India: COVID-19 Rapid Assessment Results
Responses on prevention and preparedness from 106 vision access partners across 19 states
VisionSpring’s COVID-19 emergency response relies on real time data from its partners and community mobilization teams. The data from telephonic interviews with frontline health and eye care providers across 19 states in India reveals shortages in Personal Protective Equipment (PPE), an urgent need to improve handwashing resources and practices, a call for information to plan and implement infection control, as well as a need to strengthen standard operating procedures post lockdown.
69% of respondents are non-profit/mission eye hospitals. Others include district or tertiary hospitals and small eye clinics. Of the eye hospitals, 41% provide emergency or “urgent” eye care. (1)
Healthcare and eye-care workers face shortages of PPE
Health workers, and vision care professionals in particular, work in close proximity to patients during eye examination and treatment where there is risk of cross infection. (2)
37% of facilities reported they were without, or had a low stock of full-face shields, of which 41% were eye hospitals.
Similarly, 38% lacked protective goggles (without or low stock). Of these, 48% were eye hospitals.
Handwashing facilities and practices needed without delay
In April, WHO recommended immediate allocation of resources to widely improve hand hygiene practices. This includes strengthening hand hygiene facilities and practices in healthcare settings and easy to access hand hygiene stations in any establishment, public or private. (3)
The rapid assessment results further illustrate this gap, as 52% of participating facilities lack handwashing stations at entry. Of these, 76% are eye hospitals and another 6% are district/tertiary hospitals or medical colleges.
Respondents identified handwashing as the greatest need for community awareness raising (83%). In recent data collected by the Population Council in Bihar and Uttar Pradesh, respondents’ perceived risk was very low (60-77%), still, the majority (70-90%) reported increased handwashing and hand sanitizer practices. (4)
Support frontline service providers to plan and implement infection control
Frontline service providers recognize the gravity of the COVID-19 situation in India as a ‘great threat’ and acknowledge that they, as providers, are on high alert (87%).
Nearly one-third (31%) thought it was probable they would care for patients with or suspected to have COVID-19. However, 82% were not aware of a plan or were uncertain whether they had a plan for handling these cases.
Similarly, of the 19% who fully expect to care for COVID-19 patients, 30% did not have a plan. Among their information needs, respondents indicated they most urgently require guidance on: keeping themselves as well as their families safe when they return to work (61%), reducing risk of infection during community outreach (56%), and accessing proper PPE for health workers (63%).
Support a path to a new normal
Infection control standards will undoubtedly increase across the eyecare sector. Providers must rapidly develop, test and implement safety measures within their facility and think carefully about requirements for communitylevel outreach.
While 91% of partners believe that infection control measures are important during outreach, it is of note that before COVID-19, 35% of eye hospitals surveyed did not keep a stock of face shields, and 22% had no stock of goggles.
VisionSpring is collaborating to bring additional rapid assessment data on COVID-19 prevention and preparedness from South Asia and Sub Saharan Africa to health and eyecare leaders globally.
The additional 31% of partner responses: secondary hospital (7.5%), vision center/eye clinic (5.7%), community health worker network (4.7%), tertiary hospital (4.7%), medical college (2.8%), primary care clinic (1.9%), vision capacity builder (1.9%), other (1.9%).
Guo, D., Xia, J., Shen, Y. and Tong, J. (2020), SARS‐CoV‐2 may be related to conjunctivitis but not necessarily spread through the conjunctiva SARS‐CoV‐2 and conjunctiva. J Med Virol. doi:10.1002/jmv.25856; Moravvej, Z., Soltani Moghadam, R., Ahmadian Yazdi, A., & Shahraki, K. (2020). COVID-19 Pandemic: Ophthalmic Practice and Precautions in a Tertiary Eye Hospital in Iran. Infection Control & Hospital Epidemiology, 1-6. doi:10.1017/ice.2020.164
World Health Organization (2020), Interim recommendations on obligatory hand hygiene against transmission of COVID-19, Available from: https://www.who.int/who-documents-detail/interim-recommendations-on-obligatory-hand-hygiene-againsttransmission-of-covid-19
Archarya, Rajib; Gundi, Mukta; Ngo, Thoai D.; Pandey, Neelanjana; Patel, Sangram K.; Pinchoff, Jessie; Rampal, Shilpi; Saggurti, Niranjan; Santhya, K.G.; White, Corinne; Zavier, A.J.F. (2020) “2020PGY_CovidIndiaKAPRiskPerceptionBrief.pdf”, COVID-19-related knowledge, attitudes, and practices among adolescents and young people in Bihar and Uttar Pradesh, India, Available from: https://doi.org/10.7910/DVN/8ZVOKW/AYIJGO, Harvard Dataverse, V3.