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Table of Contents
RESIDENTS CORNER
Year : 2020  |  Volume : 3  |  Issue : 5  |  Page : 92-93

Life and training in the time of corona


1 Department of Hematology and Oncology, Ascension St. John Hospital and Medical Center, Detroit, Michigan, USA
2 Department of Hematology and Oncology, Henry Ford Cancer Institute, Detroit, Michigan, USA

Date of Submission13-Apr-2020
Date of Acceptance13-Apr-2020
Date of Web Publication25-Apr-2020

Correspondence Address:
Sindhu Malapati
Department of Hematology and Oncology, Ascension St. John Hospital and Medical Center, Detroit, Michigan
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_153_20

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How to cite this article:
Malapati S, Singh SR. Life and training in the time of corona. Cancer Res Stat Treat 2020;3, Suppl S1:92-3

How to cite this URL:
Malapati S, Singh SR. Life and training in the time of corona. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Dec 1];3, Suppl S1:92-3. Available from: https://www.crstonline.com/text.asp?2020/3/5/92/283312



It is a truly unique situation for people in the health-care field at this time. We are a physician couple currently pursuing Hematology and Oncology Fellowship training in Detroit. Our city is among the hardest-hit places in the United States of America by the COVID-19 pandemic, and it is also a place where all the health-care workers have come together as one to fight this disease. It all started with news reports from China a couple of months ago, followed by our European colleagues warning us about the tremendous social effects and health-care burden of the COVID-19 pandemic. The pandemic has, for sure, humbled our generation, and it continues to give us valuable lessons in practically every aspect of life.

Given that both of us are physicians, coming in contact with multiple people on a daily basis, including patients and hospital staff, we were naturally wary of bringing the infection home. Therefore, we effected a protocol which, in addition to the practice of compulsive hand hygiene, included wearing a mask at all times in the hospital, leaving shoes outside the house, decontaminating the phones and keys, showering immediately after returning home, and washing work clothes daily. We also made it a point to avoid eating and drinking while in the hospital. The fact that many of our neighbors are elderly was all the more reason to socially isolate ourselves stringently. In addition to this, there was an added concern of our family's well-being back in India. Not a day has passed without anxious phone calls with our parents, with discussions centered mainly around updates on health and recommendations on social isolation. Many of our colleagues with young children or vulnerable family members at home had to take additional measures to protect their loved ones, such as sleeping in the garage or checking into a hotel to avoid infecting their family members.

The hospital administration took on the herculean task of responding to a previously unknown threat. They acquired and disseminated information in real time, put an effective workflow in place, and adapted remarkably in this time of great stress. We have been lucky since our hospitals have been able to provide us with adequate personal protective equipment and masks as we dealt with patients who had tested positive for the novel coronavirus. We know friends from more severely affected cities, especially New York, who were not so lucky.

Our hematology and oncology departments have been very proactive in protecting our patients who are immunocompromised and at very high risk of decompensating if they contract the infection. The departments have also been doing their utmost to protect the staff members; they have staggered the staff visits, so that only the essential number of people required to provide adequate coverage is present in the hospital. The way we practice oncology has undergone a seismic shift over the past few weeks. The nonurgent clinic visits have been rescheduled as much as possible, without compromising care. The biggest change was the rise of telemedicine, which is working surprisingly well, even with our older patients (where we initially thought that technology would be a barrier). It places less burden on the patients and allows adequate medical supervision of oncologic care. The patients have been very flexible and graceful in adjusting to all the demands that have been placed on them by the pandemic. Telemedicine is uniquely suited to the current situation, given the concern about workforce capacity, where a large number of health-care workers may be quarantined at home but are still able to perform the cognitive work that is required of them. The office staff and nurses have been the backbone of this flexible response and adoption of telemedicine in clinics. While it has been a big change for the entire system, telemedicine may be the way of the future. However, its long-term feasibility remains to be evaluated.

A study published in The Lancet reported that the risk of death or requiring intensive care was up to 5 times higher among patients with cancer affected by COVID-19 than in those without cancer.[1] Patients on chemotherapy can be quite tenuous, and their risk of developing febrile neutropenia, dehydration, infections, and side effects from chemotherapy is unchanged by the fact that there is an ongoing pandemic. To avoid patients being exposed at the hospitals, we have been trying our best to manage many of these situations from the clinic and over the phone while sending patients to the hospital only when absolutely necessary. Perhaps, this increased level of caution exercised by the patients with cancer and providers has led to the adoption of stricter precautions early on. We have anecdotally noted that only a very small proportion of those admitted because of the COVID-19 infection were patients with cancer. Talking to many patients and family members has made us realize how difficult it is for them to try and manage their symptoms at home, with no medical staff available on hand and with the fear of getting exposed to COVID-19 when they go to the hospital. The hurdles we face in oncology are less acute than those faced by the frontline workers but are equally challenging. Some of our hospitalized patients who are seriously ill are unfortunately unable to have their families at their bedside because of the restrictions on the number of visitors to limit the spread of the infection. The hospital and physicians are again using technology to help bridge this gap. During these difficult times, the advice and expertise of our mentors along with their emotional support has proved to be invaluable.

There has been a growing nationwide concern that once the pandemic is controlled, we might see a subsequent rise in the cancer-related morbidity and mortality due to the current temporary deviations from standard of care owing to the ongoing pandemic. For example, despite attempts by the academic community to limit the effect of the current lockdown on patient access to clinical trials, several trials still had to be put on hold. At the same time, people have come up with novel ways to administer cancer care. One such example is from the University of Pennsylvania, where according to a Medscape report,[2] there was a 300% increase in home-based chemotherapy administration since the onset of the pandemic. Keeping up with the rapid explosion of information surrounding cancer care in the era of COVID-19 has been another major challenge. Multiple societies, such as ASCO, ASH, ISTH, ASTRO, ASTCT, and others, have released guidelines to help their members tailor their practice to the change in circumstances. Physicians as a community have done exceptionally well across national boundaries, in learning to operate in this data-deficient environment, based on rapidly evolving scientific updates, first-hand experiences, and institutional guidelines. However, there are many important questions that are still not fully answered, such as how does COVID-19 infection cause hypercoagulability or does COVID-19 infection lead to hemoglobinopathy-like changes which could be the reason for the disproportionately low oxygen saturations in awake and minimally symptomatic patients.

Over the past few days, the lines between subspecialties have blurred as everyone has stepped into their roles as doctors first and specialists later. There are oncologists running COVID wards and cardiologists working in intensive care units. However, the majority of the burden still lies with those on the frontlines – emergency room physicians, hospitalists, intensivists, nurses, and first responders. Many of our friends from residency training in Chicago and medical colleges in India are currently working on the frontlines. They are the true heroes in these tough times as they come into work smiling, day after day, despite the uphill task they face.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. Cancer patients in SARS-CoV-2 infection: A nationwide analysis in China. Lancet Oncol 2020;21:335-7.  Back to cited text no. 1
    
2.
Available from: https://www.medscape.com/viewarticle/928505. [Last accessed on 2020 Apr 12].  Back to cited text no. 2
    




 

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