So, this is a bit of a niche subject, but my hope is that some of you might have some input.
Stem cell transplantation for hematological malignancies combines international logistics, immunosuppressed patients and the potential for complications that have to managed at an intensive care unit. You see why Corona is relevant here. I have read the recommendations from EBMT, i assume that ASBMT has some guidelines as well. I didn't find them very helpful.
My center is looking at postponing what can reasonably be postponed. But postpone till when? And what does reasonably mean in that context? Do we think the dust will settle in time for those patients?
Some patients have to be postponed already due to URTI or contact with COVID19 cases. Unless they have both, I cannot get them tested, hopefully this will change soon though. It isn't helpful either that no one seems to know how COVID19 looks in an immunosuppressed patient. Do patients without T-cells still get fever and cough?
Do we dare to start a preparative regimen when the cells come from another country with lots of cases? The problem isn't really transmission with the stem cells, it's that the donor could simply be clinically sick and that logistics and couriers suddenly aren't as reliable anymore. Freeze everything?
To the complications: If I start a conditioning regimen tomorrow and get those cells into the patient beginning of next week, they could be in need of intensive care by mid next week at the earliest. I hope they don't and it all goes smoothly, but if not, can I assume that there will be a bed for them if they need it?
Also, all the hematologists are also internal medicine hospitalists, each of us can handle NIV and some even respirators. The nurses are highly qualified too, maybe not with PPE, but general internal medicine stuff. We have rooms with air locks, usually with positive pressure, but after an easy adjustment those could become really good rooms for COVID19 patients. I fear that staff and rooms will be commandeered by the local COVID taskforce if we can't help our own patients anyway.
How are others handling this?
I'm not panicking by the way, it's just my experience that things turn out worst case more often than best case, and I try to be prepared. Situation in Sweden is 961 cases, 2 deaths, 10M population, community transmission, not everyone is being tested, no lockdowns, schools are open. Sweden has around 5,3 ICU beds per 100.000 inhabitants, 62% in use already if we assume every bed can be used 24/7 continuously, probably more like 90% from what I gather from colleagues there. Compare to Italy with 12,5 beds /100k inhabitants.
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