Brainstorming Notes

Background: 1. The Emergency Field Response Plan of Ernakulam district has taken an assumption that above 10% of the people in the district may fall ill. 2. In such a context, the more centralised the management of the crisis, the more it will constrain the healthcare system and workers from working efficiently to respond quickly to provide timely medical aid to patients. 3. A practical solution is to create systems at a Village Panchayat and Ward Level for the healthcare system to be able to respond to the crisis. The broad citizen density at a ward level and panchayat level in Kerala is as below.

4. The Primary Health Center and Local Self Government System are present at each Panchayat to handle 30,000 people. This system needs to be strengthened completely to face the present crisis. -- How to handle a worse case scenario in a panchayat: -- Goal: We have to instill strong confidence in people to sit at home as 80% of people will have only mild systems and need only sit at home. The Strategy to achieve this goal has four parts that needs to be fully integrated through a digital backbone. Part#1 - A First Line Treatment Center at the Ward Level 1. We have to decentralise the system and make a Primary Treatment Center/ First Line Treatment Center at a ward level. The medical officer of the panchayat manages the center.

2. In every ward, there is a community hall where we can set up a 25 bed Primary Treatment Center. We leverage the Government system that has 3 doctors, 5 nurses and field staff. 3. There are 80 items that are needed to set up a center. What can be taken from the field will be set up by the community and Other things which are mostly medical items like IV Stands, IV Fluids etc are provided by the center. 4. We need an organisation structure of 37 people who need this. People who got corona and have immunity are included as volunteers. 5. Every panchayat has an ambulance and a testing facility. We have to test people and find out if citizens are positive or not and in positive whether symptomatic or asymptomatic. Asymptomatic positive + mild symptoms can be managed at home.

6. Through Pulse Oximeter, we will measure oxygen levels and will ensure citizens get proper care with Corona.. 7. Patients who can't be managed at Panchayat level will be moved to Taluk Level. 8. At Taluk level,there will be ICU Ambulances. 9. We will move people who need higher levels of treatment to the Tertiary Center where we have 35 ICU ambulances. 10. If the Government systems also overflow, then we have taken the private systems to be in place.

-- Important: A. This plan is detailed out separately at https://model.coronasafe.network/primary-treatment-center B. Funds for implementing the same has been requested to the Chief Ministers Office. In this manner, we have created a parallel system to manage Corona. Once we build a system to manage Corona, then we can open up our hospitals to manage existing illnesses which are also there.

Part#2 - A field response team

1. In every panchayat, there would be a team which would go to the field.

2. Patients who have vulnerability would be given first priority to ensure Reverse Isolation of the most vulnerable patients.

3. We have to train Asha workers in the field to ensure that they are able to respond to the situations expected.

Part#3 - Corona Public Health Literacy Mission + Telemedicine System Why do we need Corona Health Education? a. General Public are tuned to go to a hospital if they have a fever.

b. We have to change that system where people know what to do if they have Corona.

1. Corona Public Health Literacy Mission has to be done at ward level on what to do if they have a fever.

2. A network of doctors and medical delivery systems is being set up at a panchayat level which is connected to the telemedicine system.

3. Asha Volunteers are contacting all people in the ward -> if a person has a fever, then they inform the medical officer.

4. If the doctor or medical officers in the field have any confusion, then they take assistance from the central telemedicine system.

5. The purpose of this telemedicine system is built to give more confidence to front line doctors in the healthcare system.

6. Every house should know which number to call if I have fever.

7. We will need to also take retired doctors on roll to create a 24 hour tele-health system to be locally managed. People in a panchayat should be able to call into a telemedicine system and then the call system automatically directs calls into doctors within that panchayat.

--- Part #4 Optimising Home Care System for Most Vulnerable Population --

1. We can bring only people who have been tested positive to the Primary Care Center.

2. There are two things that are planned. A. Do a test at home - The person going should have a PPE Kit, gloves and mask. B. We do a telesurvey by Asha worker to find answers for the below three questions

a. പ്രായം മൂലമോ രോഗാധിക്യം മൂലമോ വീട്ടിൽ നിന്നും പുറത്തിറങ്ങാൻ സാധിക്കാത്തവർ ആണോ?

b. ഗുരുതരമായ ദീർഘകാല രോഗം ഉള്ളവരാണോ?

c. എഴുപതു വയസ്സിൽ കൂടുതൽ പ്രായം ഉള്ളവരാണോ?

3. The answers to these questions will help in planning for test prioritisation at a Panchayat Level 4. We are also planning to create a system that allows for natural death for people who are bed-ridden.

Action Items (Internal to District Team) 1. We need to have a database of Doctors, Nurses, Pharmacists, Lab Technicians mapped in the district at a panchayat level.

2. We need a single Corona Clinical protocol that is shared amongst all the workers who are part of the system.

3.We need to figure out in each district what inventory kits that should be given.