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 Table of Contents  
EDITORIAL
Year : 2020  |  Volume : 11  |  Issue : 2  |  Page : 39-40

Hematologists' adaptations and contingency plans to the coronavirus disease-2019 crisis


Division of Adult Hematology and Stem Cell Transplantation, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Date of Submission15-May-2020
Date of Decision17-May-2020
Date of Acceptance19-May-2020
Date of Web Publication28-Jul-2020

Correspondence Address:
Dr. Riad El Fakih
Division of Adult Hematology and Stem Cell Transplantation, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joah.joah_71_20

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How to cite this article:
El Fakih R. Hematologists' adaptations and contingency plans to the coronavirus disease-2019 crisis. J Appl Hematol 2020;11:39-40

How to cite this URL:
El Fakih R. Hematologists' adaptations and contingency plans to the coronavirus disease-2019 crisis. J Appl Hematol [serial online] 2020 [cited 2020 Aug 6];11:39-40. Available from: http://www.jahjournal.org/text.asp?2020/11/2/39/290963

Our life has changed radically by the coronavirus disease-2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2).[1] Lockdowns, social distancing, and curfews have become ordinary. It is a new disease with no curative treatment and lots of uncertainties. With uncertainty comes fear, anxiety, worry, and despair. Efforts are ongoing to understand every aspect of the virus and the host, including the biology, epidemiology, pathophysiology, diagnosis, treatment, and susceptibility of special patient subgroups. Research to develop a vaccine and many investigational products are being explored.[2],[3] The pandemic started the late 2019 in Wuhan, China, and marched relentlessly to spread all over the world. As at the time of writing this letter, more than 3.2 million cases and 230 thousand deaths have been confirmed (https://covid19.who.int/). Healthcare workers have rapidly learned about the infectivity, the efficiency of transmission, and the case-fatality rate of this new disease, and this had important implications for containment and mitigation strategies.[4] It is estimated that each infected person spreads the infection to an additional two persons and that the case-fatality rate is close to the severe seasonal influenza rather than SARS-CoV and Middle East respiratory syndrome-CoV. Importantly, the case-fatality rate depends on the denominator which is the total community infections, which in turn depends on the scale of screening and testing in the community.[4],[5],[6] Data emerging from China and other countries show that cancer patients probably have an increased risk of complications and intensive care unit (ICU) admission. The number of cancer patients is small, and patients had different cancers and were in different phases of their therapy; in addition, no information was provided about their other risk factors and comorbidities.[7],[8],[9] In hematological malignancies, the American Society of Hematology reported 43 cases, and of these, around 30% had a severe form of the infection and around 30% died (COVID-19 Registry for hematologic malignancies. https://www.ashresearchcollaborative.org/covid-19-registry/malignant/data. Last accessed on April 20, 2020). The WHO issued clear recommendations (social distancing, widespread testing, quarantine of cases, and contact tracing) to limit the scale of the pandemic. Many national governments responded swiftly; however, many countries did not follow these recommendations in either the hope of containment elsewhere or a mood of fatality. These initial slow responses, a patchwork of harmful initial reactions from leaders, and putting off preparations now look increasingly poorly judged. Healthcare systems are overwhelmed globally, and fragile ones can crush easily. Strong proactive actions, securing testing kits and medical supplies, and sharing information timely and clearly will boost confidence and collaboration between patients and providers. As hematologists, we take care of a wide variety of diseases that range from mild to life-threatening. Some patients need immediate attention, while others can be watched without intervention, and some patients have many alternatives, while others have limited options. Patients with hematologic disorders are usually managed in a multidisciplinary approach and decisions can be complex. Now, with this outbreak, another layer of complexity is added and providers are asked to balance the appropriate patient plan, with the appropriate precautions to protect the patients, themselves, and the community. Flexible guidelines accounting for the constant stream of information and the rapidly changing conditions are urgently required. We recommend to factor in several variables when writing local guidelines. These include, but are not limited to, the curability of the disease, patient's age and comorbidities, alternative therapies, availability of ICU beds, the functional capacity of the healthcare system including transfusion support, and the local epidemiology available about the prevalence of COVID-19 in the community. In addition, in the absence of solid data, we recommend diligent preventive care measures, full supportive care for immunosuppressed patients to minimize the risk of infection, limiting patient visits to the hospital when possible, and using telecommunication technology.

Finally, awaiting a better understanding of this disease, we as providers for this group of vulnerable patients are responsible to use formal reasoning and logical thinking alongside with inference, judgment, and local as well as international expert opinions to help our patients during this difficult time.



 
  References Top

1.
Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020;395:470-3.  Back to cited text no. 1
    
2.
World Health Organization. DRAFT Landscape of COVID-19 Candidate Vaccines. World Health Organization. Available from: https://www.who.int/blueprint/priority-diseases/key-action/novel-coronavirus-landscape-ncov.pdf 2020. [Last accessed on 2020 May 05].  Back to cited text no. 2
    
3.
World Health Organization. WHO R&D Blueprint: Informal Consultation on Prioritization of Candidate Therapeutic Agents for Use in Novel Coronavirus 2019 Infection. Geneva, Switzerland: World Health Organization; 2020.  Back to cited text no. 3
    
4.
World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report-36. Geneva: World Health Organization; 2020.  Back to cited text no. 4
    
5.
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.  Back to cited text no. 5
    
6.
de Wit E, van Doremalen N, Falzarano D, Munster VJ. SARS and MERS: Recent insights into emerging coronaviruses. Nat Rev Microbiol 2016;14:523-34.  Back to cited text no. 6
    
7.
Dai M, Liu D, Liu M, Zhou F, Li G, Chen Z, et al. Patients with cancer appear more vulnerable to SARS-COV-2: A multi-center study during the COVID-19 outbreak. Cancer Discovery. 2020:CD-20-0422. doi: 10.1158/2159-8290.cd-20-0422.  Back to cited text no. 7
    
8.
Miyashita H, Mikami T, Chopra N, Yamada T, Chernyavsky S, Rizk D, et al. Do patients with cancer have a poorer prognosis of COVID-19? An experience in New York City. Ann Oncol 2020 Apr 21:S0923-7534(20)39303-0. doi: 10.1016/j.annonc.2020.04.006. Epub ahead of print. PMID: 32330541; PMCID: PMC7172785.  Back to cited text no. 8
    
9.
He W, Chen L, Chen L, et al. COVID-19 in persons with haematological cancers. Leukemia 34, 1637–1645 (2020). https://doi.org/10.1038/s41375-020-0836-7.  Back to cited text no. 9
    




 

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