Disruption in Medical Care of Non-COVID Patients in COVID-19 Pandemic

In December 2019, a novel coronavirus (COVID19) was detected in Wuhan Hubei province, China. The virus has caused a global concern because of its high potential for transmission, high morbidity and mortality. COVID-19 spreads so rapidly across an increasing number of countries worldwide that it has been found in more than 200 countries so far. The World Health Organization (WHO) has declared COVID-19 a pandemic and public health threat (1-3) . In general, COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A case fatality rate of approximately 2.3% has been reported for COVID-19. New fever, cough, lymphopenia and bilateral lung infiltrations are characteristic but not diagnostic for COVID-19. Sore throat, dyspnea, myalgia, diarrhea, and abdominal pain are other presentations of COVID19. We should also be attentive to the probability of atypical presentations in patients who are immunocompromised. While the majority of cases result in mild respiratory tract symptoms like acute bronchitis, severe cases might end in severe pneumonia, acute respiratory distress syndrome (ARDS), septic shock and death due to multiorgan damage, so early recognition of patients with suspected COVID-19 infection is crucial. The burden of the virus is not limited to physical damage, but it also has a significant impact on the mental health of the public. It can lead to generalized anxiety disorders and depression during COVID-19 pandemic (1, 4, 5) . Now many countries are in a state of crisis worldwide. Whenever the living environment changes, people feel unsafe. People's fear of COVID-19 makes them refrain from going to medical centers, which significantly impacts their access to medical care while they require acute treatment. COVID-19 outbreak in countries has pulled essential medical resources away from regular procedures. This has caused complications for patients who need treatment for other medical conditions that require timely and appropriate care. Cancer patients especially still require attention in curative or palliative settings, and women will still be delivering their infants. How can we care for these patients without exposing them to COVID19? Now many patients try to avoid going to the emergency room which is filled with patients suspected of COVID-19. For example, in our center, Imam Khomeini Hospital Complex, which admitted an average of 50 patients to emergency wards on a daily basis, this number has decreased to 3 patients daily. Furthermore, when many of these patients finally arrive, their clinical conditions are more severe (2, 5). For example, a 57-year-old man came to our emergency ward with a history of abdominal pain and vomiting from 10 days ago. He was ill and toxic, and had high grade fever, tachycardia and hypotension, oliguria from 12 hours before coming to the hospital. His laboratory tests showed elevated levels of amylase, lipase and creatinine and leukocytosis. He was admitted with impression of necrotizing pancreatitis. We visited more than 20 patients with chronic liver failure with the impression of decompensated cirrhosis who came to us with sever ascites, hyperkalemia, hepatorenal syndrome or encephalopathy. We encountered with patients with chronic kidney disease who did not oblige to their dialysis program regularly and came to us with uremic status. There were many diabetic patients that came to clinics with poorly controlled diabetes (Hemoglobin A1C>8%) and also diabetic ketoacidosis which postponed their routine diabetes care. A 22-year-old woman with a history of cholecystectomy (4 years ago) came to us with abdominal pain from 15 days ago, fever and jaundice. Her blood pressure was 60/40 mmHg, her pulse rate was 140/min, and she had tachypnea and high temperature upon admission to the emergency room. On sonography, radiologists reported dilated common bile duct, and the patient was admitted with impression of severe cholangitis and septic shock. Indeed, they all postponed receiving care. There will still be patients in outpatient, elective and non-elective settings requiring care. Furthermore, some patients need diagnostic services (e.g. a young woman with a breast mass) or they may also need ongoing therapy for a chronic medical condition such as solid organ transplants, malignancies, rheumatologic disease. Non-elective patients such as those with heart attack, stroke, pancreatitis, gastrointestinal bleeding, fulminant hepatitis, cholangitis, acute leukemia, multiple trauma and other infections requiring medical care should be managed to avoid delays in treatment. There are some diagnostic procedures such as angiography gasteroesophagoscoy and biopsies that the patients may need in the course of treatment. Therefore, we need to meet the medical needs of patients with chronic diseases such as cancer, chronic kidney disease and those who need longterm maintenance treatment. The day to day medical service of some groups of people, such as pregnant women and older adults are also very important.