key: cord-0801602-dmcm44ga authors: Keri, Vishakh C.; R.L, Brunda; Jorwal, Pankaj; Sethi, Prayas; Wig, Naveet title: Decentralizing COVID‐19 care—Moving towards a COVID‐19‐capable healthcare system (CCHS) date: 2021-04-07 journal: Int J Health Plann Manage DOI: 10.1002/hpm.3158 sha: c730a38a7089ac6495560bbc7f4dab4f8166ba7e doc_id: 801602 cord_uid: dmcm44ga nan Coronavirus disease has taken a huge toll over the world and will continue to do so for a while. Despite newer diagnostic and therapeutic options emerging daily, the resumption of healthcare facilities to pre-Covid normalcy still seems difficult. It has affected over 103 million people globally as on 4 February 2021 1 and has caused collateral damage in terms of indirectly affecting routine healthcare of non-Covid patients requiring medical attention. 2 Resumption of routine and multispecialty healthcare which have been majorly stalled worldwide is necessary to combat the collateral damage. 3 Efforts to upgrade the existing healthcare setup to become Covid-19capable is a necessity of present times. Many innovative strategies to improve the healthcare system to handle such situations have been described in literature. [4] [5] [6] [7] [8] Through this article we describe another such strategy which can be adapted at tertiary healthcare centres. 1. Compromised care of patients with comorbidities: Amidst the pandemic, care of chronically ill patients and non-Covid illness has been significantly compromised. Accessibility to healthcare facilities has become challenging amidst the scare of acquiring the infection, conversion of existing facilities into Covid-19 care areas and lockdown restraints. 3, 4 The strategy of empowering existing facilities with necessary infection prevention measures and making every medical specialty capable of providing Covid-19-related care in addition to care in the area of their expertise is necessary. 2. Need for multidisciplinary care: Covid-19 disease spectrum extends from mild asymptomatic to severe respiratory symptoms to a wide range of nonrespiratory symptoms. Patients can present with acute coronary syndrome, thromboembolic disease, ischaemic stroke, acute kidney injury and many more varied manifestations. These patients therefore require not just supportive care to treat Covid-19 related illness but also may demand definitive speciality care to resume to normal health. 9 Latter may be delayed considering the staffing and infrastructure in Covid-19 centre. Healthcare personnel deployed in these areas have varied field of expertise making uniform care less plausible. 3. Nosocomial outbreaks: Rampant nosocomial spread of the virus is a possibility. 10 patients rather than emphasis on an additional Covid-19 care centre separate from the existing facility (Figure 1 ). In a 'CCHS', patient care can be catered to by: Tele-triaging, Emergency room triaging, Emergency department, Out-patient department (OPD) triage area, OPD services, Inpatient services by departmental wards and intensive care units ( Figure 2 ). This is almost like patient care pathways in pre-Covid era but with added measures to contain infection transmission. Increasing number of cases everyday and an unpredictable trajectory of the pandemic course demands a new normalcy. Elective procedures and care of chronically ill patients cannot be halted forever. A strategy to strengthen existing healthcare system to become 'Covid-19 capable' is the need of the hour. The proposed model is 'pandemic resilient'. It can be used in future pandemics with minor modifications based on the nature of pandemic. It has farfetched implications to regulators and policymakers to make our healthcare system be prepared to deal with future pandemics with minimal disruption to normalcy. 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