Thread by @parija_d

@bmcbbsr (1) Long thread warning..
Me and wife are Medical Doctors. My 68 years old mother, who is diabetic and hypertensive (on medication) was diagnosed with Covid. Harrowing experience so far. But this is neither the time nor the place to demoralise our Health Care workers ...

(2) So what I will do (instead of complaining) is give a few humble suggestions from my Public Health background as well as my personal experience of dealing with the system in place. Hope this is taken in the right spirit by the authorities. Here goes my two cents ...

(3) A. Carry out massive, concerted and continuous awareness drive on symptoms of Covid-19 and which Hospital to approach if there are any signs of the disease.
B. Introduce a system of online / telephonic appointments to fever clinics so as to avoid long waits and rush.

(4) AIIMS Bhubaneswar has one of the better systems in place but even then, the queue and waiting times I observed there need to be dramatically cut down. We cannot have seriously ill patients, potentially infected, stand around for so long. This is dangerous.

(5) C. Keep fever clinics running round the clock. A trained para medic or Nurse too can man this if the training is made algorithm based. This will take off the burden and reduce rush and consequent spread of infection.

(6) D. Keep the Labs running round the clock. For that, trained LTs and Microbiologists (not necessarily MD Microbiology) need to be hired and reagents and kits procured. AMC should be in place, along with standby equipment, to reduce down time due to equipment breakdowns

(7) E. Rope in Private Labs. Frankly, many patients would rather have the sample collected from their residence for which they would be willing to pay. That would ease the burden of testing from the Govt Labs and reduce backlogs and reporting times. Ensure Pvt Labs report.

(8) F. Strictly monitor and ensure that all patients who test negative on the Antigen Test (which is known to be of much lower sensitivity) are retested on the rt-PCR.
G. Ensure that the turnaround times (TAT) for reporting the results are adhered to.

(9) TAT for Antigen test should be less than an hour from sample collection and the same for rt-PCR should be same day (if sample was collected in the forenoon) or next day (if sample collected later in the day). Not happening currently. Monitor & ensure this.

(10) H. Ensure test results are intimated by at least an SMS / WhatsApp to Pts & care givers on registered mobile.
I. Ensure that Pt. and family members are counselled on isolation & next steps before they leave the testing centre. Keep printed material handy for distribution.

(11) J. Upon confirmation of diagnosis, ensure that a team visits the house of the patient and does the following (this is keeping in mind an urban scenario):
(a) Arranges treatment for the Patient by tele consultation with a Doctor.

(12) (b) The regimen for asymptomatics / mild / moderate symptomatics should be finalised and a packet of these drugs (after ruling out any contra-indications) should be handed over to the patient / care giver.

(13) (c) Ensures that the conditions are suitable for home isolation and counsels the family members.

(14) (d) Most importantly, the patient and the designated care giver should be clearly explained regarding infection prevention practices, what all to monitor (Temperature, Oxygen Saturation, Pulse, Respiratory Rate, Breathing distress etc).

(15) (e) They should also be explained regarding when & whom to contact should the condition of the patient deteriorate. A printed SoP for all of these would be really useful. It can be printed in Odia, English and Hindi.

(16) (f) Since the entire family of the patient would be under quarantine (neighbours likely to avoid helping out due to stigma), the family should be provided telephone numbers for home delivery of essentials – at least grocery, medicines, vegetables and milk.

(17) It should be ensured that these vendors selected for home delivery actually deliver (taking all precautions) and not avoid visiting patient houses.
(g) Ensure daily calls to the patient / care giver to enquire about well-being.

(18) (h) Provide a certificate that the patient is disease free after the prescribed duration of isolation. This need not be a Lab test report – it can be a certificate following a telephonic consultation with a Doctor on the last day of isolation.

(19) This last one is very important to manage the stigma that the patient is likely to face even after completing his / her isolation period safely.

(20) Last but not the least - Simplify and widely publish the rules on travel, quarantine, isolation, infra status etc. Increase bed strength / O2 / deploy way more ambulances. Keep the call centre easy to access - caller shld talk to a person without waiting or pressing buttons.