Saving and Supporting Health Care Workers During the COVID 19 Pandemic in a Developing Country Using a Multidimensional Healthcare Personnel Centric Policy

Background: Health care personnel (HCP) are at an increased risk of acquiring COVID infection during this pandemic especially in developing countries like India, where they work in resource restricted healthcare settings and return to homes, unfit for safe self-isolation. Thus, many HCP were reluctant to accept COVID-19 duty as they were apprehensive about their safety and concerned about carrying the infection home to their families. Methods: We describe a novel multidimensional HCP-centric evidence-based, dynamic policy to address the expressed concerns of HCPs. The hospital was divided into three zones: high, medium, and low risk zones. In the high risk and medium risk zones, we organized pre-duty holistic training, provided on-duty support, ensured post duty HCP welfare, and send them all home after they tested negative for COVID-19. To minimize transmission, we provided appropriate PPE, ensured its proper use, kept all communication paperless. To reduce morbidity, we recruited only willing low risk HCP, aged <50 years, with no co-morbidities to perform duty in high risk zones. Social distancing, hand hygiene and universal masking were advocated in the low risk zone. Findings: Between 31st March-20th July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID suspects and they were kept in the medium risk zone. Among them, 346(11.4%) were COVID+ve (57.2% male) and managed in the high-risk zone of whom 19(5.4%) died. One ( 0.08%) of the 1224 HCP in high-risk zone tested positive; 6(0.62%) of the 960 HCP in medium risk zone and 23(0.18%) of the 12600 HCP in the low risk zone. All the 30 COVID +ve HCP have since recovered and none were critically ill.This multidimensional HCP centric policy resulted in very low transmission rates <1%, low morbidity, high satisfaction rates with training (92%), the PPE provided(90.8%), medical and psychosocial support received (79%) and with improved acceptance of COVID duty with over 54.7% now volunteering for re-deployment. Interpretation: A multidimensional HCP centric policy was effective in ensuring safety, satisfaction, and welfare of HCP in a resource poor setting and resulted in a willing workforce to fight the pandemic. Funding Statement: None. Declaration of Interests: None of the authors has any conflict of interest to declare. Ethics Approval Statement: Ethical clearance for reporting the results of our HCP protocol and feedback was taken from the Institutional Ethics Committee (Letter No INT/IEC/2020/SPL997; Dated 25.07.2020) and the need for individual informed consent was waived. This retrospective study was conducted in accordance with the Declaration of Helsinki and ICMR guidelines.