How to Use a Prioritised Approach for Treating Hematological Disorders During the COVID-19 Pandemic in India?
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REVIEW ARTICLE
How to Use a Prioritised Approach for Treating Hematological Disorders During the COVID-19 Pandemic in India? Arihant Jain1 • Charanpreet Singh1 • Rishi Dhawan2 • Nishant Jindal1 • Ritin Mohindra1 • Deepesh Lad1 • Gaurav Prakash1 • Alka Khadwal1 • Vikas Suri1 • Ashish Bhalla1 • Savita Kumari1 • Neelam Varma3 • M Joseph John4 Manoranjan Mahapatra2 • Pankaj Malhotra1
•
Received: 9 April 2020 / Accepted: 2 June 2020 Indian Society of Hematology and Blood Transfusion 2020
Abstract The current pandemic coronavirus, SARS-CoV2, is known to cause severe infection (COVID-19) in patients with comorbidities, particularly cancer or an immunosuppressed state. Most healthcare systems in the country are likely to be overwhelmed soon if the pandemic moves to a stage of community transmission. Currently, limited evidence is available for managing patients with hematological disorders during the COVID-19 pandemic. The current review summarises the possible challenges clinicians are likely to face, key considerations to guide decision making, and possible solutions to the anticipated challenges. Disease specific recommendations and possible guidance for decision making have been suggested for most hematologic diseases that are feasible in our health setup. It is not meant to replace individual clinical judgment, but to provide a template to formulate local policies. Keywords COVID-19 Hematology Cancer Pandemic Transplant
& Pankaj Malhotra [email protected] 1
Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
2
Department of Hematology, All India Institute of Medical Education and Research, New Delhi, India
3
Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
4
Department of Clinical Haematology, Christian Medical College and Hospital, Ludhiana, India
Introduction Patients suffering from cancers are vulnerable to the effects of the COVID-19 [1]. Early epidemiological studies from China have shown that cancer patients are at a higher risk of not only getting the COVID-19 infection, but also having a severe infection [2]. The pooled prevalence of COVID-19 in cancer patients was found to be 2% in a recent meta-analysis [3]. While the overall case fatality rates from COVID-19 have been reported from 1.4 to 2.4%, patients with cancer have been reported to be at a 3.5 times higher risk of acquisition of disease and a case fatality rate reported to be 5.6% [1]. Another retrospective study from 3 centres in China showed a mortality rate of 28.6% in patients with cancer. Patients who received antitumor therapy within 14 days prior to infection had a higher risk of severe infection [4]. Both these studies had patients with solid malignancies only and a small sample size. Therefore, it may not be possible to extrapolate this data to a wider population, particularly to patients with hematological cancers. On the other hand, data from multiple studies during the H1N1 pandemic showed tha
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