Fever, flu and family physicians during COVID 19 pandemic 2020 in India

Revisiting the efficacy of policies in the Indian primary healthcare sector: Interventions and approaches during the COVID-19 pandemic

The COVID-19 pandemic has wracked even the most modern healthcare systems worldwide and has influenced India’s healthcare sector and vastly affected the government’s and corporate stakeholders’ healthcare reform plans; hence, this chapter is intended to unfold the paradigm shift in India’s primary healthcare industry due to the pandemic in the last one and half years. This chapter described India’s experience with the coronavirus during the first and second waves and tried examining the public health difficulties in the COVID era. It provides a timeline of significant events of the pandemic’s growth in India and worldwide and how India responded to the situations through their economic and healthcare policies. We also go through some of the pandemic’s impacts and India’s recovery approach and strategies for its revival. All possibly available secondary data like Scopus, Web of Science, Medline/PubMed, and Google Scholar search engines, newspapers, government websites, etc., were excavated to meet this purpose; secondary sources were used to analyze the data. This chapter also examined the effect of COVID-19 on healthcare workers in India. This chapter critically examined the primary healthcare’s role during this pandemic and the government’s policies and processes to deal with COVID-19 and any other unforeseen situations which the country may encounter in the future.

COVID-19 and the flu: data simulations and computational modelling to guide public health strategies

BACKGROUND

Pandemics threaten lives and economies. This article addresses the global threat of the anticipated overlap of COVID-19 with seasonal-influenza.

OBJECTIVES

Scientific evidence based on simulation methodology is presented to reveal the impact of a dual outbreak, with scenarios intended for propagation analysis. This article aims at researchers, clinicians of family medicine, general practice and policy-makers worldwide. The implications for the clinical practice of primary health care are discussed. Current research is an effort to explore new directions in epidemiology and health services delivery.

METHODS

Projections consisted of machine learning, dynamic modelling algorithms and whole simulations. Input data consisted of global indicators of infectious diseases. Four simulations were run for '20% versus 60% flu-vaccinated populations' and '10 versus 20 personal contacts'. Outputs consisted of numerical values and mathematical graphs. Outputs consisted of numbers for 'never infected', 'vaccinated', 'infected/recovered', 'symptomatic/asymptomatic' and 'deceased' individuals. Peaks, percentages, R0, durations are reported.

RESULTS

The best-case scenario was one with a higher flu-vaccination rate and fewer contacts. The reverse generated the worst outcomes, likely to disrupt the provision of vital community services. Both measures were proven effective; however, results demonstrated that 'increasing flu-vaccination rates' is a more powerful strategy than 'limiting social contacts'.

CONCLUSIONS

Results support two affordable preventive measures: (i) to globally increase influenza-vaccination rates, (ii) to limit the number of personal contacts during outbreaks. The authors endorse changing practices and research incentives towards multidisciplinary collaborations. The urgency of the situation is a call for international health policy to promote interdisciplinary modern technologies in public health engineering.

Collateral effects and ethical challenges in healthcare due to COVID-19 - A dire need to support healthcare workers and systems

COVID-19 has affected the daily activities of people across the globe. The effects of the pandemic have not just been medical, but also societal and economical. The responses of government and the public have varied in different countries. Measures have ranged from improving hygiene, information dissemination, and social distancing to more radical measures such as social isolation, quarantine and lockdown. The disease and human responses have had consequences on the way we live, work, eat and rest. Life and livelihoods have been affected. This article highlights how the response to the pandemic has affected various aspects of healthcare and ethical dilemmas this has raised. As the pandemic progresses, awareness and evaluation of the unintended consequences of the pandemic and responses on our health and healthcare systems are needed. Discussing these points and being aware of the ethical issues may help countries and policy makers plan suitable strategies to mitigate these collateral effects, especially as the pandemic continues. It is hoped that this article will support healthcare workers, especially those in primary and secondary healthcare, as they overcome various challenges to treat patients with existing and prior diseases, and encourage them to advocate for robust and sustainable healthcare systems for public health. This would then help effectively combat future epidemics. Most importantly, it can mitigate the adverse collateral effects on healthcare that the public are experiencing and the treatment dilemmas that family and primary care physicians are facing.

Socio-economic impact of first 21 days nationwide lockdown- 1 on the spread of SARS-COV-2 in India in relation to health

On March 11, 2020 World Health Organization (WHO) declared corona virus disease (COVID-19) to be a pandemic disease, which is caused by a novel coronavirus “severe acute respiratory syndrome coronavirus-2 (SARS CoV- 2)” and till now it has affected about 213 countries. A nationwide lockdown was announced by the Honorable Prime Minister of India on 24^th March 2020 for 21 days to prevent the spread of the COVID-19. Our nation, being a developing nation and emerging market, there was a vast socio-economic consequence of this lockdown. Our health care services were at the war front. Due to this step, there was a reduction in the rate of the spread of COVID- 19. Other health hazards due to pollution, road traffic accidents, crimes including robberies, rapes, murders, thefts, etc., were decreased substantially. People learned good hygiene and family bonding, which was further strengthened. Negatively affected sectors were trading companies, schools, and education, economy, stock markets, ongoing events in sports, politics, entertainment industry, transportation, and activities related to religious places, tourists, and hotels. Due to starvation, poor people were worst affected as they were daily bread earners though, the government tried to provide money and food. Finally, it was the primary care physician, termed “corona warriors,” who suffered socially, economically, mentally, and physically. Despite all these hardships, the primary care physician learned the innovative way to help patients and ease their suffering with proper advice and awareness.

A learning experience of pandemic COVID-19 management at our medical institute

Background:

Coronavirus disease-19 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) is a novel disease.

Objectives:

Our healthcare sector is at the epicentre of this unprecedented global pandemic challenge and we are not fully aware of it's management. Here we have discussed our learning experience in managing and tackling the COVID-19 pandemic at our institute which will set an example for other hospitals as well as instill confidence in our primary care physicians who are the frontline warriors.

Methods and Results:

For combating COVID-19, dedicated teams for its management including logistic support was streamlined. Our capacity was built up for 200 isolation beds including 40 ventilator equipped beds and 645 defined quarantine rooms, to be implemented in phased manner. Till date more than 200 COVID-19 patients have been admitted here. Fever and cough were common presentations. Mortality was high in patients with advanced age or who had multiple co-morbid conditions. Efficient training and infection prevention control have resulted in a satisfactory outcome.

Conclusion:

In the wake of this pandemic all hospital setup, with collective responsibility should follow a specified protocol so that our hospital is not converted to the hotspot. COVID-19 has imposed a new challenge where not only patients have to be managed but our health care workers also need to be protected. Telemedicine and our primary care physicians will play a crucial role. Here at a medical institute, medical teaching, and learning atmosphere has to be created amidst the pandemic apprehension for our budding medicos.

Primary Health Care Facility Preparedness for Outpatient Service Provision During the COVID-19 Pandemic in India: Cross-Sectional Study

BACKGROUND

Primary health centers (PHCs) represent the first tier of the Indian health care system, providing a range of essential outpatient services to people living in the rural, suburban, and hard-to-reach areas. Diversion of health care resources for containing the coronavirus disease (COVID-19) pandemic has significantly undermined the accessibility and availability of essential health services. Under these circumstances, the preparedness of PHCs in providing safe patient-centered care and meeting the current health needs of the population while preventing further transmission of the severe acute respiratory syndrome coronavirus 2 infection is crucial.

OBJECTIVE

The aim of this study was to determine the primary health care facility preparedness toward the provision of safe outpatient services during the COVID-19 pandemic in India.

METHODS

We conducted a cross-sectional study among supervisors and managers of primary health care facilities attached to medical colleges and institutions in India. A list of 60 faculties involved in the management and supervision of PHCs affiliated with the community medicine departments of medical colleges and institutes across India was compiled from an accessible private organization member database. We collected the data through a rapid survey from April 24 to 30, 2020, using a Google Forms online digital questionnaire that evaluated preparedness parameters based on self-assessment by the participants. The preparedness domains assessed were infrastructure availability, health worker safety, and patient care.

RESULTS

A total of 51 faculties responded to the survey. Each medical college and institution had on average a total of 2.94 (SD 1.7) PHCs under its jurisdiction. Infrastructural and infection control deficits at the PHC were reported in terms of limited physical space and queuing capacity, lack of separate entry and exit gates (n=25, 49%), inadequate ventilation (n=29, 57%), and negligible airborne infection control measures (n=38, 75.5%). N95 masks were available at 26 (50.9%) sites. Infection prevention and control measures were also suboptimal with inadequate facilities for handwashing and hand hygiene reported in 23.5% (n=12) and 27.4% (n=14) of sites, respectively. The operation of outpatient services, particularly related to maternal and child health, was significantly disrupted (P<.001) during the COVID-19 pandemic.

CONCLUSIONS

Existing PHC facilities in India providing outpatient services are constrained in their functioning during the COVID-19 pandemic due to weak infrastructure contributing to suboptimal patient safety and infection control measures. Furthermore, there is a need for effective planning, communication, and coordination between the centralized health policy makers and health managers working at primary health care facilities to ensure overall preparedness during public health emergencies.