COVID 19 pandemic have had devastating impact on all aspects of life especially on the health systems. Back in March 2020, there was a war time emergency to scale up heath facilities in view of saving life without taxing the system. In response to the heavy patient load experienced at GMC, Calicut, NIT-K Mega Boys Hostel located 20 kms away from GMC Calicut was converted into a 500 bedded first line treatment centre within a short deadline of one week.

1. Operationalisation of COVID First
Line Treatment Centres (CFLTC)
COVID-19 Health Systems : Global Response
Case Study of a CFLTC under Government Medical College, Kozhikode
Dr Saran A K

2. Background
• COVID-19 : devastating impact especially on the health systems.
• The Kerala government took steps essential in adequate
preparedness and response, thereby saving lives without taxing the
health system.
• Back in March 2020, there was wartime emergency to scale up the
health facilities.
Dec 2019 – March 2020

3. • With home isolation then not approved in
the state, GMC Kozhikode faced a heavy
patient load.
• Plans to convert other public facilities
around Kozhikode into First Line Treatment
Centres.
• NIT Mega Boys Hostel situated 20 km away
from the city was one among the chosen
proposed sites.
GMC, Kozhikode
NIT Mega Boys Hostel
March 2020 – June 2020

4. Interim Guidelines 19 March 2020, WHO
THREE - TIER PATIENT
MANAGEMENT SYSTEM
Hub and Spoke Model
o COVID Care Centre (CCC),
o COVID First Line Treatment Centre (CFLTC)
o COVID Hospitals (CH)

5. Setting up CFLTC NIT – Challenges
1. Capacity building and Resource Pooling
2. Conversion of a Hostel Facility into a Hospital
3. Formulating Infection Control Strategies
4. Human Resource Allocation
5. Biomedical Waste Management
6. Food and Waste Management
7. Hospital Information Management

6. Solving the Resource Constraint Quandary
• Food and Waste Management
• Volunteers
• Hostel Compatibility
• Patient Essentials
• Funds and Equipment
• Human Resource
• IMAGE – Biomedical
Waste Management
• HIC Training
• Administrative Training
• Co-ordination
Volunteers
Volunteer
organisation

7. • Successful run was ensured by the
close participation of various levels
of government, National Health
Mission and GMCH, Kozhikode.
• Although a demand for a 1000 bed
facility was put forth by the district
administration, due to HIC mandates
the total strength was limited to
500.
Inauguration of CFTC NIT Mega Boys Hostel
July 2020
July 24, 2020

8. Administrative Control of CFLTC

9. Category Duties and Responsibilities Duty Schedule
Nodal Officers (2) • Coordination of activities
• Capacity Building
• Duty Roster, Registers and Daily
reports
Medical Officers (2) • Medical Care
• Clinical Rounds and
Documentation
• Data Management
1 x 2 shifts (12hr duty)
House Surgeons (8) 2 x 4 shifts (6 hr duty )
Head Nurse (1) • Hospital Infection Control
• Nursing Care
• Documentation
Staff Nurse (12) 3 x 4 shifts (6 hr duty )
Pharmacist (1) • Procurement of medical items
• Stock Entry
Cleaning Staff (8) 2 x 4 shifts (6 hr duty )
Volunteers (6) • Patient Care Takers
• Food Distribution
Data Entry Operator (1) • Hospital Information
Management
6 Day Duty with weekly off

10. 1. Patient Waiting Area
2. Triaging and Registration
3. Consultation Room
4. Observation Room
5. In Patient Rooms
• (56 rooms x4 floors)
6. Swab Collection Area
7. Donning/ Doffing Area
8. Pharmacy Services
9. Laundry Services
10. Staff Housing
1
2 3 4
5
6
7
8
9
Ground Floor Map : CFLTC NIT Mega Boys Hotel
10
Facilities

11. • 3123 patients were treated
during the working period of
NIT CFLTC.
• The most patient load was
experienced during the months
of September and October.
• Less than 2 percent patient
referrals to higher centre.
• No deaths during the entire
working period of 6 months.
Admissions Discharges Referrals Deaths
3123 3064 59 0
Statistics

12. Strengths
1. Efficient Resource Pooling
• Equipped with proper training, Non-clinical departments of GMCK
were entrusted with the running of CFLTC.
2. Round the Clock Medical Care
• Effective duty scheduling ensured better care without exhaustion of
HCWs.
3. Stringent Infection Control Measures
• No positive cases among HCW

13. 4. Proper Triaging and Risk
Assessment
• Very low percentage of
referrals to Higher Centres
5. Close Participation towards
a common goal
• Various levels of Health
Machinery, Government
and Public joined hands.

14. Aftermath
• CFLTCs provided institutionalized care ensuring quality primary COVID
care to all free of cost.
• Ensured equitable utilization of resources preventing overburden on the
health facilities.
• Helped in delaying the peak by reducing chances for secondary spread.
• Helped to curb the stigma when not much information was available
regarding the secondary spread of the disease.
The strategy of identifying suspects, quarantine,
testing and isolation has paid high dividends in Kerala.

15. References
1. Operational considerations for case management of COVID-19 in health
facility and community, Interim Guidance, WHO 19th March 2020
2. Reference Guide for Converting Hospitals into Dedicated COVID
Hospitals. H&FW Department, Govt. of Kerala March 2020
3. Standard operating procedure (SOP) for health care in covid-19 first line
treatment centres (cfltc), Government of Kerala June 2020
4. Armocida B, Formenti B, Ussai S, Palestra F, Missoni E. The
Italian health system and the COVID-19 challenge. Lancet
Public Health. 2020 May;5(5):e253. doi: 10.1016/S2468-
2667(20)30074-8. Epub 2020 Mar 25. PMID: 32220653; PMCID:
PMC7104094.
5. Wang, Z., Tang, K. Combating COVID-19: health equity
matters. Nat Med 26, 458 (2020). https://doi.org/10.1038/s41591-
020-0823-6