Essential Treatment vs. COVID-19

The news of a global pandemic closing businesses is nothing new for 2020. Businesses and workers labeled ‘essential’ have been on the front lines providing services while the virus seems to be spreading. So what happens when those on the front lines develop COVID-19 themselves?

Essential skin cancer treatment during COVID-19

In March, our small dermatology office with only 15 employees was labeled ‘essential.’ Unsure how long the virus would be around, we were kept open based on our treatment of skin cancers. We have been at work every day since the original shut down, extensively cleaning, wearing masks, screening patients for symptoms, and checking everyone’s temperature at the door. After nine months of a virus-free office it finally happened, COVID-19 had infected one of our own.

Positive tests in the office

A front desk employee was experiencing some cold-like symptoms and decided it was best if she got tested. She wasn’t concerned; she is young and healthy and had followed all of the social distancing guidelines. She stayed home while waiting for her results and as soon as she got them we were all made aware. She had tested positive for COVID-19.

We left work to get tested. I chose a location that had the ‘rapid antigen test’ that would tell me if the virus was active in my body. I had last seen the co-worker 5 days prior and had eaten lunch in the break room with her. I figured it had been enough time for the virus to become ‘active’ and show on a test. I was not experiencing any symptoms but also believed I could be asymptomatic due to my age and health.

Thirty minutes after a nasal swab into what felt like my brain, I received my results via text message “TEST RESULTS: POSITIVE”. Great.

Mandatory closure

As more and more results from the office were received, it turned out that half of our office had contracted the virus. How can our office function without half of the staff? It was decided that, simply, it couldn’t. The office would be closed for the full ten-day period as recommended by the local health department.

What about essential treatments?

But wait, what happens to those ‘essential treatments’? I am the only radiation therapist in the office, without me in the office there is no one to administer the radiation treatments for skin cancers. The patients are supposed to be seen twice a week and are told never to allow for more than 7 days between treatments. So what do we do?

I will return to the office with a lot of extra work. I will be re-planning the radiation treatment prescriptions for 37 patients. I will calculate the amount of ‘decay’ that has occurred during the 10 days that they were unable to receive treatment. I will make modifications to their overall dose that will ensure that any cancerous cells that were able to repopulate the area during the break-in treatment will still be eliminated as planned. The patients will not have to restart their course of treatment, but we may have to add an additional treatment to make up for the break.

Gaps in treatments and adjusting doses

A gap in treatment is not ‘the end of the world’ during a course of superficial radiation for a non-melanoma skin cancer. Of course, it is not ideal to miss treatment days but occasionally things, like a global pandemic, happen that prevent the patient from receiving treatment.

I am confident that after adjusting the treatment dose the cure rate for these patients will not be compromised. In our office, our patients always come first, even if it means extra work for us! As I see it, re-planning treatment is a small price to pay in exchange for the safety of patients and their families.