Results
A total of 16 major head and neck health care facilities were contacted across India including all regions (Table 1). The majority of the contacted stakeholders were working in government (public funded) institutions (75%, n=12) as they have the highest workload of patients in Indian set up, where treatment is practically free to the patient. Out of the 16 hospitals, 50% (n=8) were dedicated cancer centres and other half were tertiary care institutions with head and neck cancer facilities. A dedicated cancer centre, catering to a large urban population has been closed indefinitely due to the spread of COVID 19 in a large number of healthcare professionals. The majority (69%, n=11) of the institutions have halted outpatient facilities and elective surgeries, only emergency admissions and surgeries were continued in these centres (Table 1). Only 5 (31%) institutes were providing all types of HNC services, but with an increased volume of outpatients despite a decreased volume of operations due to safety precautions and limited availability of personal protective equipment (PPE).Four of these are dedicated cancer centres and were performing the full spectrum of surgical procedures. Most institutions are surveying patients by clinic visits or through telephone consultations. Few (12.5%, n=2) institutions have started telemedicine consultations with patients. As per the present government regulations, COVID-19 test is not allowed for patients with no history and symptoms. The majority (69%, n=11) of the institutes are following institutional guidelines, while others are either following state or other guidelines. Availability of (PPE) and N95 mask are limited (63%, n=10) at most of the centres and they are using them judiciously. Current recommendations by the government of India, does not allow for pre operative COVID-19 testing, so decision making for surgery on the basis of COVID-19 status is difficult.
The Ministry of health and family welfare, an apex health care body of India has categorized all suspected/positive patients into three groups and are managed in the respective COVID hospitals– Dedicated COVID Care Centre (DCCC), dedicated COVID Health Centre (DCHC) and dedicated COVID Hospitals (DCH). Out of 16 institutions contacted, four have been designated as DCHC and two as DCH.
Currently, there are no guidelines for the management of HNC in India during COVID-19 pandemic. The Foundation for Head and Neck Oncology (FHNO), a multi-specialty national society in India has provided guidelines for the management of HNC patients. These guidelines are elaborative and cover all aspect of management of HNC cancer patients, from surgical to non surgical modalities. As this is a non government body, they have advised to keep abreast of advisories and guidelines from the government of India, as these will supersede their guidelines.