In anticipation of a surge in the number of COVID-19 cases, the Health Department has decided to decongest Medical College Hospitals (MCHs), which are currently COVID-19 hospitals, by ensuring that all mild symptomatic and asymptomatic positive patients are referred back to COVID first-line treatment centres (CFTCs).

All Category A patients (COVID-19 positive, mild symptoms but no fever) and the asymptomatic patients will be moved out of MCHs and accommodated in CFTCs in COVID-19 wards from next week onwards.

Senior doctors at the MCH said that decongesting tertiary care hospitals was important to make more ICU space and nursing care available to severe or critically ill patients, whose numbers are sure to rise in the coming weeks as the epidemic peaks.

Back referrals

“Kozhikode MCH has already started back referrals and at present have only 12 patients. Thiruvananthapuram MCH on the other hand has nearly 200 patients in the COVID-19 pool (in individual isolation rooms) and another 45 positive patients. Nearly, 70-80% of them are Category A patients and need only careful observation,” a senior faculty at the MCH said.

Even though the concept of CFTCs had been mooted two months ago with the aim of decongesting MCHs, back referrals were not happening as most of the CFTCs did not have proper in-patient facilities.

At CFTCs, where medical assistance will be available round-the-clock, the doctors will assess and monitor the clinical condition of the patients systematically and consult the teams at the COVID-19 hospital for necessary advice and assistance.

What is adopted is a hub and spoke model, wherein the COVID-19 hospitals will act as the hub and remain in close consultation with the CFTCs linked to it. If any patient progresses from Category A to Category B, the CFTC medical team, in consultation with hub-team will refer the patient to the COVID-19 hospital, if necessary.

Oxygen levels

Hypoxia or drop in oxygen saturation, resulting in insufficient oxygen to the cells being one of the danger signs of COVID-19, pulse oximetry will be performed twice in all the patients admitted to CFTCs. Any drop in oxygen saturation below 94% will be immediately moved to the linked COVID hospital.

“The time is now right to activate CFTCs because the skill, expertise and human resources in tertiary care hospitals are better utilised for patients who really need it. CFTC teams can have tele-consultation with the linked COVID-19 hospitals and they have been given a clear check-list, which they can use in case they need to refer any patient to COVID-19 hospital,” a senior doctor said.

The government’s plan is to hike the number of COVID-19 hospitals as well as the CFTCs linked to each, as per requirement, as the epidemic progresses.