CMC Vellore’s COVID-19 Preparedness and Response.
In its 120-year-old history, Christian Medical College (CMC) Vellore has grappled with epidemics and pandemics. CMC began its preparation for the novel Coronavirus SARS-CoV-2 (COVID-19) pandemic from early January 2020, before the first case was reported in our country. The Hospital Infection Control Committee (HICC) brought out protocols for screening, triaging, quarantine, testing and treatment, based on available evidence, much before these were in place elsewhere. Several teams were created to equip and prepare the hospital to provide the best possible care for patients. These included the COVID central command team, mask and supplies committee, OPD/Triage team, COVID testing committee, Clinical team, Infection prevention and control team, COVID nursing task force, Staff Student Health Service and home quarantine, COVID Operating theatre and surgery team, Environmental cleaning and disinfection, Staff training team and Biomedical waste management team. These happened despite the financial challenges due to the drastically reduced patient numbers due to the lockdown.
CMC has been working with the local administration in Vellore and Ranipet Districts as well as the State Government of Tamil Nadu to create capacity to treat patients. The initial request from our Health Minister was the creation of 150 beds exclusive for COVID suspects and patients and the provision for free testing for patients who could not afford. Within the next few days it was evident that the needs would be far greater. Based on discussions with the Vellore District Collector, CMC has so far allocated 210 beds, including 36 ICU beds, in the main campus for patients presenting with influenza like illness (ILI) or severe acute respiratory infection (SARI). At the request of the Ranipet Collector to create additional capacity for Ranipet District, CMC is in the process of completing part of the work in the Kannigapuram campus to cater to up to 400 patients (including 62 ICU beds) in case the country witnesses a surge in the future. Presently on an average, around 30 patients are admitted in the SARI ward every week.
As policies evolved in the country, CMC has modified its protocols to align with all the policies laid by the government for testing and treatment, whilst ensuring that good care is provided for our patients. Most recently, an extension facility was created for the care of pregnant women who present with ILI or who come from high risk areas and for their new born babies to be cared for in specialized designated areas away from the main area. In fact, one paraplegic mother from another city, who was denied admission in various other hospitals came to us as a last resort and had a safe delivery.
The lockdown also resulted in patients being unable to visit the hospital for consultations. Following the guidelines laid by the Medical Council of India (MCI), after discussions with the authorities, teleconsultation services were started in CMC. Presently over 50 of our patients from various parts of the country who are on chronic medications use this service daily to receive important inputs on continuation of medications. This service is being ramped up.
The Departments of Community Health, Family Medicine and the Rural Unit for Health and Social Affairs (RUHSA) have been working among the local communities living in the villages, the tribal areas in Jawadhi Hills and the slums in and around Vellore. Their main concern was discontinuation of chronic medications for diabetes, hypertension and other medical problems. The healthcare teams have been visiting the villages on a regular basis and providing healthcare and medications to the communities.
In the areas covered by the Community Health and Development (CHAD) department, about 500 patients in 28 villages, were given their chronic disease medication for a month at the start of the lockdown. An additional 1500 patients with chronic diseases were covered over the next two weeks in 57 more villages. Further, with the permission of the local administration, the services in the mobile clinic were enhanced and 992 patients were seen over 12 clinic days.
A different strategy was needed in the tribal area. Medication was packed and labelled for around 250 patients by a large team of the staff, taken up to the tribal areas in just one day, and handed over to health volunteers for distribution.
The Low Cost Effective Care Unit (LCECU) of the Department of Family Medicine provides services exclusively for the poor and the slum dwellers of Vellore, in a 5-10 km radius around the hospital. Around 900 patients with chronic diseases are being followed up through the base hospital?s initiatives. Health camps were also conducted in the regions around Vellore in the schools organized by the local administration.
Nurses of the College of Nursing Community Health Department (CONCH) have been visiting patients with psychiatric problems at their homes to dispense monthly drugs.
RUHSA provides healthcare services to the K V Kuppam block. In the first two weeks after the lockdown, patients were delivered medication at home by a health worker. Later mobile outreach clinics were restarted to ensure that all persons on chronic disease treatment continue to receive care. Until the 15th of April, over 1000 chronic disease patients were reached through the special drug delivery system. Those reached through the mobile outreach clinics (16th to 27th April) numbered 425. Immobile patients in need of care were visited at their homes.
CMC also reached out to the patients and their relatives who were stranded in Vellore after the lockdown. Through Our ?Manna Meals Scheme?, patients, on the recommendation of their treating doctors, collected food coupons from a patient liaison office. Till date, over 5000 coupons have been dispensed. Our poor patients? relatives who are unable to afford to stay in hotels/lodges are provided a place to stay at a very nominal cost in the ‘Chatram’, which is run by the hospital.
Pamphlets with information on how to register on the government website to return to their home state were translated into Hindi and Bengali with the help of the Medical Superintendent?s Office and the Public Relations Office (PRO) in CMC on the advice of the Vellore Town DSP. This was distributed to all the lodges in and around the hospital.
In addition, there were 38 patients stranded in the Mental Health Centre (MHC) at Bagayam for several weeks due to the lockdown. The Psychiatry department made arrangements through the PRO for all of these patient attendants to be taken to the Nethaji Stadium, accompanied with a social worker and register with the Tahsildar. The collector has taken note of the patients and is working on travel arrangements for them.
Rice and other essentials through contributions from within the Community Health Department were distributed to 75 people in the villages of the Kaniyambadi Block. Through support from a local trust, similar supplies were supplied to 100 needy people in the Jawadhi area.
The LCECU has set up a food distribution program for more than 500 people in their low income, outreach areas to receive food packets, every day, for five days of the week. This is made possible through the joint efforts of donors, team members and community volunteers.
Six day-care centres for the elderly run by RUHSA have continued to function in order to provide lunch for the needy. Apart from this, more than 400 Individuals and families in the K V Kuppam Block who are especially vulnerable due to food insecurity are being supplied food items, to ensure better protein and fat intake until the next round of governmental support.
CMC?s medical and nursing students have together stitched more than 250 masks, 650 head covers, and 70 pairs of shoes up to end of April 2020. These masks are being used by our staff and some were supplied to the local police on request
CMC is committed to serving its people as it has always done in the past. A significant amount of charity continues to be given to patients who are unable to afford treatment. For those who come to hospital, screening is done both at the outpatient and inpatient areas to ensure that our patients are appropriately triaged. COVID suspects and positives are treated in a separate block away from other patients who do not have ILI symptoms or who are tested negative for COVID-19.
Universal mask use in the campus has been recommended. Several hand wash stations have been placed in different parts of the hospital so that patients can use these facilities. Scheduled regular cleaning of public areas are conducted. Social distancing norms are being ensured in the outpatient and inpatient setting. Special video visiting with social worker supervision has been instituted for patients in ICU and isolation where relatives are not allowed.
All these measures have been instituted in our endeavour to provide a safe environment for our patients to receive treatment for their acute and chronic problems. It is our hope and prayer, that as a nation we will soon rise above these challenges.
Report created in April 2020.