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Government issues guidelines on Covid management in rural and peri-urban areas | India News

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NEW DELHI: As rural areas see an increase in Covid-19 cases, the Center on Sunday issued new guidelines for containing the virus, warning that peri-urban and rural areas plan a Covid Care Center with a minimum of 30 beds for asymptomatic cases with comorbidities or mild cases where home isolation is not feasible.
The supply of rapid antigen test (RAT) kits should take place in all public health facilities, including health and wellness sub-centers or centers and primary health centers, the Union Ministry of Health said.
Noting that in addition to urban areas that report a large number of cases, a gradual entry is now being seen also in peri-urban, rural and tribal areas, the ministry published the ‘SOP on Containment and Management of Covid-19 in peri-urban, rural areas & Tribal Areas’ to enable communities to strengthen primary-level healthcare infrastructure at all levels to intensify the response to Covid-19.
He said Covid Care Centers (CCC) can admit a suspected or confirmed case, but must have separate areas for suspected and confirmed cases with separate entrances and exits for each.
“Suspected and confirmed cases should not be allowed to mix under any circumstances,” the SOP said.
According to the SOP, in each village, ASHA is required to conduct active surveillance for influenza-like illness / severe acute respiratory infections (ILI / SARI) periodically with the help of the Village Health, Sanitation and Nutrition Committee (VHSNC).
Symptomatic cases can be classified at the village level by teleconsultation with the Community Health Officer (CHO), and cases with comorbidity or low oxygen saturation should be referred to higher centers.
Identified suspected Covid cases should be linked for testing with healthcare facilities, either through rapid Covid-19 antigen testing or by referring samples to the nearest Covid-19 testing laboratory, according to the ICMR guidelines.
CHOs and ANMs should be trained to perform rapid antigen testing. The supply of RAT kits should be done in all public health facilities, including subcentres, health and wellness centers and primary health centers, according to the document.
Depending on the intensity of the sudden increase and the number of cases, to the extent possible, contact tracing should be done according to the Integrated Disease Surveillance Program (IDSP) guidelines, he said.
“Almost 80-85 percent of Covid-19 cases are asymptomatic / mildly symptomatic. These patients do not require hospitalization and can be treated at home or in isolation facilities from Covid care,” the SOP stated.
Since monitoring of oxygen saturation is important for the monitoring of Covid patients, it is desirable that each village has an adequate number of pulse oximeters and thermometers.
The SOP recommended developing a system to provide pulse oximeters and thermometers on loan to families with a confirmed case of Covid through ASHA / Anganwadi workers and volunteers at the village level.
Pulse oximeters and thermometers should be disinfected after each use with cotton or cloth soaked in alcohol-based disinfectant.
Follow-ups of patients in isolation or quarantine can be done through home visits by a front-line worker / volunteers / teacher by properly following required infection prevention practices, including the use of medical masks and other appropriate precautions .
“A home isolation kit will be provided for all these cases, which should include the necessary medications, such as paracetamol 500 mg, tab. Ivermectin, cough syrup, multivitamins (as prescribed by the treating physician), plus a detailed leaflet indicating the precautions to be taken, the details of the medication, the proforma for monitoring the patient’s condition during home isolation, the contact details in case of significant symptoms or deterioration of the health condition and the discharge criteria “, indicated the SOP.
The planned health infrastructure for peri-urban, rural and tribal areas will align with the aforementioned 3-tier structure: Covid Care Center (CCC) to handle mild or asymptomatic cases, Dedicated Covid Health Center (DCHC) to handle moderate cases and Dedicated Covid Hospital (DCH) to manage serious cases, according to the document.
CCCs are makeshift facilities under the supervision of the nearest PHC / CHC and can be installed in schools, community rooms, marriage halls, panchayat buildings in the vicinity of hospitals or healthcare facilities, or tent facilities on panchayat grounds, schoolchildren, etc.
These CCCs must be assigned to one or more Dedicated Covid Health Centers and at least one dedicated Covid Hospital for referral purposes.
Such COVID care centers must also have a networked Basic Life Support Ambulance (BLSA) between such CCCs equipped with sufficient 24/7 oxygen support to ensure the safe transportation of patients. to specialized superior facilities if symptoms progress from mild to moderate or severe.
The Primary Health Centers or Community Health Centers and Subdistrict Hospitals in these areas will be the Covid Dedicated Health Center for Covid-19 management. The facility can plan for a minimum of 30-bed DCHC. The district should be prepared to increase DCHC beds based on the case trajectory and the expected increase in cases, according to the document.
These centers will offer care for all cases that have been clinically assigned as moderate (Patient out of breath; Respiratory rate greater than 24 per minute; Saturation between 90 and
District hospitals or other identified private hospitals or a block of these hospitals will become dedicated Covid Hospitals.
In addition, hospitals at the sub-district or block level that meet the requirements may also be designated as dedicated Covid hospitals for the CCCs and DHCCs identified in their area of ​​influence. The improvement in health facilities will be carried out based on the trajectory of cases or the increase in cases, indicated the SOP.

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