ABSTRACT
UNSTRUCTURED: India experienced a surge in COVID-19 cases during the second wave in April-June, 2021. A rapid rise in cases posed challenges in triaging patients in hospital settings. Chennai, the fourth largest metropolitan city with an eight million population, reported 7564 COVID-19 cases on May 12, 2021, nearly three times higher than the peak of 2020. A sudden surge of cases overwhelmed the health system. We had established standalone triage centers outside the hospitals in the first wave, which catered to up to 2500 patients per day. In addition, we implemented a home-based triage protocol from May 26, 2021, onwards to evaluate the COVID-19 patients who were aged ≤45 years without comorbidities. Among the 27,816 reported cases between May 26 and June 24, 2021, 16,022 (57.6%) were aged ≤45 years without comorbidities. The field teams triaged 15,334 (55.1%), and 10,917 patients were evaluated at triage centers. Among 27,816 cases, 69% were advised of home isolation, 11.8% were admitted to COVID care centers, and 6.2% in hospitals. Only 3513 (12.7%) patients opted for the facility of their choice. We implemented a scalable triage strategy covering nearly 90% of the patients in a large metropolitan city during the surge. The process enabled early referral of high-risk patients and ensured evidence-informed treatment. We recommend that the out-of-hospital triage strategy can be rapidly implemented in low-resource settings.
ABSTRACT
Congregate work settings are at increased risk for SARS-CoV-2 transmission and predispose to super spreader events. We investigated a COVID-19 outbreak among security guards to identify the risk factors and propose recommendations. We defined a COVID-19 case as a laboratory-confirmed reverse transcription polymerase chain reaction-positive case. We traced the contacts actively and described the cases by time, place, and person. We conducted a case-control study and collected data on potential exposures. We identified 20 (27%) COVID-19 cases among 75 security guards. Among the cases, 17 (85%) were male and 12 (60%) were symptomatic. We recruited all the 20 COVID-19-confirmed cases and 55 COVID-19-negative controls for the case-control study. SARS-CoV-2 infection was higher among those had high-risk exposure (60%, [12/20]) than who did not (16%, [9/55], adjusted odds ratio = 5.9, 95% confidence interval = 1.6-22.1). Having had high-risk exposure with COVID-19 cases led to COVID-19 outbreak among the security guards. We recommended avoiding the activities predisposed to high-risk exposure.