Guidelines for COVID-19 healthcare centres: types, requirements and operations

With the COVID-19 pandemic spread across 210 nations and territories across the world, most countries including India are amping up their preparedness to better fight this highly contagious infectious disease. Guided by the World Health Organization (WHO), Indian Council of Medical Research (ICMR) and other respectable bodies, the Indian Ministry of Health and Family Welfare (MoHFW) is taking all necessary steps to arrest the spread of COVID-19.

In a recent advisory, the MoHFW revealed that as the number of cases increases in India it’s even more important to prepare the Indian health system for it while also utilising the existing resources judiciously. It’s equally important, the Ministry insists, to create and enforce mechanisms for triaging and decision-making to identify proper COVID dedicated facilities to provide proper care to COVID-19 patients of different categories.

The Ministry then goes on to describe the standard operating procedures (SOPs) to identify available healthcare centres and hospitals which can be categorized and utilized for the appropriate care of COVID-19 patients. These SOPs then specify the different types of facilities which need to be set up for various types or categories of COVID-19 cases.

There are three types of healthcare facilities which will be set up to correspond with the three levels of symptoms the presumptive or confirmed patients of COVID-19 present with: mild, moderate and severe. Once the patients are divided on the basis of their symptoms and dispatched to the appropriate health centres, they should be cared for in isolation wards as per the Ministry guidelines. The following is everything you need to know about the COVID-19 health centres.

Guiding principles behind COVID-19 management
Types of COVID-19 dedicated health facilities
Categorization of patients for dedicated COVID facilities

Guiding principles behind COVID-19 management

The MoHFW has laid down a few guiding principles for COVID-19 management by the selected health centres and the personnel selecting as well as managing their day-to-day activities. The following are the chief guiding principles for the selection and operation of health centres dedicated for the treatment of COVID-19:

All the selected facilities should be solely dedicated for the management of COVID-19 patients.
Three types of COVID-dedicated facilities should be prepared to deal with COVID-19 patients.
All three types of healthcare facilities should have separately maintained areas for presumptive COVID-19 patients and confirmed COVID-19 patients.
All presumptive patients, irrespective of the severity of their symptoms, will be tested for COVID-19. Management of these patients will depend on their clinical status and result of COVID-19 testing.
All three types of facilities will be linked to the MoHFW’s Integrated Disease Surveillance Programme (IDSP).
All these healthcare facilities are expected to strictly adhere to infection prevention and control practices.

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Types of COVID-19 dedicated health facilities

There are basically three types of dedicated healthcare facilities that the MoHFW recommends the commissioning of. These are mentioned below.

COVID Care Centre (CCC)

The COVID Care Centres or CCCs are going to be makeshift facilities which will offer care to only patients who have been clinically diagnosed to have mild symptoms of COVID-19. These CCC facilities may be set up in public or private hostels, hotels, schools, stadiums, etc. The MoHFW also insists that existing quarantine facilities should also be turned into CCCs.

Functional hospitals dedicated to caring for non-COVID patients should be commissioned as CCCs only as a last resort. This is necessary because non-infected sick people, pregnant women, newborn babies, etc need regular care during the epidemic as well. (Read more: What pregnant women need to know about COVID-19)

CCCs can house both presumptive as well as confirmed patients of COVID-19, but in no situation should these two groups of people mix, mingle or come across each other. Separate designated entries, exits and wards should be maintained for both these groups at all times. Presumptive patients should be isolated in single rooms as much as possible.

Every CCC also needs to have:

Health centres for moderate and severe cases for referrals or in case a patient’s condition gets worse.
A dedicated basic life support (BLS) ambulance to ensure the safe transportation of patients. These ambulances should be disinfected according to MoHFW guidelines. (Read more: How to take a COVID-19 patient to the hospital)
AYUSH doctors and other trained staff can also be called in to man these centres under the supervision of allopathic doctors.

Dedicated COVID Health Centre (DCHC)

The Dedicated COVID Health Centres or DCHCs are supposed to offer care to all presumptive and confirmed patients with moderate symptoms of COVID-19. DCHCs can be hospitals, or blocks of a hospital separated from the others by entry, exit and zoning. Private hospitals can also be designated as DCHCs.

All DCHCs must have beds with assured oxygen support, and should be associated with at least one Dedicated COVID Hospital for referrals and severe patients’ care. These hospitals must also have at least one dedicated BLS ambulance equipped with sufficient oxygen and this ambulance should be disinfected after every use.

Under no situation are presumptive and confirmed COVID-19 patients housed at DCHCs to mix or mingle with each other. These patients should be placed in separated areas and their entry/exit should be separate as well.

Dedicated COVID Hospital (DCH)

Dedicated COVID Hospitals or DCHs are fully functional hospitals which will provide comprehensive care to patients of COVID-19 who have been clinically diagnosed to be severe. DCHs can be private or public hospitals, or a separate block of such functional hospitals with separate entry, exit and zoning.

Apart from beds with assured oxygen support, DCHs must have fully functional and adequate intensive care units (ICUs), ventilators, etc to care for severe COVID-19 patients. DCHs are supposed to function as the ultimate source of care for COVID-19 patients and would also function as referral centres for DCHCs and CCCs.

DCHs must have separate areas for presumptive and confirmed COVID-19 patients, preferably with separate entry and exit gates as well. Patients housed in these distinct areas must not be allowed to mix under any circumstances.

Categorization of patients for dedicated COVID facilities

The correct assessment of patients is key in designating them to the appropriate health centres, and this needs to be the most important area of focus for the helpline staff, ambulance staff, as well as the supervisory medical officer at the hospitals and at fever clinics. Patients must be categorized into three primary groups, based on which care will be provided to them.

Group 1: Mild and very mild

Presumptive and confirmed cases in Group 1 are those who have been assigned as mild or very mild. These patients, both suspected and confirmed ones, present with fever and upper respiratory tract illness. These patients would be assigned to the CCCs, where they would be tested. Until the result of the testing is gathered, the patient will be isolated in the CCC, preferably in a separate room.

If tested positive, the patient would be shifted to a separate room and treated until they get better and are tested negative for COVID-19. If they get worse, they will be shifted to a DCHC or DCH.

If tested negative, the presumptive patient will be given treatment for the symptoms, and discharged with the recommendation of following the prescription while taking appropriate care at home.

Group 2: Moderate

Presumptive and confirmed patients in Group 2 present with moderate symptoms of COVID-19, namely pneumonia with no signs of severe illness with a respiratory rate of 15 to 30/minute, SpO2 90%-94%). These patients will be assigned to DCHCs, where they will be tested and isolated until the results arrive.

If positive, the patients will be shifted to the confirmed patients’ wing and treated until recovery or shifted to a DCH in case of severe symptoms. If tested negative, the patient will be immediately shifted to a non-COVID hospital where he or she will receive treatment appropriate for their clinical assessment.

Group 3: Severe

Presumptive and confirmed patients in Group 3 present with severe symptoms like severe pneumonia with respiratory rate ≥30/minute and/or SpO2 < 90% in room air, acute respiratory distress syndrome (ARDS), or septic shock. These patients are assigned to DCHs’ ICU, where they are given the utmost care and isolated as well as tested for COVID-19.

If tested positive, the patient will remain in the COVID-19 ICU and receive appropriate treatment. If tested negative, patients will be shifted to a non-COVID ICU and treated appropriately for clinical symptoms while maintaining infection prevention and control practices.