Govt releases Covid-19 SOP, patients to be divided into 3 groups

For the management of Covid-19 cases, the government, on Tuesday, released the guidance document on appropriate handling of suspect/confirmed Covid-19 cases and divided them into three categories on the basis of their severity.

With this, the Health Ministry has put in place the Standard Operating Procedure (SOP) for care of Covid-19 patients.

It will ensure that hospital beds are used only for moderate to severe cases. The SOP also specifies the different types of facilities to be set up for various categories of Covid-19 cases.

According to data, nearly 70 per cent of Covid-19 patients in India exhibit mild or very mild symptoms. Such cases may not require admission to Covid-19 blocks/dedicated hospitals.

Three types of Covid-19 dedicated facilities have been proposed in this document, which will have separate areas for suspect and confirmed cases and they will not be allowed to mix under any circumstances. These facilities will be linked to the surveillance team (IDSP).

All suspect cases (irrespective of the severity of disease) will be tested. Further management of the cases will depend on their clinical status and result of testing.

The Covid Care Centre (CCC) will offer care only for cases that have been clinically defined as mild or very mild or suspect.

The CCCs are makeshift facilities and may be set up in hostels, hotels, schools, stadiums and lodges, etc – both public and private. If needed, the existing quarantine facilities could also be converted into CCCs. Hospitals like CHCs, handling regular and non-Covid cases, could be designated as the CCCs as a last resort.

Wherever a CCC is designated for admitting both confirmed and suspected cases, they must have separate areas for suspected and confirmed cases, with preferably separate entry and exit. The cases must not be allowed to mix under any circumstances.

As far as possible, wherever suspect cases are admitted to the CCCs, preferably individual rooms should be assigned.

The next in line is the Dedicated Covid Health Centre (DCHC), which are hospitals that shall offer care for cases clinically defined as moderate. These should either be a full-fledged hospital or a separate block in a hospital with preferably separate entry/exit/zoning. Private hospitals may also be designated as the DCHC. These hospitals will have beds with assured oxygen support.

The Dedicated Covid Hospitals (DCHs) shall offer comprehensive care primarily for those who have been clinically assigned as severe. Private hospitals may also be designated as the DCHs. These hospitals would have fully-equipped ICUs, ventilators and beds with assured oxygen support.

For the assessment of patients, in addition to those arriving directly through helpline/referral to above facilities, in field settings during containment operations, the supervisory medical officer must assess the severity of the case detected and refer them to the appropriate facility.

The states and UTs may identify hospitals with dedicated and separate space and set up fever clinics in such hospitals. The fever clinics may also be set up in CHCs, in rural areas subject to availability of sufficient space to minimise the cross-infection risks.

In urban areas, the civil hospitals, Urban CHCs and municipal hospitals may also be designated as fever clinics. These could be set up preferably near the main entrance for triage and referral to appropriate Covid dedicated facility. Wherever space allows, a temporary make-shift arrangement outside the facility may be arranged for this triaging.

Patients may be categorised into three groups and managed at the respective Covid hospitals – Dedicated CCCs, dedicated CHCs and dedicated Covid hospitals.

Suspect and confirmed cases, clinically assigned as mild and very mild, have a clinical criteria of cases presenting with fever and/or upper respiratory tract illness (influenza like illness).

The suspect and confirmed cases, clinically assigned as moderate, go to the dedicated CHCs and for them the clinical criteria is pneumonia with no signs of severe disease.

The suspect and confirmed cases, clinically assigned as severe, will go to the DCHs. The clinical criteria is severe pneumonia and such cases will be directly admitted to a dedicated Covid hospital's ICU till such time as test results are obtained..