Covid 19 is a pandemic by this time. As healthcare professionals first, we need to counter the panic and then the virus! As oncologists, we have a unique perspective in counselling patients affected by the dreaded disease. We just need to apply them universally and gently coax the individuals out of self-inflicted hysteria. Tackling this crisis requires a clear command of situation, communication and amplifying the guidelines from health authorities.
Based on my assessment, I am generating a “proposal” to highlight the precautions for patients undergoing radiation therapy as well as seize the opportunity to create an open dialogue as health care workers. Public Health is our responsibility too!
Here’s the list of ideas (and it is a proposal):
A. The initial step is to triage individuals- those with rhinorrhea, malaise or fever (or a combination of all).
B. Isolate and aggressively monitor vulnerable patients undergoing XRT:
- Head and Neck Tumours- especially those with affected swallowing/indwelling Ryles Tube or those having PEG Tubes and those undergoing chemotherapy.
- XRT for lung primaries. They have a range of possible issues because of compromised lung function- either due to XRT induced pneumonitis/primary disease itself.
- Other thoracic malignancies like Esophagus- where the lung component undergoing XRT is substantial.
- Gliomas and TMZ+XRT- to closely monitor the ANC (due to TMZ induced leukopenia).
These are the immediate top of the mind recall vulnerable subgroups. In case, the rationing happens for the surgical masks, these are the ones who would require them immediately.
It is essential to be aware of their symptoms; a continuous system of tracking symptoms needs to be developed. Fever or “runny nose” needs to be reported to the healthcare team. Assuming a patient is suspected of having acquired coronavirus, as radoncs, we need to take the call to prevent contact and have them tested according to the protocols as advocated by the health authorities of their respective countries.
A quarantine usually requires around 14 days (we are not sure about the viral “gestation” period, yet). It is a lot of downtime for those undergoing radiation therapy. As such, the discretion needs to be applied for a possible break in treatment.
It would also raise the issue of disinfecting the treatment couch for each subsequent treatments- as such, the radiation therapists need to be educated and informed in this respect.
I would also involve the infection control teams at this critical juncture- to define the contact period for disinfectants, for example.
As long as the pandemics are in place, it would be prudent to assume that all fevers are arising from coronavirus unless proven otherwise. It would be a subject of continuous monitoring and modify the statement after the pandemic ebbs.
There are some encouraging reports of a vaccine breakthrough, but by some accounts, it would take around 18 months before it can be pressed into service. We are not even sure how the pandemic pans out (since it is the early part of the infectious stage), but we need to be calm collectively.
More importantly, we need to redefine the follow-up protocols for those who have just completed Radiation Therapy- they are recovering for their mucositis/pneumonitis etc. Judicious use of steroids/antibiotics and an aggressive course of diet needs to be instituted. It would be an excellent idea to constitute home visits for those patients to monitor their symptoms.
I am still on the fence for remote telemonitoring. Notably, because such emergency measures have not had a thorough think-through and existing systems have several deficiencies. I would be hard-pressed to believe that they have been scaled up effectively. One way to look into them is to utilise methods for gamers like Twitch/Discord servers. I would stay away from solutions like Microsoft Teams or Google Hangouts only because they have not been proven to be scalable. Slack is a definite no-no. It only adds to the chaos of effective workmanship. As physicians, we have to juggle several hats- unfamiliarity with the video conferencing systems and remote telehealth would only exacerbate the dissatisfaction. On a technical level, it would be difficult to define their codecs/packet encryption, universal availability and ease of user interface for patients.
Let’s pool in our resources and collective thinking into generating the best response scenario for these pandemics and subsequent emergencies that may arise in the future.