Musings for Patient Strategy During Covid 19 Epidemic

A major fallout of the global shutdown and the Covid-19 scare has been the relative neglect of patients suffering from cancer. Guidelines have been written by several societies to ensure that the hospitals remain empty to prepare for the deluge of Covid-19 patients and India has been no different.

Due to the national lockdown, patients have not had access to potentially curative treatment. Guidelines by several societies adds to further confusion. Not following guidelines is looked down upon by colleagues and other consultants as being reckless.

However, the situation begs the question of challenging the qualification of those writing the guidelines. This pandemic is an unprecedented event and the last time such a global health scare happened was in 1918 with the Spanish flu that claimed around 50 million lives.

course, those were different times when medical science was in its infancy. Policy and guideline makers of today have themselves never faced this situation and it would not be wrong to think that their guess at how to handle this situation is as accurate or as flawed as yours or mine.

As it stands in Mumbai city, most hospitals are running at half strength with added precautions, which is appreciable. But several of them are not allowing elective cancer surgeries to decrease the potential workload and exposure of the healthcare staff to the corona virus.

The fallout of this situation is that potentially curable patients are having their surgeries delayed as only life-saving emergencies are allowed. Medical Oncologist are wary of giving aggressive chemotherapy as net-adjuvant therapy because they fear that if the patient develops febrile neutropenia, the patient will be clubbed with Covid-positive or indeterminate patients in the isolation wards, where the medical oncologist and the patient will have a high risk of contracting the Covid infection.

In solid organ malignancies, expensive therapies are justified for a few months of survival benefit because we know that every bit matters.

The greatest survival benefit is from a complete and timely surgery and adjuvant therapy, and in anticipation of the “deluge” of Corona patients, we are depriving patients of this benefit. In countries like Italy and United Kingdom, where there is national health and the treatment of the patients is completely sponsored by the state, this kind of triage of resources is justified.

But in India, where the patient pays for his or her treatment, to subject the patient to sub-standard treatment in anticipation of infective cases, and to lay down guidelines to that effect, could be considered superfluous and unjust, to put it mildly.

As a private practitioner, where the patient puts his faith and money on line, expecting standard of care for his disease, I find it morally and ethically challenging to recommend treatment according to these so called guidelines. This is not in criticism of the policy makers; and I don’t know the right way out.

What I do know is that if a patient and his family has put their faith in me to deliver quality care for their life-threatening illness, the least I can do is treat it to the best of my ability and be honest about it.