Shift focus from hospitals to primary care (Battling COVID-19 and the aftermath)

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 Shift focus from hospitals to primary care (Battling COVID-19 and the aftermath)

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• Hospitals in the frontline: Till date, detection / isolation / management of COVID-19 patients is happening only in hospitals, which may become carriers of the virus. That needs to change now.
• The Italian experience: The town of Bergamo was an epicentre of the epidemic, and doctors warned against using the hospitals for COVID-19 management. So from a patient-centred care system, we may need to move towards  community-centred care. India needs to listen carefully.
• How to test in India: People have to either come to a lab located in tertiary hospitals, or go to district hospitals. Samples are sent to labs. Citizens have to travel large distances anyway, carrying risk of getting infected (or transmitting infections).
• Creating capacity: Centre and States are creating capacity in hospitals (or building new ones), to hold a spurt in numbers. Data from China and Italy shows that 5-10 per cent of those infected need admission (severely ill), 70% need supportive care and oxygen, and 30% need critical care (ECMO, ventilator, etc.)
• Migrant movements: Indian migrant labour has moved back to rural areas, and most are far away from these big hospitals. The only way out is personal and community behaviour.

1. The sheer fear of disease and social stigmatisation can affect behaviour, and only restrictions do not help.
2. Proper santiary practices need to be reinforced.
3. Other diseases get little attention and their mortality rates may rise (e.g. TB)

• Primary care: India has 25000 PHCs (primary health centres) and 5300 CHCs (community health centres) all over. Many NGOs also provide primary healthcare. This is the time to use this network fully.
• Home recovery: Patients with probable (or confirmed) coronavirus infections must rest and recover at home. Primary healthcare providers can support most such people. But care is needed. Oxygen availability at PHCs, CHCs and small nursing homes must be ensured.
• Detection must be expanded: Low number of testing labs is a deterrent for many, and infection spreads in travel. Sample collections can be done by PHCs closer to communities, and samples sent to labs. Training is needed urgently for it. The PHCs can also ramp up support for other diseases - TB, diabetes, hypertension - so that mortality rates do not rise.
• States in action: They must support the primary healthcare systems immediately, to manage the epidemic better.
• Summary : The right management of the epidemic will need a focus on unburdening the hospitals and involving the primary healthcare facilities.

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