A Tertiary Care System Response to COVID-19 in a Resource Limited Setting: a 6-Month Experience

Kerala recorded the initial cases of COVID/SARS-CoV-2 in India and managed to successfully contain it initially through its public health system. As the number of cases increased, the private sector also needed to be prepared. Here, we describe the preparedness and response of a tertiary care system in the nonpublic sector. The Health system response and preparedness consisted of establishment of leadership and infrastructural modification; screening-fever clinic, inpatient admission pathway, dynamic screening strategy training; developing protocols for emergencies and review visits of patients requiring dialysis and chemotherapy. Other priorities included maintaining supply chain of PPE, other essentials such as antivirals and establishing tele consultation. A strong leadership spearheaded infrastructural developments, meetings and troubleshooting every day to adapt to the changing epidemiological and clinical scenario. The Fever clinic was the designated area for consultation of patients with positive symptoms complex and epidemiological risk factors. In early March the screening strategy focused on the presence of a combination of epidemiological and clinical risk factors. As the number of contact cases rose, the focus shifted to identifying any of the defined epidemiological risk factors among persons reaching the hospital. The challenges included redesigning a patient movement pathway, deployment of human resources from their regular work to the screening activities, training of the repurposed human resource, procurement of good quality PPE, coordinating among the specialties, ensuring psychological support etc. The implementation of a timely COVID screening strategy aided our tertiary care centre to provide health care to all patients during the pandemic seamlessly.