COVID CORNER

COVID 19

Cancer patients are more vulnerable to the novel coronavirus, COVID-19, because of their compromised immune systems due to disease and/or treatment. Ensuring the health and safety of our patients and staff is our top priority. Even in this time of uncertainty, Rajiv Gandhi cancer Institute & Research Center (RGCIRC) is a place for hope and healing — and we’re delivering the care you need.

RGCIRC is open and operating under normal business hours and offering teleconsult when appropriate for our patients. We are closely monitoring developments related to coronavirus disease (COVID-19) and are committed to the safety and well-being of our patients and staff during this COVID-19 pandemic.

What You Need To Know Before You Visit Rgcirc

To ensure the safety of our patients and staff, we continue to monitor the impact of the coronavirus (COVID-19) pandemic, and to proactively ensure that our patients and workforce remain safe and protected. RGCIRC has created a FLU corner and when you arrive, you will be directed to this place. The patient and the attendant are asked about their exposure, whether they have been tested for COVID-19 and if they exhibit any of the following symptoms:

If you do have these symptoms and need to be seen for your appointment, we will help you take steps to ensure that we can see you in a way that is safe not just for you, but for other patients and our staff members. Please note that all patients are screened only at the Flu Corner and then directed towards RGCIRC building, even if you have scheduled appointment.

If you have been tested for COVID-19 outside of RGCIRC, share a copy of your results with your team before your appointment.

If you have questions or concerns about this or you have any symptoms of respiratory infection, please call your RGCIRC care team at +91-47022222 before you come

COVID19 Testing Facility at RGCIRC

We have developed the ability to quickly test for the virus that causes COVID-19 and are testing all patients prior to surgery or admission, as well as before other treatments when clinically appropriate. If you have already been tested for the COVID-19 virus, please contact your care team to make them aware of this.

Visitor’s Policy

Limiting the number of people in our facilities is one of most important safeguards we’ve put in place, and one way we’re doing that is by maintaining a limited visitor policy. Only one attendant is allowed per patient. Safety of the patients and staff is of paramount importance to RGCIRC, keeping the safety of all in mind, the visiting hours have been suspended in RGCIRC till further notice

Virtual Visit

Video and audio consults may be the most appropriate options for appointments before, after or in place of face-to-face care. Appointment coordinators will recommend a virtual visit if it best fits your individual needs.

Video visits allow you to interact with your provider through live video and audio on your own device. You will be able to talk to your provider, similar to an office visit, by using your smartphone, tablet or computer to connect through:

On mobile devices: Install and use RGCI Care app

On desktops: Access the same services using RGCI Website

How You Can Protect Yourself

Always wear a mask in public in avoid spread of infection.
Wash your hands often, for at least 20 seconds. Use soap and water or an alcohol-based hand sanitizer.
Do not touch your eyes, nose, or mouth with unwashed hands.
Cover your mouth and nose with a tissue when coughing or sneezing. Discard the tissue and clean your hands. If a tissue is not available, cough or sneeze into your upper sleeve.
Maintain social distance. This means you should avoid contact with other people and keep a distance of at least six feet between yourself and others.
Do not shake hands with others.
Avoid direct contact with people who are sick.

Steps Taken by Rgcirc For the Safety of All

Carefully monitored entrance points
Screening of all patients for symptoms and possible COVID-19 exposure before entering our buildings
Universal masking required for all patients, visitors and staff
Waiting areas arranged for social distancing
Enhanced cleaning of exam rooms and equipment after each patient
Frequent deep cleaning of OPD and Reception area
All members of your care team at RGCIRC are required to wear protective face masks while at work to help further protect our patients.
Reconfiguring Dining area seating to allow for recommended social distancing.
Observing standards for staff use of personal protective equipment (PPE).

Government Of India Guidelines On Covid 19

Categorize the patient as per following criteria :

Category A (Mild)

Category B (Moderate)- any one of the following

Category C (Severe)- any one of the following

Management As Per Category

Category A

Category B

Investigations:

Treatment:

Patients who need O2
Patients with high risk of progression to severe infection: >60yrs/CAD/Htn/CKD/DM/COPD/obesity/cancer etc
Don’t give if GFR <30ml/min or AST/ALT > 10ULN (not an absolute contraindication; can consider giving if benefits outweigh risks and close monitoring to be done)

Prophylactic LMWH/UFH (escalate to therapeutic doses if clinical deterioration esp with rising d dimers- more than 3-4 times the normal limit)
Continue all comorbidity medications
Clinical deterioration or repeat fever- send Blood C/S, Urine R/M, Procalcitonin- escalate or start antibiotics if high, G-CSF

To be used with caution(can give if concomitant bacterial/fungal sepsis which is not responding to anti-biotics)
Give for shortest possible time
Rest management as per Febrile Nuetropenia guidelines

To be considered only in patients with moderate symptoms whose Covid antibody titres (IgG is negative) and those exposed to anti-B cell therapy (Rituximab)
Benefit is questionable though

Category C

Investigations:

Treatment:

Don’t give if GFR <30ml/min or AST/ALT > 10ULN (not an absolute contraindication; can consider giving if benefits outweigh risks and close monitoring to be done)

Prophylactic LMWH/UFH/DOAC (escalate to therapeutic doses if clinical deterioration esp with rising d dimers)
Continue all comorbidity medications ( as per clinical scenario)
Clinical deterioration or repeat fever- send Blood C/S, Urine R/M, Procalcitonin- escalate or start antibiotics if high,
G-CSF

To be used with caution(only if absolutely unavoidable)
Give for shortest possible time
Rest management as per FN routine

Worsening O2 requirement with CRP>2-3 times the normal limit and/or raised IL6 levels in patients who are needing increasing O2 (NIV, HFNC, NRBM)
ICU patients/ patients needing ventilator – ASAP (preferable within 24 hours)
Give Ivermectin prophylaxis (only single dose)
Has to be given along with steroids
No constipation/ high risk features should be present for Intestinal perforation
Not to give if P/C <50,000 or TLC <500
Not to give if documented systemic infection
Not to give if LFTs>5ULN

¹Diabetes mellitus, hypertension, chronic kidney/liver/lung/heart disease, obesity, smoking, immuno suppression, PLHIV Anti-bacterial agents can be initiated as per hospital policy after discussion with primary unit and after taking appropriate cultures. CT Thorax is not indicated in all patients, it can be done on case to case basis.

Covid Unit

There is a dedicated COVID management unit at RGCIRC. COVID Unit has total of 8 consultants which help in managing patients with COVID and provide both out-patient and in-patient services along with post-COVID care. Oncology team also takes care of cancer needs of the patient during their COVID infection.