Continuing cancer surgery through the first six months of the COVID-19 pandemic at an academic university hospital in India: A lower-middle-income country experience.

BACKGROUND: The novel coronavirus pandemic (COVID-19) hinders the treatment of non-COVID illnesses like cancer, which may be pronounced in lower-middle-income countries. METHODS: This retrospective cohort study audited the performance of a tertiary care surgical oncology department at an academic hospital in India during the first six months of the pandemic. Difficulties faced by patients, COVID-19-related incidents (preventable cases of hospital transmission), and modifications in practice were recorded. RESULTS: From April to September 2020, outpatient consultations, inpatient admissions, and chemotherapy unit functioning reduced by 62%, 58%, and 56%, respectively, compared to the same period the previous year. Major surgeries dropped by 31% with a decrease across all sites, but an increase in head and neck cancers (p = .012, absolute difference 8%, 95% confidence interval [CI]: 1.75% - 14.12%). Postoperative complications were similar (p = .593, 95% CI: -2.61% - 4.87%). Inability to keep a surgical appointment was primarily due to apprehension of infection (52%) or arranging finances (49%). Two COVID-19-related incidents resulted in infecting 27 persons. Fifteen instances of possible COVID-19-related mishaps were averted. CONCLUSIONS: We observed a decrease in the operations of the department without any adverse impact in postoperative outcomes. While challenging, treating cancer adequately during COVID-19 can be accomplished by adequate screening and testing, and religiously following the prevention guidelines.

Searching for answers: Cancer care during the COVID pandemic.

The unprecedented novel coronavirus disease pandemic has wreaked havoc on healthcare systems worldwide and raised myriads of questions. The delivery of cancer care is an essential service that cannot take a backseat, even amid a global pandemic. Oncology involves the disciplines of surgical oncology, radiotherapy, chemotherapy, and palliative care which are all affected, including the possible impact of the pandemic on the mental health of patients and healthcare workers alike. This commentary attempted to review these questions in light of the best available evidence. The delivery of cancer care is generally safe when routine safety precautions are followed, and decisions are based on rational scheduling and logistical prioritisation. The impact on the mental health is profound that needs to be addressed with adequate avenues. Teleoncology is a reasonable alternative, whenever applicable. Evidence-based decision making should be the standard of care, and multidisciplinary management decisions are as indispensable as ever.

Assessing the interplay between travel patterns and SARS-CoV-2 outbreak in realistic urban setting.

BACKGROUND: The dense social contact networks and high mobility in congested urban areas facilitate the rapid transmission of infectious diseases. Typical mechanistic epidemiological models are either based on uniform mixing with ad-hoc contact processes or need real-time or archived population mobility data to simulate the social networks. However, the rapid and global transmission of the novel coronavirus (SARS-CoV-2) has led to unprecedented lockdowns at global and regional scales, leaving the archived datasets to limited use. FINDINGS: While it is often hypothesized that population density is a significant driver in disease propagation, the disparate disease trajectories and infection rates exhibited by the different cities with comparable densities require a high-resolution description of the disease and its drivers. In this study, we explore the impact of creation of containment zones on travel patterns within the city. Further, we use a dynamical network-based infectious disease model to understand the key drivers of disease spread at sub-kilometer scales demonstrated in the city of Ahmedabad, India, which has been classified as a SARS-CoV-2 hotspot. We find that in addition to the contact network and population density, road connectivity patterns and ease of transit are strongly correlated with the rate of transmission of the disease. Given the limited access to real-time traffic data during lockdowns, we generate road connectivity networks using open-source imageries and travel patterns from open-source surveys and government reports. Within the proposed framework, we then analyze the relative merits of social distancing, enforced lockdowns, and enhanced testing and quarantining mitigating the disease spread. SCOPE: Our results suggest that the declaration of micro-containment zones within the city with high road network density combined with enhanced testing can help in containing the outbreaks until clinical interventions become available.