Information on precautions and preliminary protective measures against Coronavirus-19 for persons in villages and remote areas and rural health care workers

The information in the document is meant to provide health education information that persons in rural and remote communities can use as a first line of management against coronavirus-19. The information is not meant to replace medical advice or any government advisory on medical practices. Any person with worsening symptoms or signs must consult a qualified medical doctor immediately.

It is important that rural and remote areas of India receive adequate information about Coronavirus so that the effects of the virus on these communities can be minimized as much as possible.
Medical care in these communities is restricted to primary health centres and community health centres that are run by the government and non-government sectors, small community hospitals, individual doctors of different medical streams and community- based health care providers who may not have a formal health care education.
The resources available and persons and quality available will differ from region to region and the information in this document must be adapted to your setting.
Always ensure that you follow all guidelines and instructions issued by the local government agencies. This document does not replace those instructions.

  1. What should I look for to know if people have coronavirus?

2. If the person HAS ONLY THE GREEN signs and DOES NOT HAVE any RED Signs
a. They are considered low risk.
b. Do not be afraid. Most (up to 85%) low-risk people recover and do not need hospital admission.
c. Drink enough water.
d. Eat warm food.
e. Take rest, do only light activities.
f. Stay in your house and do not go out. Keep windows open.
g. Wash hands with soap and water regularly
h. Clean your own clothes with soap and water.
i. Wipe or wash anything you touch or use with soap and water.
j. Wear a mask at all times. Use an N95 or medical mask or use two masks.
k. Stay at least 3 meters away from other people.
l. If you have a fever, take paracetamol 500 mg 4 times a day for 3 to 5 days.
m. If you have a runny nose, take cetirizine tablet 10mg one tablet once a day at bedtime for 3 to 5 days.
n. Warm gargles with water and salt
o. Use Nasal saline drops if the nose is blocked.
p. If you do not feel better after 3 to 5 days or become worse before that, consult your doctor immediately.

3. What should I do if I find anyone with high risk?
a. Immediately inform your village health worker and the primary health centre doctor or the doctor treating you
b. Check with a doctor if can be managed at home or should be shifted to a higher centre.
c. Make sure everyone including the patient is wearing a mask.
d. Make sure that everyone washes their hands with soap and water before and after they touch anything the patient uses.
e. Make sure that everyone maintains a distance of at least 3 meters from each other.
f. Use gloves or hand coverings if you have to touch the patient.
g. Contact your village authorities to ensure smooth care for the person including transport if necessary.

4. How do I know if the patient is developing shortness of breath or finding difficulty in breathing?
a. Place a 2 rupee coin on the chest of the patient.
b. Count how many times it rises in a minute. Count only the number of times it goes up with breathing.
c. Keep counting for one minute.
d. If the coin rises with the chest more than 24 times in a minute, the patient has difficulty in breathing. Inform the village health worker and doctor immediately.
e. Have the patient lie face down with face turned to one side.
f. After 1 -2 hours, ask the patient to lie on the right side. After another 1-2 hours ask the patient to lie on the left side. Then ask the patient to lie face up for an hour and then again lie face down.
g. Wash the coin with soap and water after use.
h. Give oxygen only if and as advised by doctor.
i. Do not give any medicine unless the doctor tells you to.

  1. How do I know if the temperature of the patient is increasing?
    a. Monitor temperature with a thermometer. Wipe the thermometer after each use.
    b. Wet a cloth like a small thin towel. Twist it to take away extra water, and then place on the place on the forehead of the patient if you do not have a thermometer. If it dries very fast within 5 to 10 minutes and you have to replace the cloth fast, inform your village health worker and doctor.
    c. Cool the body by placing wet clothes on the forehead of the patient.
  2. How can I keep my village safe?
    a. Avoid big gatherings, functions, weddings, crowds.
    b. Maintain social distance. Do not go near other people or let them come near you. Greet and talk to people from a distance.
    c. Wear a mask at all times.
    d. Avoid going out unless necessary.
    e. Wash your hands with soap and water regularly, before and after eating, after coming from outside, before cooking, cleaning etc
    f. Wash your mask with soap and water after use.
    g. Do not touch your face without washing your hands with soap and water.
    h. Do not spit in open places.
    i. Do not shout in public places.
    j. Do not cough or sneeze into open spaces. Cover your mouth and cough or sneeze into a folded elbow.
    k. Clean the things you use regularly.
    l. Keep your surroundings clean.
    m. Take care of your health, the health of your family. Inform the village health worker if you do not feel well.
    n. Discuss with your village authorities and make sure you have the telephone numbers of village health workers and primary health centre doctor with you.
    o. Discuss with the village authorities and check if a dedicated vehicle can be there to transport people who need further care.
    p. Discuss with the village authorities how you can help others in the village.
  3. What should I NOT do?
    a. Take medicines only as advised by your doctor. DO NOT TAKE MEDICINES unnecessarily saying I took this earlier for fever,
    b. Do tests only as advised by your doctor. DO NOT go and ask for a chest X ray or a CT scan or blood or urine tests without the doctor advising you to do a test.
    c. 85 of 100 people will have only mild symptoms and will not need hospital admission. DO NOT be afraid and try to use medicines on your own
  4. Who needs home quarantine?
    All households and close contacts of confirmed and suspect cases must be home quarantined.
    A contact is a person who is:
    a. Providing direct care without proper personal protective equipment (PPE) for COVID-19 patients
    b. Staying in the same close environment as a COVID-19 patient (including workplace, classroom, household, gatherings).
    c. Traveling together in close proximity (1 m distance) with a COVID-19 patient in any kind of conveyance within a 14‐day period after the onset of symptoms in the case under consideration
    d. Has returned to village from a place with high Covid rates
  5. What is the duration of home quarantine? (Check latest guidelines)
    People who are home quarantined must be followed up till the time test results of the suspect case (whose contacts are being home quarantined and followed up) comes negative.
    All persons with a positive test result become ‘true’ contacts and have to be home quarantined for 14 days and followed up till test results become negative.
  6. What are the best ways to stop the virus?
    a. Social Distancing
    b. Masks
    c. Regular wash with soap and water
  7. Does everyone need saline drips or oxygen?
    a. No. give saline drips or oxygen only as advised by doctor.
    b. Take enough water.
  8. What food should I eat?
    a. Eat the locally grown and available food and home-cooked food.
    b. Eat warm food or freshly cooked food.
    c. Eat lightly so that you do not feel hungry and don’t overeat.
    d. Use less salt, masala and sugar.
    e. If possible, eat bananas, guava and other locally available fruits.
    f. Eat green leafy vegetables and locally available vegetables.
    g. Use less oil while cooking.
    h. Use less chilly or Mirchi power.
    i. Use turmeric, ginger and garlic while cooking.
    j. If neem trees are available, chew a few neem leaves daily.
    k. Have buttermilk daily.
    l. Take tender coconut water if it is available.
    m. Sip warm and cooled water at regular intervals

    Anyone can get COVID. Most people get only a mild form. Do not be afraid.
    We can help each other. We can work with the village authorities to see every family has food and water.
    Keep yourself safe and keep your family safe. That will keep you and others in the village safe.
    Make sure the phone numbers of health workers and doctors are available and the village has access to some transport system to take people who need care.
    Inform everyone who comes to the village about the safety precautions to be taken.
Dr Praveen Nirmalan

Written by Dr Praveen Nirmalan

Dr. Nirmalan did his basic medical education from Thrissur, Kerala and followed it with a PG Diploma in Ophthalmology from Aravind Eye Care System, Madurai and a Vitreo-retinal Fellowship from Mumbai. Subsequently, he completed his MPH and a Public Health Ophthalmology Fellowship from the Johns Hopkins School of Public Health in the USA. He has led community-based and clinical research in some of the top eye care institutes of India and led a clinical research program at a top tier obstetric and neonate institute as well. He has experience chairing Ethics Committees and has helped with the setting up of Institutional Review Boards. Besides mentoring clinical faculty, he has mentored DNB and PhD students through their dissertation work and research methods.

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