Hector Martinez Said, MD
National Cancer Institute, Mexico
What are the unique challenges your institution faced since being confronted with the pandemic?
During this unprecedented event, on March 11, 2020, the World Health Organization (WHO) determined that infection with the SARS-COV2 virus and the resulting entity, now known as COVID-19, could be characterized as a pandemic given the alarming levels of spread of the disease and its severity, as well as the also alarming levels of inaction. For its part, the General Health Council of our country declared it as a “Health Emergency due to force majeure” on March 31, 2020.
Originally in Wuhan, Hubei province, China, at the end of last year, this pandemic has radically changed the global context and the lives of millions of people in just a few months. Mexico is no exception: changes in the daily routine of health personnel, of the hospital centers, of the economic centers, of the mass and cultural communication media, changes in the expectations and life plans of all the inhabitants of this country.
We have been instructed to social distance, to keep “Susana Distance” (social distance characterized by an animated character) and other social measures, such as the suspension of non-essential activities with the intention of reducing contagion and spreading of the disease in order to achieve flattening the curve so as not to saturate the National Health System.
These measures, which for many people have been very difficult to apply, have been impossible for others, since their immediate livelihood depends on going to work and trying to obtain the minimum income. This is the case in a country where 56.2% of the economically active population over 15 years of age is informal, which increases social inequality, exposing the economically most vulnerable population to the SARS-COV2 pandemic.
Another important challenge has been interdisciplinary communication, between medical oncologists, surgeon oncologists and radiotherapists, in order to establish the best management sequence.
How did hospital administration tap into surgical oncology staff to support COVID-19 patients?
Measures are in place for cancer risk stratification, comorbidity and SARS-COV2 infection and the development of COVID-19. Generally, if there are patients with a low risk of progression of their oncological disease who could wait at least a couple of months to pass the maximum incidence peak and those whose risk of progression is too high to delay treatment. If the patient has comorbidities that puts them at risk of severe COVID-19, patients are referred according to their oncological risk to neoadjuvant treatments or essential delays (the shortest possible time), as well as the process of very high aerosolization and exposure to body fluids, the preference has been to postpone as long as possible, as long as the oncological risk allows.
From this pandemic, the patients undergo a viral test for SARS-COV2 and 48 hours before the surgery, a chest tomography is taken to determine the presence of suggestive changes related to COVID-19, and then sending them to isolation during this time to avoid contagion before surgery.
How has the pandemic changed your cancer patient treatment regimens? Have you had to delay many surgeries?
Generally, they have been delayed, either due to the inherent risks discussed in the previous question or due to patients’ fear of visiting medical facilities during the pandemic
What is your current case volume (%) of cancer surgeries and what type of procedures are you doing? Where do you think you are at on the curve – and how do you see it changing over the coming weeks?
About 50% of the treatments have suffered some degree of delay. Of all kinds of procedures, the only ones that have drastically decreased have been those of minimal invasion with greater aerosolization.
Can you share some of the personal and professional challenges you have faced during these unprecedented times?
Once this period of uncertainty has ended, we will find a higher mortality rate from cancer than what has been registered, we will face patients with more advanced diseases than in other scenarios and, in addition, we will have to deal with the lags caused by the passage of COVID-19 in our health system. SARS-COV2 is here to stay indefinitely challenging the status quo and urging us to make decisions with no chance for mistakes. As doctors and, in parallel, as oncologists, we must face this pandemic with the best that we can give: disposition, wisdom and expertise, and treating our oncology patients who deserve, with or without a pandemic, the same treatment and care they have been receiving and the best treatment option available.