Being Sensible and Optimistic during Pandemic
Outbreak of Coronavirus has been earth-shattering so far. Globally, over 27 lakhs cases and over 2 lakhs deaths have been reported till now. Fortunately, the spread and the damage by the devil in India is not as deep and wide as in the western world; something to cheer for in the time of crisis. There are multiple factors that contribute to the efficient containment of the extent of damage by the COVID-19 pandemic in India, including the differentiated immunity of the Indians evolved or acquired over time and the foresighted Lockdown by government of India. However, there are a set of soft targets of the Coronavirus that must remain cautious and take prophylactic precautions in order to be safe. I will elaborate on the specific population that carries a high risk of developing the infection and what precautions should they take.
The most comprehensive data available to date on the cancer-specific mortality rate is a 'Report of the WHO-China Joint Mission on Coronavirus Disease', published on February 28, 2020. This report indicates that in China, as of the data cut-off (February 20) the case fatality rate for patients with cancer as a co-morbid condition and laboratory confirmed infection was 7.6%. This is as compared to; 'overall, 3.8%', 'no co-morbid condition, 1.4%', 'cardiovascular disease, 13.2%', 'diabetes, 9.2%', 'hypertension, 8.4%', 'chronic respiratory disease, 8.0%. Though we can not extrapolate it to Indian population directly, we have something to refer to as a trend. There are several other reports published or under development which lack sufficient patient population as on today to be able to generalize the findings in a statistically significant manner. Those may become important point of references in future as they collect more data and update their findings.
Cancer patients who are under treatment or those who are survivors, fall into high risk category for COVID-19 infection; however with the appropriate preventive measures and adopting a few essential practices, the risk can be significantly reduced. Undoubtedly, practices like keeping social distance, frequent and proper hand washing, avoiding large crowds, keeping surfaces clean and disinfected and not touching the face when hands are not thoroughly washed are all good strategies for anyone but critically essential for cancer patients or survivors who are in a immune-compromised state of their health.
Those cancer patients who are on active treatment should consult their treating doctors about either the continuation / postponement of their treatment and the benefits or risks associated with it. Oncologists are advising cancer patients to postpone surgical interventions if the disease is not posing immediate threat to patients and offering them alternative interim treatment protocols to minimize the risk of disease progression. Patients who are on Injectable Chemotherapy are being asked to take alternative oral medications, if available and if it is too difficult for them to reach to hospitals or chemotherapy centers for administration of drugs. Patients are being covered with appropriate medications to prevent infections in them as well as advised to take extra care while on treatment. The option of delaying treatment to ongoing patients or postponing it for patients who were about to start treatment can not be generalized to every patient. We understand that some delays can be fatal and treating oncologists are the best judge to customize the treatment approach for their respective patients.
Patients under treatment should resort to telephonic or web based consultations for critical and trivial tasks like reporting cough, cold and fever, taking emergency prescriptions for acute toxicities, dose adjustments, supportive care recommendations etc; as well as the tasks like prescription renewals, interim follow-ups between the treatments, showing test reports etc. respectively. Mumbai Oncocare Centre encourages digital consultations for cancer patients wherever possible in the interest of the patient well-being during this pandemic. We have evolved and made ourselves technologically viable to support digital consultations through our new initiative, "Doctor on Screen"! We hope that the anxiety of our patients will be put to rest with this initiative.
Indians are trained by the circumstances to find out easy, cost effective yet efficient means to accomplish required tasks while the resources are limited or out of reach. There can not be a parallel measure to remaining Sensible and Optimistic during the time of COVID-19 pandemic.
Dr. Pritam Kalaskar
Director & Consultant Medical Oncologist
Mumbai Oncocare Centre
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