HEALTHCARE SYSTEM

AND REGULATIONS
DURING COVID-19 : A
CRITICAL REVIEW

BY : RACHITA DAS
REG NO ; 1641801041
10TH SEM
BBA LLB (H)
2016-2021
 WHAT IS COVID 19 ?
• COVID-19 is an acronym that stands for coronavirus disease of 2019. The name was
given by the World Health Organization (WHO) on February 11, 2020 for the disease
caused by the novel coronavirus SARS-CoV-2.

• COVID-19 is an acute respiratory illness characterized by:

o Fever,
o Dry cough and
o Shortness of breath.
o Some patients may also have aches and pains, nasal congestion, runny nose, sore throat
or diarrhea.
• The incubation period (time between infection and appearance of first sign/symptom) of
COVID-19 is up to 14 days
 People at risk of COVID-19

• COVID-19 is a new disease which has never existed before. Thus humans do not have any
natural immunity against the virus

• COVID-19 affects people of all age groups

 Transmission of COVID-19

Depends on several factors like infectiousness of agent, susceptibility of

population and exposure of susceptible population.

How to reduce
• Reducing the spread of agent from infected host (eg. Isolation, quarantine)
• Reducing exposure of susceptible host (eg. Social distancing, use of PPE)
• Reducing environmental survival of agent [eg. Disinfection of frequently touched
surfaces, such as floors, and other commonly used areas (toilets, wash basins etc.)
and objects(doorknobs, handles, keys etc.)]
• Increase resistance of susceptible hosts (eg. Vaccination)
 Problem statement – global scenario
COVID-19 spread rapidly across the world in a span of less than 3 months:
• December 31, 2019 – Cluster of 27 pneumonia cases of unknown etiology were reported from Wuhan, China.

• January 9, 2020 – Novel coronavirus was detected as the causative agent. Disease named as COVID-19.

• January 20, 2020 – Coronavirus disease spread to 3 countries outside China (Thailand, Japan and Korea).

• January 31, 2020 – Disease spread to 20 countries including India (9826 cases confirmed, 213 deaths).

• March 13, 2020 – Disease spread to 123 countries, first death reported in India (Karnataka)

• April 28, 2020 – 29,54,222 confirmed cases and 2,02,597 deaths reported worldwide (212 countries/territories/areas).

On 11th March 2020 WHO declared COVID-19 as a pandemic.

 Problem statement – India
COVID-19 has not left any part of the world untouched and India is one of the worst affected countries
in the world. The cases in India are rising steadily with each passing day. As of August 10th 2020, India
has over 2.3 million (the second million coming in exactly three weeks since the country hit a million
infections on July 16, with 42 percent of the new cases coming from Andhra Pradesh,2020
29th February Karnataka, Uttar
– 3 cases
Pradesh, West Bengal and Bihar) confirmed COVID-19 cases and 46,188 10threported deaths. The worst
affected states of India include Maharashtra, Tamil Nadu, Andhra Pradesh, 20th Karnataka, Delhi and Uttar
Pradesh. Another growing concern is that interior parts of the country 30 areth emerging as new hotspots.
Four states in eastern India, namely, Odisha, Bihar, Assam and West Bengal are2020
29th April increasingly
– 31,332reporting
cases
positive cases. The two main reasons being reported for this surge in cases in rural areas are the
returning migrants from major cities who did not undergo screening or were asymptomatic and the poor
healthcare infrastructure in the rural settings. Out of a total of 739 districts in India, 13 districts (across 8
states and a union territory) account for 1 in seven Covid-19 deaths. The 13 districts are: Kamrup Metro
in Assam, Patna in Bihar, Ranchi in Jharkhand; Alappuzha and Thiruvananthapuram in Kerala, Ganjam
in Odisha, Lucknow in UP; North 24 Paraganas, Hooghly, Howrah, Kolkata and Maldah in West
Bengal, and Delhi. These districts account for nearly 9 percent of India’s active cases and about 14
percent of COVID-19 deaths. Over the spring and summer, the COVID-19 situation in India has really
deteriorated and could get much worse on the current trajectory with around 60,000 cases being reported
per day and around 900 daily deaths.
HEALTH CARE
SYSTEM AND
REGULATIONS
 Preventing Transmission: Key Principles
1. Control the source of infection
• Source of infection: Confirmed COVID-19 cases (both symptomatic and pre-symptomatic)
• Methods to control source of infection: Testing of suspected symptomatic and close contacts (includes
pre-symptomatic cases) and isolation of positive cases. Since there is no proved treatment of the disease,
isolation of cases remains the mainstay for controlling the source of infection.

2. Break the chain of transmission

• Chain of transmission: Direct and indirect spread (refer slide 9)
• Methods to break the chain of transmission: Reducing direct contact with respiratory droplets from
infected persons (hand hygiene, respiratory hygiene, use of masks, social distancing, quarantine of
contacts) and reducing indirect contact with surfaces infected with respiratory droplets (infection
prevention and control protocols)

3. Reduce susceptibility to infection

• Vaccination of susceptible individuals. Since it might take more than a year to develop a vaccine
against the disease, the focus till then is to break the chain of transmission and flatten the curve of
disease.
 Social/Physical distancing

• In order to reinforce the need for such distancing, the Government of India
announced nationwide lockdown and restricted movement on 24th March
2020.
• Staying at home helps reduce contact between people and therefore reduces
the possibility of transmission.
• Since the entire population is susceptible to COVID-19, physical
distancing is the key to control the pandemic.

Physical distancing methods effectively reduce and help in control the

pandemic
 WHO prescribed steps of handwashing

• Wash hands with soap

and clean water for at
least 40 seconds

• Clean hands with

alcohol-based hand rub
for at least 20 seconds

Make sure to wash your

hands :
• After coming home from
outside or meeting other
people especially if they
are ill.
• After having touched
your face, coughing or
sneezing.
• Before preparing food,
eating or feeding
children.

• Before and after using

toilet, cleaning etc.
 Use of masks
Triple layer surgical mask should be used by
• Persons with respiratory symptoms
• Persons in quarantine
• Healthcare workers in low risk settings (not in direct contact with COVID-19 patients).
N-95 respirator mask should be used by healthcare workers at high risk settings (e.g. during clinical
examination of patients, conducting aerosol generating procedures, etc.)Reference:
Directorate General of Health Services (EMR Division). Novel Coronavirus Disease 2019 (COVID-19): Guidelines on rational use of
Personal Protective Equipment [Internet]. DGHS, MOHFW, GOI 2020 [cited 25 March 2020]. Available from:

Wash hands after removing and before wearing fresh masks

Masks are effective only when used properly in combination with frequent handwashing with soap
and water or hand cleaning with alcohol-based hand rub and other physical distancing measures
 Measures to reduce indirect transmission
Don’t touch surfaces
• The virus survives on surfaces of inanimate objects for a few days.
• Therefore, avoid touching doors, handles, table tops, key boards, mobiles etc. of other people in public
places.
• Also wash hands thoroughly after any contact with these

Disinfect
• Clean AND disinfect frequently touched surfaces at least once daily with household disinfectants and 1%
sodium hypochlorite. This includes table tops, doorknobs, light switches, countertops, handles, desks, toilets,
and sinks.
• Phones, computers, remote controls etc. should be disinfected with alcohol based (70% or more) disinfectant
• Clothes should be washed with common detergent. If handkerchief is used to cough or sneeze, or as a face
mask, it should be washed daily before reusing.

Dispose safely
• All tissues and non-reusable masks should be disposed safely by burning or deep burial after disinfection with
1% sodium hypochlorite solution.
 Case definitions for COVID-19
A SUSPECT CASE is one who is likely to have been infected and should be tested for the disease immediately at
designated testing centers. Definition of suspect case:

• A patient with acute respiratory illness {fever and at least one sign/symptom of respiratory disease (e.g., cough, shortness
of breath)}, AND a history of travel to or residence in a country/area or territory reporting local transmission of COVID-
19 disease during the 14 days prior to symptom onset;
OR
• A patient/Health care worker with any acute respiratory illness AND having been in contact with a confirmed COVID-19
case in the last 14 days prior to onset of symptoms;
OR
• A patient with severe acute respiratory infection {fever and at least one sign/symptom of respiratory disease (e.g., cough,
shortness breath)} AND requiring hospitalization AND with no other etiology that fully explains the clinical presentation;
OR
• A case for whom testing for COVID-19 is inconclusive.

LABORATORY CONFIRMED CASE: A person with laboratory confirmation of COVID-19 infection, irrespective of
clinical signs and symptoms.
 Testing Strategy for COVID 19

1. All symptomatic contacts of laboratory confirmed cases

2. All symptomatic healthcare workers
3. All hospitalized patients with Severe Acute Respiratory Illness (fever AND cough
and/or shortness of breath)
4. Asymptomatic direct and high-risk contacts of a confirmed case should be tested once
between day 5 and day 14 of coming in his/her contact
6. In hotspots/cluster (as per MOHFW) and in large migration gatherings/evacuee centres:
all symptomatic ILI (fever, cough, sore throat, runny nose) should get tested.
 Isolation and home quarantine
Isolation in a health facility is for:
• All confirmed positive cases of COVID-19 in order to prevent transmission of infection
• Isolation is for the period of disease (ie, till the person tests negative for the disease)

Home quarantine is for:

• All asymptomatic individuals who have undertaken international travel from any COVID-19 infected
countries or interstate travel from any COVID-19 infected state in the last 28 days.
• Home quarantine is for a period of 14 days since the day of travel
• All those who fit the definition of ‘contact’ should be- home quarantined and monitored for symptoms
of COVID-19

A contact in the context of COVID-19 is one who:

• Provided direct care to a COVID-19 positive person without personal protective equipment (PPE)
• Stayed in the same close environment of a COVID-19 patient (including workplace, classroom,
household, gatherings).
• Traveled in close proximity (1 m) with a symptomatic person who later tested positive for COVID-19.
 Guidelines for home quarantine
Instructions for contacts being home quarantined
The home quarantined person should
• Stay in a well-ventilated single-room preferably with an attached/separate toilet.
• If another family member needs to stay in the same room, it’s advisable to maintain a distance of at least one
and a half meter between the two.
• Needs to stay away from elderly people, pregnant women, children and persons with co-morbidities within the
household.
• Restrict his/her movement within the house.
• Under no circumstances attend any social/religious gathering e.g. wedding, condolences, etc.

Instructions for the family members of persons being home quarantined

• Only an assigned family member should be tasked with taking care of the such person
• Avoid shaking the soiled linen or direct contact with skin
• Use disposable gloves when cleaning the surfaces or handling soiled linen
• Wash hands after removing gloves
• Visitors should not be allowed
• In case the person being quarantined becomes symptomatic, all his close contacts will be home quarantined
(for 14 days) and followed up for an additional 14 days or till the report of such case turns out negative on lab
testing
 Vulnerable populations
Stay at home with physical distancing and other preventive measures:

• All people who do not have history of high risk contact but have high risk conditions such as
immunocompromised status, heart or lung disease etc.
• All people above age of 60 years
• All these people must be monitored for symptoms of COVID-19 since they are at high risk
of getting severe disease if they get infected
 Environmental cleaning
• Machine washing with warm water at 60−90° C. The laundry can then be dried according to
routine procedures.
• If machine washing is not possible, linens can be soaked in hot water and soap in a large
drum using a stick to stir and being careful to avoid splashing.
• The drum should then be emptied, and the linens soaked in 0.05% chlorine for
approximately 30 minutes.
• Finally, the laundry should be rinsed with clean water and the linens allowed drying fully
in sunlight.

• Follow proper hand hygiene after every work/procedure

 Environmental cleaning
• Machine washing with warm water at 60−90° C. The laundry can then be dried according to
routine procedures.
• If machine washing is not possible, linens can be soaked in hot water and soap in a large
drum using a stick to stir and being careful to avoid splashing.
• The drum should then be emptied, and the linens soaked in 0.05% chlorine for
approximately 30 minutes.
• Finally, the laundry should be rinsed with clean water and the linens allowed drying fully
in sunlight.

• Follow proper hand hygiene after every work/procedure