Tamil Nadu to adopt syndromic approach towards COVID-19 management

Exponential rise in case and sample loads prompts decision

Given the exponential rise in COVID-19 cases and sample load, the State will adopt a syndromic approach towards the pandemic management.

Under this, active case search will be taken up through house-to-house visits, and screening/triaging will be taken up at Interim COVID-19 Care Centres (ICCCs). All persons with suspected symptoms approaching screening centres/ICCCs may not be subjected to RT-PCR testing as all syndromic cases are considered COVID-19 unless proved otherwise.

In a May 13 circular, the Director of Public Health and Preventive Medicine said the positivity rate for the past one week was 15.9%, the highest so far. The average number of deaths for the past 10 days was 150.

Around 80% of the confirmed cases can be treated as outpatients in home isolation or at COVID-19 Care Centres (CCC), while 20% may require hospitalisation and 5% need intensive care.

The State government took a policy decision to diagnose COVID-19 through the RT-PCR method. But the exponential increase in the case and sample loads has added to the burden on the health system. At the same time, appropriate treatment is necessary to reduce mortality. So it was proposed to adopt the syndromic management. Some of the advantages of the approach include implementation on a large scale, patient-centred care, lab tests are not required always, cost-effective and simplified surveillance.

SOP issued

The Director of Public Health issued the Standard Operating Protocol for the approach. This included active case search and referral — the local body/the Greater Chennai Corporation/the Health Department must engage health workers, including trained volunteers, self-help groups and NGOs (one per 100 houses at all places). A health worker must visit a house twice a week, check the temperature of all residents and the oxygen saturation level of symptomatic persons and confirmed cases in home isolation.

Under passive surveillance or screening/triaging at ICCCs, all persons with suspected symptoms may not be subjected to testing. The medical history, including symptoms, duration of symptoms and co-morbidities, would be enumerated. Based on the findings at the screening centres/ICCCs, suspect/confirmed cases would be categorised as mild, moderate and severe and referred to appropriate institutions. One upgraded Primary Health Centre (PHC) in each block will be converted into an ICCC. The 30-bed ICCC would have partitions for confirmed patients and those with suspected symptoms. Mild and moderate cases would be managed at ICCCs. All beds should have oxygen support and adequate drugs, including those prescribed for COVID-19. One vehicle should be kept ready for referral.

All antenatal clinics and delivery services in the PHC upgraded as ICCC should be shifted to the nearest PHCs.