COVID-19 pandemic and lock-down protocols: Impact in an indian tertiary cancer center.

Dear editor

On January 30, COVID-19 was declared a global emergency and on 11 March 2020 as a pandemic by WHO [1]. India reported its first case on 30 January 2020 [2]. On, 22 March 2020, the Government of India announced a 14-hour curfew. To control the spread of COVID-19, the first phase of the nationwide lockdown was implemented from 24 March 2020 for 21 days till 14th April 2020 [2], [3], [4]. The second phase of lockdown was for 19 days till May 3rd, followed by phases 3 and 4 each for 14 days with relaxations. For more than 2 months India was under lockdown till 31st May 2020. Relaxations and services were restored with exceptions in the containment zones [3], [4].

Cancer, a disease characterized by uncontrolled proliferation of cells with evasion of apoptosis is another challenge to mankind owing to the high morbidity and mortality rates. Every year there are about 18.1 million people diagnosed with cancer. Around 9.6 million die every year due to cancer. In India, 1.1 million people are diagnosed every year, of which a majority are diagnosed only during the terminal stage [5]. Cancer patients are most susceptible to secondary infections due to immunosuppression caused by anticancer therapy [6]. During this pandemic, health care resources have been redirected towards the treatment of COVID-19 patients [7]. For example, some of the cancer centers were converted to COVID-19 treatment facilities [8]. Due to travel restrictions and fear of exposure to the virus cancer screening, research, clinical trials were significantly impaired [5], [7].

As frequent hospital visits can increase the risk of exposure to the virus [9], cancer patients must battle between increased risk of COVID-19 infection and adverse effects of postponing anticancer treatment [5]. There was a major reduction in the patients reporting to cancer centers even in large metropolitan cities [10], [11]. Globally, irrespective of income status, data show a downfall in the number of patients accessing cancer treatment. Delayed treatment will have a serious public health impact in the coming years, with a predicted surge in the mortality rate within the next 5–10 years [8]. To assess the impact of COVID-19 and nationwide lockdown protocols, we assessed the changes in the in-patient flow in a tertiary cancer center in Chennai, India from January 2020 to March 2021. The records of the number of new and old in-patients who were admitted to a Tertiary Cancer Centre in Chennai, India for diagnosis, treatment, or follow-up visits of cancer were assessed from January 2020 to March 2021. The number of surgical procedures performed every month was also recorded. The obtained data were presented as descriptive statistics.

The number of the new, and old in-patients who were admitted to the center every month from January 2020 to March 2021 is depicted in Fig. 1 . April 2020 had the least number of old and new patients vising the center. The total number of old patients was highest in March 2021, however, the number of new patients was highest in June and October 2020. The number of old and new patients visiting the center and the number of surgeries performed was the least in April 2020 owing to the intense lockdown imposed by the Government [2], [3], [4]. During such disastrous situations, the initiation of teleconsultation is the only choice that can be provided to the patients [12]. The number of new patients was highest in April, depicting the awareness of patients who suspected cancer and had reported for early diagnosis. The total number of old patients were highest in March 2020, which can be attributed to the fact that awareness of COVID and the national lockdown was imposed on 24th March 2020 [2], [3], [4] The number of new patients was highest in June and October 2020 and number of surgical procedures were highest in February and October 2020 that could be attributed to the process of unlocking down, relaxation of rules and vaccination drive [2], [4], [13]. Thus, this unforeseen crisis has taught us to provide adequate cancer diagnosis and cure without jeopardizing the curve of a pandemic by taking adequate safety protocol, and using telemedicine, as early management of this dreaded disease is the only way for improvement of prognosis despite the pandemic situation.

Fig. 1

Descriptive statistics of the number of patients and surgical procedures from January 2020 to March 2021

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.