After weeks of havoc across the country amid the second wave, Covid-19 cases in India are finally declining. In these moments of the much-needed respite, it’s worth remembering that we have only limited time left before we face the looming threat of the third wave.
It is time for us to look back, learn from experiences and scale up what worked. One of such experiences is how collective community conscience transcended into affirmative action. The way thousands of SOS calls on social media were responded to and uncountable human lives were saved by unknown messiahs is a testimony to this.
Community actions of various kinds have been working successfully in various pockets of the country. It is now important to scale such successful community models,.
Despite the deadly nature of the second wave, it is noteworthy that over 80% of total infections are still mildly symptomatic or asymptomatic, as was the case in the first wave. However, due to the higher rate of transmission, mildly symptomatic patients transmit the infection to their family members much faster – the reason we see entire families being affected, unlike the first wave.
Many of these are high-risk individuals and possess a higher threat of developing moderate-to-severe symptoms when infected. These are the ones who need hospitalisation. They need a hospital bed, perhaps oxygen support, possibly ICU care and potentially a ventilator. As the number of such patients increases, hospitals run out of available infrastructure leading to a lack of medical care, and subsequently more deaths.
Augmenting hospital infrastructure, although extremely crucial, will always be a temporary and tertiary-level solution as it does not contain the spread of the disease. Instead, focusing on primary care would help limit the disease spread and in turn, reduce the burden on the healthcare system for a long-term impact.
What if, going forward, we focus on mildly symptomatic and asymptomatic patients, try to stop the spread at their level – government guidelines suggest this too – and do this with community support to avoid numerous preventable deaths?
Role of community
Besides the virus itself, unprecedented problems have emerged during the Covid-19 pandemic across the country – be it the doubts about the very existence of the virus, the apathy to Covid-appropriate behaviours, the constant stream of misinformation on social media or the extreme stigma around Covid-19 patients.
The repercussions of such issues have been scary, mainly because irresponsible actions have an impact on the entire community, given the highly infectious nature of the disease. Therefore, collective responsibility and actions through the “one-of-all and all-for-one” approach is likely to help communities in fighting the pandemic in the long run.
Public health strategies guided by the principles of community mobilisation have seen great success across the globe. For instance, the Community Health Clubs in Zimbabwe were instrumental in health promotion through hygiene, community-led total sanitation has successfully reduced open defecation in Bangladesh and many parts of India, and we are largely aware about the various community-based participatory actions taken to fight HIV/AIDS and eradicate polio. Decentralising people-centric actions through community support, therefore, could be a way to tackle the pandemic in the future.
Community Covid care
In the government’s three-tier system for Covid-19 management, Covid Care Centres are the primary healthcare nodes where asymptomatic and mildly symptomatic patients are treated. The Union government has recently come up with a plan to increase the number of centres in peri-urban and rural areas. However, with limitations on the number of government facilities, mixed levels of their acceptance by people, poor accessibility and lack of available human resources, it could be useful to open smaller versions of centres, which could be established and managed by communities.
Many housing societies in urban areas and local leaders in rural areas have taken a step towards establishing small spaces within communities for isolating mildly symptomatic or asymptomatic patients. We have attempted to bring uniformity in such efforts, developed guidelines for what we have named “Community Covid Care Centres”. This could potentially become a widespread community movement and aid government interventions in the long run.
A Community Covid Care Centres is a common space agreed upon and managed by communities where asymptomatic or mildly symptomatic Covid-19 patients can be isolated. Community Covid Care Centres are not medical treatment centres, hospitals, or clinics, but are merely care centres for those who have been advised home isolation.
This is potentially a self-sustainable model that could be implemented in urban, peri-urban and rural areas. For urban settlements, these spaces could be empty flats or apartments, clubhouses, common rooms, gym or yoga halls in housing societies, empty houses or bungalows, small community centres, classrooms of empty schools in the community and community prayer places.
For rural areas, Community Covid Care Centres could be set up in gram panchayat halls, school classrooms, community prayer places, or any other such places that can be used for isolation.
Community, resource mobilisation
To run this model, developing a sense of ownership among community members is crucial. To achieve this, community members will have to be brought aboard through a democratic process. Gram panchayats, religious organisations, housing societies, local clinics, primary health centres, non-governmental organisations, community-based organisations, locally influential people could play a major role in this by initiating a dialogue with community members.
Community youth, who naturally have leadership qualities and are widely trusted by community members will be key in setting up and running Community Covid Care Centres. These leaders by holding meetings with decision-making people, could temporarily acquire possible properties and mobilise local resources to establish Community Covid Care Centres.
Infrastructure and other resources needed to establish and run Community Covid Care Centres could be pooled through donations in kind and/or cash. The local ecosystem would need to be enrolled in providing continual support to these centres.
Involving local volunteers, doctors, community kitchens, nurses, chemist stores, ambulance services, laboratories will potentially make Community Covid Care Centres self-reliant and sustainable. WhatsApp groups could be activated to facilitate Community Covid Care Centres functioning and localised support can be availed without much hassle.
Community members, volunteers and patients’ family members could take the responsibility of security and food for patients through individual and/or collective efforts. Additionally, because the service providers and beneficiaries will likely know each other, a sense of togetherness will prevail that could potentially bring about long-term benefits beyond health.
Types of community care
As long as a clean, empty space with basic amenities such as ventilation, light, electricity, toilet and drinking water is available, a Community Covid Care Centres can be established. The scope of Community Covid Care Centres’ work could be decided based on the available resources and operational feasibility. Community Covid Care Centres could range from being two-four bedded facilities to 20-25 bedded ones.
We have broadly divided Community Covid Care Centres into four categories based on the available resources and local requirements. The basic Community Covid Care Centres will isolate confirmed Covid-19 patients who have been suggested home isolation. Additional possible services such as isolating suspect patients in a separate area, having medical equipment (such as nebulizer, oxygen concentrator) for stabilising a patient until an ambulance reaches or they get a hospital bed could be provided if resources permit.
Each Community Covid Care Centres would be mapped to a government Covid Care Centres or Dedicated Covid Health Centre for further support that may be needed for patients who might need expert medical care than available at community centres. This will help create a chain of facilities so that patient referral could be smoother and only the needy will approach higher treatment centres.
Allied activities
Community Covid Care Centres should be viewed as a well-rounded ecosystem for containing the disease spread. Field teams of youngsters could be created who can help in tracing contacts of positive patients and pursue them to get tested early.
They can also be trained for counselling patients and their relatives. A team of doctors could be made available for treating the patients through telephonic or online consultations of patients in the Community Covid Care Centres.
These doctors could also help in patients’ referrals to higher centres when needed. Additionally, groups and organisations of doctors could be asked to train local youth, AYUSH doctors on managing patient care, using equipment such as nebulisers and oxygen concentrators and follow-up post-Covid patients.
Patient education material, phone numbers of key persons and services should be displayed in the patient area and circulated on local WhatsApp groups, so any help needed can be availed in quick time. Local organisations such as Rotary or Lions clubs, doctors’ organisations, police officers, business persons, locally influential people could be involved in the management of these centres. Lastly, good coordination between the bureaucracy and community leadership will be a must for smooth functioning and better planning and implementation of Community Covid Care Centres.
Potential impact
Community Covid Care Centres are thought to be primary healthcare facilities run by the people and for the people. This is a step towards the communitisation of healthcare – a key goal of the Indian government’s flagship programme, the National Health Mission.
Being treated in one’s own vicinity would provide the much-needed psychosocial support to patients, which has a positive impact on prognosis. This would also help reduce out-of-pocket expenditure to a great extent. Due to appropriate implementation of isolation guidelines, it would help reduce disease transmission.
Continuous medical monitoring of mild cases would help identify warning signs early, thereby reducing potential complications and deaths. Additionally, Covid-19 patients who recover at the community level would help communities build a positive narrative around the disease. Lastly, the whole initiative, especially parts such as psychological counselling of patients and families would reinforce community solidarity and its role in tackling the pandemic.
Building community movement
The idea of community-run isolation centres is not new. We have merely made an attempt to standardise such efforts and develop detailed guidelines on how to establish and operationalise Community Covid Care Centres. A public appeal to creating such centres has been made by the popular Hindi film actor Mohammad Zeeshan Ayyub through social media with an aim to develop this into a community movement across the country.
To help people with technicalities and resource mobilization, his team and he have created a dedicated email id and a Facebook page for people to reach out. The response this is getting needs to be converted into field-level action soon. We cannot afford to be complacent again and wait for the third wave to hit us before acting. We are not completely over the second wave yet, but a call to action for containing the third wave has to be made now – it has to be considered SOS.
Operational guidelines for Community Covid Care Centres drafted by the authors of this piece could be accessed at: https://cutt.ly/zbQjqtV. Suggestions and feedback on the guidelines could be sent at c2c2model@gmail.com.
Pradip Awate works as State Surveillance Officer, Public Health Department, government of Maharashtra.
Sumedh MK is a public health professional, currently working as an independent consultant with the Maharashtra government’s public health department.