1
JSA and AIPSN
Peoples Health Movement Advisory to our families and communities
What should myfamily do?What should my local community do? What should we do?
A.What should the familydo?
What your family should do would correspond to which of
these three situations your family finds itself in:
Situation1:Fever, Dry Cough or later Respiratory distress in my house :Some one in your house has developed fever usually of moderate degree-
over 100F-with or without cough and with or
without body aches:
Situation 2 :No Fever in my house-but definite history of Contact with COVID- 19 positive.
Situation 3: No fever in my house and no definite history of contact with COVID-19 positive case
Situation1:Feverinthehouse:Someoneinyourhousehasdevelopedfever
-usuallyofmoderatedegree-over100F-withorwithoutcoughandwithor
withoutbodyaches:
Step1:ImmediatelyfollowthehomequarantineinstructionsPLUSAskthem
iftheyknowwhom theygotitfrom.
Step2:Iftheyknowfrom whom theygotitcheckoutwhetherthatperson
hasbeendiagnosedwithCOVIDorhascompletelyrecovered.Ifthatperson
hassincebeendiagnosedwithCOVID—19thenimmediatelyusethe
contact/helplinenumberandaskforhometesting.Ifhometestingdoesnot
occurgototherecommendedhospitalandaskfortesting.Byprotocolthis
testingmustbedone.
Step3:Ifittestspositive:
i. doasmedicallyadvised-admissioninhospitalorisolationin
designatedfacilityorhomeisolation.
ii. Ifyouwereunabletogetthetestdone-homeisolation.
Step2:
IfthatpersonhasnotbeentestedforCOVID-19,andhasfully
recovered,orwastestedandthetestwasnegative,thereisnoneed
forisolation.Butremainalertandfollowthehomequarantine
recommendations.
IftheydonotknowwheretheygotthediseaseORtheygotitfrom a
personwhoisasymptomaticbutmetanotherpersonwhohadCOVID-
19symptoms-thenfollowhomequarantineroute.
2
Step3:Ifafterthreedaysthisfeverhasnotsubsidedorevenworsened,then
contactthecontact/helplinenumberandaskforhometesting.Ifhome
testingdoesnotoccurgototherecommendedhospitalandasktoseethe
doctor.Ifthedoctoradvisestesting,suchtestingmustbedone.
i.Ifittestspositivedoasmedicallyadvised-admissionin
hospitalorisolationindesignatedfacilityorhome
isolation.
ii.Ifyouwereunabletogetthetestdonedespitedoctors
advice-homeisolation.
iii.Ifdoctorhasdiagnosedanothercauseforfever,follow
treatmentinstructions.
Situation2:NoFeverinmyhouse-butdefinitehistoryofContactwithCOVID
-19positive.
Step1-homequarantineforall-withrelativeisolationoftheonewhohadthe
contact.
Step2:Iffeverdevelopsgotoguidelinesasforsituation1.
Situation3:Nofeverinmyhouseandnodefinitehistoryofcontactwith
COVID-19positivecase
Onlyphysicaldistancing-andpreparationsforisolation:
InstructionsforIsolation:
IsolationatHome
1.Allocatearoom forisolation.Ifnoseparateroom ispossibleperhaps
partoftheroom with6to10feetbetweenwherethepatientislimited
andwhereothersmoveandreside.
2.Personwithfeverremainsinisolationroom onlycomingoutforgoing
totoilet.Couldbeallowedtocomeintoopenspacewitheveryoneelse
keepingadistance.
3.Donotallowvisitorstothehouse-evenrelatives.Iftherearepressing
reasonsforcominglettherebeagoodacrosstheroom separation.
4.Personwithfeverusesonlyelbowsinopeningdoorsandwindows.
Everyplacetouchedcanbewipedwithsoapandwater.Sanitizercould
bebetter-butthisshouldbeasgood.
5.Keepabasinwithsoapandwaterandafewspongesorwetclothinitwhichcanbeusedforwipingsurfaces.
Oneforthepersonwhoisin
isolationandanotherforusebyothers.
6.Whentheisolatedpersonvisitsatoilet,haveanearlierdecisionon
whichareashe/shewoudtouchandtheycangiveitawipebeforethey
leaveandtheotherscanfollowit.
7.Towelsmustbeseparatefortheinfectedperson.
8.Keepabuckethalffilledwithsoapywater.Clothesofpatientscouldbe
putinthisandpatientcouldtakeoffandimmersehisclothesinthis
3
water.Thisisthenleftfor15to20minutesormoreandthencanwhen
enoughhasaccumulateditcouldbewashedandhunginthesuntodry.
9.Keepabasinhalf-filledwithsoapywater.Ifthereareglasses,vessels,
platesandspoonthatthepatientusesitcouldbedroppedbyhim in
thissoapywater.Thiscouldlaterbewashedoffbyothers.Therecould
beoneonestagewheretheywashtheirownplatesinonebasinand
thenitispassedtoanotherbasiswherethenon-infectedwashthe
plates.
10.Trywearingamaskatalltimes.Ifnotascarforlargehand-kerchief
acrossthefaceespeciallywhencoughingwouldbemostuseful.
Handkerchiefscanbewashedasdescribedabove-butonecould
additionallyusehotwater.Maskdisposal(andtidduedisposalisa
problem).Suggestputtinginhotsoapywaterforsometimeandthen
cuttingitupanddisposalisspeciallycommunityear-markedsites.
Isolationinafacility:
Guidelinestobedeveloped.Notewemayneedcommunityorganized
isolationsiteswherethereismuchover-crowdingandhomeisolationisnota
possibilityandgovernmentisunabletoorganizeisolationortheconditionsin
thesearesopoor,thatgovernmentpermitscommunityorganizedisolation.
Thiswouldalsobemorefeasiblewherethereareassociationsofpeopleslike
beediworkersassociationetcinplace.
TheDoNOTsofIsolation:
DoNOTblamethepersonforgettingill-howeverjustifiedyoumayfeelyour
blameis.
Usepersuasion-notcoercion.Therearelegitimateneedsandsupportthat
mustbeacknowledgedandhelpedwith-notignoredanddismissed.
InstructionsforHomeQuarantine:
1.Alltheinstructionsasstatedfortheisolationaredesirable.Separation
betweenindividualsinthehomeisnotmandatory.Childrenwillneed
reassuranceandcaring,andunlessoneisonquarantinebecauseof
directorcontactwithaninfectedperson,distancingneednotbe
insistedupon.
2.Ensureadequateaccesstocontraceptiveswhererelevant.
3.Buyathermometerifoneisavailable.Donotdecideonfeverby
perceptionalone,measureit.
4.Goeswithoutsayingthatspittingisavoided,andotherhygienic
practicesarefollowed.
InstructionsforPhysicalDistancing:
1.Atthework-placeensurethatpersonswhoareilldonothavetocome
forwork.Andthosewhoareexposedbutnotillshouldalsobe
4
encouragednottocome.Howeverifunavoidablebemorerigorousin
followinginstructionswiththem.
2.Handwashing–
a.Howtowash:instructionsareeverywhereandthesearegood.
Followthem.Washallpartsofthehandespeciallybetween
fingersandundernails.Takeatleast20secondatowash.Use
soapandwaterandassecondchoicesanitizerwithatleast60%
isopropylalcohol.
b.Whentowash:Makeyourownwhentowashrules.Ofcourse
handwashingafterusingthetoiletandbeforepreparingmeals
isgoodhygieneanyway.Inadditionitshouldbeusedwhenyou
enterthehouseorplaceofworkfrom outside–sincewehave
touchedmanyunknownsurfaceswhenoutside.Alsowashif
youhavehadtoshakehands.
3.Masksarenotadvised-butifyouwouldliketowearthem-thenensure
theyarechangeddaily,anddisposedasindicatedearlier.Andthough
almostimpossibletopractice,avoidtouchingthem andtheface
repeatedly.
4.Avoidhand-shakesandhugs.
5.Avoidtouchingthefollowingsurfaceswithyourhands-handrails,
switches,press-buttons,doorhandles.Youcouldusenon-dominant
hand,oranelboworsomeobjecttopushit.
6.Nottouchingthefaceisgoodadvice,butalmostimpossibletofollow.
Dototheextentpossible.
7.Keepingadistanceof6feetbetweenyourselfandanotherpersonisa
desirableadvice-butusuallyimpossibletocarryout.Usingitasa
guidingprinciple-andfollowitwherepossible.Itispossibleinmore
placesthanyoumaythink.
8.Intheworkplace-seehowtoorganizeworksothattransmissionis
lesslikelyegifsittingandworkingwithgreaterdistancebetween,not
sharingsametoolsetc.Wewarnthatinmostsituationssuch
instructionsmaynotbepossible.
9.Wearenotaskingforavoidingpublictransport-sincethese
instructionsarewrittenforthosewhocanaffordnothingelse.
10.Trytoavoidgatherings.Themorepersonsanyindividualcomesinto
contact,themorelikelytheycomeacrossaninfectedperson.Since
wehavemanyinfectedpersonswhohavenosymptoms,andtherefore
donotknowthattheyareinfectedandspreadingthedisease,itmakes
sensetoavoidanygathering.Theproblem withthisadviceisthat
thereisnoclearend-point.Duringtheperiodoflockdownthenumber
ofpersonswithinfectionwillcomedown-butitwillnotbeeliminated.
Thereforeoncethelock-downisover,thespreadwillstartagain.
Unlesswehaveidentifiedandtreatedmostinfectedpersonsduring
thisperiod.
NoteonPhysicalDistancing(alsoknownassocialdistancing)
Physicaldistancingreducestheprobabilityofgettinginfection.Itdoesnot
5
eliminateit.
Physicaldistancingmustbeaccompaniedbydecreasingsocialgaps-this
createstrustandsupport.Youcoulddothisbymakingsurethatwerespect
them andcontinueoursocialrelationship.Thiscanbedonebytalkingmore
pleasantlytothem orbyothersymbolicgestureslikeplacingthehandacross
onesheartandbowinglightly,orblowingakiss.Makesurethey
understandingthatyouarenotblamingthem ordiscriminatingagainstthem
bythewordsyouspeakandthegesturesandbodylanguageyouuse.
Inpublichealthterm socialdistancingisonlyarelativelylimited
supplementarymeasure-moresoinourcircumstances.Andlockdowns
whichareextremeformsofsocialdistancinghaveanevenmorelimitedand
transientroletoplay.Totheextentthattheyreducetheprobabilitywemust
adoptthem.Alsothisiswhatmostofuscando.Butletitnotdistractor
dilutetheotherrequirementsofepidemiccontrolandmanagement–which
restsonwhatgovernmentsmustdo.
B.TreatingtheCOVID19sickindividual:
OnceapersonisdiagnosedwithCovid-19,thetreatmentisperdoctors
advice.Thedoctorsisexpectedtotreataspertheprotocolthatwillbeissued
from timetotimebythegovernment.Theseprotocolsarebasedonexpert
consultationandprovideguidancetothedoctor.
Howeversomeunderstandingofthisisusefulforusasindividualsandasthe
communitytoknowwhetherthetreatmentisontherighttrack.
Mostpatientswouldhaveonlymildormoderatesymptoms.Atpresentthere
isnoneedforanytabletexceptforparacetamoltorelivethefeverandpain.In
3to5daysthepatientwouldrecover.Thepatientshouldtakerestandfurther
takeeasilydigestiblesoftfoodthatisagreeabletothem.
Ofcoursetheyshouldbeisolated-andwhetherwedohomeisolation,
communityisolationorhospitalisolationwilldependonthehealthsystems
context.Thestategovernmentwouldhaveissuedinstructions.
Somepatientswoulddevelopamoreseverecoughplusdifficultyinbreathing.
Insuchacasethedoctorshouldexamine,andmayorderanX-ray.Such
patientsshouldbehospitalized-andthisisessentialiftheX-rayshowssigns
ofpneumonia.Doctorscanalsosuspectpneumoniafrom clinicalexamination.
WhereCTscanisthere,thedoctormayorderthis,thoughthisisusuallynot
necessary,wheretheX-rayshowsit.
Ifthedifficultyinbreathingworsensandthepatientbecomessicker,they
wouldneedintensivecareinahospitalthathasbeendesignatedbythe
governmentforprovidingsuchcare.Thiscouldbepublichospitalorprivate
hospital.Treatmentwouldbefreeinthepublichospital-andwherethe
governmenthastakenovertheprivatehospital,itshouldbefreetherealso.In
6
districtswheretherearemanyCOVID19patientsrequiringhospitalization
peoplesmovementshavebeendemandingthatgovernmenttemporarilytake
overtheprivatehospital-orenforcetheirprovidingfreecare.
Oncethepersonisrecoveredthepatientshouldbediseasefreeandhopefully
immunetoevergettingthisparticulardiseaseagain.
C.TracingtheContactsoftheSick:
WheneverapatientisdiagnosedwithCOVID-19,evenifthediagnosisishighly
suspected,oneshouldenquirewhoallthepatientmetinthepreceeding14
days-emphasisontheprevious7days.Categorisethem intothosewith
whom theyspentalotoftimecloselytogetherthosewithwhom theyspent
sometimecloseupandthosewhowereintheroom butnotreallyinteracted.
Thislistofcontactsshouldbegiventoateam whowouldfindouttheirphone
numbersoraddresses(withinformationfrom thepatientandhisrelativesor
colleaguesorfriends).Theteam wouldcontactthem andfindoutwhether
theyhaveanysymptoms.Iftheyhavesymptomstheyshoulddoasin
situation1-isolate,testandtreat.Iftheydonothavesymptomstheyshould
identifyhomequarantine-asdescribedinsituation2.Notonlythepatientbut
thoseinthehomeshouldbeinformed.Thelocalhealthworkersshouldalso
beinformed.
HoweverotherthantheASHAand/orotherhealthcareproviderswhohaveto
providesupporttothoseinhomequarantineorisolation,othersinthe
communityshouldnotbeinformed-asitwouldviolatetherighttoprivacy
andcouldcreatestigmatizationorevenhostilereactionsinthecommunity.
Patientcanhoweverbeencouragedtotellthoseinthecommunitywhowould
besupportivetothem.
D.WhatshouldthelocalCommunityDo?
Therearesixthingsthatallcommunitiesmustdoandthreethingsthatthey
mustNOTdo.
Whatcommunitiesmustdo:
1.Ensurethateveryoneinthecommunityknowsofthedisease-andwhat
isthemeaningofisolation,homequarantineandsocialdistancing.
Thiscanbeexplainedthroughpamphlets,orwallwritings,oversocial
media,orevenbycarefullyplannedhousevisits.
2.Encouragephysicaldistancingatalllikelyplacesofcongregationtemples,
shops,postofficesetc.Justafewchalkmarksorlinesonthe
floor6feetapartwherepersonscanstandinaqueuewouldhelp.Even
atemplecanbeenteredonebyone.
3.Providesupporttothoseinhomequarantineorisolationwithrespect
toaccesstoessentialcommoditiesandservices.
4.Cooperatewithhealthauthoritiesandlocalhealthcareprovidersand
7
communityhealthworkersinprovidinghealtheducationand
healthcareservicesinthecommunityandincontacttracingwhere
requestedtodoso.
5.Providesupporttothoseofweakersectionswhoaredependentonthis
communityfortheirlivelihoodsbycontinuingwiththeirservicesand
payments,takingreasonablecaretokeepphysicaldistancingwhere
necessary.
6.Provideeconomicandsocialsupporttotheextentpossibletothose
affectedbythelockdownandlossofincome.Helpingthoseinweaker
sectionstoaccessgovernmentcreatednewentitlements–likefood
grainsthroughpublicdistributionsystems,homedistributionof
anganwadiorschoolnutritionsupplements,incometransfersforthe
poorestsetc.Inadditiononecouldalsoconsiderpersonalinterestfree
loans,deferring,preferablywritingofinterestpaymentsonalready
givenloansforthelockdownperiod,sharingofprovisions-for
examplefoodgrains,areallpotentiallypossible,thoughthiswould
requireveryhighlevelsofsolidarityandmaythereforeoftenbe
impractical.
ThreethingsthatcommunitiesshouldNOTdo:
1.Blamingthosewhoaresickorconfinedtohomequarantineas
beingresponsibleforbringingthisdiseaseintothecommunity.
Evenwheretheyhavenotobservedtherules.Theworstformsof
thisareviolenceagainstthosewhoaresick.Attributingtheir
sicknesstothecommunitytheybelongtoisanotherhostile
behaviorthatshouldbecondemned.
2.Spreadingorencouragingunprovenremediesandtreatmentforthe
diseaseanditsprevention-thuscreatingfalseconfidence.
3.Creatingapanic,orpromotingrumorsthatdothesame.
E.WhatcanASHAs,anganwadiworkersandANMsandothercommunity
workersfrom anygovernmentdepartmentorNGO
1.Ensurethattheydonotcutbackontheirusualservices-andthatsuch
servicesarecontinuedwithoutinterruption.
2.Takecareoftheirownsafety,bytakingsafeprecautionsasapplicable
tofrontlinehealthworkers.
3. Visiteveryhomeandidentifythoseinneedofisolation,home
quarantineandeducatethem onthesame,andsupportthem in
planningthisoutandimplementingthis.
4.Securetheconfidenceofeveryhouseholdsothattheywouldapproach
andinform thefrontlinehealthworkerassoonastheyhavesymptoms.
5.Helpthesicktoaccesshospitalcareandtestingservicesasrequired.
Thereisaneedtoencouragehometesting,whereverthatispossible.
6.Activelycombatfoodtaboosandfoodfadsandallsortsofother
unverifiedbeliefsaboutthediseaseanditsconsequences.
7.Identifypersonswithmentalillnessorsignsofstressanddepression
8
andprovidesupportandlinkthem toappropriatecareproviders.
8.Identifypersons/householdswhoarefacinganeconomiccrisis(like
hunger,harassmentfrom money-lenders),andinform keycommunity
members,civilsocietyorganizationsaswellasauthorities–sothat
immediatereliefcanbeprovided.
9.Helpwithcontacttracing:
F.Whatshouldthelocalbranchofapeoplesmovementorganizationor
NGOdo?
1.Stayactive.Donotgetmentallylockeddown,evenifphysical
movementisrestricted.Itisintimesofcrisislikethisthatyour
contributionismostneeded.Thisisthedifferencebetweenany
organizationjustouttomaketheirlivelihoodandyourorganization.As
theysay–whenthegoinggetstough,thetoughgetgoing.
2.Staysafe:Followalltherulesofsocialdistancingandkeepingoneself
safe,butwithinthelimitsofdoingwhatisneededforthecommunityat
timeslikethis.
3.Educatepeople:Thisincludeseducatingcommunitybased
organizationslikeselfhelpgroups,localcommunityleaders,local
frontlinehealthworkers-sothattheycaninturneducateindividual
households.
4.Shareexperiencesfrom othersuccessfulcommunitymobilization,so
thatthelocalcommunityisalsoengaged.
5.Usesocialmediaextensivelytopromotetherightmessagesand
debunkthefalseremediesandotherfakemessages,hateorfear
creatingmessageandrumors.
6.Helpandsupportcommunitiestoperform allthecommunityfunctions
listedearlier.
7.Monitorpublicservicesandreliefmeasuresthataremeanttocontinue
orhavebeencreatedasepidemicresponse,facilitatetheirdeliveryand
correspondwithauthoritiestonotifyandrectifygaps.
8.Ensurethathealthcareservicesarereachingthepopulationandthatin
thehealthcarecenterappropriateinfectionpreventionpracticesarein
place.
9.Helpwithcontacttracing,andeducatecontacts,andputthem intouch
withkeylocalauthorities.
JSA and AIPSN
Peoples Health Movement Advisory to our families and communities
What should myfamily do?What should my local community do? What should we do?
A.What should the familydo?
What your family should do would correspond to which of
these three situations your family finds itself in:
Situation1:Fever, Dry Cough or later Respiratory distress in my house :Some one in your house has developed fever usually of moderate degree-
over 100F-with or without cough and with or
without body aches:
Situation 2 :No Fever in my house-but definite history of Contact with COVID- 19 positive.
Situation 3: No fever in my house and no definite history of contact with COVID-19 positive case
Situation1:Feverinthehouse:Someoneinyourhousehasdevelopedfever
-usuallyofmoderatedegree-over100F-withorwithoutcoughandwithor
withoutbodyaches:
Step1:ImmediatelyfollowthehomequarantineinstructionsPLUSAskthem
iftheyknowwhom theygotitfrom.
Step2:Iftheyknowfrom whom theygotitcheckoutwhetherthatperson
hasbeendiagnosedwithCOVIDorhascompletelyrecovered.Ifthatperson
hassincebeendiagnosedwithCOVID—19thenimmediatelyusethe
contact/helplinenumberandaskforhometesting.Ifhometestingdoesnot
occurgototherecommendedhospitalandaskfortesting.Byprotocolthis
testingmustbedone.
Step3:Ifittestspositive:
i. doasmedicallyadvised-admissioninhospitalorisolationin
designatedfacilityorhomeisolation.
ii. Ifyouwereunabletogetthetestdone-homeisolation.
Step2:
IfthatpersonhasnotbeentestedforCOVID-19,andhasfully
recovered,orwastestedandthetestwasnegative,thereisnoneed
forisolation.Butremainalertandfollowthehomequarantine
recommendations.
IftheydonotknowwheretheygotthediseaseORtheygotitfrom a
personwhoisasymptomaticbutmetanotherpersonwhohadCOVID-
19symptoms-thenfollowhomequarantineroute.
2
Step3:Ifafterthreedaysthisfeverhasnotsubsidedorevenworsened,then
contactthecontact/helplinenumberandaskforhometesting.Ifhome
testingdoesnotoccurgototherecommendedhospitalandasktoseethe
doctor.Ifthedoctoradvisestesting,suchtestingmustbedone.
i.Ifittestspositivedoasmedicallyadvised-admissionin
hospitalorisolationindesignatedfacilityorhome
isolation.
ii.Ifyouwereunabletogetthetestdonedespitedoctors
advice-homeisolation.
iii.Ifdoctorhasdiagnosedanothercauseforfever,follow
treatmentinstructions.
Situation2:NoFeverinmyhouse-butdefinitehistoryofContactwithCOVID
-19positive.
Step1-homequarantineforall-withrelativeisolationoftheonewhohadthe
contact.
Step2:Iffeverdevelopsgotoguidelinesasforsituation1.
Situation3:Nofeverinmyhouseandnodefinitehistoryofcontactwith
COVID-19positivecase
Onlyphysicaldistancing-andpreparationsforisolation:
InstructionsforIsolation:
IsolationatHome
1.Allocatearoom forisolation.Ifnoseparateroom ispossibleperhaps
partoftheroom with6to10feetbetweenwherethepatientislimited
andwhereothersmoveandreside.
2.Personwithfeverremainsinisolationroom onlycomingoutforgoing
totoilet.Couldbeallowedtocomeintoopenspacewitheveryoneelse
keepingadistance.
3.Donotallowvisitorstothehouse-evenrelatives.Iftherearepressing
reasonsforcominglettherebeagoodacrosstheroom separation.
4.Personwithfeverusesonlyelbowsinopeningdoorsandwindows.
Everyplacetouchedcanbewipedwithsoapandwater.Sanitizercould
bebetter-butthisshouldbeasgood.
5.Keepabasinwithsoapandwaterandafewspongesorwetclothinitwhichcanbeusedforwipingsurfaces.
Oneforthepersonwhoisin
isolationandanotherforusebyothers.
6.Whentheisolatedpersonvisitsatoilet,haveanearlierdecisionon
whichareashe/shewoudtouchandtheycangiveitawipebeforethey
leaveandtheotherscanfollowit.
7.Towelsmustbeseparatefortheinfectedperson.
8.Keepabuckethalffilledwithsoapywater.Clothesofpatientscouldbe
putinthisandpatientcouldtakeoffandimmersehisclothesinthis
3
water.Thisisthenleftfor15to20minutesormoreandthencanwhen
enoughhasaccumulateditcouldbewashedandhunginthesuntodry.
9.Keepabasinhalf-filledwithsoapywater.Ifthereareglasses,vessels,
platesandspoonthatthepatientusesitcouldbedroppedbyhim in
thissoapywater.Thiscouldlaterbewashedoffbyothers.Therecould
beoneonestagewheretheywashtheirownplatesinonebasinand
thenitispassedtoanotherbasiswherethenon-infectedwashthe
plates.
10.Trywearingamaskatalltimes.Ifnotascarforlargehand-kerchief
acrossthefaceespeciallywhencoughingwouldbemostuseful.
Handkerchiefscanbewashedasdescribedabove-butonecould
additionallyusehotwater.Maskdisposal(andtidduedisposalisa
problem).Suggestputtinginhotsoapywaterforsometimeandthen
cuttingitupanddisposalisspeciallycommunityear-markedsites.
Isolationinafacility:
Guidelinestobedeveloped.Notewemayneedcommunityorganized
isolationsiteswherethereismuchover-crowdingandhomeisolationisnota
possibilityandgovernmentisunabletoorganizeisolationortheconditionsin
thesearesopoor,thatgovernmentpermitscommunityorganizedisolation.
Thiswouldalsobemorefeasiblewherethereareassociationsofpeopleslike
beediworkersassociationetcinplace.
TheDoNOTsofIsolation:
DoNOTblamethepersonforgettingill-howeverjustifiedyoumayfeelyour
blameis.
Usepersuasion-notcoercion.Therearelegitimateneedsandsupportthat
mustbeacknowledgedandhelpedwith-notignoredanddismissed.
InstructionsforHomeQuarantine:
1.Alltheinstructionsasstatedfortheisolationaredesirable.Separation
betweenindividualsinthehomeisnotmandatory.Childrenwillneed
reassuranceandcaring,andunlessoneisonquarantinebecauseof
directorcontactwithaninfectedperson,distancingneednotbe
insistedupon.
2.Ensureadequateaccesstocontraceptiveswhererelevant.
3.Buyathermometerifoneisavailable.Donotdecideonfeverby
perceptionalone,measureit.
4.Goeswithoutsayingthatspittingisavoided,andotherhygienic
practicesarefollowed.
InstructionsforPhysicalDistancing:
1.Atthework-placeensurethatpersonswhoareilldonothavetocome
forwork.Andthosewhoareexposedbutnotillshouldalsobe
4
encouragednottocome.Howeverifunavoidablebemorerigorousin
followinginstructionswiththem.
2.Handwashing–
a.Howtowash:instructionsareeverywhereandthesearegood.
Followthem.Washallpartsofthehandespeciallybetween
fingersandundernails.Takeatleast20secondatowash.Use
soapandwaterandassecondchoicesanitizerwithatleast60%
isopropylalcohol.
b.Whentowash:Makeyourownwhentowashrules.Ofcourse
handwashingafterusingthetoiletandbeforepreparingmeals
isgoodhygieneanyway.Inadditionitshouldbeusedwhenyou
enterthehouseorplaceofworkfrom outside–sincewehave
touchedmanyunknownsurfaceswhenoutside.Alsowashif
youhavehadtoshakehands.
3.Masksarenotadvised-butifyouwouldliketowearthem-thenensure
theyarechangeddaily,anddisposedasindicatedearlier.Andthough
almostimpossibletopractice,avoidtouchingthem andtheface
repeatedly.
4.Avoidhand-shakesandhugs.
5.Avoidtouchingthefollowingsurfaceswithyourhands-handrails,
switches,press-buttons,doorhandles.Youcouldusenon-dominant
hand,oranelboworsomeobjecttopushit.
6.Nottouchingthefaceisgoodadvice,butalmostimpossibletofollow.
Dototheextentpossible.
7.Keepingadistanceof6feetbetweenyourselfandanotherpersonisa
desirableadvice-butusuallyimpossibletocarryout.Usingitasa
guidingprinciple-andfollowitwherepossible.Itispossibleinmore
placesthanyoumaythink.
8.Intheworkplace-seehowtoorganizeworksothattransmissionis
lesslikelyegifsittingandworkingwithgreaterdistancebetween,not
sharingsametoolsetc.Wewarnthatinmostsituationssuch
instructionsmaynotbepossible.
9.Wearenotaskingforavoidingpublictransport-sincethese
instructionsarewrittenforthosewhocanaffordnothingelse.
10.Trytoavoidgatherings.Themorepersonsanyindividualcomesinto
contact,themorelikelytheycomeacrossaninfectedperson.Since
wehavemanyinfectedpersonswhohavenosymptoms,andtherefore
donotknowthattheyareinfectedandspreadingthedisease,itmakes
sensetoavoidanygathering.Theproblem withthisadviceisthat
thereisnoclearend-point.Duringtheperiodoflockdownthenumber
ofpersonswithinfectionwillcomedown-butitwillnotbeeliminated.
Thereforeoncethelock-downisover,thespreadwillstartagain.
Unlesswehaveidentifiedandtreatedmostinfectedpersonsduring
thisperiod.
NoteonPhysicalDistancing(alsoknownassocialdistancing)
Physicaldistancingreducestheprobabilityofgettinginfection.Itdoesnot
5
eliminateit.
Physicaldistancingmustbeaccompaniedbydecreasingsocialgaps-this
createstrustandsupport.Youcoulddothisbymakingsurethatwerespect
them andcontinueoursocialrelationship.Thiscanbedonebytalkingmore
pleasantlytothem orbyothersymbolicgestureslikeplacingthehandacross
onesheartandbowinglightly,orblowingakiss.Makesurethey
understandingthatyouarenotblamingthem ordiscriminatingagainstthem
bythewordsyouspeakandthegesturesandbodylanguageyouuse.
Inpublichealthterm socialdistancingisonlyarelativelylimited
supplementarymeasure-moresoinourcircumstances.Andlockdowns
whichareextremeformsofsocialdistancinghaveanevenmorelimitedand
transientroletoplay.Totheextentthattheyreducetheprobabilitywemust
adoptthem.Alsothisiswhatmostofuscando.Butletitnotdistractor
dilutetheotherrequirementsofepidemiccontrolandmanagement–which
restsonwhatgovernmentsmustdo.
B.TreatingtheCOVID19sickindividual:
OnceapersonisdiagnosedwithCovid-19,thetreatmentisperdoctors
advice.Thedoctorsisexpectedtotreataspertheprotocolthatwillbeissued
from timetotimebythegovernment.Theseprotocolsarebasedonexpert
consultationandprovideguidancetothedoctor.
Howeversomeunderstandingofthisisusefulforusasindividualsandasthe
communitytoknowwhetherthetreatmentisontherighttrack.
Mostpatientswouldhaveonlymildormoderatesymptoms.Atpresentthere
isnoneedforanytabletexceptforparacetamoltorelivethefeverandpain.In
3to5daysthepatientwouldrecover.Thepatientshouldtakerestandfurther
takeeasilydigestiblesoftfoodthatisagreeabletothem.
Ofcoursetheyshouldbeisolated-andwhetherwedohomeisolation,
communityisolationorhospitalisolationwilldependonthehealthsystems
context.Thestategovernmentwouldhaveissuedinstructions.
Somepatientswoulddevelopamoreseverecoughplusdifficultyinbreathing.
Insuchacasethedoctorshouldexamine,andmayorderanX-ray.Such
patientsshouldbehospitalized-andthisisessentialiftheX-rayshowssigns
ofpneumonia.Doctorscanalsosuspectpneumoniafrom clinicalexamination.
WhereCTscanisthere,thedoctormayorderthis,thoughthisisusuallynot
necessary,wheretheX-rayshowsit.
Ifthedifficultyinbreathingworsensandthepatientbecomessicker,they
wouldneedintensivecareinahospitalthathasbeendesignatedbythe
governmentforprovidingsuchcare.Thiscouldbepublichospitalorprivate
hospital.Treatmentwouldbefreeinthepublichospital-andwherethe
governmenthastakenovertheprivatehospital,itshouldbefreetherealso.In
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districtswheretherearemanyCOVID19patientsrequiringhospitalization
peoplesmovementshavebeendemandingthatgovernmenttemporarilytake
overtheprivatehospital-orenforcetheirprovidingfreecare.
Oncethepersonisrecoveredthepatientshouldbediseasefreeandhopefully
immunetoevergettingthisparticulardiseaseagain.
C.TracingtheContactsoftheSick:
WheneverapatientisdiagnosedwithCOVID-19,evenifthediagnosisishighly
suspected,oneshouldenquirewhoallthepatientmetinthepreceeding14
days-emphasisontheprevious7days.Categorisethem intothosewith
whom theyspentalotoftimecloselytogetherthosewithwhom theyspent
sometimecloseupandthosewhowereintheroom butnotreallyinteracted.
Thislistofcontactsshouldbegiventoateam whowouldfindouttheirphone
numbersoraddresses(withinformationfrom thepatientandhisrelativesor
colleaguesorfriends).Theteam wouldcontactthem andfindoutwhether
theyhaveanysymptoms.Iftheyhavesymptomstheyshoulddoasin
situation1-isolate,testandtreat.Iftheydonothavesymptomstheyshould
identifyhomequarantine-asdescribedinsituation2.Notonlythepatientbut
thoseinthehomeshouldbeinformed.Thelocalhealthworkersshouldalso
beinformed.
HoweverotherthantheASHAand/orotherhealthcareproviderswhohaveto
providesupporttothoseinhomequarantineorisolation,othersinthe
communityshouldnotbeinformed-asitwouldviolatetherighttoprivacy
andcouldcreatestigmatizationorevenhostilereactionsinthecommunity.
Patientcanhoweverbeencouragedtotellthoseinthecommunitywhowould
besupportivetothem.
D.WhatshouldthelocalCommunityDo?
Therearesixthingsthatallcommunitiesmustdoandthreethingsthatthey
mustNOTdo.
Whatcommunitiesmustdo:
1.Ensurethateveryoneinthecommunityknowsofthedisease-andwhat
isthemeaningofisolation,homequarantineandsocialdistancing.
Thiscanbeexplainedthroughpamphlets,orwallwritings,oversocial
media,orevenbycarefullyplannedhousevisits.
2.Encouragephysicaldistancingatalllikelyplacesofcongregationtemples,
shops,postofficesetc.Justafewchalkmarksorlinesonthe
floor6feetapartwherepersonscanstandinaqueuewouldhelp.Even
atemplecanbeenteredonebyone.
3.Providesupporttothoseinhomequarantineorisolationwithrespect
toaccesstoessentialcommoditiesandservices.
4.Cooperatewithhealthauthoritiesandlocalhealthcareprovidersand
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communityhealthworkersinprovidinghealtheducationand
healthcareservicesinthecommunityandincontacttracingwhere
requestedtodoso.
5.Providesupporttothoseofweakersectionswhoaredependentonthis
communityfortheirlivelihoodsbycontinuingwiththeirservicesand
payments,takingreasonablecaretokeepphysicaldistancingwhere
necessary.
6.Provideeconomicandsocialsupporttotheextentpossibletothose
affectedbythelockdownandlossofincome.Helpingthoseinweaker
sectionstoaccessgovernmentcreatednewentitlements–likefood
grainsthroughpublicdistributionsystems,homedistributionof
anganwadiorschoolnutritionsupplements,incometransfersforthe
poorestsetc.Inadditiononecouldalsoconsiderpersonalinterestfree
loans,deferring,preferablywritingofinterestpaymentsonalready
givenloansforthelockdownperiod,sharingofprovisions-for
examplefoodgrains,areallpotentiallypossible,thoughthiswould
requireveryhighlevelsofsolidarityandmaythereforeoftenbe
impractical.
ThreethingsthatcommunitiesshouldNOTdo:
1.Blamingthosewhoaresickorconfinedtohomequarantineas
beingresponsibleforbringingthisdiseaseintothecommunity.
Evenwheretheyhavenotobservedtherules.Theworstformsof
thisareviolenceagainstthosewhoaresick.Attributingtheir
sicknesstothecommunitytheybelongtoisanotherhostile
behaviorthatshouldbecondemned.
2.Spreadingorencouragingunprovenremediesandtreatmentforthe
diseaseanditsprevention-thuscreatingfalseconfidence.
3.Creatingapanic,orpromotingrumorsthatdothesame.
E.WhatcanASHAs,anganwadiworkersandANMsandothercommunity
workersfrom anygovernmentdepartmentorNGO
1.Ensurethattheydonotcutbackontheirusualservices-andthatsuch
servicesarecontinuedwithoutinterruption.
2.Takecareoftheirownsafety,bytakingsafeprecautionsasapplicable
tofrontlinehealthworkers.
3. Visiteveryhomeandidentifythoseinneedofisolation,home
quarantineandeducatethem onthesame,andsupportthem in
planningthisoutandimplementingthis.
4.Securetheconfidenceofeveryhouseholdsothattheywouldapproach
andinform thefrontlinehealthworkerassoonastheyhavesymptoms.
5.Helpthesicktoaccesshospitalcareandtestingservicesasrequired.
Thereisaneedtoencouragehometesting,whereverthatispossible.
6.Activelycombatfoodtaboosandfoodfadsandallsortsofother
unverifiedbeliefsaboutthediseaseanditsconsequences.
7.Identifypersonswithmentalillnessorsignsofstressanddepression
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andprovidesupportandlinkthem toappropriatecareproviders.
8.Identifypersons/householdswhoarefacinganeconomiccrisis(like
hunger,harassmentfrom money-lenders),andinform keycommunity
members,civilsocietyorganizationsaswellasauthorities–sothat
immediatereliefcanbeprovided.
9.Helpwithcontacttracing:
F.Whatshouldthelocalbranchofapeoplesmovementorganizationor
NGOdo?
1.Stayactive.Donotgetmentallylockeddown,evenifphysical
movementisrestricted.Itisintimesofcrisislikethisthatyour
contributionismostneeded.Thisisthedifferencebetweenany
organizationjustouttomaketheirlivelihoodandyourorganization.As
theysay–whenthegoinggetstough,thetoughgetgoing.
2.Staysafe:Followalltherulesofsocialdistancingandkeepingoneself
safe,butwithinthelimitsofdoingwhatisneededforthecommunityat
timeslikethis.
3.Educatepeople:Thisincludeseducatingcommunitybased
organizationslikeselfhelpgroups,localcommunityleaders,local
frontlinehealthworkers-sothattheycaninturneducateindividual
households.
4.Shareexperiencesfrom othersuccessfulcommunitymobilization,so
thatthelocalcommunityisalsoengaged.
5.Usesocialmediaextensivelytopromotetherightmessagesand
debunkthefalseremediesandotherfakemessages,hateorfear
creatingmessageandrumors.
6.Helpandsupportcommunitiestoperform allthecommunityfunctions
listedearlier.
7.Monitorpublicservicesandreliefmeasuresthataremeanttocontinue
orhavebeencreatedasepidemicresponse,facilitatetheirdeliveryand
correspondwithauthoritiestonotifyandrectifygaps.
8.Ensurethathealthcareservicesarereachingthepopulationandthatin
thehealthcarecenterappropriateinfectionpreventionpracticesarein
place.
9.Helpwithcontacttracing,andeducatecontacts,andputthem intouch
withkeylocalauthorities.
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