8 April 2020

Dr. Harsh Vardhan
Hon’ble Union Minister for Health & Family Welfare
Govt. of India
Dear Dr. Harsh Vardhan ji

Over the past few days, there have been many reports from across the Country highlighting the fact that healthcare professionals are getting infected with COVID 19. Hospitals are becoming out of bounds, and increasingly, many healthcare professionals are being quarantined. If this trend continues, the healthcare system may very well collapse.

Currently, unless patients undergoing surgeries are symptomatic, they are not entitled to undergo RT PCR COVID 19 testing. At the moment, there is a directive from Govt. of India that only emergency surgeries must be undertaken and elective surgeries should be deferred.

However, there is a third category of “URGENT” surgeries that must be undertaken for those diagnosed with cancer. With over 11, 00, 000 new cases being diagnosed and 8, 00, 000 succumbing every year to one of the ten leading causes of deaths in India, Cancer is a ‘tsunami” in the Country.

As majority of patients with COVID 19 are asymptomatic, there is a distinct possibility that many of these patients who are infected and may inadvertently transmit the infection to healthcare professionals, thus potentially jeopardizing the health & safety of treating Clinicians.

Cancer surgeries cannot wait too long. With a possibility of lockdown being extended, ICMR must look into the possibility of incorporating guidelines for patients requiring cancer surgeries.

Patients who require cancer surgery as determined by the Multidisciplinary Tumour Board (MDT) must be eligible to undergo RT PCR testing. If this does not happen (as is the current scenario), and surgery is undertaken with all precautions presuming the patient is potentially COVID positive, we would end up wasting the very precious PPEs, which are already in short supply. These precious PPEs should ideally be reserved for health care professionals taking care of COVID positive patients in ICU setting.

Moreover, the costs of providing 8 – 10 PPEs to operating theatre staff for each of such cancer surgeries should also be taken into consideration. COVID testing in this scenario not only protects the operating team, it also prevents these healthcare professionals from becoming potential “super spreaders”.

Another important point to note is that by indefinitely deferring patients that require cancer surgery as deemed necessary by the MDT, there is a distinct possibility of stage migration of the cancer resulting in early cancers progressing to advanced stage, thus leading to loss of lives and eventually adding to the already overwhelmed costs of cancer care. In a Country like India, this would be a disaster, in waiting…

There is thus an urgent need for ICMR guidelines for patients requiring such “urgent” cancer surgeries, with feasibility of doing a RT PCR testing prior to surgery.

In the interest of safeguarding healthcare professionals, and equally, to ensure cancer patients are provided optimal care, I would be most grateful if this matter is addressed on an urgent basis.

Kindest regards.
Yours, in service of ASI…

Dr. P. Raghu Ram
MS, FRCS (Edin), FRCS (Eng), FRCS (Glasg), FRCS (Irel), Hon. FRCS (Thailand), FACS

Padma Shri Awardee (2015)
Dr.B.C. Roy National awardee (2016)

President, The Association of Surgeons of India

CC. Prof. Balram Bhargava
Director General, ICMR