Given the exponential rise in COVID-19 cases and sample load, the State will adapt a syndromic approach to COVID-19.
Under this, active case search would be taken up through house-to-house visits and screening/triaging would be taken up at Interim COVID-19 Care Centres (ICCC). All persons with suspected symptoms approaching screening centres/ICCC may not be subjected to RT-PCR testing as all syndromic cases are considered as COVID-19 unless otherwise provided.
In a circular issued on May 13, the Director of Public Health and Preventive Medicine said that the positivity rate for the past one week was 15.9, the highest so far. The average death for the past 10 days was 150.
Around 80% of confirmed cases of COVID-19 can be treated as outpatients under home isolation or care in COVID-19 Care Centres (CCC), while up to 20% may require hospitalisation and five percentage need intensive care.
Increased case burden
The State government took a policy decision to diagnose COVID-19 by RT-PCR method. However, the exponential increase in case load and sample load has increased the burden on the health system. At the same time, appropriate treatment is necessary to reduce mortality. So, it was proposed to adapt syndromic management for COVID-19. Some of the advantages of the approach included implementation on a large scale, patient-centred care, lab tests are not required always, cost effective and simplifies surveillance, he said.
The DPH issued the Standard Operating Protocol for the approach. This included active case search and referral - local body/Greater Chennai Corporation/Health department must engage health worker including trained volunteer, self-help group, NGO (one per 100 houses at all places), health worker must visit the house twice a week, check temperature for all residents, check oxygen saturation for symptomatic persons and for confirmed cases in home isolation.
Under passive surveillance or screening/triaging at ICCC, all persons with suspected symptoms may not be subjected to testing. The medical history including symptoms, duration of symptoms, co-morbidities would be enumerated.
Based on the findings at the screening centre/ICCC, suspect/confirmed cases of COVID-19 would be categorised as mild/moderate/severe cases and referred to appropriate institutions as per guidelines.
Setting up of ICCCs
One upgraded Primary Health Centre in each block will be converted into an ICCC - in all 385 blocks, one per zone in all corporations, minimum of one in each municipality. The 30-bed block would have partitions for confirmed patients and those with suspected symptoms. Mild and moderate patients would be admitted and managed in ICCCs. All beds should have oxygen support and adequate drugs including those prescribed for COVID-19 management. One vehicle should be kept ready for referral.
All antenatal clinics and delivery services in the upgraded PHC that would be converted into ICCC should be shifted to nearest PHCs.