COVID Training 3

Community Covid Care Centers

Community Care Center Overview

• Center for persons who are showing mild symptoms of COVID 19, and do not have adequate space and facilities in their house for home isolation.

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• The key premise of COVID-19 care on which the COVID Isolation center will be operated:

1. Highest quality of care

2. Compassion and empathy to the patient

3. Maintaining ethical standards

4. Respecting confidentiality of the patient

5. Ensuring equitable treatment and addressing issues of stigma and discrimination

6. Ensuring safety of the caregiver

7. Providing tele consulting with a qualified health provider and tele-counseling support

Early Identification

• Mild symptoms of fever, cough, cold
• To be isolated immediately
• Testing if possible
• If Covid test is not done, initiate Covid Isolation and Management Protocol

Facility Overview

• Identify school or Panchayat Bhavan in the village with good ventilation
• Away from other people in the village, crowded or populated areas
• Preferably should have better approachability to a tertiary hospital facility having critical care and isolation facility
• Rooms/Dormitory separated from one another may be preferable with a capacity of 5-10 beds/room (government school, panchayat bhavan, sub center)
• Each bed to be separated 2 meters (6 ft) apart from all sides.
• Mosquito net
• Lighting, well-ventilation, electricity, ceiling fan and lights
• Clean. Safe drinking water to be available
• Functional clean toilets to be available
• Where possible, television
• Where possible, a vehicle for hire to transport patient to hospital

Break Out Room 1

Why is a Covid Care Center Important?

What do you think will happen if there is no facility for isolation in a village?

Patient Care Requirements

• Monitoring of Patients
• Temperature monitored with infrared thermometer
• Pulse Oximeter for oxygen monitoring

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• Education of Patients
• Patients educated on breathing exercises and proning when required
• Educate patients on disposal of mask
• Teleconsulting with doctor

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• Services provided to Patients
• Patients to be given three nutritious meals / day
• Food can come from home
• If not, set up community kitchen
• Patients to be given clean and safe water
• Surgical and cloth masks to be provided to patients
• Access to doctors through teleconsultation & tele counselling
• Daily check-in for every patient

Emergency Medicines

At the isolation center

• Paracetamol - 500 mg
• Vitamin C 1000 mg
• Zinc
• Montelukast LC 10mg (Antihistamine)
• Nebulizer with multiple masks
• Budecort vials

With ASHA / Health Worker/ ANM

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These medicines only to be given on prescription of doctor

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• Dexamethasone 6 mg
• Ecosprin 75 mg

Community Kitchen

In case the families are not able to supply food then a Community Kitchen will be set up in the village

• A community kitchen should be set up close to the isolation center by the volunteers and leaders from the community
• They should prepare the meals to meet the nutritional needs of the patients in the isolation centers
• Basic hygiene like wearing of mask, frequent hand washing to be followed by the persons cooking and supporting the community kitchen
• Physical distancing to be maintained along with masking
• Food to be served to the patients in their own plates and the plates and other utensils used by the patients should be washed separately in hot water
• No member of the community to enter the rooms where patients are staying to serve food
• CSOs can support with supplementary nutrition requirements (egg, milk, Dhal, channa etc)

Isolation Center Flow Chart

Oxygen Monitoring

• The saturation is monitored by a pulse oximeter. The isolation center should have access to pulse oximeters (at least 2-3 per center) which need to be used by the patients to monitor their saturation every 6 hours.

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Proning

Monitoring Temperature

• Temperature should be checked every 6 hours and reported to the Volunteer/ASHA on phone.
• Paracetamol dose 1gm every eight to six hours can be advised if fever persistent
• If the temperature is above 100 immediately call the doctor for consultation
• Record of temperature and Saturation to be maintained by each patient in the attached template.

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Pragmatic tips for managing COVID-19 at home / isolation center

when hospital or medical care is not accessible [Version 3]

Get home oxygen probe (pulse oximeter)

Mask yourself and family to protect everyone

Paracetamol for fevers and aches

Hydration with water & fluids with sugar and salt

(e.g. oral rehydration solution)

Home oxygen if available (use lowest amount to keep saturations > 92%)

Monitor oxygen saturations and urgently seek hospital care, if saturations < 85% or oxygen needs are > 4L/minute

Stay (Isolate) at home and rest

Stay hydrated

Paracetamol

Sleep prone (on your stomach) if possible, to improve lung oxygenation

Inhaled budesonide (steroid) 2 puffs twice a day

until symptoms resolve

Sleep prone

(on your stomach)

Hydration and Paracetamol for fevers

Source: Dr. Zain Chagla (@zchagla) and Dr. Krutika Kuppalli (@KrutikaKuppalli), Infectious Disease Physicians

Open windows and ensure proper ventilation

Monitoring Chart

Serious Symptoms

• Immediate medical attention must be sought if serious signs or symptoms develop. They are

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• Persistent fever > 7 days
• Dyspnea (Shortness of breath)
• Oxygen Saturation < 94%
• Pulse Rate> 120/min
• BP <90 mm Hg
• Fall in urine output
• Alteration in consciousness

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• Transfer to a higher centre – District hospital should be considered

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Facility Requirements

• Remote caregiver for monitoring patients
• Daily visit by ANM/ASHA
• Where possible, by PHC doctor
• Infra-red thermometer
• Finger Pulse Oximeter
• BP Apparatus
• Glucometer
• Emergency Medicines
• Oxygen concentrator - where available
• Nebulizer with mask and budocort vials for stabilization
• Gowns, N-95 masks, and gloves for health workers

• Clean bedding and towels
• Cots
• Mosquito nets
• Adequate safe drinking water
• Hand sanitizer
• 3 layer cloth masks/surgical masks
• Disposable gown and gloves
• Closed dustbin for waste
• Telephone facility
• Where possible Television
• Vehicle on hire for transfer of patient to hospital

Break Out Room 2

Who needs to be isolated and why?

Is it possible to set up a care center in your community?

If you were to set up, what is the kind of support you would need?

Patient Protocols

• Double masking at all times
• Rest and drink 2 L of water per day
• Follow cough etiquette
• Follow doctor’s instructions and self monitor
• Report worsening symptoms immediately
• Do not socialize with people who are not patients

Infection Control Protocols

• Patients to wear mask at all times
• Double mask (cloth + surgical)
• Masks changed every 8 hours
• Dispose mask into the designated closed bin
• Patients maintain 3-6 meter distance
• Frequent hand wash/sanitization
• No sharing of personal items like soaps, towels, bedding
• Clothes, towels, masks, and bedding washed daily and dried in hot sun
• Caregiver to use gloves, masks and gowns at all times
• Floors mopped daily
• Clean and disinfect bathroom daily
• To be done by patients themselves

Caregiver Protocols

• Daily check in with doctor for every patient
• Double masking at all times
• To wear protective gown and gloves
• Hand hygiene followed at all times
• Avoid touching eyes, nose or mouth
• Avoid direct contact with body fluids of patient
• Ensure patient follows prescribed treatment
• Ensure counselling services through tele counselling whenever needed
• Self monitor for symptoms

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Biomedical Waste Management

• All waste used like masks, gloves, etc. should be put in closed bin and handed to nearest hospital or PHC
• Treat waste in 1% hypochlorite solution/sanitizer/bleaching solution before disposing

Case Study

Name: Volunteer X Gender: Female Age: 35 years

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Issue: Spiking COVID cases in the community and no support from Gram Pradhan

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Problem Statement:-

How can we best determine a plan where community people are protected from COVID-19 transmission and following home isolation and COVID-19 prevention steps with no support from community leaders.

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Main Issue:-

Volunteer X from a community in Gujarat is observing that the number of ill persons are increasing in her community and they are showing major COVID symptoms. When she discussed the situation with the community leader (Gram Pradhan), no support was provided.

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Question: What do you think can be done to ensure that people are protected from the transmission?