Medi snips | Sunday Observer

Medi snips

26 April, 2020

Oncologists offer guidelines to patients, health staff, to  minimise risks of  COVID

Rising concerns of health officials  dealing with patients with cancer who could be exposed to  COVID-19 leading to further complications in their already lowered immunity systems, has prompted the  Sri Lanka College of Oncologists ( SLCO)  to  issue a set of guidelines to all cancer patients. Warning cancer patients islandwide that the virus now spreading across Sri Lanka and the world should not be taken lightly ,and could be specially harmful to cancer patients with impaired immune systems, they have emphasised  that cancer patients should  minimise close contact with infected persons at all times.

The guidelines given to patients include the following:

1.            Patients who have completed active treatment, please refrain from coming to clinics, follow up radiological investigations (Ultra sound scans, CT scans, Mammograms etc) till further notice.

 2.           Patients who have completed cytotoxic treatment (Chemotherapy, radiotherapy, surgery) but who need ongoing medicine (Tamoxifen, thyroxine etc) please send a responsible person with the relevant documents to collect them from hospitals.

3.            Patients who are on active treatment (chemotherapy, radiotherapy or planned surgeries for cancer), will need to attend hospital as previously planned. Please note relevant units will decide if treatment need to be modified on a case by case basis.

4.            If you have any respiratory symptoms (Cough, fever, shortness of breath) please contact the nearest hospital. If you have reason to suspect you have got COVID-19 infection (Above symptoms and recent foreign travel or contact with a confirmed COVID-19 patient) please contact the closest designated COVID-19 treatment center, and do not directly visit an oncology unit.

“These measures are taken to minimize the risk of COVD-19 virus to cancer patients of Sri Lanka. New dates will be given for all missed appointments when the acute period is over. Please contact your own cancer treatment unit for further clarifications” the media release has  reiterated. 

Health Ministry sources told the Sunday Observer that  the Director General of Health Services Dr Anil Jasinghe has  informed all Provincial Directors of Health Services, Regional Directors of Health Services, Directors of National Hospital /Apeksha Hospital,Teaching Hospitals/Provincial and District General Hospitals, all Medical Superintendents of Base Hospitals, all Regional Epidemiologists of the  Interim Guidelines for Management of Cancer Patients during the OutbreakofCOVID-19 Infection

 In a statement he has said  that an  interim guideline for management of cancer patients, which had been  prepared  based on the recommendations of the College of Oncologists  would be  effective until further notice. The objective of this guideline is to utilize the limited hospital resources effectively to manage the  cancer patients during period of the current outbreak and to arrange optimum care for cancer patients suspected/confirmed with COVID-19 while minimizing exposure to health care staff, in—ward patients and patients attending the OPD/clinics, he pointed out.  The guideline  intended for all health care personnel involved in cancer care services includes the following instructions:

1. Deferring routine clinic visits of all patients who have completed active treatment and are currently being followed up for surveillance

2. For patients who are on long-term systemic anti-cancer medications without risk of immune suppression (e.g. hormonal therapy for breast cancer), individual oncology units should facilitate issuance of these medicines minimizing person to person contact. Within the, constraints of logistical limitations drugs could be issued for a minimum of two months.

3. For patients who are currently on systemic anti-cancer medicine and are at risk of immune suppression, treatment continuation should be considered after weighing risks and benefits. This might mean withholding anti-cancer medicine for some patients.

4. New patients who are awaiting initiation of systemic anti-cancer medications should have their treatment decisions made after considering and discussing the risks and benefits. This may mean deferring or not recommending treatment in some patients.

5. Consider deferring non-urgent radio therapy treatment (e.g. prostate cancer)for an appropriate period of time. To minimize hospital visits, consider hypo—fractionated treatment schedules where appropriate (e.g. single dose for pain relief).

6. Patients who are on active systemic anti-cancer treatment and who meet the current definition of a  suspected COVID— l9 infection should follow the national guidelines and seek treatment from recommended centres. They are discouraged from visiting oncology units directly.

7. Clinical decisions should be individualized considering patient, disease and treatment related factors.

COVID 19 pandemic can spike child cruelty impact development  - SLACD Head

The islandwide lockdown leading to long hours of being cooped inside the confines of their homes has led to a surge in child cruelty by parents and adults living in the same house according to recent child rights activists . The Sunday Observer spoke to the President, Sri Lanka Association for Child Development ( SLACD ) Dr Saraji Wijesekara on how COVID 19  has impacted the mental and physical development of young children caught up in this  sudden disruption of their normal daily routines without knowing why exactly.

Dr Wijesekara said as a community we should understand that this is a pandemic and this is the first time most of us are experiencing this kind of a global emergency. “Covid 19 pandemic hit Sri Lanka on March 10, 2020 when the first Sri Lankan patient was detected. Since then patients are being detected in different districts of the country. To contain the infection of COVID 19 the Government closed all schools, universities and other academic institutions and later the government and private sector workplaces imposing an islandwide curfew. Both children and parents are confined to the home with no opportunity to go out and play and no entertainments. Parents who are working outside their homes are frustrated as they now engage in daily chores at home. Although it seemed  a good break initially, as the lockdown extended for over a month the level of anxiety and frustration among all, especially children has been building up. Because of this, we as adults should realize that children of all age groups are under immense stress and  may act differently not understanding the real situation”, she said.       

She said children of parents of essential services also suffer from depression and anxiety when their parents have to remain at work longer than the usual hours sometimes even days not visiting them. As a result these children are neglected as they are cared for by either grandparents, relatives, neighbours or older siblings. In addition  carers who have also been continuously housebound with no external relationships may find it difficult to deal with having the children  at home all the time and may take out their mental frustrations on the children. “Don’t bully, punish or abuse them physically and psychologically when you are under stress over financial or professional issues, as your arrogance  will cause more mental stress in their lives”, she warned.

Instead, she suggested that carers of children should spend time with them engaging in stress relieving activities .games and also helping them with school assignments.

Dr Wijesekara said this period could see a spike in sibling rivalry which could increase the level of cruelty within the  home . “Sibling rivalry begins for example when one child grabs the only television set or any other electronic device at home and engages with it most of the time. When the gaps in ages of siblings vary, their choices become more diverse.” She also highlighted that when parents whose daily income from some trade they are engaged in have been closed due to the curfew, it  results in  them unable to purchase  food and basic needs for their families. “Children of such families  are victimized by verbal, physical and mental abuse and their psychological status could be vulnerable,” she said.

She said marital disharmony and wife battery which could also surge at this time could harm children physically and psychologically.

She pointed out to the plight of children who get quarantined either in their own homes, locked down villages and centers. “The vulnerability of these children for psychological stress is immense and may impact their future self-esteem. The children of persons who are affected by the disease and die due to the disease may suffer guilt and fear as the community would point fingers at them in schools and other public places and may even threaten them to death or physical abuse,” she warned.

Summing up she observed that any kind of cruelty towards young people may affect their future lives in different ways. “It is thus imperative that we understand the situation and try to avoid bullying and physical, verbal and psychological abuse of children in this special situation,” she reiterated.