Primary care for the urban poor in India during the pandemic: Uninterrupted management of non-communicable diseases and home-based care of patients with COVID-19 infection.

Problem: The two waves of COVID-19 severely affected the healthcare system in India. The government responded to the first wave with a strict nationwide lockdown which disrupted primary care, including the management of non-communicable diseases (NCDs). The second wave overwhelmed healthcare facilities leading to inadequate access to hospital services. Collectively, these issues required urgent responses, including the adaptation of primary care. Approach: The Low-Cost Effective Care Unit (LCECU) of Christian Medical College, Vellore (CMC) has a network of community volunteers, community health workers, an outreach nurse, social workers and doctors who operate clinics in six poorer areas of Vellore. The network adapted quickly, responding to the lockdown during the first wave and ensuring ongoing primary care for patients with non-communicable diseases. During the second wave, the team developed a system in collaboration with other CMC departments to provide home-based care for patients with COVID-19. Local setting: The LCECU is a 48-bed unit of the Department of Family Medicine, part of the 3,000-bed CMC. It originated in 1982, aiming to care for the poor populations of Vellore town. It has been actively working among urban communities since 2002, with a focus on delivering Community Oriented Primary Care (COPC), for six poor urban communities since 2016. Relevant changes: During the first wave of COVID the LCECU team ensured patients with NCDs had uninterrupted primary care and medications by visiting them in their homes. The team also addressed food insecurity by organizing a daily lunch service for 600 people for over 2 months. In the second wave, the team responded to community needs by organizing and delivering home-based care to monitor patients affected by COVID-19. Lessons learned: The COVID-19 pandemic raises many questions about the preparedness of health systems for disasters that disproportionately affect marginalized populations globally. COVID-19 is only one of the many potential disasters, including non-communicable diseases, mental health problems, pollution, climate change, and lifestyle illness. There is an urgent need to study models of care that support vulnerable communities in an accessible, cost-effective, and patient-oriented way, particularly in low- and middle-income countries. This paper outlines lessons on how the LCECU team addressed disaster management:1. The COVID-19 pandemic has highlighted the importance of primary care-based rapid response interventions in disaster management.2. The LCECU model demonstrated the effectiveness of a primary care intervention based on pre-existing networks and familiarity between primary care teams and the community.3. Establishing community-based health care via interdisciplinary teams, including community health workers, community volunteers, outreach nurses, and doctors, is key.4. Addressing other social determinants of health, such as food insecurity, is an important component of care delivery.

Primary care for the urban poor in India during the pandemic: Uninterrupted management of non-communicable diseases and home-based care of patients with COVID-19 infection

Problem The two waves of COVID-19 severely affected the healthcare system in India. The government responded to the first wave with a strict nationwide lockdown which disrupted primary care, including the management of non-communicable diseases (NCDs). The second wave overwhelmed healthcare facilities leading to inadequate access to hospital services. Collectively, these issues required urgent responses, including the adaptation of primary care. Approach The Low-Cost Effective Care Unit (LCECU) of Christian Medical College, Vellore (CMC) has a network of community volunteers, community health workers, an outreach nurse, social workers and doctors who operate clinics in six poorer areas of Vellore. The network adapted quickly, responding to the lockdown during the first wave and ensuring ongoing primary care for patients with non-communicable diseases. During the second wave, the team developed a system in collaboration with other CMC departments to provide home-based care for patients with COVID-19. Local setting The LCECU is a 48-bed unit of the Department of Family Medicine, part of the 3,000-bed CMC. It originated in 1982, aiming to care for the poor populations of Vellore town. It has been actively working among urban communities since 2002, with a focus on delivering Community Oriented Primary Care (COPC), for six poor urban communities since 2016. Relevant changes During the first wave of COVID the LCECU team ensured patients with NCDs had uninterrupted primary care and medications by visiting them in their homes. The team also addressed food insecurity by organizing a daily lunch service for 600 people for over 2 months. In the second wave, the team responded to community needs by organizing and delivering home-based care to monitor patients affected by COVID-19. Lessons learned The COVID-19 pandemic raises many questions about the preparedness of health systems for disasters that disproportionately affect marginalized populations globally. COVID-19 is only one of the many potential disasters, including non-communicable diseases, mental health problems, pollution, climate change, and lifestyle illness. There is an urgent need to study models of care that support vulnerable communities in an accessible, cost-effective, and patient-oriented way, particularly in low- and middle-income countries. This paper outlines lessons on how the LCECU team addressed disaster management: 1. The COVID-19 pandemic has highlighted the importance of primary care-based rapid response interventions in disaster management. 2. The LCECU model demonstrated the effectiveness of a primary care intervention based on pre-existing networks and familiarity between primary care teams and the community. 3. Establishing community-based health care via interdisciplinary teams, including community health workers, community volunteers, outreach nurses, and doctors, is key. 4. Addressing other social determinants of health, such as food insecurity, is an important component of care delivery.

Early Symptoms of Patients With COVID-19 in Family Medicine Centers in South India: A Retrospective Study

Introduction:A recent Cochrane review on the diagnostic accuracy of initial signs and symptoms of COVID-19 reported on the lack of evidence from studies conducted in community-based health-care settings. Since a broad spectrum of patients present to primary health-care services, testing for patients with noninfluenza-like illness and atypical presentations is debatable. Hence, there is an urgent need for documenting the early presenting symptoms of COVID-19 among patients seeking medical care in primary health-care settings.Aim:In this study, we aim to document the early symptoms of patients with COVID-19 and the proportion of asymptomatic infection in family medicine centers in South India.Design:This is a retrospective study of the early symptoms of patients who tested positive between June and December 2020. The data and clinical notes of patients were retrieved from the hospital information system.Setting:This study was undertaken by the Department of Family Medicine (DFM) in a private not-for-profit academic institution in South India. The DFM provides primary and secondary health-care services to nearly 1,50,000 patients from the local urban communities.Results:A total of 330 patients were tested for COVID-19 and the study included 94 patients who tested positive. Around 37% participants were asymptomatic. The commonest symptom was fever (58.6%), followed by tiredness/myalgia (48.3%), loss of taste or smell or appetite (43.1%), and cough or cold (37.9%). Most participants (78.2%) were hospitalized and the rest (21.8%) were home-quarantined. Only 5 (5.7%) of them died due to COVID-19 infection.Conclusion:The results of the study reiterates the role of social distancing, self-isolation, proper masking, and greater vaccination coverage as significant public health interventions.

Primary care for India's urban dwellers living in informal settlements during the COVID-19 pandemic: The experience of the Christian Medical College, Vellore, Department of Family Medicine.

COVID-19 disproportionally affects India's 81 million people living in urban informal settlements, where inadequate housing, water and sanitation increase the risk and rate of infection.