Indus Health Network is supporting the provincial Governments right from the onset of
COVID-19 in Pakistan.

Contribution in Policymaking Decisions

The honorable Chief Minister of Sindh, Syed Murad Ali Shah included The Indus Hospital (Indus Health Network) in the anti-coronavirus campaign. Dr. Abdul Bari Khan, Chief Executive Officer was selected as a member of Chief Minister of Sindh’s Corona Task Force. Dr. Bari’s contributions were based on the insights derived from the massive COVID-19 workload that The Indus Hospital was catering to and were instrumental in the formulation of province-wide policies for pandemic control.

Formation of COVID-19 Lead Group

To govern and manage all pandemic-related activities in a streamline manner several committees were formed as a part of the lead group which includes members of the Emergency Response Committee, Disaster Management team, and Infection Control Committee

CSM as Operations Lead for COVID-19 Activities

As a response to the rapidly evolving international guidelines on COVID-19 management, a Clinical Services Management (CSM) was established, and assigned the role of COVID-19 operations lead. This was also endorsed by hospital operations, thus enabling uniformity of command and quick execution of decisions relating to COVID-19 management. CSM was also the focal department dealing with COVID-19 related internal and external affairs, including engagement with the respective government departments and agencies, as well as private donors and other stakeholders.

Mobilization of Human Resource

With the increase of COVID-19 dedicated beds in the in-patient settings, physicians, nursing, and ancillary staff number was increased by re-allocating them to the COVID-19 unit.

Arrangement of Equipment

Equipment, including ventilators and monitors, was ensured in close collaboration with other hospitals as well as Indus’ Supply Chain and Biomedical departments.

Availability of Medications

All specialized medicines were made available in TIH and RTEH by the pharmacy department.

Crowd Management

It was ensured by limiting the number of attendants and a ‘No Visitor’ policy.

Personal Protective Equipment (PPE)

A centralized PPE counter was established to control the consumption of PPE at TIH. A protocol was designed for not only providing the front line operators with appropriate PPE but also to ensure its availability.

Respiratory Emergency Room

To ensure staff and patient safety, it was necessary to control the spread of COVID-19 within the Emergency Room. Appropriate ventilation mechanisms to handle airborne infections were designed and installed, modifying the Emergency Room into a Respiratory ER and a non-Respiratory ER, each having 11 beds

Modifications at Sheikh Saeed Memorial Campus

Obstetric Labor Room, Neonatal ICU, and Operating Room were modified at SSMC to continue maternal and neonatal care without compromising on safety and volume. A COVID-19 labor room and operating theater was established to deliver coronavirus positive mothers in a safe environment.

Blood Donation

The COVID-19 pandemic has adversely affected all areas of healthcare delivery, blood transfusion services being one of them. Social distancing, reduced mobility, and the lockdown have resulted in reduced blood donor mobilization and blood collections. To overcome the hurdle, the Indus Hospital Blood Center contacted potential donors through social media. It was a mid-scale campaign to connect with donors to organize small-scale blood drives at their residences. The Indus Blood Center managed to conduct 97 blood drives, 42 home collections and drew 1,858 units of blood in March 2020.

Psychosocial Support

The psychosocial team has been playing an active role in providing psychological counseling, morale-boosting activities, and mental health support to patients and caregivers.

Research Proposals and Studies

The Indus Hospital Research Center (IHRC) has conducted multiple researches on COVID-19. To date there are nearly 37 research studies at various stages; seven of which are sponsored studies. The sponsored studies are as follows:

Drug Trial

• Solidarity Trial [WHO]
• Efficacy and Safety of Favipiravir on mild COVID-19 patients [Martin Dow]
• Efficacy and Safety of JHQ granules for treatment of mild COVID-19 patients [International Center for Chemical and Biological Science (ICCBS, Karachi University), and Beijing Institute of Biological Products Co.]

Training and Learning at GHD

During the pandemic, GHD’s training and learning department conducted training on awareness, screening, sampling, sample handling, and the use of PPEs. 333 healthcare professionals from IHN and other partner institutes were trained.

Drive-through Screening and Testing

In March 2020, a public-private partnership between Karachi’s District South administration and GHD was initiated to screen and/or test individuals for COVID-19. The district administration set up the country’s first drive-thru COVID-19 screening and testing facility. Citizens can make a phone call to the helpline 1166 to get an appointment for PCR testing after answering a few basic risk-assessment questions. Due to the low coronavirus numbers and decreased demand, it is currently functioning as a walk-in clinic. The on-ground operations of the facility includes verbal symptom screening, assessment by a medical officer, chest X-ray, and nasopharyngeal swab collection — are all managed by the GHD team. The goal of this testing facility is to screen and test masses while minimizing physical contact by limiting individuals to their vehicles. Through this initiative, more than 1,800 people have been screened and tested and more than 1,100 cases have been identified.

Active Screening COVID-19 Clusters

In collaboration with the district governments, GHD provided screening, triage, and swab collection facilities in sub-sets of different districts in Karachi that had been identified as high-burden areas for COVID-19.

In districts Malir and West, GHD teams have been working alongside the deputy commissioner and district health office teams in high-burden areas identified based on case detection. The mobile X-Ray vans were mobilized on a need basis near hotspots where they would set up a screening and testing camp. As District West was identified as a high-burden vicinity, a fixed screening, and testing facility was set up at Qatar Hospital, Orangi Town by The Indus Hospital, District West administration, and GHD. It facilitated walk-in patients, six days a week without prior appointments. GHD made its screening and testing services available for public and private sector organizations — people at Baldia Police Training Center, SITE police station, Binoria University hostel, and several factories and offices were screened and tested for COVID-19 through this facility.

Contact Tracing

This component functioned when the district would alert the GHD team for the cases that had been detected through the PCR testing and had close contacts that fell under the criteria of high-risk populations. The District Health Office would manage to bring in all such people to a nearby health facility where the GHD team would set up a contact screening and testing facility with a mobile X-Ray van. In all such instances, the X-ray image was also read for TB indication.

Primary Care Community Health Centers

The Community Health Centers remained open while most public health programs operations were impacted. Tuberculosis, HIV, Maternal and Neonatal Child Health, Malaria, and Hepatitis-C teams came up with solutions to ensure the continuation of medication supply for those under treatment to prevent treatment failures. These solutions included: provisions of medicine for a longer period; delivery of TB medicine at the patients’ homes; active follow-up, etc. Teleconsultation was provided to those patients that suffered from chronic conditions.

Community Health

Community Health Workers (CHW) were integrated into COVID-19 response. They were initially involved in delivering COVID-19 awareness sessions in the community before lockdown. CHWs conducted 186 sessions in communities across Karachi, interior Sindh, and Punjab, having engaged 1,753 participants.

CHWs are now involved in COVID-19 screening, testing, data collection, and management across all the Primary Care Program sites in which Community Engagement Center is operational. These operations have reached thousands of individuals seeking care for COVID-19. They also conducted follow-up phone calls and voice note engagements with community members during this time to understand their experiences of COVID-19 and link them to help where possible. CHWs have also, with the help of community engagement center (CEC) teams, identified 4,250 vulnerable families in need of immediate support during the pandemic. Through funds from external donors, CEC was able to provide 3,226 families with ration support.

Mental Health

In partnership with IRD’s ‘Pursukoon Zindagi’ program a comprehensive mental health response to the pandemic was developed that catered to various populations, such as COVID-19 patients, caregivers, employees, parents with children who are differently-abled, and the general public. Psychosocial support for patients tested for COVID-19 was provided during their isolation or quarantine period to provide mental health support as well as check-ins regarding physical health, contact tracing, and referrals to facilities. Between April and June 2020, over 6,000 patients were reached out to provide integrated support. Mental health support to frontline service-providers was provided through webinars, support groups and check-in calls for clinicians in isolation. Between April and June 2020, 144 healthcare providers were provided mental health check-ins.

Counselling for Partners

Additionally, collaborations were initiated with organizations including Karachi Down Syndrome Program, Loreal, JS Bank, and Daraz to engage employees and beneficiaries with mental health and coping strategies. Between April and June 2020, 471 people were provided psychosocial support through the helpline.

Psychosocial Support Intervention

The COVID-19 pandemic called upon an immediate psychosocial response to the emerging public health emergency at both facility and community levels; this was done by responding to the needs and supporting healthcare staff and daily wage earners. The staff contributed to the sample collection of 4300+ individuals at the facility in Karachi.

Mobilization of TB vans

GHD runs 55 TB mobile vans across the country that are mobilized in the community as well as private and public hospitals to screen for tuberculosis. 28 of those vans were used to help battle the COVID-19 along with screening for tuberculosis. The mobile X-ray vans aided with artificial intelligence-based software that detect pulmonary infiltrates and other abnormalities providing real-time screening for communicable diseases such as TB and COVID-19. The vans are being used in several different facilities and community settings to help with the COVID-19 response.

In areas of Sindh, specifically Karachi, the vans are being used by teams of trained healthcare workers to screen and triage for COVID-19 in the Emergency Department at The Indus Hospital, Civil Hospital, Karachi, and Qatar Hospital, Orangi Town to help lessen the overwhelming burden in the ERs. To ensure thorough screening, all individuals were also provided a chest X-ray in the van. Between March-June, 2020 more than 27,000 individuals were screened and redirected to testing areas ensuring that presumptive cases were separated to control further transmission. From this, more than 1,100 COVID cases were identified.