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Table of Contents
EDITORIAL
Year : 2021  |  Volume : 18  |  Issue : 1  |  Page : 3-6

“Combating COVID-19 pandemic- Challenges and strategies” at a newly established state medical college of Madhya Pradesh


1 Dean and CEO Government Medical College, Ratlam (MP), Madhya Pradesh, India
2 Department of Community Medicine, Government Medical College Ratlam, Madhya Pradesh, India

Date of Submission05-Oct-2020
Date of Decision02-Nov-2020
Date of Acceptance30-Nov-2020
Date of Web Publication05-Feb-2021

Correspondence Address:
Dhruvendra Pandey
Department of Community Medicine, Government Medical College, Ratlam, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_120_20

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How to cite this article:
Dixit S, Pandey D, Sinha U. “Combating COVID-19 pandemic- Challenges and strategies” at a newly established state medical college of Madhya Pradesh. Apollo Med 2021;18:3-6

How to cite this URL:
Dixit S, Pandey D, Sinha U. “Combating COVID-19 pandemic- Challenges and strategies” at a newly established state medical college of Madhya Pradesh. Apollo Med [serial online] 2021 [cited 2021 Apr 11];18:3-6. Available from: https://www.apollomedicine.org/text.asp?2021/18/1/3/308807




  Introduction Top


World Health Organization has notified a novel coronavirus disease in China that was later named COVID-19. On March 11, 2020, this outbreak was declared a pandemic.[1] At the same time, disease also entered in Indian boundaries through various international travels and then transmitted in the general population.[2] The first case of the COVID-19 in India was reported on January 30, 2020 and in Madhya Pradesh on March 20, 2020.[3] The first confirmed case in Ratlam was reported on April 10, 2020.

The last 4 months have been challenging to the whole medical fraternity and local administration, on each day there were new challenges to face, new hurdles to cross, but with the help of the health care delivery system of the district, the road to success in the management and treatment of the patients suffering from this virus has become clear. Inter-sectoral co-ordination was keys to combat this situation [Flow Diagram 1].



A nodal coordinated committee under the chairmanship of the district collector has been framed and all stakeholders of the medical fraternity and local administration and others are made available to work in coordination with them.[4] Government Medical College Ratlam initially identified as a quarantine center and then converted into dedicated COVID hospital (DCH) and dedicated COVID health center (DCHC). This is a new medical college situated in Ratlam district of Madhya Pradesh established recently in 2018. There was no separate functional hospital for medical college, so the district hospital was attached for imparting the clinical treatment. The hospital was made functional urgently for COVID-19. This paper describes the various challenges faced and strategies adopted to tackle this emergent situation.


  Challenges and Strategies Top


Establishment of dedicated COVID hospital and dedicated COVID health center

During the initial phase of the pandemic, Medical College was designated as a quarantine center and positive cases were kept at the district hospital. At that time, only the building for 950-bedded hospitals was ready and the equipment/hospital beds and the rest of the hospital was in the process of installation. There was a need of fast-track development of the entire infrastructure and equipment required to start the hospital. Within 1 month, we succeeded to start DCHC and DCH in medical college itself. Now all the positive cases from the Ratlam district are referred to medical college.

DCHC and DCH started with 50- and 10-bedded capacity, which currently reached to 200 and 20 beds respectively in phase-wise manner. Future up gradation plan is to increase bed capacity to 300 beds in DCHC and 60 beds in DCH. The challenges regarding facility development and equipment were initially managed with coordination and support with private hospitals and association of private doctors.

Patient care

In patient care, apart from medical care, psychological care is also important. In this scenario, patient's care became typical because their relatives or attainders are not allowed to take care of them. For better care of patients, this institute provided ward-wise mobile phone for communication, television, and radio for entertainment, and Yoga and Meditation classes for psychological care. Immunity boosters like Kaadha, hot water and Vitamin C, D, and zinc were given to both symptomatic and asymptomatic patients.

Establishment of reverse transcription-polymerase chain reaction laboratory

This College had well-established microbiology department, but molecular lab facility was not available in the institute. Initially, COVID-19 samples of district were sent to Indore and Bhopal reverse transcription polymerase chain reaction (RT-PCR) lab which leads to delayed results. This was a challenge for our new institute but we stand to the challenge and developed viral lab facility within 2 months duration. Molecular lab started with bio-safety level II lab establishment and RT-PCR machine. As RT-PCR was new for everyone, so faculties were sent to nodal center for training. After all efforts, the microbiology department started a lab for testing of COVID-19 samples with per day testing capacity of approximate 250 samples. In starting, we were testing samples of Ratlam district only, but later on testing of samples from nearby districts like Mandsaur, Neemuch also started. At present, lab is working 24 × 7 in three shifts. Another Automated RNA extractor and RTPCR machine was also installed to upgrade the testing capacity. The testing capacity is now increased to 500–600 samples/day.

Sampling strategies

The sampling strategies as per the Indian council of medical research criteria started with three categories of sampling, thereafter it increased to five categories and now there are eight categories and one guideline. This sampling strategy mainly includes symptomatic patients and only one category is for asymptomatic high-risk contacts. It is very difficult to strictly follow these criteria, but after giving leadership to the otorhinolaryngology and dental departments, this work became easy. Furthermore, hand-on training and supportive supervision improved the skill of the technician and empowered them for proper sampling.[5]

Protocol development

Everything about COVID-19 is done on real-time basis. As we get new information about COVID-19 from the ministry of health and family welfare and state government, we convert it into simplified local language and display it in the hospital staff room and also in specific-related places.[6] With the increasing number of cases day by day, continuous change in strategies is always required to make our plan more successful. It is very important to be updated about it. The protocol mainly developed is related to discharge policy, home isolation, treatment guidelines, contact tracing, dead body management, check-list for discharge and information bulletin for home quarantine. The treatment protocol was divided into four parts based on associated comorbidities. The versions of these protocols are also created to understand the level of up gradation.

Fever clinic establishment

A new fever clinic is established in the institute as per guidelines with separate entry and exit.[7] Because of the proximity to the medical college, this fever clinic has gained importance in the urban area of Ratlam. The two important parameters that always kept in mind were, first is safety of our staff and second are proper following of social distancing criteria that ultimately lead to patient safety. This was mainly done by the partition of outpatient department hall in different parts through polythene sheets, continuous mopping facility, separate entry and exit for patients and health care workers, hand washing facility at door and token system. This fever clinic also enabled us for proper triaging of referred patients. Patient management in a fever clinic is based on four T concept, that is Tracing, tracking, tools and Treatment.[7]

Contact tracing

Contact tracing had played a very important role in the early prevention of the spread of infection in the community.[8] The first case which leads to the start of the spread of disease in Ratlam was through a dead body who had died at Indore and whose funeral was held in Ratlam. Contact tracing means more elaborative history of possible contact of every case.[8] It requires an answer of each and every moment of the past 2–5 days. The possibility of recall bias was always there in contact tracing, but detailed history and tracking of every moment will help in correctly doing it. Medical college helped in contact tracing through developing protocol, training and also actively participated in it. For every one positive case, on an average 14–15 contacts are being traced [Flow diagram 2].



Containment area

Initially, there were no cases in the Ratlam district, but at the same time, cases were increasing very rapidly in nearby districts.

The containment zones and buffer zones were created to map out the local transmission of the disease and prevent it from spreading.[9],10],[11],[12] The zones were identified based on the extent of cases listed and mapped.[13],[14],[15],[16] Monitoring was done through the help of CCTV cameras, drones, and the development of temporary units at entry and exit points of the containment zone. The survey of the containment area and the buffer zone was conducted [Flow Diagram 3].



Training

As COVID-19 is a new disease to everyone, it is necessary to train the health care personnel about this disease in various aspects technique of sample collection. ICMR sampling criteria, Personal Protection Measures, Patient Management, Biomedical waste management, Preventive and containment measures, management, and orient on various guidelines issued by the government on time to time. The Module-based training was organized at this institution by the faculties of Community Medicine, Microbiology, Medicine, and ENT Department. The training includes This training was conducted in multiple phases for all doctors, private practitioners, interns, nurses, nursing students, paramedics, class IV employees, and security guards. These trainings were more hands-on training than classroom teaching. Ventilator management training is also conducted by the Anesthesia department. This training is for all anesthetists and nominated medical officers working in Ujjain Division. Later, oxygen therapy was emerging out as the main treatment strategy, so this training help our adjusting district to effectively manage the disease.

Training of health workers of COVID care centers and DCHC for different districts was also conducted. Apart from training, one important thing was the continuous motivation of all faculties so that they come up together and actively sort out measures to provide relief to the people. The important thing needed for each administrator or leader is to supervise the things routinely by taking round of ward wearing PPE kit, which will motivate all other staff to provide efficient care to positive patients.

Human resources

Human resource availability is always a challenging point in every sector, including this institute. As a new medical college, most of the post of clinical departments, especially medicine and pulmonary medicine, are vacant. There is also deficiency of senior and junior residents. The other backbone of patient care is nursing and Paramedical staff, which is completely deficient in new institutions. Another challenge was that this is a divisional institute and college has to take care of all districts of the Ujjain division. This institute is doing mentoring of all associated district in terms of epidemiological linkage, Planning, and Patient management.


  Conclusion Top


In upcoming days this pandemic may become a huge threat for the country, but it can be stated that the above-mentioned strategies will be helpful to combat the situation. The standards for patient care should be at par and a coordinated effort is required to combat the current situation. We have learnt the lesson from COVID-19 that biosafety measures should be made compulsory. Human resource management is an important component for dealing with pandemic situation. Overexertion of key faculties should be avoided. Ergonomics rules should be implemented more rigorously in this time. Training is the heart of the management of any situation, but it should be hands-on, not a classroom type. This should be conducted at regular interval because guidelines are changing so fast and there always remains some knowledge gap till it reaches to the lowest level of health workers.

Recommendations

Technical leadership should be given to Community Medicine department who have the experience to deal with such kind of scenario. Containment strategy should be strict and confined to the region of at least 50 m and there should be provision for providing essential items as per their needs. Contact tracing of confirmed cases should be done promptly and also there is a need of advance contact tracing, which means, first contacts of every suspect cases should be traced and advice them home quarantine, which will help in breaking the chain of transmission. Protocols should be made in the local language and taking into account the local customs for easy understanding. Information disseminated for the public should be done by local influencers so that they can persuade the general beliefs, understanding and behavior in the desired way. Regular and repetitive messages by the local leaders and influencers can make the public more acceptable towards the needed action. Coordination between local administration, health and family welfare, Medical education department, and the local medical association sis of utmost importance to combat this kind of disease.

Acknowledgment

The authors are especially thankful to Principle Secretary, Commissioner and Director of Health and family welfare and Medical Education, and commissioner Ujjain for their continuous guidance and support. Authors are also grateful to work with Collector, district administration, Health department, and local health bodies. This work could not be completed without the support of faculties and staffs working at Government Medical College, Ratlam.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Statement on the Second Meeting of the International Health Regulations (2005) Emergency Committee Regarding the Outbreak of Novel Corona Virus (2019-nCoV). Geneva: World Health Organization; 2020.  Back to cited text no. 1
    
2.
Sadam R. Andhra Ropes in Private Hospitals, Medical Colleges to Combat Covid-19 Pandemic as Cases Rise to 87. Available from: https://www.news18.com/news/india/andhra-govt-ropes-in-private-hospitals-in-state-to-fight-covid-19-pandemic-2560245. [Last accessed on 2020 Jun 25].  Back to cited text no. 2
    
3.
Madhya Pradesh Records First COVID-19 Cases; 4 from Jabalpur Test Positive. Deccan Herald. 20 March 2020.  Back to cited text no. 3
    
4.
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Sampling and Lab Protocols. Government of Madhya Pradesh. 2020. Available from: http://mphealthresponse.nhmmp.gov.in/covid/wp-content/uploads/2020/05/Presentation-on-Sample-and-Lab-Protocols.pdf. [Last accessed on 2020 Sep 15].  Back to cited text no. 5
    
6.
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7.
Fever Clinic Establishment Guidelines. Govt. of Madhya Pradesh. 2020. Available from: http://mphealthresponse.nhmmp.gov.in/covid/wp-content/uploads/2020/06/Fever-Clinic-Guidelines.pdf. [Last accessed on 2020 Sep 20].  Back to cited text no. 7
    
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Containment Plan for Large Outbreaks. Available from: https://ncdc.gov.in/WriteReadData/l892s/26879905961586019971.pdfw [Last accessed on 2020 Sep 05].  Back to cited text no. 11
    
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Revised Containment Area Guidelines. Govt. of Madhya Pradesh; 2020. Available from: http://mphealthresponse.nhmmp.gov.in/covid/wp-content/uploads/2020/06/Revised-Containment-Area-Directive-1.pdf. [Last accessed on 2020 Sep 19].  Back to cited text no. 13
    
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NCDC Updates Link for Different SOPs. Available from: https://ncdc.gov. in/index4.php?lang=1&level=0&linkid=127&lid=432. [Last accessed on 2020 Sep 05].  Back to cited text no. 14
    
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Containment Strategy. Madhya Pradesh; 2020 Available from: http:// mphealthresponse.nhmmp.gov.in/covid/wpcontent/uploads/2020/04/ContainmentStrategy.pdf. [Last accessed on 2020 Sep 07].  Back to cited text no. 16
    



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Raju Vaishya,SatishKumar Agarwal
Apollo Medicine. 2021; 18(1): 1
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