1. Background and Function
Globally, well being methods have been challenged by the overwhelming calls for of the COVID-19 pandemic. Sources and employees are being diverted to check and supply remedy for individuals with presumed or recognized COVID-19, and provides are restricted. Some healthcare companies are being compromised as a way to meet the calls for of caring for COVID-19 sufferers, and many individuals concern accessing healthcare services because of concern of buying the virus. These fears could also be worsened by misinformation.1 Throughout the Ebola outbreak in West Africa in 2014–2015, elevated morbidity and mortality in different illnesses (e.g., measles, malaria, HIV/AIDS, and TB) had been seen because of discount in entry to and utilization of healthcare companies, and deaths from these illnesses outnumbered deaths from Ebola.2 It is very important guarantee continuity of important well being companies as a way to forestall sickness and dying from non-COVID-19 sicknesses. This may doubtless require variations to service supply fashions and settings.3,4 As well as, an infection prevention and management measures to cut back the danger of publicity to COVID-19 amongst sufferers and healthcare employees (HCW) must be built-in into all healthcare settings.5
The aim of this doc is to offer ministries of well being, public well being authorities, and implementing companions with a framework for implementing methods to cut back preventable sickness and dying through the COVID-19 pandemic in individuals with non-COVID-19 sickness and damage, notably in low-resource settings.
2. Actions to mitigate the affect of COVID-19 on well being companies
Nationwide and sub-national public well being authorities play a essential position in figuring out how one can mitigate the affect of COVID-19 on individuals needing important non-COVID-19 companies in a wide range of healthcare settings. Particular areas of focus for nationwide and sub-national authorities may embrace:
- Prioritizing places for focused interventions to cut back the affect of COVID-19 on different illnesses. This might be primarily based on COVID-19 prevalence, in addition to burden of non-COVID-19 illnesses or the necessity for companies (i.e. immunization companies), and inhabitants measurement.
- Creating focused communications and academic supplies to be used in all healthcare settings on:
- COVID-19 signs, prevention, and transmission amongst sufferers and healthcare employees
- An infection prevention and management (IPC) for each healthcare employees and sufferers
- Creating strategies to facilitate entry to facility and community-based healthcare companies by service suppliers, sufferers, and their supporters during times of motion restriction.
- Sustaining satisfactory provides and commodities to offer companies and scale back danger of publicity of sufferers and HCWs to COVID-19 in any respect service supply factors:
- Making certain satisfactory provide and use of private protecting gear (PPE), hand hygiene provides (cleaning soap and water or hand sanitizer with no less than 60% alcohol), in addition to cleansing and disinfecting provides.
- Forecasting and ordering for multi-month shelling out of medicines (e.g., 3- or 6-month shelling out) for chronically unwell sufferers who’re secure to cut back size of time between clinic contacts. Use telehealth to watch and help sufferers between in-person visits.
- Establishing, staffing, and supplying neighborhood isolation facilities for mild-to-moderately unwell COVID-19 sufferers to isolate and get well.
- Planning for and buying provides wanted to maneuver important non-COVID-19 companies into makeshift clinics in areas most closely affected by COVID-19. Coordinating with IPC focal individuals for IPC issues and necessities in such settings.
- Making certain monitoring plans monitor service supply occurring outdoors of healthcare services as a way to monitor retention in well being applications, together with these for persistent illness, antenatal care (ANC), and immunization companies.
3. Modification of service supply to keep up important non-COVID-19 companies
Modify Service Entry
- Decide which important companies will proceed and which must be paused or referred to a different clinic because of burden of COVID-19 sufferers.
- Display screen sufferers for signs of or publicity to COVID-19 earlier than they get to the well being facility; think about using telehealth platforms to display screen sufferers earlier than they arrive to the well being facility and to make referrals, if wanted.
- Triage and check sufferers for COVID-19, together with, the place potential, touchless temperature checks.
- Guarantee hand hygiene (all individuals getting into and exiting facility ought to wash fingers with cleaning soap and water or use hand sanitizer with 60% alcohol), acceptable use of PPE, and common cleansing and disinfection, particularly of continuously touched surfaces and shared objects.
- Guarantee use of a medical masks for all sufferers with respiratory signs or different signs suggestive of COVID-19 and encourage the usage of masks for different sufferers.5
Modify Clinic Area:
- Separate sufferers by sustaining no less than a distance of about 2 arm lengths (about 2 meters) when potential (e.g., transfer ready areas outdoors) and limiting the variety of individuals within the facility at a time, particularly in small areas akin to pharmacies and hallway ready areas.
- Take into account altering and repurposing clinic house or designating sure services for COVID-19 care whereas others are designated for important non-COVID-19 companies.
- Modify underused areas in services which have entry to improved water sources (water equipped by means of a family connection, public standpipe, borehole properly, protected dug properly, protected spring, or rainwater assortment) and good air flow (e.g., operates correctly and will increase circulation of outside air as a lot as potential) to be used as isolation areas for presumptive or optimistic COVID-19 sufferers.
- Guarantee separate areas that enable for bodily distancing can be found for evaluation of acutely unwell individuals and supply of important non-COVID-19 companies.
Modify Service Supply:
- Decrease affected person contacts with HCW and different sufferers to cut back danger of publicity or an infection:
- Lengthen time between appointments for secure, wholesome sufferers.
- Use telemedicine visits (both video, telephone calls, SMS (quick message service)) for screening, follow-up, and refilling prescriptions.
- Implement 3- or 6-month shelling out of medicine for wholesome, secure sufferers.
- Present staggered appointments to cut back the variety of individuals in ready areas and implement and implement an appointment scheduling system to decongest clinics.
- Present fast-track companies for acute and persistent sufferers to cut back contact with a number of suppliers (e.g., charts pulled, medicines prepared, affected person solely sees supplier if wanted, one supplier sees affected person by means of all companies).
- Restrict variety of guests who might accompany affected person to clinic or community-based companies.
- Relocate companies—every neighborhood and healthcare facility might want to decide which of the next choices most closely fits their circumstances and accessible assets.3,4,7 Selections might differ primarily based on the variety of COVID-19 instances locally.
- Well being services with few presumptive or optimistic COVID-19 sufferers might designate an space inside the facility the place COVID-19 sufferers could be remoted.
- In websites the place there’s a larger burden of COVID-19 instances, the ability might think about:
- Transferring important non-COVID-19 companies outdoors of the ability into neighborhood areas, (e.g., a vacant faculty, church, or neighborhood middle) to cut back danger of publicity at services, guarantee these sufferers stay in care and on remedy as some might concern getting sick in the event that they return to the clinic, and scale back crowding at clinics so they’re higher capable of take care of COVID-19 sufferers.
- Transferring companies for COVID-19 sufferers with gentle or average signs to neighborhood isolation facilities to keep up house in services for important non-COVID-19 companies.
- Selling home-based take care of COVID-19 sufferers with gentle or average signs who can safely isolate at residence.
- Supply a number of “no-contact” drug pick-up choices for sufferers with persistent sicknesses:
- Scheduled drugs pick-up at neighborhood or clinic pharmacies, or neighborhood pick-up factors (e.g. homes of worship or colleges). Take into account variations to attenuate in-person contact and publicity danger. Various modes of communication might embrace telemedicine calls, SMS, or social media.
- Implement 3- or 6-month shelling out of medicine for wholesome, secure sufferers.
- Preserve routine contact with secure sufferers. Present extra frequent contact to new sufferers and sufferers in danger for loss to follow-up.
- Shift and share duties as wanted:
- Re-assign employees from much less busy companies to help with important companies.
- Work with the Ministry of Well being (MOH) and native HCW societies to find out how process shifting can greatest be used to offer important companies.
- Guarantee HCWs are appropriately educated in provision of take care of sufferers with COVID-19, and that clear steering/ working procedures exist for coaching on transmission of COVID-19, donning and doffing private protecting gear, and so forth.
Hyperlinks to Illness Particular Suggestions: