There are many questions that plague us everyday, as health care professionals. But in times of COVID-19 the very core of medical practice – its humanitarian approach is under threat. The questions now in front of health care professionals, for different reasons are: “To treat, or not to treat”
“Is it right, or is it wrong?”
Further, “How long can we defer treatment?” This decision is neither simple nor easy, as treating doctors, we have to think of the patient and the family in the context of the pandemic, and what we do based on strong evidence.
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For instance, early common cancers are curable. In such cases, it will be unethical to delay treatment. An advanced disease can be controlled, and if untreated, it might progress to the stage of palliative care. Again, palliative care cannot and should not be denied to patients.
And then, uncommon cancers with a doubtful outlook, advanced age, and with multiple co-morbidities form a category all by themselves. They have to be treated based on individual decisions and are ideally deferred. The expenses involved, in relation to survival, will not be either risk or cost beneficial.
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As of now, only partial, selected cases are being treated. Should this continue?
NGOs, and voluntary charitable institutions providing free cancer care, of which Cancer Institute is one, are facing a major crisis.
Patients have a serious problem, with the lockdown, they are not able to findtransportation to reach the centre for treatment.
While with residential staff, there are no issues, because they live on campus.However, non–residential health care staff too face the same problem – lack of transport to reach the hospital. As for housekeeping staff, who are key to running a hospital well, the institution has to make transport arrangements until the condition improves. Some medical staff members too, who do not have their own personal vehicles, need assistance to reach the centre.
General criteria
We need specific guidelines or criteria for providing personal protection equipment, masks, gown etc for professional and paraprofessional workers. For one, it will be helpful to reduce staff fear/panic and convince them that they are well protected with the gear.
This is for those who are not working with those who tested positive, are on routine hospital duty, including doctors, technicians and nurses who are working with patients who have not been tested.