CARE

Panchayat Level:

Each ward has a ward level team. At Panchayat level, this body is supervised by the Panchayat Monitoring Committee (LSG level monitoring committee), comprising of:-

• Panchayat President

• Medical Officer

• ICDS (Integrated Child Development Scheme) Supervisor

• CDS Chairperson

Each of these individuals are the direct supervisors of the 4 official members ward level team. Therefore, they do not sit in the Committee in their individual capacity but they sit as representatives of the system following the hierarchy.

To support them, there is the

• Village officer. The village officer has no hierarchical subordinate at a lower level than the panchayat. Village officer is part of the Revenue System. Therefore they have control over all the land, to collect taxes and enable transactions relating to land.

• Police

• KSEB Office

• Water Authority

• Education Department (Nodal officers of government schools)

• Agriculture Officer.

These are all independent bodies working alongside the Panchayat.

Block Level:

At the block level, we have:-

• The Block President

• Block Medical Officer

• CDPO (Child Development Program Officer)

-Tahsildar

-Police

-Assistant. Engineer - KSEB

-Assistant. Engineer - Water authority etc

District Level:

Similarly, all corresponding officers at a district level form a committee here. There is the Zilla Panchayat President, ICDS district officer, District Medical Officer, Collector, RTO, Water Authority representative, Police etc.

Municipality and corporation:

The municipalities and corporations are also divided into Divisions. A division is bigger than a ward with almost 10 times the population. Each division again has a Rapid Response Team (RRT) with a Counsellor (instead of a ward member), ASHA (Accredited Social Health Activist) worker (usually more than 1, depending on the population), Anganwadi Worker and Area Development Society (ADS) by Kudumbashree.

Thus, the various departments of state government are intertwined along with Local Self Governments to create a strong decentralised system of working in Kerala. This decentralised system is what is working at the grassroots level to stop the pandemic from spreading beyond what we canRapid response team

How does the government system deal with Coronavirus spread within a Ward?

The CoronaVirus has not just affected our health as a population but has also managed to alter the behaviour of our whole community. It is important to learn how the community has evolved to deal with the CoronaVirus. While public gatherings are restricted, travelling is also discouraged.

It is the Ward level Team which at the face of this calamity is acting as the Rapid Response Team(RRT) that is given the responsibility to enforce this quarantine. The RRT is expected to maintain a line list (a list of all such persons with their necessary information and relevant dates).Because the RRT is part of the community there, they are expected to know the individuals or families living there. The team has to have surveillance over the 400 odd families in that community. If this job is done with care and precision, half the battle against Corona is won.

The RRT is expected to take daily updates from the people staying in home isolation and make sure that they are healthy and also that they have all facilities required for a comfortable stay.

If the person has any health issues, the ASHA worker must take action, report the same to higher authorities and get the person health support.

the person has any health issues, the ASHA worker must take action, report the same to higher authorities and get the person health support.

Because the people who form RRT are from the local area, they can call the persons in quarantine and have candid conversations about his well being.If there is any problem faced by a mother and child in quarantine, the Anganwadi worker is the person to tend to it.

If a person does not follow the rules laid out by the government, the RRT may report the same to the Panchayat. The panchayat has the support of the police and is empowered to enforce the quarantine.

Management of COVID patients 

Around 70 % of the patients are asymptomatic. They may be managed with the help of the following systems. These will be dealt with in detail in the coming chapters

1.TeleHealth Helpline: The Medical Officer of the Panchayat shall facilitate setting up of TeleHealth Helplines. This will be the states first line of defence against Corona. The patients who are in isolation in their own homes may call into this TeleHealth Helpline for any health-related assistance like a consultation with a doctor for any symptoms, COVID related or not, or to order delivery of medicines to their doorsteps. There is also a Central TeleHealth Helpline at the district level for the healthcare workers to call for referrals. The doctors and nurses at the panchayat level may utilize the TeleHealth Helpline to clear any doubts that they have.

2.First-Line Treatment Centres: These are for individuals who do not have facilities to self isolate themselves in their homes.

3.Field Response home care teams: The Medical Officer of each panchayat may constitute a Field Response Home Care Team to give medical care to people in home isolation in their own homes.Treatment of covid 19 patients

There are two key principles that have to be made the foundation stone in this war.

First Principle:“Separating COVID and Non COVID by creating a parallel COVID Healthcare System & utilizing existing Healthcare system for Non COVID patients”.

A clear demarcation between a non-COVID Patient and a COVID Patient has to be made.

When the existing healthcare systems are overburdened as the COVID-19 cases rise, we need to create an alternative parallel healthcare system exclusively for COVID-19 patients.

This way, other patients, like cardiac patients, antenatal cases, orthopedic patients etc. can easily avail the mainstream healthcare systems.

Second Principle:”Decentralization of the existing system to the panchayat and ward level”

We cannot build hospitals overnight and thus have to protect the existing healthcare system from crashing due to an overload of patients.

This is done by decentralizing the treatment through a three-tier system under the direct supervision of the district administration.

Categorisation of covid patients:

Based on the severity of symptoms of COVID-19, patients are categorized into symptomatic (with symptoms) or asymptomatic (no symptoms).

Symptomatic patients are sub classified into Mild, Moderate and Severe.

Mild category

Mild category consists of patients with mild symptoms of fever/sore throat/dry cough/rhinitis or diarrhoea. Patients belonging to this category generally can be managed in home quarantine with symptomatic treatment with the help of Tele-Health Helpline Unit.

The tele-health helpline unit is situated in the district control room. The members are doctors, nurses, pharmacists, information technology and management experts. They will receive calls for help from the patients and RRT members. The helpline will give expert advice to patients and help in transferring the patients to hospitals or treatment facilities.

Those who are unable to maintain home quarantine due to any constraints can be managed at the First Line Treatment Centres (FLTC).These patients can be shifted from home to FLTC using double chambered auto-rickshaw

Moderate Category

Moderate Category is formed by patients whose symptoms have worsened despite symptomatic management or those with comorbidities like uncontrolled diabetes mellitus, hypertension, chronic kidney disease, coronary artery disease, malignancies, etc. along with moderate symptoms.

Pregnant women and immunocompromised individuals with moderate symptoms are also included in this category. These group of patients can be managed at Secondary Level Treatment Centres (SLTC).

Such patients are shifted to an SLTC using a double chambered ambulance.

Severe Category

Severe Category is the third group of patients who exhibit severe symptoms or symptoms of Acute Respiratory Distress Syndrome. These are the patients who require the highest level of care.

Common features noted are breathlessness, drowsiness, drop in pressure, blood stained sputum while coughing or bluish discoloration of skin which are important red flag signs that have to be kept in mind during the management of these patients.

In the pediatric age group, influenza-like illness is an alarming sign to be kept in mind.

Worsening of underlying comorbidities/diseases is also a common feature seen in these patients. Hence it is ideal to manage them at the highest level centres or the Apex Centre.Shifting of severe category patients will require ICU ambulances to ensure proper monitoring and supportive care is given during the shift to an Apex Centre.

3 –Tier healthcare system:

Various initiates were implemented by different state governments during this COVID pandemic, one of the effective initiative by Government of Kerala was introducing a 3-tier system for pandemic treatment.

First Line Treatment Centre

The First Line Treatment Centre (FLTC) cater to patients who are below the age of 60 years and have mild symptoms with no significant comorbidities. Generally, this population will be advised to maintain home isolation with symptomatic treatment but will be admitted at this facility if they are unable to maintain home isolation due to any reasons.

SECOND LINE TREATMENT CENTRES (SLTC)

Second Line Treatment Centres (SLTC) will be formed by the Government Taluk Hospitals and designated private hospitals. SLTC will be catering to patients with moderate symptoms and those above 60 years / having any comorbidities with moderate symptoms.

These facilities will be equipped with adequate infrastructure and equipment to monitor all the mandatory baseline investigations and provide any emergency interventions.

SLTC will conduct all laboratory investigations and chest X-ray to attain a clearer status of the patient's health.

APEX CENTRES

Apex Centres will be set up in the hospitals with advanced facilities like the medical colleges and private hospitals of each district. These facilities will be equipped to cater to all severe cases of COVID-19. Apex facilities will have ICU beds, ventilators, dialysis machines and well trained human resources to cater to all complicated cases of COVID-19.

More hospitals may be notified by the district administration as Apex Centres for COVID-19 as and when the need arises.

District Administration at Ernakulam has successfully conducted two Mockdrills to test the feasibility of this 3-Tier Healthcare system and the efficient working of other systems like the Ambulance system, Teleconsultation system etc in sync with this 3-Tier healthcare system.

ACTIVATION OF THESE TREATMENT CENTRES:

There are 3 Phases to the way COVID-19 is treated.

Phase 1 is when a panchayat only has 3 or less than 3 cases in a population of 10,000. During this phase, all the COVID-19 patients are treated in the Apex Centres.

Phase 2 is when any panchayat starts to have more than 3 cases in a population of 10,000. Then, the SLTCs are activated. All the mild and moderate cases will be treated in the SLTCs while only the critically ill will be sent to the Apex Centres. Phase 3 is when a Panchayat starts to have more than 10 cases in a population of 10,000. Then, FLTCs are activated to treat the asymptomatic and mildly symptomatic patients. The SLTCs continue to treat the moderately symptomatic patients and Apex Centres only treat the most severely ill.

When number of cases still goes up, the panchayat boundaries of such Hotspots are sealed to contain the virus.

Vaccines:A vaccine is a biological preparation that provides active acquired immunity to a particular infectious disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and to further recognize and destroy any of the microorganisms associated with that agent that it may encounter in the future.

Widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the restriction of diseases such as polio, measles, and tetanus from much of the world.

Production of vaccines

On average, it takes between 12-36 months to manufacture a vaccine before it is ready for distribution. Successful manufacturing of high-quality vaccines requires international standardization of starting materials, production and quality control testing, and the setting of high expectations for regulatory oversight of the entire manufacturing process from start to finish, all while recognizing that this field is in constant change.

Any licensed vaccine is rigorously tested across multiple phases of trials before it is approved for use, and regularly reassessed once it is introduced. Scientists are also constantly monitoring information from several sources for any sign that a vaccine may cause health risks.

Post Vaccination in India

Right after getting vaccinated, you are monitored for 30 minutes for any possible Adverse Event Following Immunisation(AEFI) before leaving.

AEFI is classified into :

• Minor AEFI : Common and self-limiting reactions.

Eg: pain, swelling at site of injection,fever, irritability,tiredness,dizziness and nausea

• Severe AEFI: Disabling or rarely life-threatening, no long term problems.

Eg: High fever, allergic reactions

• Serious AEFI: require inpatient hospitalisation, may cause significant disability

If you develop symptoms at the site,

All vaccinators and supervisors at the site will be trained to provide primary treatment.

If needed, cases are referred to the nearest hospital/health facility and are reported to the appropriate authorities.