Adopted COVID Care Centre Model with Mental Health Promotion at a Non-COVID Hospital: NIMHANS Experience

Dear Sir,

Till July 10, 2020, the city of Bangalore had 15,669 confirmed cases of COVID-19 and 213 deaths due to the disease, and 3481 persons had recovered from it. ¹ The resources for handling the pandemic were at a premium.

In early July 2020, the Ministry of Health and Family Welfare set up three models of facilities to manage COVID-19 positive individuals: COVID Care Centre (CCC) for asymptomatic individuals, and Dedicated COVID Health Centre (DCHC) and Dedicated COVID Hospital (DCH) for moderate to severely symptomatic ones. ² Given that the bed occupancy in the designated hospitals was increasing exponentially, in July 2020 itself, the Government advised “home isolation” for health workers and all asymptomatic COVID-19 positive persons. ³ Home isolation was to help the hospitals preserve beds for the patients in need.

In this context, the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, adopted the “CCC” model to accommodate its staff, students, and their dependents who tested positive for COVID-19. The rationale to start this facility was to self-manage, with the existing resources, the staff for whom home isolation was not feasible.

A COVID Task Force (CTF) was formed to oversee the facility. Two separate CCC—COVID care facilities, with 50 beds each, were arranged inside the campus from the second week of July 2020. People who are unable to isolate themselves at home ⁴ for various reasons like inadequate ventilation, lack of attached toilet, no caregiver, single bedroom, too many members living at home, elderly or children at home, etc., were permitted by the governmental agencies to avail isolation there.

By August 21, 2020, 84 members had availed this facility—51 employees (including doctors and nurses), 16 students, 3 contract staff, and 14 family members of employees. Out of 84, 3 developed respiratory symptoms and were shifted to COVID Designated Hospital. Currently, there are ten members housed there. The average duration of stay was 11 days and ranged from 2 to 26 days (including those shifted out and with revisions in Government policy). ⁵

During the stay at the facility, the following services were extended—medical and nursing care and provision of medication packages containing Zinc, B. Complex, Vitamin C, and other medications for symptomatic treatment, such as paracetamol, cetirizine, pantoprazole, and azithromycin, from the hospital Health Welfare Scheme. Each individual was also provided surgical masks, hand sanitizer, hypochlorite solution, digital thermometer, and pulse oximeter. The nutritional arrangement was made from the hospital kitchen, and advice was obtained from a dietician. The inmates were also allowed to arrange their food; on delivery of the same, the inmates were informed over phone/WhatsApp to collect their food packs labeled with their names. They were also advised on foods rich in protein and vitamin C. Keeping in mind the stress associated with the diagnosis and potential stigma, mental health services such as individual and telephonic counseling were provided by psychologists. The common concern was fear of infecting the family members in most of the inmates and public stigma in members who lived in rented accommodation. Yoga, teleconnect for supporting wellbeing, and relaxation techniques, using online platforms, were conducted daily in liaison with the yoga center. The hospital had free Wi-Fi to enable these activities.

Daily rounds were conducted by a doctor and a nurse to monitor vital parameters, oxygen saturation, and mental health issues. Additionally, telephonic “rounds” were done twice a day. The inmates were provided with emergency contact numbers of CTF nodal officers, to communicate as needed. Necessary protective measures were adequately supplied for use by the visiting healthcare workers. Housekeeping personnel was trained on maintaining physical distancing, donning and doffing, steps in proper handwashing, preparation of 1% hypochlorite solution, surface cleaning fourth hourly, and waste segregation and disposal. Also, a regular audit was conducted by the hospital infection control committee, to ensure adherence to protocol.

Resources are limited for patients who either are asymptomatic or require hospitalization. As the resources were available in the existing infrastructure, the hospital took responsibility for the requirements of our staff. This also reduced the staff members’ burden in searching and finding a CCC for admission. Models of holistic bio-psychosocial care like this can be replicated across hospitals where feasible, to limit the straining of resources on individual staff and to improve physical and psychosocial wellbeing. Further research on perspectives of the service-users and providers is needed to improvise and strengthen the services.