Encountering COVID in a Cancer Ward: Lessons in Infection Prevention
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Encountering COVID in a Cancer Ward: Lessons in Infection Prevention
We wish to highlight certain issues related to containing COVID-19 infection in a non-COVID facility: Non COVID facilities- low risk or high risk? In hospitals catering to both COVID-19 and non-COVID patients, albeit in separate buildings, COVID areas are considered high-risk, and non-COVID areas aree considered low risk. As per the MOHFW initial and revised guidelines on rational use of PPE, wards and ICUs in non-COVID areas continue to be marked low-risk [6.7]. As majority of COVID-19 positive in our country have been asymptomatic, it is only logical that many patients/attendants we encounter in non-COVID areas may be carriers of the virus, thus placing all the HCW in these areas at risk of infection. Thus the demarcation between low- and highrisk areas is no longer absolute. All HCW encountering patients (COVID or non-COVID) should take utmost precautions for personal protection to reduce exposure to the virus.
The coronavirus disease (COVID-19) pandemic has brought in unique issues for healthcare workers (HCW) managing health services of non-COVID patients [1]. This infection poses a double-edged sword while managing immuno-compromised patients [2]. As these individuals are at an increased risk of mortality from infections, most centers treating cancer have reduced hospital visits, modified chemotherapy protocols and rely heavily on tele-consultations [3]. The other major concern that has emerged while managing these children is the safety of healthcare workers (HCW) and sustainability of the nonCOVID treatment centers.
PPE rationalization: In resource-limited settings, rationalizing PPE use to ensure adequate supply to those HCW working in COVID hospitals and to prevent misuse, seems judicious [8]. However, without adequate PPE, accidental encounter with patients places HCW to high-risk category of exposure with mandatory quarantine of entire units, thus resulting in closure of treatment centers. Additionally, there is a bigger risk of exposure of other patients in the same facility, which could be more dangerous. Hence, when non-COVID areas are made functional in hospitals, adequate supply of PPE needs to be ensured for all HCWs.
We recently managed a child with acute lymphoblastic leukemia (ALL) who was subsequently diagnosed as being COVID positive. On examination in our daycare, she was afebrile, mildly tachypneic (respiratory rate of 25 breaths/min) with saturation of 88-89% in room air, and bilateral consolidation in lower lobes on X-ray chest. Although acute leukemia presenting with pneumonia is not unusual, the presence of hypoxia in room air was more suggestive of viral/ pneumocystis etiology. She was shifted to the COVID isolation ward without admission in the cancer ward. On evaluation, she was detected to be RT-PCR positive for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) and was managed as per standard guidelines. She recovered and was discharged after few weeks. Bone marrow evaluation confirmed ALL and she wa
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