T.N. updates COVID-19 triage, treatment protocol

It provides clear instructions on home isolation and admission to various facilities: Health Secretary

Tamil Nadu has updated its COVID-19 triage and treatment protocol in the light of the rapid surge in fresh coronavirus infections and Omicron variant.

According to a Government Order issued on Monday, an expert committee meeting was convened on December 30, 2021, to revise the existing clinical management protocols to guide the State’s response and handling of the new variant, Omicron. Patients eligible for home isolation and treatment in primary care facilities were reaching higher facilities due to panic and lack of awareness. This resulted in the utilisation of time and resources of treating hospitals that needs to be prioritised for severe COVID-19 cases.

The committee recommended updated guidelines for initial triaging and managing COVID-19 patients at all healthcare facilities other than medical college hospitals/government hospitals/dedicated COVID-19 hospitals.

Health Secretary J. Radhakrishnan, in a communication to all district Collectors, Greater Chennai Corporation (GCC), district-level health teams, deans and city health officers, said considering the need to give clear triaging protocols to GCC and districts, the updated protocol focusing on home isolation for fully-vaccinated, asymptomatic persons and other categories has been issued now.

The protocol was updated in consultation with the directors of Public Health and Preventive Medicine, Medical Education and Medical and Rural Health Services, senior health officials and clinical experts. This was to provide clear instructions on home isolation and admission to COVID-19 care centres (CCC), COVID-19 health centres (CHC) and hospitals.

If home isolation was not possible, patients could be referred to CCCs. All COVID-19 positive pregnant and lactating mothers, patients aged above 60 years should be referred to COVID-19 hospitals. Persons with family history of severe COVID-19 or death should be referred to higher centres. Irrespective of symptoms, unvaccinated individuals who have co-morbidities would be admitted in CCC and kept under observation for a minimum of five days, while those with no co-morbidities and no symptoms would be observed in home isolation.

Who will be admitted?

As per the protocol, persons testing positive for COVID-19 will be admitted to designated COVID-19 hospitals if their respiratory rate is more than 30/minute and oxygen saturation (SpO2) level is less than 90.

If a person has a respiratory rate of 24 to 30 and SpO2 of 90 to 93 and has no co-morbidities, they would be admitted to a CHC or CCC. For those with co-morbidities, their vaccination status would be taken into consideration. Those who had taken two doses of COVID-19 vaccines would be admitted to CHC or CCC.

Age comes in as an added factor for those with co-morbidities and have received one dose of vaccine or are unvaccinated. Persons aged less than 60 and had taken a single dose or nil vaccination would be admitted to CHC/CCC, while those aged above 60 would be admitted to a COVID-19 hospital.

Those testing positive and having a respiratory rate of less than 24 and SpO2 of more than 94 would be sent for home isolation/CCCs.

Persons who have symptoms but test negative for the infection would be checked for their contact history and vaccination status. If clinical, laboratory and radiological parameters are in favour of COVID-19 suspect, then they would be considered for admission based on various criteria.

In any case, patients with SpO2 of more than 94 should not be admitted to a COVID-19 hospital unless specific clinical condition warrants admission in a higher centre.

The Health Secretary said that the COVID-19 triaging and admission protocol should be followed strictly. It should be followed uniformly in the field and while triaging in the facilities in the government, local body as well as in private hospitals.

For this, the officials were urged to ensure that adequate screening centres were opened and made operational to facilitate implementation of the updated protocol. Adequate CCCs should be made operational. Human resources should be deployed in the screening centres with standard blood test and other equipment, while CCCs should be staffed at all levels.

Stressing on the importance of clinical management of cases, he said officials should ensure that the 1.15-lakh currently available beds for COVID-19 treatment and additional 50,000 beds, especially CCCs including interim CCCs adjacent to habitations and streets or wards, are made fully operational.

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