Using a national level cross-sectional study to develop a Hospital Preparedness Index (HOSPI) for Covid-19 management: A case study from India.

BACKGROUND: We developed a composite index-hospital preparedness index (HOSPI)-to gauge preparedness of hospitals in India to deal with COVID-19 pandemic. METHODS: We developed and validated a comprehensive survey questionnaire containing 63 questions, out of which 16 critical items were identified and classified under 5 domains: staff preparedness, effects of COVID-19, protective gears, infrastructure, and future planning. Hospitals empaneled under Ayushman Bharat Yojana (ABY) were invited to the survey. The responses were analyzed using weighted negative log likelihood scores for the options. The preparedness of hospitals was ranked after averaging the scores state-wise and district-wise in select states. HOSPI scores for states were classified using K-means clustering. FINDINGS: Out of 20,202 hospitals empaneled in ABY included in the study, a total of 954 hospitals responded to the questionnaire by July 2020. Domains 1, 2, and 4 contributed the most to the index. The overall preparedness was identified as the best in Goa, and 12 states/ UTs had scores above the national average score. Among the states which experienced high COVID-19 cases during the first pandemic wave, we identified a cluster of states with high HOSPI scores indicating better preparedness (Maharashtra, Tamil Nadu, Karnataka, Uttar Pradesh and Andhra Pradesh), and a cluster with low HOSPI scores indicating poor preparedness (Chhattisgarh, Delhi, Uttarakhand). INTERPRETATION: Using this index, it is possible to identify areas for targeted improvement of hospital and staff preparedness to deal with the COVID-19 crisis.

The use of integrative therapy based on Yoga and Ayurveda in the treatment of a high-risk case of COVID-19/SARS-CoV-2 with multiple comorbidities: a case report.

BACKGROUND: We report a high-risk case of a coronavirus disease 19 (COVID-19)-positive patient with comorbidities including diabetes mellitus (DM), hypertension (HTN), hypothyroidism and chronic kidney disease (CKD), treated successfully using an integrative therapy plan based on Ayurveda and Yoga, along with government-mandated compulsory modern western medicine (MWM) treatment. Recently, some evidence has been emerging on the use of Ayurveda for treatment of COVID-19. The classical texts of Ayurvedic medicine such as Charaka Samhita and Sushruta Samhita contain descriptions of pandemics of similar proportions and describe them as Janapadoddhvansa, meaning the destruction of communities, along with their causes and treatment. CASE PRESENTATION: The case reported herein is a 55-year-old man from Delhi, India, with confirmed (tested) COVID-19, who first took MWM for 7 days before seeking integrative therapy. The patient has comorbidities including DM, HTN, hypothyroidism and CKD and had developed symptoms including fever (which was resolved by the time integrative therapy was started), sore throat, dry cough, body aches, weakness, bad taste and smell, and heaviness in the abdomen. Based on the patient's symptoms and comorbidities, a treatment plan including Ayurvedic medicines, Yoga protocol, dietary recommendations and lifestyle modifications was prescribed by a registered Ayurveda doctor and a Yoga consultant. The patient started experiencing improvement in all the symptoms within 2 days after starting the treatment; he reported approximately [Formula: see text] relief from the symptoms after 5 days, and almost complete relief within 9 days. Also, the blood sugar levels (both fasting blood sugar [FBS] and postprandial blood sugar [PPBS]) exhibited significant improvement after 5 days, and decreased to within the normal range within 12 days. Besides relief in symptoms, the patient's real-time reverse transcription polymerase chain reaction (RT-PCR) test done on the 19th day returned negative results. CONCLUSIONS: Integrative therapy was found to be effective in mitigating the symptoms of COVID-19 in this patient with multiple comorbidities. Moreover, a significant improvement in blood sugar levels (not under control with modern medicine) was also achieved. Integrative therapy based on the classical texts of Ayurveda and Yoga may offer a promising and scalable treatment option for COVID-19 patients. A case series or a suitably designed randomized controlled trial is needed to assess its efficacy.