.

WHO Regional Director for Europe Dr Hans Henri P. Kluge, has released a statement on the transition to a ‘new normal’ during the COVID-19 pandemic, stressing that it must be guided by public health principles.

Refugees and migrants face the same health risks from COVID-19 as their host populations.

 

19TH APRIL

Health worker rights include that employers and managers in health facilities:

  • assume overall responsibility to ensure that all necessary preventive and protective measures are taken to minimize occupational safety and health risks1;
  • provide information, instruction and training on occupational safety and health, including;

o Refresher training on infection prevention and control (IPC); and

o Use, putting on, taking off and disposal of personal protective equipment (PPE);

  • provide adequate IPC and PPE supplies (masks, gloves, goggles, gowns, hand sanitizer, soap and water, cleaning supplies) in sufficient quantity to healthcare or other staff caring for suspected or confirmedCOVID-19 patients, such that workers do not incur expenses for occupational safety and health requirements;
  • familiarize personnel with technical updates on COVID-19 and provide appropriate tools to assess, triage, test and treat patients and to share infection prevention and control information with patients and the public;
  • as needed, provide with appropriate security measures for personal safety;
  • provide a blame-free environment for workers to report on incidents, such as exposures to blood or bodily fluids from the respiratory system or to cases of violence, and to adopt measures for immediate follow-up, including support to victims;
  • advise workers on self-assessment, symptom reporting and staying home when ill;
  • maintain appropriate working hours with breaks;
  • consult with health workers on occupational safety and health aspects of their work and notify the labour inspectorate of cases of occupational diseases;
  • not be required to return to a work situation where there is continuing or serious danger to life or health, until the employer has taken any necessary remedial action;
  • allow workers to exercise the right to remove themselves from a work situation that they have reasonable justification to believe presents an imminent and serious danger to their life or health. When a health worker exercises this right, they shall be protected from any undue consequences;
  • honour the right to compensation, rehabilitation and curative services if infected with COVID-19 following exposure in the workplace. This would be considered occupational exposure and resulting illness would be considered an occupational disease,
  • provide access to mental health and counselling resources; and
  • enable co-operation between management and workers and/or their representatives.

 

20TH APRIL

The urgent need for a COVID-19 vaccine underscores the pivotal role immunizations play in protecting lives and economies. Dr Hans Henri P. Kluge, WHO Regional Director for Europe, marking the European Immunization Week 2020, stressed ‘we must not, especially now, let down our guard on immunizations’. WHO and UNICEF have released a joint statement to mark European Immunization Week 2020.

WHO has published a brief on the use of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with COVID-19. Concerns have been raised that NSAIDs may be associated with an increased risk of adverse effects. However, as explained in the brief, at present there is no evidence of severe adverse effects.

WHO has recently published an updated strategy to help guide the public health response to COVID-19.

 

21st APRIL

According to the latest figures published by Johns Hopkins University, 2,531,804 cases have been detected worldwide, with 174,336 deaths and 665,458 people now recovered.

 

In India there have been 18,985 cases with 603 deaths. 3,273 people have recovered from the virus.

The new coronavirus lingers for as long as three weeks in the bodies of patients with severe disease, Chinese researchers reported Tuesday.

The virus can be found deep in the lungs and in the stool of patients, and the sicker they are, the longer it stays, the team at a hospital in China’s Zhejiang province reported. But the virus was found in the urine of patients less than half the time, and rarely in the blood at first.

The team tested 96 patients treated in their hospital for Covid-19 between January and March. They tested samples from the nose and throat, from deeper in the respiratory system, in the blood, stool and urine. They wanted to see how long people had virus in their systems and whether it was likely to spread in various ways. The findings support other studies showing that the virus could spread in stool from infected people.

In general, the sicker people were, the longer the virus could be detected. That could be important for doctors to know, so they can predict which patients will fare better, and, perhaps, how long they may remain infectious to others.

 

22nd APRIL

Global deaths pass 175,000

At least 177,445 people have died in the coronavirus pandemic so far, according to data from Johns Hopkins University. There are more than 2.5 million confirmed cases worldwide. The number of cases in the US – the country hardest hit by the virus – exceeds 788,000 and there have been more than 42,000 deaths there. The UK has more than 125,000 cases and more than 16,500 deaths.

India’s total number of coronavirus positive cases rose to 20,471 on Wednesday, 22 April. This number includes 15,859 active cases, 652 deaths and 3,959 recoveries.

Meanwhile, the Jammu and Kashmir administration has withdrawn its press note announcing the cancellation of this year’s Amarnath Yatra due to the COVID-19 outbreak.

India has ordered a pause in testing for antibodies to the coronavirus because of concern over the accuracy, health officials said on Wednesday, complicating the fight against the epidemic as its tally of cases nears 20,000.

India trails many countries in conducting the standard swab tests to determine the presence of the novel coronavirus because of limited testing equipment and protective gear for medical workers.

 

23rd APRIL

All available evidence for COVID-19 suggests that SARS-CoV-2 has a zoonotic source. Many researchers have been able to look at the genomic features of SARS-CoV-2 and have found that evidence does not support that SARS-CoV-2 is a laboratory construct. A constructed virus would show a mix of known elements within genomic sequences – this is not the case.

33 new coronavirus cases were reported as of 8:00 AM on Apr 23 in Bengal, according to data released by the Ministry of Health and Family Welfare. This brings the total reported cases of coronavirus in Bengal to 456. Among the total people infected as on date, 79 have recovered and 15 have passed away.

District-wise breakup is available for 392 of the total 456 cases reported in the state. Kolkata had the highest number of Covid-19 cases at 184 confirmed infections. The table and map below show confirmed cases for all districts.

The Indian Medical Association (IMA) Monday declared it will observe 23 April as a ‘Black Day’ to protest against increasing attacks on doctors and healthcare workers, the country’s frontline in the fight against the highly infectious Covid-19 disease.

The IMA has also demanded that the central government enact a law to punish those perpetrating violence against medical personnel.

Doctors, nurses and healthcare workers in several parts of the country have been attacked and abused by people scared of contracting the virus from them.

 

24th APRIL

Global health actors, private sector partners and other stakeholders are launching a landmark collaboration to accelerate the development, production and equitable global access to new COVID-19 essential health technologies.

One meeting was held on 13/04/2020 in the Green Room, Swasthya Bhawan, with different Experts

from the field of Microbiology, Medicine and Tropical Medicine on the issue of re-utilization of N95

masks, PPE, Coveralls and Face shields during this acute crisis of COVID19 Pandemic, jointly chaired

by the DME and DHS, Government of West Bengal. The following protocols are recommended.

  • The face shields, PPE, Coveralls, gowns, surgical masks, N95 masks etc. should be used properly

and judiciously.

  • Use of N95 masks may be restricted to fever clinics, suspect and confirmed COVID wards,

prioritizing the aerosol generating procedures like the sample collection, intubation of a COVID-

19 positive case, during CPR, during bronchoscopy etc.

  • For proper utilization of the PPE, masks etc. these should be decontaminated and reused as per

following protocols:

Heat sensitive equipment (PPE): Preferably with Hydrogen peroxide vapor, Ethylene oxide

sterilization technique.

o Single warm cycle (55°C and 725 mg/l 100% EtO gas). Items and a chemical indicator

placed in an individual standard poly/paper pouch. EtO exposure for 1 hour followed by 4

hour of aeration.

o Standard Autoclaving can also be used in facilities where the above methods are

unavailable. Taking into account that the PPE may be discarded if the elasticity of the

rubber materials of the PPE is lost after repeated autoclaving.

Cloth items (gowns, cloth masks): Preferably Autoclaving or washing with soap and hot water.

Face shields and goggles: Immersion in 0.5% Sodium Hypochlorite solution or cleaning with

70% alcohol.

Heat sensitive equipment like N95 masks directly coming in contact of the skin: Though

Hydrogen peroxide vapor is the preferable method, UV C radiation may be utilized, if

available.

o The laminar flow machine can be used for decontamination of the N95 masks, which will

be properly labeled with the name of the users, and will be exposed to the UV C rays, 15

minutes each side (outer and inner), to 176–181 mJ cm2 exposure of the masks, with a 40-

W UV-C light (average UV intensity experimentally measured to range from 0.18 to 0.20

mW cm2). The masks will be kept 3 feet from the 40 W UV-C light source for 15 minutes.

  • The HCW are advised to wear a surgical mask over the N95 mask for better protection and to

prolong the life of the mask. The surgical mask will be discarded after 1 shift (8 hours) of usage

and the N95 mask may be reutilized as noted below.

  • Disposable N95 respirators may be re-used or worn for extended use as long as they are able to

seal, were not worn during an aerosol generating procedure or have reached the end of their use by

being soiled, damaged or moist from sweat or insensible fluid loss through breathing. The N95

masks can be utilized up to 5 cycles of usage and decontamination. DO NOT use ALCOHOL

AND CHLORINE [bleach]-based disinfection methods.

  • Equipments which are subjected to decontamination or reutilization/reuse should be used or worn

as per the standard protocol of Donning and Doffing of PPE and Masks.

 

25th APRIL

PROTECTIVE GEARS FOR THE HEALTH CARE WORKERS (HCWs)

  1. Health Care Workers (HCWs) should refrain from touching own Mouth, Nose or Eyes

with potentially contaminated gloved or bare hands, and touching the surfaces

  1. HCWs to Practise Hand Hygiene

o Before touching a patient

o Before any clean or aseptic procedure is performed

o After exposure to body fluid

o After touching a patient, and after touching the patient’s surroundings

o Alcohol-based hand rub (ABHR) preferred if hands are not visibly soiled, Soap and

water preferred when they are visibly soiled

o After examining each patient, they must wash their hands (with gloves on) with soap

water or ABHR sanitisers

  1. Full Set of PPE (Personal Protective Equipment) includes

o N-95 mask

o Eye protection (Goggles) or facial protection (face shield)

o Clean, non-sterile, coverall, long sleeved gown

o Head Cover

o Gloves

o Shoe Cover

  1. Donning and doffing of PPEs to be done in separate areas with separate entry and exit.

 

 

26th APRIL

SPECIMEN COLLECTOR MUST WEAR FULL PPE

  1. Specimens Collection
  • Nasopharyngeal Swab: Insert flexible wire shaft minitip swab through the nares parallel to the

palate (not upwards) until resistance is encountered indicating contact with the nasopharynx.

o Swab should reach the depth equal to distance from nostrils to outer opening of the ear.

o Gently rub and roll the swab.

o Leave swab in place for several seconds to absorb secretions.

o Slowly remove swab while rotating it.

  • Oropharyngeal Swab (Throat Swab): Insert swab into the

o Posterior pharynx and tonsillar areas.

o Rub swab over both tonsillar pillars and posterior oropharynx

o Avoid touching the tongue, teeth, and gums.

  1. Storage

o Place swabs immediately into sterile tubes containing 2-3 mL of Viral Transport Media.

o Store specimens at 2 – 8°C for up to 72 hours after collection.

  1. Transport

o Send the sample specimen in Viral Transport Media to Testing Centre immediately

o If delayed, store specimens at 2-8°C, and transport overnight on ice pack.

 

27TH APRIL

FOLLOWING PARAMETERS SHOULD BE OBSERVED BY DOCTOR / SISTER DURING

DAILY ROUNDS AND RECORDED THRICE A DAY / ON WORSENING OF SYMPTOMS

  1. Temperature
  2. Pulse
  3. Respiratory Rate
  4. Blood Pressure
  5. Urine Output
  6. SpO2
  7. Sensorium (conscious, drowsy or stupor)
  8. Chest Examination – Breath sound, crepitations and bronchi.

INVESTIGATIONS FOR MILD CASES

  1. Complete Hemogram- common abnormalities are Leukopenia with Lymphocytopenia (On

Admission and Daily)

  1. X-Ray Chest PA view (On admission / every 3rd day/ at worsening of symptoms)

Common X-Ray Chest findings

o Bilateral / Unilateral / Patchy infiltrates

o Ground Glass opacities

o Interstitial Changes.

  1. LFT – Raised Transaminases, Hyperbilirubinemia (Send on Admission / day 4 / day 7 / on

Worsening)

  1. Serum Creatinine – May be raised (Send on Admission / day 4 / day 7 / on Worsening)
  2. ECG – To look for ST-T changes suggestive of Myocarditis changes and to look for QTc

prolongation. If the QTc is prolonged >450 mSecs, Hydroxychloroquine is to be

administered cautiously, and to be avoided if it is >500mSecs. (To be done on Admission /

on Worsening of symptoms)

  1. ABG : (To be done 12 hourly / on Worsening of symptoms)

Calculate PaO2/FiO2 Ratio to find the level of ARDS as described above.

 

28th APRIL

FEATURES FOR PROGRESSION FROM MILD DISEASE TO MODERATE DISEASE

  1. Respiratory Rate >24/min
  2. HR >100/min
  3. SpO2 < 94% at Room Air
  4. Stupor, Drowsiness or Confusion
  5. SBP <90 mmHg, DBP <60 mmHg
  6. X-Ray Chest PA- showing Bilateral infiltrate / Unilateral infiltrate / Ground glass opacity
  7. ST-T changes in ECG suggestive of Myocarditis
  8. Exacerbation of Comorbid Conditions

POOR PROGNOSTIC SIGNS

  1. Neutrophil : Lymphocyte Ratio ≥ 3.13
  2. Development of Acute Kidney Injury
  3. Raised Serum Ferritin
  4. Raised Bilirubin or Liver Enzymes
  5. Infiltrates & Ground Glass opacities in Chest X-Ray
  6. Type 1 Respiratory Failure in ABG or PaO2/FiO2 ratio <300
  7. Hypotension
  8. Features of Myocarditis (Trop-T positive)
  9. Elevated Lactate level (>2mmol/lit)
  10. Elevated Procalcitonin

TREATMENT OF MILD CASES

Symptomatic Treatment

o Rest

o Paracetamol for FEVER

o Antitussive for COUGH

o ORS for DIARRHOEA

o Metered Dose Inhalers for MILD BREATHLESSNESS

o Plenty of Fluids

o Nutritious Diet

Specific Treatment for High Risk Cases

o Tab. Hydroxychloroquine 400mg BD on Day 1, followed by 400 mg OD for 4 Days.

 

29TH APRIL

Older people at a higher risk to contract the virus. Younger people more likely to get infected by it but gradually get immune to it. The solution?

TEMPORARY SEPARATION OF THE OLD FROM THE YOUNG.

When young people contract the virus and come in close proximity to old people they risk the latter. According to studies 0-0.1% young people have died of covid(under the age of 20/30).

But the mortality rate for old people who have contracted the virus is 1 out of 7 individuals.

Eventually, the young population is also going to contract the Corona virus and unknowingly, within a period of 3 to 4 weeks they’ll become immune to it. And once when that percentage of population reaches 60-70% then the pandemic will be over. It might take 2 to 3 months from now to happen.

HIGH RISK GROUP : Patients with

o Age > 60 years

o Chronic Lung Diseases

o Chronic Liver Disease

o Chronic Kidney Disease

o Hypertension

o Cardiovascular Disease

o Cerebrovascular Disease

o Diabetes

o HIV

o Cancers

o On Immunosuppressive drugs

 

30TH APRIL

WHEN TO REFER TO HIGHER FACILITY

Any patient developing ANY ONE of the following:

  1. SpO2 < 94% at Room Air
  2. Confusion, Drowsiness
  3. SBP <90 mmHg, DBP <60 mmHg
  4. X-Ray Chest PA- showing Bilateral infiltrate / Unilateral infiltrate / Ground glass opacity
  5. Deranged Liver or Kidney Function

WHEN TO DISCHARGE

  1. Patient afebrile without Paracetamol
  2. Asymptomatic. No respiratory symptoms
  3. Vitals Stable
  4. Other organ parameters normal/satisfactory
  5. Chest X-ray PA view – Clear
  6. Viral clearance in nasal-pharyngeal swabs after two tests become negative at 24 hours apart

FOLLOW UP

  • All patients must follow strict Home Quarantine for 14 days after discharge
  • Clinical Follow up at 14th day and 28th day

 

1ST MAY

Following Government medical colleges are approved to perform TrueNatTM beta CoV test on TruelabTM workstation as a screening test. All positive samples need to be reconfirmed by a separate confirmatory assay for SARS-CoV-2 mapped with each institute as mentioned below. Negative test results uploaded by TrueNat laboratory will be deemed as final for that episode of testing.

 

 

2nd MAY

WHO and the European Investment Bank yesterday signed a collaboration agreement to accelerate investment in health preparedness and primary healthcare in countries most vulnerable to the COVID-19 pandemic. The first phase will strengthen primary healthcare in ten African countries. The Director General Dr. Tedros, in his regular media briefing yesterday said that, with the signing of the agreement, “We are deepening our relationship with the European Union”. He also reminded all that the European Commission will host a pledging conference on 4 May to raise funds for investment in vaccine research.

This crisis surely is one of its kind and has no precedent to it – there are no rulebooks, no standards that tell governments what to do; how to shut down economies; when to re-open; and a how to exit strategy. We cannot deny the fact that this virus is a cross-species transmission (CST), also called interspecies transmission – it has jumped from its animal host to humans; it is pernicious as it seems to find new ways to hide itself; and now that we can be asymptomatic and yet be a carrier of infection is really deadly and devastating.

But what we should really be thinking about amidst this lockdown, where we all are trying to adapt to the “new normal”, is that, what are the challenges that our healthcare system is facing today; what are some of the most important innovations our healthcare industry needs to battle against this pandemic.

 

3rd MAY

Some of the biggest challenges in testing/diagnosing the current situation are:

 

Identification of suspected cases and faster diagnosis

Continuous revision of testing strategies

Augmenting the testing capacity Limited

Availability of infrastructure (like Biosafety 2-3 standards etc)

Limited NABL accredited diagnostic labs – Need to fast track accreditation

Limited Skilled workforce

Safety of manpower

Limited resources like PPEs – innovators stepped up and helped with some innovative models and was made available with the help of government interventions, but costs are high

Type of sample collection nasopharyngeal / oropharyngeal /buccal)

When to collect samples – time of sample collection (affects the accuracy of the diagnosis)

Storage and transportation of the samples ( spl Viral transport media required and cold chain needs to be maintained )

Availability of ICMR approved testing kits

Logistic and supply chain disruption

Scared Manpower and need for strong motivation and assurance

Health being a state subject there is some disconnect and a lack of alignment on goals between the centre and the states. quality validation

Catering to India’s 1.3 billion population is a huge task and calls for a smoother operational mechanism for the success of this collaborative approach.

State governments need to step up measures and ensure a hurdle-free procedure and a safe environment for the medical and testing workforce.

 

4TH MAY

COVID-19 AND PREGNANCY

o Reported cases of COVID-19 pneumonia in pregnancy are milder and with good recovery. Pregnant women with heart diseases are at higher risk of severity

o There is no data suggesting any increased risk of miscarriage or loss of early pregnancy

o COVID-19 is not an indication for Medical Termination of Pregnancy

o There is no recorded case of vaginal secretions being tested positive for COVID-19

o There is no recorded case of breast milk being tested positive for COVID-19

o Vaginal delivery is recommended, if feasible, unless severely ill. If urgent delivery by Caesarean Section is needed, spinal anaesthesia is recommended to minimise the need for general anaesthesia. Always aim to keep the oxygen saturation above 94% during the procedure

o Transmission of the disease from the mother to the baby after birth via contact with infectious respiratory secretions is a major concern

o Mother has to be isolated from the new-born until the mother becomes negative two times by RT-PCR at 24 hours apart. A separate isolation room should be available for the new-born

o The new-born has to be tested by RT-PCR whenever symptomatic. If the new-born remains asymptomatic, test should be done after 14 days of two RT-PCR negative reports of the mother.

BREAST FEEDING

o The risks and benefits of temporary separation should be discussed with the mother

o During temporary separation, if the mother is not seriously ill and she wishes to breastfeed the baby, breast milk can be expressed in a dedicated breast pump, after appropriate hand hygiene. Baby is fed the expressed breast milk by a healthy caregiver after disinfecting the pump

o If the new-born requires “rooming in” with the sick mother in the same room as per the wish of the mother or it becomes unavoidable due to facility limitation, due consideration should be given to implement measures to reduce the viral exposure of the new-born. The mother should always wear a three-layered medical mask

o The decision to discontinue temporary separation should be made on a case-by-case basis after proper consent and after ensuring appropriate measures to reduce exposure of the baby

o If the mother is not too sick and if the mother and baby are kept in the same room, mother can breast feed the baby, after putting on a three-layered medical mask, appropriate hand hygiene and proper cleaning of her breast and nipple before each feeding.

 

5TH MAY

o If we follow the management protocol for all COVID-19 patients, the recovery rate is satisfactory and the death rate is only around 3% of all the affected persons

o We should address the hypoxia or acute respiratory failure component and multi-organ involvement as early as possible in moderate to severely ill patients to save the maximum number of affected patients

o The patient should be referred to Critical Care Unit in proper time on proper indications

o During the course of treatment, we should always reassure the patient to alleviate his/her fear or panic related to the disease

o HCWs must write the appropriate treatment notes time to time in the management Top Sheet

o Appropriate and adequate self-protection of the HCWs is of paramount importance during patient care.

o Any lack in safety measures and infection prevention is extremely undesirable.

 

6TH MAY

Putting it together, Dr Gupta told that there are three dimensional aspects to one’s well being, that is Spirit, Body and Mind.

Whether we talk about insomnia, strange dreams, or even too much sleep, all are types of sleep disturbances that are a part of our body’s response to trauma and anxiety.

“Heal thy self” and “self-awareness” are the key to good health that we all need to take care of. Mindfulness and relaxation techniques are proven to improve mood and sleep quality by enhancing the control over the body’s focus and arousal system as well as in managing anxiety and concerns.

Stress, in such a situation is quite normal and can be healthy (as it motivates one to take necessary actions), but too much sustained stress is not. High and unregulated levels of stress can have various negative consequences on the brain, immunity and also on the vascular system of the body, leading to blood sugar imbalances, high blood pressure, impaired immunity and inflammatory responses – the very precise opposite of what we need to fight the potential impact from this COVID-19 exposure.

Good sleep, healthy diet, good sleep and meditation are important practices to be taken into consideration. Three dimensional healthy lifestyle can do wonders and everyone should try to follow it, irrespective of one being at home, in a hospital or anywhere else.

 

7TH MAY

The following govt. testing laboratories in West Bengal are approved by the ICMR for CoV sample testing :

 

8th MAY

Dialysis of COVID positive cases at MR Bangur Super Speciality hospital and considering the nature and trend of cases over the last 3 weeks, the hospital authority is directed to expand the facility as per plan below:

 

 

9th MAY

Due to prolonged lockdown, people in quarantine centres and in home isolation and also the people confined in their houses, may suffer from mental distress and may need counselling support.

To cater the need for psychological counselling, this dept. has commenced on tele-consultation facility with Psychologists free of cost, which will be available from 11 am to 5 pm everyday through helpline of Health and Family Welfare Department 1800 313 4444 222/ 033 2431 2600.

Upon receiving a call the operator of the helpline will pre-book a counselling session for the caller and inform the time schedule of the counselling session so that the caller can keep himself/ herself free for the counselling.

 

10th MAY

Immunization is one of the essential health services to be continued during COVID-19 outbreak to protect children and pregnant women from Vaccine Preventable Diseases (VPD). The increasing cohort of unimmunized children poses a risk of VPD outbreak and need to be immediately addressed. With a focused view to continue providing essential health services, without hampering COVID-19

related services, it is important not only to maintain population trust in the health system to deliver essential health services but also to minimize increase in morbidity and mortality from other health conditions. (Annexures: D. 0. No. 7(23)2020-NHM-l, Dated the: 281h April, 2020 of Secretary, Ministry of Health & Family Welfare, Government of India and presentation on “Immunization Services during and post COVID-19 Outbreak” by Ministry of Health & Family Welfare, dated. 24th April, 2020)

The districts are now categorized into:

  1. Hotspot Districts (Red Zone)
  2. Non-Hotspot Districts (Orange Zone)
  3. Non-Infected Districts (Green Zone)

Within each Hotspot and Non-Hotspot district, areas with COVID-19 cases will be identified as:

  1. Containment zone
  2. Buffer Zone
  3. Areas beyond buffer zone

Guiding Principles:

  1. Practices of social distancing, hand washing and respiratory hygiene need to be maintained at all immunization sessions irrespective of district categorization by all (i.e. beneficiaries and service providers) in all sessions.
  2. Birth dose vaccination at health facilities would continue irrespective of district categorization.
  3. The categorization of districts into Hotspot, Non-Hotspot & Non-Infected districts is a dynamic process which is updated on a weekly basis. Hence immunization service guidelines are to be implemented as per the updated category.

 

11TH MAY

Immunization services are to be delivered through three platforms:

  1. Birth dose vaccination: Birth dose vaccinations at delivery points in health facilities.
  2. Health Facility based sessions: Immunization sessions at fixed health facilities like MCH, DH, SDH, SGH, RH, PHC, UPHC, SC, Urban Health Post etc.
  3. Outreach sessions: As part of Urban/Village Health Sanitation and Nutrition Days

(UHNDNHND) services.

  1. Hotspot Districts/ Zone (Red Zone) and Non-Hotspot Districts/ Zone (Orange Zone):

Modified outreach Session

  • One outreach session for <500 population to limit the total beneficiaries to IO to I 5/session.
  • Staggered approach for each session to avoid crowding.
  • At any a given time during session, not more than 5 persons be present at a session site with at least meter distance between each.
  • Organization of such session will be at the discretion of district administration with clear planning for social distancing and hand washing

Any area exiting a ‘containment/ buffer zone’ can start facility based and outreach immunization activities as in ‘areas beyond buffer zone’ after a gap of minimum 14 days following delisting.

However, as per the State guideline, the District administration should make a local assessment of COVID risk before starting the outreach or health facility based immunization with mobilization of beneficiaries.

  1. Non-infected Districts/Zone: All remaining districts in the country other than the districts in Hotspot & Non-hotspot category.

Standard Guidelines for all Outreach Sessions irrespective of district categorization

  • Universal prevention and control principles for COVID- I 9 to be followed for each session
  • All outreach sessions to follow staggered approach and community mobilization strategy to be adapted accordingly to prevent overcrowding at session site.
  • Pre-identification of session site with adequate seating space for beneficiaries and caregivers while maintaining social distancing (at least I-meter gap) with clear area of demarcation for incoming beneficiaries, post vaccination waiting area and a reserve zone if gathering increases
  • Support from Panchayat/Urban Local Body to be sought for identification of appropriate session site with space to practice social distancing (at least 1 meter).
  • Various ‘session’ approaches to be adopted in all districts for immunization services.

 

12TH MAY

A health facility should continue immunization services with below mentioned prerequisite arrangements:

  • Pre-identification of a well-ventilated seating area with demarcated seating location I meter apart.
  • An adequate number of pre identified, fixed vaccination staff depending on the injection load and the required documentation.
  • Staff conducting vaccination should wear a surgical mask & gloves and should frequently sanitize their hands with soap.
  • Support staff to manage seating arrangement, queue management etc. for the pregnant women and care givers.
  • Hand washing units for public use at the entrance to the health facility may be ensured.
  • Disinfect the seating space after completion of the immunization session.
  • Adequate availability of MCP card and due updating of records.
  • Adequate availability of vaccines and logistics for the uninterrupted immunization session
  • Display visual alerts in clinics, such as posters, with information about COVID-19 disease and reminders on individual prevention strategies.

 

13th MAY

Medical College Kolkata is designated as tertiary level COVID Hospital

For the treatment of COVID-19 patients, the Government has notified 67 (sixty-seven) Government hospitals and Government-requisitioned hospitals across the State, of which 05 (five) hospitals are in Kolkata.

Now, in order to augment the infrastructure for the treatment of COVID patients, it has been decided to designate the Medical College & Hospital, Kolkata (1,000 beds) as a tertiary level COVID hospital.

The Principal and MSVP, Medical College 86 Hospital, Kolkata will take immediate steps to operationalise the said hospital for treatment of COVID patients with effect from 07.05.2020.

 

14TH MAY

THE FOLLOWING REQUESTS ARE MADE TO THE :

The Commissioner, Kolkata Municipal Corporation

The District Magistrate, all districts

The Commissioner, other Municipal Corporations.

The services of medical and paramedical staffs including ANM, ASHA, FTS, HHW are urgently required in meeting the challenges of COVID-19 pandemic.

Furthermore, they have to render normal responsibilities, such as conducting immunization sessions maintaining preventive measures of CO VI D-19 such as social distancing, It and respiratory hygiene etc. Please ensure the supply of appropriate PPE to the vaccinators and mobilisers.

You are requested to take necessary steps for smooth movements of the staffs as well as vaccine.

Urban local body, Borough and Gram Panchyats 111ay be requested to ensure well ventilated seating area with demarcated seating arrangement of I meter apart for the sessions. We may consider A WW centre, Schools. Panchayat building. Community centers etc. in addition to subcentres/ UPHC/Health posts.

  1. In Red and Orange zone:
  2. In Containment and Buffer Zone: Birth dose will be continued. Vaccinator and vaccine should be available in health facilities such as MCH, DH, SDH, SGH, RH, PHC, UPHC, SC, Urban Health Post etc., so that beneficiaries, who will report for immunization. are not deprived. But no active mobilization is needful now.
  3. Outside the Buffer Zone: Birth dose and vaccination at health facilities such as MCH, DH, SDH, SGH, RH, PHC, UPHC, SC, and Urban Health Post etc. will be continued. Modified outreach session wi II have to be conducted.
  4. In Green Zone:

Birth dose, vaccination at health facilities such as MCH, DH, SDH, SGH, RH, PHC, UPHC. SC, Urban Health Post etc. and outreach sessions will be continued.

 

15TH MAY

The health care personnel working in hospitals are at increased risk of acquiring the COVID-19 disease, if there is a breach in the personal protection while managing patients.

The health-work force is a valuable and scarce resource. Large number of COVID-19 affected health personnel getting isolated for treatment and their close contacts undergoing quarantine affects the health/ hospital service delivery.

Hospitals shall activate its Hospital Infection Control Committee (HICC).

The HICC in the health facility is responsible for implementing the Infection Prevention and Control (IPC) activities and organizing regular trainings on IPC for HCWs.

A Nodal Officer (Infection Control Officer) shall be identified by each hospital to address all matters related to Healthcare Associated Infections (HAIs). With reference to preventing such infection among healthcare workers, he/she will ensure that:

  1. Healthcare workers in different settings of hospitals shall use PPEs appropriate to their risk profile as detailed in the guidelines issued by this Ministry (available at:

https://www.mohfw.gov.in/pdf/GuidelinesonrationaluseofPersonalProtectiveEquipment.pdf , and

https://www.mohfw.gov.in/pdf/UpdatedAdditionalguidelinesonrationaluseofPersonalProtectiveEquipmentsettingapproachforHealthfunctionariesworkinginnonCOVID19areas.pdf )

  1. All healthcare workers have undergone training on Infection Prevention and Control and they are

aware of common signs and symptoms, need for self-health monitoring and need for prompt reporting of such symptoms.

iii. Provisions have been made for regular (thermal) screening of all hospital staff.

  1. All healthcare workers managing COVID-19 cases are being provided with chemo-prophylaxis under medical supervision.
  2. Provisions have been made for prompt reporting of breach of PPE by the hospital staff and follow up action.

 

16TH MAY

Action for Healthcare Workers

  1. Ensure that all preventive measures like frequent washing of hands/use of alcohol based hand sanitizer, respiratory etiquettes (using tissue/handkerchief while coughing or sneezing), etc. are followed at all times.
  2. He/she shall use appropriate PPE at all times while on duty.

iii. A buddy system* to be followed to ensure that there is no breach in infection prevention control practices.

  1. Any breach in PPE and exposure is immediately informed to the nodal officer/HoD of the department
  2. HCWs after leaving the patient care units (wards/OPDs/ICUs) at the doctor’s duty rooms/hostels/canteen or outside the HCF must follow social distancing and masking to prevent transmission to/acquiring infection from other HCWs who may be positive.
  3. Pregnant/lactating mothers and immuno-compromised healthcare workers shall inform their medical condition to the hospital authorities for them to get posted only in non-Covid areas.

*Buddy system: Under this approach, two or more-person team is formed amongst the deployed hospital staff who share responsibilities for his/her partner’s safety and well-being in the context of (i) Appropriately donning and doffing of PPEs, (ii) maintaining hand hygiene and (iii) taking requisite steps on observing breach of PPEs.

 

17TH MAY

All the Healthcare workers must report every exposure to COVID-19 to the concerned nodal officer and HoD of the concerned department immediately.

The Nodal officer will get the exact details of exposure to ascertain whether the exposure constitutes a high risk or low risk exposure as described below:

  • High risk exposure:
  • HCW or other person providing care to a COVID-19 case or lab worker handling respiratory specimens from COVID-19 cases without recommended PPE or with possible breach of PPE
  • Performed aerosol generating procedures without appropriate PPE.
  • HCWs without mask/face-shield/goggles:

o having face to face contact with COVID-19 case within 1 metre for more than 15

minutes

o having accidental exposure to body fluids

  • Low risk exposure:

Contacts who do not meet criteria of high risk exposure.

 

18TH MAY

In January 2020 the World Health Organization (WHO) declared the outbreak of a new coronavirus disease, COVID-19, to be a Public Health Emergency of International Concern. WHO stated that there is a high risk of COVID-19 spreading to other countries around the world. In March 2020, WHO made the assessment that COVID-19 can be characterized as a pandemic. WHO and public health authorities around the world are acting to contain the COVID-19 outbreak. However, this time of crisis is generating stress throughout the population. The considerations presented in this document have been developed by the WHO Department of Mental Health and Substance Use as a series of messages that can be used in communications to support mental and psychosocial well-being in different target groups during the  outbreak.

Messages for healthcare workers

  1. Feeling under pressure is a likely experience for you and many of your colleagues. It is quite normal to be feeling this way in the current situation. Stress and the feelings associated with it are by no means a reflection that you cannot do your job or that you are weak. Managing your mental health and psychosocial well-being during this time is as important as managing your physical health.
  2. Take care of yourself at this time. Try and use helpful coping strategies such as ensuring sufficient rest and respite during work or between shifts, eat sufficient and healthy food, engage in physical activity, and stay in contact with family and friends. Avoid using unhelpful coping strategies such as use of tobacco, alcohol or other drugs. In the long term, these can worsen your mental and physical well-being. The COVID-19 outbreak is a unique and unprecedented scenario for many workers, particularly if they have not been involved in similar responses. Even so, using strategies that have worked for you in the past to manage times of stress can benefit you now. You are the person most likely to know how you can de-stress and you should not be hesitant in keeping yourself psychologically well. This is not a sprint; it’s a marathon.
  3. Some healthcare workers may unfortunately experience avoidance by their family or community owing to stigma or fear. This can make an already challenging situation far more difficult. If possible, staying connected with your loved ones, including through digital methods, is one way to maintain contact. Turn to your colleagues, your manager or other trusted persons for social support – your colleagues may be having similar experiences to you.
  4. Use understandable ways to share messages with people with intellectual, cognitive and psychosocial disabilities. Where possible, include forms of communication that do not rely solely on written information.
  5. Know how to provide support to people who are affected by COVID-19 and know how to link them with available resources. This is especially important for those who require mental health and psychosocial support. The stigma associated with mental health problems may cause reluctance to seek support for both COVID-19 and mental health conditions. The mhGAP Humanitarian Intervention Guide includes clinical guidance for addressing priority mental health conditions and is designed for use by general healthcare workers.

Messages for team leaders or managers in health facilities

  1. Keeping all staff protected from chronic stress and poor mental health during this response means that they will have a better capacity to fulfil their roles. Be sure to keep in mind that the current situation will not go away overnight and you should focus on longer-term occupational capacity rather than repeated short-term crisis responses.
  2. Ensure that good quality communication and accurate information updates are provided to all staff. Rotate workers from higher-stress to lower-stress functions. Partner inexperienced workers with their more experienced colleagues. The buddy system helps to provide support, monitor stress and reinforce safety procedures. Ensure that outreach personnel enter the community in pairs. Initiate, encourage and monitor work breaks. Implement flexible schedules for workers who are directly impacted or have a family member affected by a stressful event. Ensure that you build in time for colleagues to provide social support to each other.
  3. Ensure that staff are aware of where and how they can access mental health and psychosocial support services and facilitate access to such services. Managers and team leaders are facing similar stresses to their staff and may experience additional pressure relating to the responsibilities of their role. It is important that the above provisions and strategies are in place for both workers and managers, and that managers can be role-models for self-care strategies to mitigate stress.
  4. Orient all responders, including nurses, ambulance drivers, volunteers, case identifiers, teachers and community leaders and workers in quarantine sites, on how to provide basic emotional and practical support to affected people using psychological first aid.
  5. Manage urgent mental health and neurological complaints (e.g. delirium, psychosis, severeanxiety or depression) within emergency or general healthcare facilities. Appropriate trained and qualified staff may need to be deployed to these locations when time permits, and the capacity of general healthcare staff capacity to provide mental health and psychosocial support should be increased (see the mhGAP Humanitarian Intervention Guide).
  6. Ensure availability of essential, generic psychotropic medications at all levels of health care. People living with long-term mental health conditions or epileptic seizures will need uninterrupted access to their medication, and sudden discontinuation should be avoided.

 

 

19TH MAY

Coronavirus has infected around 548 doctors, nurses and paramedics across the country so far, according to data maintained by the Centre, official sources said on Wednesday.

The figure does not include field workers, ward boys, sanitation workers, security guards, lab attendants, peons, laundry and kitchen staff among others.

According to an official source, it has not been ascertained from where these doctors, nurses and paramedic staff have acquired the infection. The figure includes doctors, nurses and paramedics from Centre-run and state government-run facilities across states and union territories.

“No epidemiological investigation of the cases were done. So there is no clear segregation on how many contracted the disease at workplace and how many got it from the community,” the official source said.

Several doctors, who tested positive for Covid-19, are also reported to have died in the country. Though their exact numbers were not immediately known.

The official said that 69 doctors in the national capital have so far contracted the disease. Covid-19 has claimed 1,694 lives and infected 49,391 people nationwide till Wednesday morning.

Besides, 274 nurses and paramedics have so far been infected by the virus.

As many as 13 healthcare personnel, including seven resident doctors and a professor, have tested positive for coronavirus over the past two months at the Centre-run Safdarjung Hospital, the sources said.

Around 10 healthcare workers, including a resident doctor and five nurses, have contracted the disease so far at the AIIMS. Besides, some security guards have also been infected in the premier hospital.

Besides, several healthcare workers working in various central and Delhi government hospitals have also been infected by the disease, according to the data.

 

 

 

 

 

 

 

 

20TH MAY

MANAGEMENT OF COVID-19 IN WEST BENGAL EXPLAINED THROUGH THE FOLLOWING FLOWCHART:

                

GENERAL PRINCIPLE FOR OUTDOOR SETTINGS IN ALL HOSPITALS

  1. Screening of patients with fever and respiratory tract symptoms in dedicated fever clinics
  2. All patients attending fever clinic must wear a face mask, or may be provided with a mask
  3. Maintain more than one-meter distance from patient
  4. Use appropriate PPE while seeing patients
  5. Avoid face-to-face sitting with the patients

GENERAL PRINCIPLE FOR INDOOR SETTINGS IN COVID HOSPITALS

  1. All patients Must Always wear a 3-layer surgical mask after admission
  2. No family member will be allowed in patient areas to meet the patient
  3. Patient will not be allowed to carry any phone/mobile inside the ward along with him/her
  4. A designated help line will communicate patient relatives about the patient’s condition
  5. Separate lifts should be used to transport the patients
  6. Patients should be placed in single rooms. If single rooms are not available, patients should

be placed sufficiently apart. Distance between two beds should be more than one meter preferably 2 meters.

  1. All the paper works, e.g. writing notes in BHT or Treatment Cards should be done in a separate area.
  2. Avoid moving and transporting patients out of their room unless medically necessary
  3. Clean Environmental surfaces with detergents and 1% Sodium Hypochlorite solution
  4. Manage Laundry, Food Service, Utensils and Medical Waste with safe routine procedures.

 

22ND MAY

Member States at the World Health Assembly today agreed three resolutions on universal health coverage (UHC). They focus on: primary healthcare, the role of community health workers, and the September UN General Assembly high-level meeting on UHC.

Primary health care towards universal health coverage

The first resolution urges Member States to take measures to implement the Declaration of Astana, adopted at the 2018 Global Conference on Primary Health Care.

It recognizes the key role strong primary health care plays in ensuring countries can provide the full range of health services a person needs throughout their life – be it disease prevention or treatment,  rehabilitation or palliative care. Primary health care means countries must have quality, integrated health systems, empowered individuals and communities, and that they must involve a wide range of sectors in addressing social, economic, and environmental determinants of health.

The resolution calls on the WHO secretariat to increase its support to Member States in this area. WHO is also required to finalize its Primary Health Care Operational Framework in time for next year’s World Health Assembly.  WHO and other stakeholders are tasked with supporting countries in implementing the Declaration of Astana and mobilizing resources to build strong and sustainable primary health care.

Community health workers delivering primary health care

The second resolution recognizes the contribution made by community health workers to achieving universal health coverage, responding to health emergencies, and promoting healthier populations. It urges countries and partners to use WHO’s guideline on health policy and system support to optimize community health worker programme, and to allocate adequate resources. At the same time, the WHO Secretariat is requested to collect and evaluate data,  monitor implementation of the guideline, and provide support to Member States.

Community health workers have a key role to play in delivering primary health care – they speak local languages and have the trust of local people. They need to be well trained, effectively supervised, and properly recognized for the work they do, as part of multi-disciplinary teams. Investing in community healthworkers generates important employment opportunities, especially for women.

Universal health coverage high-level meeting

The final UHC resolution endorsed by Member States supports preparation for the UN General Assembly high-level meeting on universal health coverage in September 2019. The resolution calls on Member States to accelerate progress towards universal health coverage with a focus on poor, vulnerable and marginalized individuals and groups. The UN high-level meeting will call for the involvement of governments in coordinating the work required across all sectors to achieve universal health coverage. Member States identified key priorities such as health financing, building sustainable and resilient people-centred health systems, and strengthening health workforces. They also emphasized  the importance of investing in and strengthening primary health care.

 

 

 

 

23RD MAY

COVID-19, a disease caused by a novel corona virus (SARS CoV-2), is currently a pandemic, which produces high morbidity in the elderly and in patients with associated comorbidities.

Chronic kidney disease stage-5 (CKD-5) patients on dialysis [maintenance haemodialysis (MHD)or continuous ambulatory peritoneal dialysis (CAPD)] are also vulnerable group because of their existing comorbidities, repeated unavoidable exposure to hospital environment and immunosuppressed state due to CKD-5. These patients are therefore not only more prone to acquire infection but also develop severe diseases as compared to general population.

Patients on regular dialysis should adhere to prescribed schedule and not miss their dialysis sessions to avoid any emergency dialysis.

There will be three situations of patients who require dialysis; patients already on maintenance dialysis, patients requiring dialysis due to acute kidney injury (AKI) and patients critically ill requiring continuous renal replacement therapy (CRRT).

GUIDELINES FOR HEMODIALYSIS

  1. For Patients
  2. Before Arrival to Dialysis Unit
  3. All units should instruct their patients to recognize early symptoms of COVID-19 (recent onset fever, Sore throat, Cough, recent Shortness of breath/dyspnoea, without major interdialytic weight gain, rhinorrhoea, myalgia/body ache, fatigue and Diarrhoea) and contact dialysis staff before coming to dialysis centre. The unit needs to make necessary arrangement for their arrival in the screening area.
  4. Patients, who are stable on MHD may be encouraged to come to the unit alone without any attendant.
  5. Screening Area
  6. We recommend that dialysis unit should have a designated screening area, where patients can be screened for COVID-19 before allowing them to enter inside dialysis area. Where this is not possible, patients may wait away from the dialysis unit until they receive specific instructions from the unit staff.
  7. The screening area should have adequate space to implement social distancing between patients and accompanying persons while waiting for dialysis staff. In screening area, every patient should be asked about:

▪ Symptoms suspected of COVID-19 as above.

▪ History of contact with a diagnosed case of COVID 19

▪ History of contact with person who has had recent travel to foreign country or from high COVID-19 prevalence area within our country as notified by the Central and State/ UT governments respectively.

  1. Patients with symptoms of a respiratory infection should put on a facemask before entering screening area and keep it on until they leave the dialysis unit. Dialysis unit staff should make sure an adequate stock of masks is available in screening area to provide to the patients and accompanying person if necessary.
  2. There should be display of adequate IEC material (posters etc.) about COVID – 19 in the screening area.
  3. Inside Dialysis Unit
  4. Suspected or positive COVID-19 patients should properly wear disposable three-layer surgical mask throughout dialysis duration.
  5. Patients should wash hands with soap and water for at least 20 seconds, using proper method of hand washing. If soap and water are not readily available, a hand sanitizer containing at least 60% alcohol can be used.
  6. Patients should follow cough etiquettes, like coughing or sneezing using the inside of the elbow or using tissue paper.
  7. Patients should throw used tissues in the trash. The unit should ensure the availability of plastic lined trash cans appropriately labeled for disposing of used tissues. The trash cans should be foot operated ideally to prevent hand contact with infective material.
  8. There should be display of adequate IEC material (posters etc.) about COVID – 19 in the dialysis area.
  9. For Dialysis Staff
  10. Screening Area
  11. The unit staff should make sure an adequate stock of masks and sanitizers are available in screening area to provide to the patients and accompanying person if necessary.
  12. During Dialysis
  13. It should be ensured that a patient or staff in a unit does not become the source of an outbreak.
  14. Each dialysis chair/bed should have disposable tissues and waste disposal bins to ensure adherence to hand and respiratory hygiene, and cough etiquette and appropriate alcohol based hand sanitizer within reach of patients and staff.
  15. Dialysis personnel, attendants and caregivers should also wear a three-layer surgical facemask while they are inside dialysis unit.
  16. Ideally all patients with suspected or positive COVID-19 be dialyzed in isolation. The isolation ideally be in a separate room with a closed door, but may not be possible in all units. The next most suitable option is the use of a separate shift, preferably the last of the day for dialyzing all such patients. This offers the advantage of avoiding long waiting periods or the need for extensive additional disinfection in between shifts. The next suitable option is to physically separate areas for proven positive and suspected cases. Where this is also not possible, we suggest that the positive or suspected patient may be dialyzed at a row end within the unit ensuring a separation from all other patients by at least 2 meters.
  17. Staff caring for suspected or proved cases should not look after other patients during the same shift.
  18. Dialysis staff should use of all personal protective equipment (PPE) for proven or strongly suspected patients of COVID-19. Isolation gowns should be worn over or instead of the cover gown (i.e., laboratory coat, gown, or apron with incorporate sleeves) that is normally worn by haemodialysis personnel. If there are shortages of gowns, they should be prioritized for initiating and terminating dialysis treatment, manipulating access needles or catheters, helping the patient into and out of the station, and cleaning and disinfection of patient care equipment and the dialysis station. Sleeved plastic aprons may be used in addition to and not in place of the PPE recommended above.
  19. Separating equipment like stethoscopes, thermometers, Oxygen saturation probes and blood pressure cuffs between patients with appropriate cleaning and disinfection should be done in between shifts.
  20. Stethoscope diaphragms and tubing should be cleaned with an alcohol-based disinfectant including hand rubs in between patients. As most NIBP sphygmomanometer cuffs are now made of rexine they should also be cleaned by alcohol or preferably hypochloritebased (1% Sodium Hypochlorite) solutions however the individual manufacturer’s manuals should be referred to.
  21. Staff using PPE should be careful of the following issues

▪ While using PPE, they will not be able to use wash room so prepare accordingly.

▪ After wearing eye shield, moisture appears after some time and visibility may become an issue. Therefore, machine preparation can be done in non-infected area before shifting to near the patient.

▪ If dialysis is to be done bed-side in the hospital, portable RO should be properly disinfected with hypochlorite (1% Sodium Hypochlorite) solution between use of two patients.

24TH MAY

According to trusted sources, 11 healthcare workers, including two resident doctors, have tested positive for coronavirus at the AIIMS on Friday, taking the total number of hospital staff infected so far to 206.

Since 1 February, 206 healthcare workers including two faculty, ten resident doctors, 26 nurses, nine technicians, five mess workers, 49 hospital attendants, 34 sanitation workers and 69 security guards have been infected by the novel coronavirus, an AIIMS official was quoted by PTI as saying.

PERSONAL PROTECTIVE EQUIPMENTS (PPE)

Personal protective equipment must be used while handling COVID-19 positive patients.

These include:

▪ Shoe covers

▪ Gown

▪ Surgical cap or hood

▪ Goggles or eye shields

▪ Mask: Ideally all masks should be N95 respirators with filters. However, as the life of such masks is approximately 6-8 hours and they can be uncomfortable over a long term and are also in short supply, they should be prioritized for aerosol generating procedures, namely intubation, open suction and bronchoscopy. Surgical triple layer masks and cloth masks can be used as alternatives for all other procedures.

▪ Surgical gloves.

The correct method of donning and doffing personal protective equipment’s (PPE) can be viewed on YouTube at https://youtu.be/NrKo2vWJ8m8. However, it is always better to give hands on training of donning and doffing to staff who is going to handle suspected or positive patients.

 

25th MAY

ACCORDING TO A CIRCULAR BY Government of West Bengal Directorate of Health Service (PH & CD Branch) Swasthya Bhavan,

The COVID- 19 situation has been evolving continuously since the outset and accordingly the detection strategy and testing criteria have been revised in our country from time to time.

in the present scenario, the need has arisen to people in certain situations where he/she is asymptomatic or has no definite contact history. Hence the issue of OPD based testing has also come up. Opening up of provisions for home isolation/ quarantine has made the matter further relevant. Considering the above. the undersigned likes to slate that private hospitals ‘which also have an approved laboratory for test of SARS-COV-2 may go for a walk-in sample collection system, maintaining, the necessary bio-safety measures. The intending patient has to be taken to the sample collection unit through the OPD (or Fever Clinic if he is symptomatic) and sample is to be taken on Doctor’s advice. Social distancing and in control practices have to be duly maintained in the concerned units.

Reporting from the laboratory will continue as per the existing norms.

 

26th MAY

The ongoing COVID-19 pandemic has laid bare the deep fault lines in the Indian healthcare system. In days to come, it is expected that there will be a clamour for greater surveillance, need for better tools to target healthcare delivery, and thus, an increase in use of health information data. While data tools will be essential to plug many gaps in healthcare, a guarded watch over data protection and privacy is necessary.

Not just Aadhaar, there are other digital health technologies that are seeing a rise in usage and will continue to do so. Like the example of telemedicine, approved for by Ministry of Health and Family Welfare (MoFHW), to facilitate consultancy with doctors during lockdown period, there will be several that will demand and use individual health data. The need for stronger laws, its implementation and awareness around it is thus vital.

Aadhaar has been linked to various health-related schemes in India. There has been a growing demand to link Aadhaar with Health Management Information Systems (HMIS) that the National Health Mission (NHM) established across states. This merger of digital identification system with digital health records is considered to bring greater efficiency in healthcare delivery in the country.

Maternal and Child Tracking System, which maintains information of pregnant women; Janani Suraksha Yojana, a conditional cash transfer scheme; Revised National Tuberculosis Control Program and National AIDS Control Program are few examples of Aadhaar linked healthcare delivery. A weak data protection regime is a massive concern in use of Aadhaar for healthcare. This usage has seen many litigations in the country’s courts. The Electronic Health Record Standard, 2016, lacked the tooth of law and leaks of Aadhaar details both in private as well as government websites have been reported. However, the Puttuswamy judgement by the Supreme Court, addressing the question of the validity of Aadhaar changed as it made privacy a fundamental right.

The Personal Data Protection Bill tabled in December 2019, which is with the Parliamentary Standing Committee, focuses on setting up a Data Protection Authority. However, the Bill has come under criticism for allowing government agencies to be exempt from measures to ensure privacy of citizens. In case of Aadhaar linked to healthcare, the insistence of health workers to enrol Aadhaar details to the health information system is commonly heard of. The lack of awareness of one’s rights, the prospect of delay or refusal of benefits often coerce people in subtle ways to part with their data. The challenge faced by low and middle-income countries is enforcing the rule of law.

In India, where public health expenditure is a miniscule 1.28% of its GDP, effective targeting and monitoring of welfare programs are essential components in healthcare delivery. In that regard, accurate data is of utmost importance. The linking of Aadhaar with Health Management Information System (HMIS) can provide such data. Be it Ayushman Bharat or other state-sponsored health schemes, Aadhaar has become a mainstay requirement for access to these insurance and benefit programs. When India is past Covid-19, greater focus and spending on healthcare may be in order coupled with heightened use of existing and newer data structures. The availability, accuracy, usage and protection of this data should be ensured. It should be seen that the already existing principal-agent problem in healthcare should not get exacerbated. If concerns of privacy are not addressed it would lead to an epidemic of another sort, a data capture epidemic. Where individuals will be bereft of any protection of their personal data, where companies will mine data for profit, where the state will have a tool to differentiate between a people. Delivery of democracy and healthcare both would be affected if Indians do not demand for a stronger data protection law and its implementation.

 

27th MAY

Revised SOP for Medical Screening of Migrant Workers/Stranded Tourists/Students arriving in Groups

  1. All the migrant workers/stranded tourists/stranded students arriving at different stations/state borders in groups will be sent to the destination districts. District administration of the disembarking station/ state border will communicate the details of these persons to the destination district immediately.
  2. All arriving persons will be medically screened at the destination district. District administration will put up proper facility for this purpose. Details of all arriving persons including their residential addresses and phone numbers will also be collected at this point. Special attention will be given to the medical screening of the people arriving from five high burden States e.g. Maharashtra, Delhi, Gujarat, Madhya Pradesh and Tamil Nadu.
  3. After medical screening, all asymptotic persons, other than those coming from above mentioned five high burden states, will be released with an instruction for 14 days strict home quarantine.
  4. All the persons coming from the above mentioned five high burden states will be taken for institutional quarantine, as far as possible close their residence, for 14 days.
  5. Family members of quarantined persons will be allowed to provide food to them without coming into any physical contact. In case food is not available from the family members, suitable fooding arrangements will be done by the district administration with the help of local SHGs as done in the case of relief camps. The in-charge of the quarantine centre will ensure proper sanitization of the quarantine centre and maintenance of health hygiene protocol. Norms of social distancing shall be strictly enforced in these quarantine centers.
  6. Swab of only symptomatic persons will be collected and those with mild symptoms and not coming from above mentioned five high burden states, will be released with an instruction for 14 days strict home quarantine.
  7. All the persons with moderate to severe symptoms will be treated as per COVID-19 health management guidelines.
  8. All the persons in institutional quarantine will be medically examined and tested as per ICMR guidelines, if required, before release.
  9. For persons in home quarantine, an advisory containing Do’s and Don’ts shall be provided by the district administration which shall also include a clear warning that any violation of home quarantine conditions shall invite penal action. The details of all such persons shall be collected in “Sandhane” app for further tracking.
  10. Regular monitoring of people in home/institutional quarantine shall be done by the district administration. For any person developing symptoms, protocol of isolation, testing and treatment shall apply.

 

28TH MAY

Industry body Medical Technology Association of India (MTaI) on Thursday sought the government’s intervention to ensure that elective surgical procedures are resumed at the earliest, as this would enable hospitals to re-start their normal operations.

Elective surgeries account for about 50 per cent of revenues for hospitals in normal business conditions. Reduced revenues have curtailed hospitals’ ability to pay for supplies of pharmaceuticals, diagnostics and medical devices, thereby severely disrupting entire healthcare value chain, it added.

The fall in revenue of hospitals is creating an unprecedented financial crisis for the medical device sector due to delays in payment, the statement said.

“The healthcare sector is in dire need of support to resume services to the optimal level. One quick measure in the current circumstances is resumption of elective procedures at the earliest,” MTaI Director Sanjay Bhutani said.

Hospitals need to work in tandem with the government to start elective surgeries without compromising their capabilities to handle COVID-19 cases, he added.

“Creation of a clear communication module is equally important in order to allay any fears in the minds of patients,” Bhutani said.

 

29TH MAY

Health workers constitued 5 per cent of the total confirmed COVID-19 cases in India, till April 30, a report by the scientists at the Indian Council of Medical Research along with other collaborators has revealed.

The study published in the ICMR’s Indian Journal of Medical Research revealed that of the total 40,184 confirmed cases in the country till the end of last month, 2,082 or nearly 5.2 per cent of them were healthcare workers including those with symptoms and those without who had come in contact with infected people without adequate protection.

The number of symptomatic healthcare workers who tested positive for coronavirus stood at 947 while this number was 1,135 for the other category.

This is the first time the government agency has released some data related to the prevalence of COVID-19 infection among healthcare workers in the country.

The study titled “Laboratory surveillance for SARS-CoV-2 in India: Performance of testing & descriptive epidemiology of detected COVID-19, January 22 – April 30, 2020” is based on analysis of 1,021,518 samples tested till April 30, 3.9% of whom had tested positive.

The study carried out by ICMR scientists along with researchers at the WHO, Public Health Foundation of India and some independent public health specialists found that the proportion of positive cases was the highest among symptomatic and asymptomatic contacts, 2-3-fold higher than among those with severe acute respiratory illnesses or those with an international travel history or contact with healthcare workers.

The analysis noted that 6.1 per cent of all hospitalized SARI patients tested positive for COVID-19—recording a significant rise in the percentage of people testing positive, compared to the data released last (till April 2) when this percentage was at 2.8.

The study also said that over 2 per cent of all who had influenza like symptoms in hotspots also tested positive. This, together with positivity rate among SARI patients, is an indicator of growing community transmission of the infectious disease in India.

The researchers noted that of the total infections, 25.3 per cent were asymptomatic family contacts, 10.6 per cent were symptomatic contacts and 10.5 per cent were SARI patients.

Among the 12,810 cases with reported symptoms at the time of specimen collection, cough and fever were the most commonly reported symptoms and around one-third of cases reported sore throat and breathlessness.

Gastrointestinal symptoms such as abdominal pain, nausea, vomiting and diarrhoea were reported by less than 5 per cent of cases.

The study also said that the attack rate (per million population) was the highest among those aged 50-59 and 60-69 years (64.9 and 61.8, respectively) and was lowest among those under 10 years. While the per cent positive among tested was slightly higher among females (4.2 versus 3.8 %), the attack rate (per million population) was higher among males (41.6).

States with the highest proportion of districts reporting positive cases included Delhi, Maharashtra, Kerala, Punjab, Haryana, Tamil Nadu, Andhra Pradesh and Gujarat. The states with the highest test positivity were Maharashtra, Delhi (7.8%), Gujarat (6.3%), Madhya Pradesh (6.1%) and West Bengal (5.8%).

 

30TH MAY

India will enter Lockdown 5.0 from June 1 as the Centre announced the extension of the lockdown till June 30 to curb the spread of coronavirus. Movement of people shall remain prohibited between 9 pm to 5 am. The Ministry of Home Affairs guidelines state that the lockdown will be strictly implemented in containment zones. Malls, restaurants and places of worship can open from June 8. The decision to open schools and educational institutions will be taken in July. The country registered its highest-ever single-day spike of 7,964 cases. According to Worldometer, the number of COVID-19 infections in the country has risen to more than 174,355, with the total number of deaths close to 5,000. As per a study by ICMR scientists, at least 28 percent of people who tested positive for coronavirus till April 30 were asymptomatic. The Department of Science and Technology has initiated a ‘COVID-19 Indian National Supermodel’ to predict the transmission of the infection. After announcing a total lockdown on Sundays, Karnataka reversed its decision and stated that normal life will continue on Sundays. Tamil Nadu opened up its entertainment industry, allowing a maximum of 60 people to participate in shooting of TV serials. Meanwhile, Madhya Pradesh extended the lockdown till June 15, with the state having more than 7,600 confirmed cases. COVID-19 infections across the world crossed six million, according to Worldometer. Mosques in Iran have been allowed to resume daily prayers across the country recording more than 2,800 new cases in the last 24 hours. The Director of the Venice Film Festival has stated that the 77th edition of the event, to be held in September, will go ahead as planned. The death toll in Brazil has surpassed that of Spain as the country’s case count is second only to the US.