Recently, the state government and BBMP decided to allow apartment RWAs (Resident Welfare Associations) in Bengaluru to set up their own in-situ COVID Care Centres (CCCs). CCCs are facilities where COVID patients with mild or no symptoms can be isolated and monitored. The idea was to relieve the burden on the healthcare system as the city’s daily COVID count rose to the thousands.
Though the government has released guidelines on community CCCs, setting these up remains a difficult task, requiring RWAs to arrange hard-to-obtain medical equipment and expertise.
On July 19, the apartment management software platform ADDA in collaboration with Citizen Matters, organised a webinar on the topic. Dr Ferzaan N Engineer, co-founder and chairman of Nightingale Home Health Services, and Dr Dhruv Joshi, co-founder of the tele-ICU company Cloudphysician, shared their expertise. Manish Bansal, a resident of Rohan Vasantha apartment in Marathahalli, shared their experience of setting up a community CCC.
Dr Ferzaan said that setting up community CCCs is critical since hospitals had been hit by a tsunami of cases in the previous two months. “We don’t have enough equipment, oxygen, ICU beds or even ICU-trained doctors and nurses.”
In apartment CCCs, a COVID-positive resident can get admitted after triage (initial assessment by a doctor to understand the severity of illness), and will be monitored regularly. However, certain categories of patients, such as pregnant women, those with co-morbidities, etc., are not eligible to use the facility. Read BBMP’s requirements for setting up community CCCs here.
Dr Dhruv agreed that apartment communities need to build capacity. “Everyday I’m getting calls from patients looking for ICU beds…the city’s hospitals and the BBMP are out of their depth here. It’s probably going to get worse before it gets better.”
Setting up a community CCC: What you need to know
Dr Ferzaan said that RWAs need to think digital. “Most of the things required to maintain a facility in-site can be done digitally or with minimal contact.”
As per government guidelines, community CCCs should have access to a doctor as well as 24/7 nursing care. However, many RWA representatives have raised concerns that the city is already dealing with a shortfall of trained medical personnel.
According to Dr Ferzaan and Dr Dhruv, remote digital consultation with specialists is the solution to this problem. “There is a deluge of information out there, but it’s hard for citizens to make sense of it. You need the expertise of a qualified doctor. Having access to the right person at the right time can make a big difference,” says Dr Dhruv.
[Note: However, BBMP guidelines currently mandate visits by a doctor to the facility at least once a day, for triage.]
Equipment, costs and logistics
Residents of Rohan Vasantha in Marathahalli were among the first to set up an in-situ facility for COVID patients, in their clubhouse. They acquired two oxygen cylinders privately, an oximeter, and set up a few beds for basic care of patients until they could find their way to a hospital if need be.
Manish Bansal said, “The whole idea [to set up a community CCC] came to us when the situation in Delhi and Mumbai worsened because patients couldn’t find ambulances or beds. We thought we should have a facility to provide support till patients get access.”
According to Manish, they spent around Rs 20,000 on the oxygen cylinders and the oximeter, and raised the funds from the apartment association. “We haven’t taken a call on whether we will recover it from patients, but it will most likely be free.”
Oxygen: For critically-ill patients, access to oxygen supply can mean the difference between life and death in the interim period before they find a hospital bed. Dr Dhruv says, “The minimum oxygen supply a COVID patient needs is about 2 litres per minute. It can go up to 60 litres per minute for severely-ill patients.”
A typical oxygen cylinder contains about 660 litres of oxygen. This means, a COVID patient can exhaust a cylinder in about 5-6 hours (mild cases) or just 10 minutes (severe).
Other than cylinders, oxygen can be supplied to patients through oxygen concentrators, which work on a power source and can keep generating as much oxygen as required. Both the doctors recommend using an oxygen concentrator as the first choice, if you can find one.
But finding one could be a problem. “Concentrators are either unavailable or really expensive now. I would say the price range is between Rs 40,000 and Rs 1 lakh,” says Dr Ferzaan. In this context, oxygen cylinders may be ideal even though these would have to be refilled.
Testing: Associations like the Bangalore Apartments’ Federation (BAF) are partnering with private testing labs for conducting tests if the need arises.
However, there are many types of tests out there and you must know the right one to take. The doctors recommend using RT-PCR test as a gold standard, since it’s accurate and can detect COVID early. RT-PCR test results can take anywhere between 24 hours and five days. Antigen tests, they say, may turn some false positives/negatives. Dr Dhruv says, “If you do get an antigen test and test positive, assume you have COVID. If you have symptoms but test negative, consider going for an RT-PCR test.”
Antibody tests are only useful for epidemiological studies and not for personal assessment. According to the doctors, you should be wary of these tests though they are heavily advertised.
“The need of the hour is to fend for yourselves”
Despite the grim events over the last month or so, Dr Dhruv sees room for self-reliance in the coming months. “The good thing is that most patients will be mild cases, and won’t need much attention apart from isolation, ensuring PPEs, waste management, etc.”
In the coming months, the load on the city’s healthcare infrastructure is only expected to increase, which will require communities to work on private solutions. Closing the webinar, Vikram Rai of BAF made a few suggestions for RWAs, drawing on experiences of the past couple of months.
“First, the fear and panic needs to go. There was already so much of it when cases were one kilometre away, now they’re much closer. Second, assume that it [COVID] will happen to you and prepare for it already. Expect that beds may be in short supply. Third, create an interim facility based on government guidelines if possible, in your apartment,” he said.