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The coronavirus outbreak has affected millions of people in more than 210 countries and territories around the globe, and the world’s governments are currently struggling to contain its spread through different health and socio-economic measures.
A surge in the number of infections has also been apparent in Southeast Asia. The WHO has acknowledged the presence of infection clusters in India. As of April 16, India’s Ministry of Health and Family Welfare reported 13,387 people in the country had tested positive for COVID-19, and 437 had been killed by it. In a seemingly desperate effort to preemptively slow the virus’s transmission through India, Prime Minister Narendra Modi announced a nationwide lockdown from March 24 for 21 days. But the ill-planned effort rendered lakhs of labourers around the country jobless, unsafe and hungry.
Indeed, many groups of people around the country are in one way or another more susceptible to COVID-19 than they would be were it not for preexisting socio-economic and/or health conditions. And even when the government may not be directly responsible for their current plight, it has a responsibility to protect them that it can’t abdicate.
One such group is of people suffering from cancer. The anti-coronavirus lockdown has exacerbated their bio-psychosocial health issues. In this crucial time, they haven’t received due attention, and the lockdown has been blind to them like it has been blind to anyone else with chronic illnesses that need uninterrupted medical care.
In India, cancer is the second most common disease and accounts for 10% of all registered deaths every year. According to a study published in 2018, around 1.16 million people in India developed cancer in that year, 2.25 million people already had cancer and 0.78 million died of cancers.
Cancer patients are more susceptible to a COVID-19 infection than those without cancer because their immune systems have been compromised by the cancer itself or suppressed by treatment (and side-effects). Specifically, according to a report drafted jointly by the WHO and China, cancer patients are estimated to be at twice as much risk of developing COVID-19 than the general population. A 2020 study also reported higher incidence and risk of severe complications among cancer patients from the virus, including requiring ICU admission and invasive ventilation, and in some cases resulting in death.
There are no guidelines for cancer care according to the kinds of cancer, treatment types and a patient’s demographic profile vis-à-vis COVID-19. So for cancer patients who are more vulnerable to COVID-19 than others, the foremost risk is inability to receive essential services, including cancer-specific treatment such as radiotherapy and chemotherapy, and to receive them continuously. Indeed, patients receiving radiotherapy need to visit the hospital five or six days every week, and are advised not to skip their treatment.
However, most public transportation has been suspended with the lockdown, and the government has advised citizens to isolate themselves and follow physical distancing norms. Additionally, there aren’t many hospitals in India that offer cancer-specific treatments, and most of them are located within cities, posing an additional challenge to patients from remote areas.
Hospitals’ supply of drugs has also been hit, as has the attendance and workforce participation of hospital personnel (clinical and non-clinical). For example, many hospitals aren’t offering medical services to newly diagnosed or symptomatic patients attending their OPDs. Services are extended to the patients on a priority basis.
Considering the high risk of contracting COVID-19, many patients with weak immune systems have discontinued their treatment (esp. radiotherapy and chemotherapy) in an attempt to improve their chances of fighting off a COVID-19 infection.
Many hospitals, including the Silchar Medical College and Hospital and the Cachar Cancer Hospital in Assam1, have temporarily limited the amount of palliative care for patients considering their higher vulnerability to COVID-19. These patients have instead been advised to stay at home, and visit the hospital only in case of an emergency.
Aside from their direct effects, all of these measures also imperil patients’ mental health and wellbeing. For instance, the physical distancing stipulation could render cancer patients to feel lonelier than they already do. And all these issues could in turn result in poor prognosis and survival rates.
Nobody disagrees that the coronavirus pandemic has presented India – and every other country – with a crisis, but a crisis is no excuse to focus all of one’s efforts on one disease at the expense of many others. Considering the serious medical and emotional needs of patients, the government needs to issue scientifically drafted guidelines about managing cancer patients and handling their care against the backdrop of the COVID-19 outbreak. Further, health professionals engaged in cancer care also have a responsibility to communicate information about appropriate medical care, practice modifications and treatment regimens to the people in their care.
Finally, it’s high time that we mounted a collective effort to ensure that all medical interventions are relevant, appropriate and healthy.
Firdous Barbhuiya is a senior research fellow at the Tata Institute of Social Sciences, Mumbai. Farhana Yasmin Laskar is a medical social worker at the Cachar Cancer Hospital and Research Centre, Assam.
Where one of the authors works↩