Health Department, Haryana
स्वास्थ्य विभाग, हरियाणा

Haryana State-specific Comprehensive COVID-19 Management Plan

Background:

World Health Organization (WHO) declared COVID-19 a pandemic on 11.03.2020, and on the same day State Govt. issued “The Haryana Epidemic Disease, COVID-19 Regulations, 2020”(Annexure-1). Since then, COVID-19 planning has got a huge response from all quarters, and there have been various guidelines with regard to COVID-19 issued by Central/State Govt., such as, containment plans, testing strategies, tracing of contacts, quarantine/ isolation/ hospitalization/ discharge policies, etc. The guidelines are dynamic in nature, have been revised depending on the behaviour of the disease in our country and response to various management modalities implemented in various countries across the world.

Scope of document:

A state specific strategy congruent to local needs is prepared. The document provides comprehensive and easily accessible information regarding COVID-19 management.

A. The process flow of COVID management:

1st contact with
the suspect/ patient

1. Identification: The suspect/patient is identified in the process of Active/Passive Surveillance. Active Surveillance: Primary suspects, Contacts of positive cases, persons with ILI, etc. Passive surveillance: Coming to hospitals/Flu corners, SARI cases, patients with co-morbidities, etc. As per the guidelines issued vide Letter No. 32/3-IDSP/1917-38 dated 3.4.2020 (Annexure-2)

Clinical examination
of suspect/ patient

2. Clinical classification:

  • a) No symptoms i.e. Asymptomatic
  • b) Pre-symptomatic/ very mild to mild symptomatic
  • c) Moderate symptoms
  • d) Severe symptoms

Additionally, the course of action depends upon the other conditions, such as, co-morbidities, pregnancy, age less than 10 or more than 60 years, etc.

Testing of the suspect/ patient

3. Testing: Every suspected case shall be tested for COVID-19. The testing may be done through:

  • a) RT-PCR: for all the cases, as per guidelines of ICMR
  • b) CBNAT/ True NAAT: for emergency conditions, when immediate report is required.
  • c) RDT kits: withheld (will be used as per ICMR guidelines)

Whom to TEST

ICMR: Strategy for COVID-19 testing in India (Version 5, dated 18/05/2020)(Annexure-3)

As per the guidelines of ICMR (GoI) every suspected case shall be tested for COVID-19. The testing facility in the state is available at the following Labs:

a) Govt. Labs

  • i. PGIMS, Rohtak
  • ii. BPS GMC, Sonepat
  • iii. ESIC, Faridabad
  • iv. KCMC, Karnal
  • v. ICAR Equine Centre, Hisar
  • vi. SHKM GMC, Nalhar, Nuh
  • vii. THSTI, Faridabad
  • viii. Civil Hospital, Panchkula
  • ix. Civil Hospital, Ambala
  • x. Civil Hospital, Gurugram
  • xi. Maharaja Agrasen MC, Agroha

In addition, CB NAAT/ True NAAT testing facilities are available at:

  • i. IRL Public Health lab, Karnal
  • ii. Maharaja Agrasen MC, Agroha
  • iii. Civil Hospital, Faridabad
  • iv. Civil Hospital, Gurugram
  • v. Civil Hospital, Karnal

Additionally, RT PCR labs at Institute of Microbial Technology CSIR, Chandigarh and Command Hospital, Chandimandir are also functional.

b) Private Labs

  • i. Core Diagnostics, Gurugram
  • ii. Pathkind Diagnostics, Gurugram
  • iii. Dr. Lal Path Labs, Rohini, Delhi
  • iv. MoIQ Laboratory, Gurugram
  • v. Modern Diagnostics and Research Centre-Lab., Gurugram
  • vi. Strand Life Sciences, Gurugram
  • vii. SRL Limited, Gurugram
  • viii. Medanta- The Medicity, Gurugram

NOTE: The entries for all the samples for COVID-19 testing shall be ensured through RT-PCR App, so that real time data is captured on COVID19CC.NIC.IN portal.

State Government has fixed the rates for Covid-19 testing

     The terms and conditions for testing of suspects from Govt. Health Facilities at private labs have been described in the letter No. 3PM(COVID)/2020/3029-3228 dated 29.03.2020; Memo No. 1/DGM(T)-HMSCL/2020/1416-20 dated 21.04.2020 and No. 1/DGM(T)-HMSCL/2020/487 dated 13.05.2020 (Annexure-4,5,6). However, the most important condition for sending the samples to private labs is exhausting of testing capacity of Govt. Labs for the day. State Government has fixed the rates for RtPCR Covid-19 testing vide order no. 3PM(COVID)/2020/10056-10105 dated 22-08-2020.(Click Here)

State Govt. has fixed the rates of Covid-19 testing vide order no. 3PM(COVID)/2020/19247-19297 dated 21-08-2020.(Click Here)

The rates for COVID-19 testing have been further revised vide order no. 3PM(COVID)/2020/19348-19398 dated 28-08-2020.(Click Here)

4. Infrastructure for managing suspects/patients: All the COVID-19 facilities shall be dedicated for COVID-19 management (Partially/Fully), as per the guidelines of MoHFW. The three types of COVID-19 facilities may be identified:

a) Home Isolation: Most of the asymptomatic, or with very mild to mild symptoms COVID-19 patients may be managed at home, however, only on the advice of treating physician, as per the guidelines issued vide Letter No. 32/3-IDSP-020/2738-91 dated 13.05.2020. Revised vide Letter No. 32/3/IDSP/2020/3725-66 dated 17.06.2020. (Annexure-7)
Note: Contacting the home-isolated person telephonically at least twice daily shall be ensured, besides health monitoring by district surveillance team as per protocol.

Stay arrangements of
the suspect/ patient

b) COVID Care Centres (CCC): For Quarantine and Isolation facilities, shall be used for suspects or mild to very mild Lab-positive cases, in separate from each other establishments. These facilities are Non-medical facilities, such as, hotels, hostels, lodges, etc. Such facilities shall be identified strictly as per the guidelines, using the checklist (Annexure-8). The management of cases shall be as per laid down SOPs (issued by MoHFW- Annexure-9) in these facilities. These may be of 2 types:

NO
Inter-mingling of
suspects & positive cases

  • i. Govt. facilities for non-affording persons, where expenditure would be borne by State Govt.
  • ii. Private facilities, wherein the expenditure would be borne by person himself.

Hospitalization of the suspect/ patient

c) Dedicated COVID Health Centre (DCHC): for clinically moderate cases. These facilities are hospitals or separate blocks in the hospital, having beds with assured oxygen supply.

d) Dedicated COVID Hospital (DCH): for clinically severe cases. These facilities are well established hospitals with fully equipped ICUs, Ventilators and oxygen supply.

The State Govt. has notified 9 Medical Colleges (Govt. & Private) and 42 hospitals (Govt. & Private) in the State as Dedicated COVID hospitals. The list is annexed at (Annexure-10). Further, the details of all the healthcare facilities dedicated for COVID-19 patients is updated from the office of concerned Civil Surgeon at District level and same is available on the S-3 portal.

Note: Ensure regular updation of information on Facility App regarding dedicated COVID-19 facilities be ensured, so that the same is reflected on the S3 portal, monitored by GoI.covid19.nhp.gov.in

Where to hospitalize the patients

The State Govt. has mapped the dedicated COVID Hospitals/ Medical Colleges for referral of COVID-19 patients from various districts of state vide order No. DMER/2020/4807-08 dated 01.06.2020 (Annexure-11)


Who & How to make payments for quarantine/ isolation/ hospitalization

The State Govt. has fixed the rates for utilizing quarantine facilities, and rates for treatment at private hospitals (Annexure-12). The payment for the treatment of hospitalized patients is to be made as per the mode of payment issued vide State Govt. letter No. 2020/2PM-Pkg(COVID-19)/4776-4975 dated 20.04.2020 and No. 2020/2PM-Pkg(COVID-19)/6867-7066 dated 20.05.2020 (Annexure-13 & 14). Further, State Govt. has fixed the rates for utilizing Isolation Facilities vide letter No. 2020/2PM-Pkg(COVID-19)/6660-6859 dated 22.05.2020 (Annexure-15).State Govt. has revised the rates for COVID-19 treatment at private hospitals

Cinque Terre

5. COVID-19 related infrastructural Modification:

The modifications with regard to COVID-19 required in the hospitals i.e. DCHC and DCH are enlisted below:

  • i. COVID Labour Room & Operation Theatre:The guidelines for a dedicated COVID Labour Room & OT have been issued vide Letter No. 3PM(COVID)/2020/4012-4033 dated 14.04.2020 (Annexure-16)
  • ii. Dialysis Facility: all the dedicated COVID Hospitals shall arrange at least 2 separate Dialysis Machines for the COVID-19 patients. The instructions have been issued by concerned branch (Annexure-17)
  • iii. Installation of elbow operated taps & elbow-operated soap dispensers in OPD and other patient care areasfor healthcare providers/ foot operated soap/hand sanitizer dispensers for patients in all healthcare facilities.
  • iv. Installation of Glass barricaded Flu corners.
  • v. Space enhancing alteration in sitting arrangements in waiting areas.
  • vi. Installation of Queue management systems.
  • vii. Display of IEC material in all healthcare facilities.
  • viii. Installation of Gas Manifold System/Central oxygen, to increase beds with oxygen supply, wherever possible.
  • ix. Alteration in Air ventilation of Hospitals i.e. Central Air conditioning Units/ Split AC/ Window AC: Clear guidelines with minute details may be issued by Public Health & Engineering Dept./ Hospital Engineering Dept.
  • x. Installation of sheds in registration/ waiting areas of hospitals.
  • xi. Installation of Flash Autoclaves/ UV Boxes/ ETO equipment, with proper guidelines and safety measures.
  • [The same may be used for re-use of PPE/N95 masks. The guidelines for rational use of PPE and re-use of N95 masks have been issued vide Letter No. 3PM(COVID)/2020/5944-5965 dated 05.05.2020 (Annexure-18)]

6. Discharge Policy: The patient shall be discharged as per the guidelines provided in the discharge policy, issued vide Letter No. 32/3-IDSP-2020/2619-40 dated 11.05.2020 (Annexure-19). However, the patient shall be under surveillance for next 14 days.

7. Management of dead bodies: The management of dead bodies shall be done strictly as per the guidelines issued vide letter No. 3PM/(COVID)/2020/3780-3801 dated 08.04.2020 (Annexure-20).

8. Death Audit Committee: The constitution of COVID Death Audit Committee (CDAC) in each district shall be ensured, as per guidelines issued vide Letter No. 32/3/IDSP/20/ 2692-2713 dated 13.05.2020 (Annexure-21)

B. Sanitization and Waste management:

  • The standard Infection Prevention & Control Practices shall be adhered to.
  • Continuous training of the whole staff.
  • Guidelines for sanitization of hospitals/ ambulances/ equipment/etc. issued as PPT by IDSP shall be followed strictly (Annexure-22)
  • Preparation of 1% Hypochlorite Solution shall be supervised; Measurement containers shall be made available.
  • Management of Bio-medical waste as per the CPCB guidelines circulated vide letter No. COVID-19/5270-5300 dated 24.04.2020 (Annexure-23)
  • Ensure availability of PPEs for workers handling BMW.
  • Foot-operated dustbins with lids.
  • Doubling of BMW bags for COVID-19 BMW.
  • Separate Recordkeeping for COVID-19 BMW.

C. Other aspects of COVID management:

  • The President of India promulgated “The Epidemic Diseases (Amendment) Ordinance, 2020” for safety and security of Healthcare providers across the country(Annexure-24)
  • State Govt. has designated State/District Nodal Officers for implementation of the Epidemic Diseases (Amendment) Ordinance, 2020 (Annexure-25)
  • State Govt. has given additional pay benefit for Healthcare workers, who are posted in COVID ICU/Isolation wards and who perform any procedure/surgery/conduct delivery of COVID patient (Annexure-26).
  • State Govt. has given benefit of life cover of Rs. 50 Lakhs for Govt. employees i.e. Doctors, Nurses, Gp. ‘C’ and Gp. ‘D’ employees, posted in COVID ICUs, COVID Isolation wards, COVID OTs and an ex-gratia of Rs. 10 Lakhs against loss of life due to COVID-19 till June 30 ’2020 for all Govt. employees whether regular, part time or contractual, working in various containment zones including ASHA workers (Annexure-27).
  • Govt. of India has provided a life cover of Rs 50 Lakhs for all healthcare providers i.e. Pradhan Mantri Garib Kalyan Package: Insurance Scheme for Health Workers Fighting COVID-19 (Annexure-28).
  • The guidelines for rational use of PPE for healthcare providers were issued vide letter No. 3PM(COVID)/2020/5944-65 dated 05.05.2020 (Annexure-17).
  • All the suspects/ patients undergo enormous psychological stress during the whole duration of being identified as a suspect or patients till the surveillance period is over; and require psycho-social and psychiatric care. The SOPs for the same have been prepared and circulated vide Letter No. DMHP/Main/II/2020/1897 dated 15.05.2020 after approval by State Govt. (Annexure-29).
  • Procurement of Mortuary Vans by ULB/PRI: As the Health Department does not have any Hearse/dead body carrying vans, the same may procured by the departments of ULB/Development & Panchayats to facilitate general public.
  • Spread of awareness in general public w.r.t. COVID-19 through IEC material by Development & Panchayats departments. The concerned department has already been requested for the same vide Letter No. 3PM/2020/5187 dated 21.04.2020 and 3PM(COVD)/2020/6083 dated 13.05.2020 (Annexure-30,31)
  • Continuous trainings/ sensitization of all healthcare providers for self care as well as patient care w.r.t. COVID-19.
  • Additional manpower has been provided at Districts.

D. Non-COVID services:

A concept note for Non-COVID services would be issued separately after the approval of authorities.

E. Future Plan:

• COVID-19: All the Civil Surgeons in coordination with district administrative authorities shall prepare a plan for the eventuality of huge surge of COVID-19 cases and do micro-planning, keeping in view each aspect, such as, identifying additional manpower/beds, involvement of IMA members, taking over of private hospitals, shifting of RRT manpower for CCC management, arrangements of extra linen/consumables (Oxygen masks, Oxygen nasal cannulas, linen, etc.), upgrading of health infrastructure in Govt. Health Facilities, especially with regard to Intensive Care management. Provision of digital payments in all Govt. Health facilities to be explored.

• Non-COVID-19:Preparing and submitting plan for carrying out Non-COVID-19 OPD, Indoor, Operative, Emergencies services in the districts by respective district authorities.