At the Saint Petesburg Dr. Berezin Medical Institute, efforts are made to maintain the attention of all specialties despite the "dictatorship" of the pandemic
At the moment, anti-COVID healthcare is rapidly displacing non-COVID healthcare and the volume of specialized cancer care, like other types of specialized care, is rapidly declining. Healthcare professionals note a sharp drop in people seeking initial care, reduced access to elective surgery, timely treatment of diseases of the cardiovascular system, hemodialysis, and much more.
How oncology hospitals can address these challenges?
Dr. Berezin Medical Institute (Saint Petersburg, Russia) trying to maintain cancer treatment despite of COVID-19. Main actions based on reducing the chances of infection for both staff and patients:
● Epidemic-control points at the entrance
● Temperature measurement
● Thorough hand sanitizing
● Separation of patient flows
● Visitation restrictions
● Widespread use of medical masks
● Testing patients for COVID-19 before hospitalization
● Quarantine measures in all facilities
● Ongoing frequent cleaning with disinfectants
● Airing the rooms
● maintaining social distancing as much as possible during the day
● reducing the number of personnel in each particular room.
Surgery is critical, but hospital decided to stop elective surgical activities where it is possible, in radiation oncology, based on the recommendations of American and European oncological societies, standard radiotherapy was replaced by radiosurgical treatment and hypofractionation; chemotherapy has been maximally shifted into outpatient setting, which allows to reduce the total number and duration of visits to clinics and reduce the chances of infection.
Proton therapy center is fully operational - in outpatient setting continue to treat 75+ people daily, 60% of which are children. About 20 children are treated daily under anesthesia. In addition, to help the city healthcare system, MIBS opened an outpatient triage center for COVID-19 positive or suspected patients with pneumonia.
This idea allows to:
● Relieve the emergency rooms of hospitals
● Reduce downtime of the ambulances.
The main thing is not to occupy hospital bed with non-severe patients, freeing the beds for the more needy (return home about 30-50% of the patients presented to clinics, when pneumonia is not confirmed or occurs in a mild form that does not require hospitalization).
Every day around the clock, center receive more than 100 ambulances.
The triage outpatient center is more than just computed tomography. Each patient is examined by physician, oxygen saturation (SpO2) is measured, the presence and severity of respiratory failure is assessed, and then a low dose chest CT is performed.
The decision on hospitalization is made by the doctor based on the whole picture. Then the patient is sent to a COVID-hospital by the same ambulance. In case of critical patients, center is equipped according to the Advanced life support protocol with oxygen, defibrillator, ALS pack, crash-cart.
To protect personnel, the interior is divided into zones (red, yellow and green zones), a sanitary lock where doctors and nurses put on and take off personal protective equipment (PPE) is set up. In the undressing zone, everyone shall pass through a shower in order to reduce virus contamination.
From the publications and videos from Chinese hospitals, we saw that they work in PPE for 12-24 hours. It is very hard physically and in Saint Petersburg staff works in the red zone in shifts of 6 hours. But despite the current situation and hospital participation in the fight against the pandemic, Medical oncology and Radiation oncology is the high priority for cancer patients and it shouldn’t be stopped.