Re-Emerging Trends in Covid – 19: How the Hospitals Should Gear up

The unprecedented scale and potential of Covid – 19 have completely overwhelmed the public health systems along with the contagions of misinformation and fear. By 26 June 2022, World Health Organization reported over 541 million confirmed cases with an 18% increase in comparison to the previous week. This is mainly attributable to the highly contagious nature of covid – 19 where the RNA recombination, reassortment, and mutation along with the expanding human population, globalization, and altered ecosystems have only facilitated the recurring emergence of pathogenic coronavirus.

With most of the countries facing the twin crisis of public health and their consequent economic slowdown, India has an additional challenge of dealing with the massive migrant worker crisis from the covid outbreak. High numbers of new cases (93,281) are being reported with a 25% increase from the previous week at 6.8 new cases per hundred thousand. A comparison of these trends with 97,859 daily new cases of covid during September 2020 showed covid fatality rates that were much lower than the global fatality rate of 6.14%.

Standardization of preparedness measures is critical to the response of hospitals regarding the management of covid – 19 patients. This would require a framework of the health system to analyze the losses incurred during pandemic preparedness with some following actionable points.

Hospital Planning:

Developing a hospital emergency response plan with a continuous update on Covid – 19 contingency plan in accordance to the guidelines as per the hospital condition

  • Determining the hospital capacity for future planning with a list of hospital requirements such as resource allocation, medical equipment for diagnosis, treatment and other support items.

Prioritizing of the patients and surveillance system:

  • Identification of early warning signs and screening of suspected and confirmed cases of Covid – 19 at separate hospital entrances under the following guidelines:

 

 

Mild                           Low priority              Home Care

Moderate                   High priority             In patient Care

Severe                        High priority             Intensive Care

  • Control of acute respiratory symptoms, thermometry, and other suspected symptoms at the entrance of a clinic or hospital itself.

Hospital Incident Command System:

 This involves coordinating the hospitals with the health centers and reference laboratories by:

  • Providing continuous monitoring of the hospital situation and establishing communication with the emergency operation center.
  • Embedding the presence of other related organizations in the hospital command center for transferring facilities, equipment, and patients during its complete

Surge Capacities:

Uneven distribution of the Healthcare workforce and low staffing level (particularly among nurses), shortages in personal protective equipment kits, insufficient training along with limited testing capacity have gravely contributed to the burden of India’s pandemic support system. This needs to be augmented with the adequate distribution of physical space, staff, and medical supplies.

Covid 19 patient Management:

  • Covid 19 patients should be managed following national and international
  • Availability of appropriate Donning and Doffing areas.
  • Allocation of separate hospital wards and ICU to covid – 19 patients.
  • Presence of counselors and psychologists to strengthen the morale of COVID- 19

Management of Medical Tools and Equipment:

This would require hospitals to adopt the following contingent points-

  • Proper stockpiling and safe storage of drugs and medical equipment.
  • Continuous monitoring of drug reserves and medical equipment consumed along with other residual items

There is a need for healthcare centers to adopt a proactive testing strategy in breaking the chains of transmission and offer a clearer epidemiological picture. This has resulted in many countries rapidly decentralizing their testing capacity for strengthening or developing new laboratory networks with public health interventions that are embedded within the community. Such tasks should be accompanied by a proper Infection Control Certification Online for identifying sources of infection and high-risk points in the hospital. For this, healthcare professionals need to apply standard precautions measures for COVID-19 patients in the entire inpatient department. Training on standard precautions and health principles to personnel, patients, and visitors via posters, video clips, brochures, and workshops is the need of the hour for establishing decontamination facilities with proper disposal of waste from covid – 19 inpatients. A further implementation of these preparedness plans would only help the hospitals to minimize the morbidity from the pandemic with sustainable solutions.

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