Since the recent surge in COVID-positive cases, Bengaluru’s health infrastructure has been overburdened. There are several reports of government agencies’ delayed response and of patients not finding hospital beds in time.
Vikram Rai, a member of the governing council of Bangalore Apartments’ Federation (BAF), says, “The response from the BBMP is more and more delayed as the number of cases rises. Sometimes, it can take up to 2-3 days.” BAF is an association of over 750 RWAs and AOAs (Apartment Owners Associations) in the city.
So, when an apartment resident tests positive now, the onus of first response often falls on the community.
What can apt RWA do when a resident tests positive
RWAs and AOAs have been working with BBMP ever since the pandemic hit Bengaluru. They are often the first point of contact for new patients, and mediate between the patients and BBMP. They can help prevent panic and contain the spread until authorities arrive on the scene.
BAF recently compiled a guide based on the learnings of member-apartments who have dealt with COVID patients. As per the guide, here are the steps you can take as an RWA if a resident tests positive:
- Step 1 – Inform and Coordinate: Though labs and fever clinics are supposed to inform authorities about the positive case, confirm that BBMP is in the know. Reach out to Primary Health Centres (PHCs) and BBMP ward/zonal officers.
- Step 2 – Containment Zone: Ensure isolation of the floor in which the patient resides, as well as one floor above and one below. BBMP’s response may be delayed, which means the onus of immediate containment falls on RWAs.
- Step 3 – Support for residents in isolation: Form a group of volunteers who can help those in isolation get access to essentials. A bag or basket can be placed at the perimeter of the isolated floor for this.
- Step 4 – Sanitisation: Due to delayed response by authorities, many apartments have resorted to getting their buildings sanitised through private channels.
- Step 5 – Waste Management: All waste coming from containment zones is treated as medical waste and is supposed to be treated by BBMP only. At an apartment level, a best practice has been to appoint one person, fully equipped with Personal Protective Equipment (PPE), to handle and collect waste from the floors designated as containment zone.
Read BAF’s full guide on COVID response here.
RWA can create its own COVID Care Centre
To deal with the overburdened healthcare system, towards June end, state government adopted the strategy of reserving hospital beds for critical patients, and treating patients with mild or no symptoms in COVID Care Centres (CCCs).
On July 1, the state government passed another order permitting home isolation for those with mild/no symptoms. On July 10, after a series of talks between the city’s RWAs and BBMP, the government decided to allow RWAs to create their own in-house COVID Care Centres (CCCs) as well.
That is, patients with mild/no symptoms now have three choices:
- Home isolation (provided they meet the prescribed eligibility criteria)
- Isolation at the community CCC (eligibility criteria mentioned later in this article)
- Isolation at a government CCC facility
Not all apartment RWAs need set up community CCCs. Only those who have the required equipment/personnel should do this, government has clarified.
How to set up an in-situ CCC for your apartment
Facilities Needed
- Vacant houses, community halls and flats within apartments can be turned into CCCs
- Separate accommodation for women and children
- Individual occupancy in a 10X10 feet room, preferably with attached bathroom and toilet
- If individual rooms are not possible, 4-6 positive patients can be accommodated in a hall with an attached bathroom
- Beds, mattresses, furnishings and linens, water and power supply
- Temporary partitions of either PVC or side screen, 6-feet distance between beds
- Dedicated area for volunteers, healthcare workers, etc., to don PPEs.
| Who is eligible for admission to a community CCC? |
|---|
| Only apartment residents can use the CCC. All asymptomatic and mildly symptomatic COVID-positive residents are eligible, except the following categories: * Those aged above 60 years * Those who have co-morbidities such as hypertension, kidney disease (requiring dialysis), heart disease, stroke, TB, cancer, HIV. Those who are immuno-compromised, are on steroids or immunosuppressants. * Those who have any other serious medical/psychological condition * Pregnant women four weeks before the expected date of delivery * Children under 10 years of age |
Clinical care to be provided at the CCC
- Triaging: Tie up with a medical team or a doctor residing in the premises for triaging and clinical support.
- Nursing: Nurses should monitor symptoms, and record temperature and SpO2 levels thrice a day; should have tele-consultation with the doctor for any instructions.
- Hospitals: Tie up with a private hospital or DCHC (Dedicated COVID Healthcare Centre) for referring a patient if needed.
- Medical equipments, sanitisation: Ensure supply of PPE kits, N-95 masks, surgical masks, gloves, hand sanitisers, thermal scanners, pulse oximeters, glucometer, BP apparatus, stethoscope, medicines like hydroxychloroquine, vitamin-C, zinc, etc.
- Ambulance: Private or government ambulance service (108 helpline) should be obtained for emergencies.
- Data Entry: Maintain patient charts and records, verified by the doctor.
Additional amenities needed
- 24/7 support staff: Designated support staff for food provision/supervision of patients in a 1:12 ratio
- Security: Designated security personnel and CCTV cameras
- Disinfection: Facility for disinfection, and sterilisation of patients’ used linen and utensils
- Internet: Necessary to transfer patients’ data to government authorities
- Waste: Waste generated in the CCC to be treated as biomedical waste and sent to the designated biomedical waste processing centre
Other conditions
- Data: CCC has to submit daily reports of admissions and releases, as well as the medical condition of patients, in a software provided by the state government or directly to the District Surveillance Officer (DSO).
- Testing and Discharge: Testing and discharge of patients should be done as per state government guidelines and on the recommendation of the doctor
- Public’s access to the CCC should be restricted
Read the full guidelines on setting up a community CCC here (Order dated July 10).
Not all requirements compulsory, officials clarify
In a virtual meeting with apartment RWA representatives on July 12, Commissioner for Health & Family Welfare Pankaj Kumar Pandey and BBMP Commissioner B H Anil Kumar gave clarifications on the operation of CCCs. Following is a summary.
Are all provisions in the guidelines compulsory?
Many of the provisions are optional, but the availability of medical personnel for triage is mandatory. So, while the availability of doctors and nurses 24/7 is optional, it’s crucial that there be qualified medical personnel at the facility at least once a day.
Triage refers to the process by which medical professionals assess a patient and decide the severity of illness. In the context of COVID, it is a crucial step which decides what kind of treatment a patient needs and whether they are eligible for isolation at home/CCC.
Another compulsory requirement is that the patient information should be regularly updated on a software provided by the government. Anil Kumar said, “We will provide access to a software for all RWAs/AOAs to regularly upload patient data. This is important so that we know when a patient needs to be shifted to a hospital, if the need arises.”
Does the RWA need to approach the BBMP to set up an in-house CCC?
RWAs need not approach government authorities to establish a CCC. They can work with private healthcare providers in the neighbourhood.
So what is the role of government authorities in community CCCs?
It seems the government is leaving most details to the discretion of the RWAs. When RWA representatives asked if the government can provide a starting kit or supervision in establishing CCCs, Anil Kumar said, “There is no starting kit as such, communities should look at the guidelines and do the needful”.
The officials took a similar stance on pricing, acquisition of equipment, and networking with service providers. Anil Kumar said, “We leave it to the RWAs to decide the pricing, but we hope that, like government CCCs, community CCCs will be free or at a nominal cost for residents.”
On clinical support, Pankaj Kumar said, “RWAs should reach out to hospitals and other medical service providers in the neighbourhood. They should also get in touch with vendors to acquire the required equipment.” He added that the government would help RWAs get in touch with vendors/service providers.
How will the government make sure that community CCCs are functioning properly? Are RWAs liable if anything goes wrong?
Government authorities will not supervise or assess community CCCs. However, as mentioned earlier, community CCCs need to follow these two conditions:
- Have competent medical personnel for triage
- Regularly communicate patient data to the government
Pankaj Kumar clarified that there would be no added liability on RWAs.
Some RWAs have started in-situ programmes
Some apartment RWAs have started their own in-situ programmes. Vikram says, “BAF has been putting together an Apartment COVID Treatment (ACT) programme, through which member-apartments can opt for in-house solutions to manage mild COVID cases. We have reached out to major healthcare service providers to collaborate on this.”
BAF currently follows a five-pronged strategy to support COVID patients:
- Testing through private players
- Ensuring home isolation according to government guidelines
- In-house CCC, if the apartment is able to do it
- Facilitating institutional isolation at private CCCs (hotels, hostels, etc.)
- Facilitating hospitalisation if needed.
Vikram says, “The city’s healthcare system is overburdened, and severely-ill patients who need beds aren’t getting these. We need to free up space for them.”
Hence BAF’s programme aims primarily to build in-house capacity to care for COVID patients. And then, to connect with relevant service providers at each step and cut down the reliance on the city’s CCCs and hospitals. Vikram says that they hope to make the programme a single platform for all apartment RWAs – including those that aren’t BAF members – to plug into and seek solutions.
Fairly comprehensive report. Good job BAF
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RWA care is still denied to people over 60, even if they are free of co-morbidities and meet the other criteria.
Does not sound realistic. Sounds like a palace built in thin air. Who sat down to come up with these guidelines?
Apartments have been stopping domestic workers and ostracising health workers. Now we expect them to set up a COVID care centre in the heart of the complex.
How many doctors and scientists were consulted before coming up with this? People working at hospitals are trained to do the job they do. How well are RWAs equipped ? This might sound glamorous but might end up creating more hotspots in Bengaluru. Asymptomatic or mild symptomatic patients can self isolate at home. Don’t bring them out to the community halls. After charting out such guidelines, in the end everything is left to the discretion of RWAs. We have already seen draconian measures implemented by management committees. Yet another opportunity for RWA committees to impose arbitrary guidelines on the residents. The government is not going to supervise these care centres. But they also want regular updates from the Carr centres. And then they say RWAs will not be liable. This program is full of contradictions, and does not seem to be well thought out. For sure, private companies, health care providers, clinics, etc. can make good money out of this exercise. Good for them during this bad phase. Poor apartment owners of gated communities. They have been made experimental guinea pigs by handful of people who have claimed themselves as representatives of RWAs
Hi,
Is it mandatory to go for tests by local panchayat/BBPM tests for all residents who are diabetes and or above 60 years of age even without having any symptoms? Suppose if any one is corona positive in the same apartment?