Taking care of sickle cell anaemia patients during the pandemic
Monday, June 22nd, 2020
With less than six months into the pandemic, there are already eight million confirmed cases and more than 430,000 deaths globally.
More than 3500 cases and 100 deaths have been reported in Kenya and the country has as yet to reach the pandemic curve.
Majority of the deaths are from people considered high risk population, including persons aged 60+ and those with chronic blood disorders such as sickle cell anaemia (SCA), diabetes, heart and lung diseases.
It is important to note that carriers of sickle cell gene without clinical disease (traits HB AS) are not at any higher risk than the normal population.
Given that COVID-19 is a new disease, there is still a lot that remains unknown, though there is a flood of scientific publications describing experiences from countries that have gone through the pandemic over a longer period, especially China.
Covid-19 infection triggers SCA crises and super-imposes itself on an already immune-compromised child.
Of major concern is acute chest syndrome, which even under circumstance without the pandemic is associated with high risk of death.
This is not surprising given Covid-19 manifests with severe chest infection that interferes with normal oxygen exchange.
The virus also causes abnormal blood coagulation that could make pain and blockage of blood vessels in SCA worse.
Caring for children with SCA
With the marking of World Sickle Cell Day on June 19, it would be good to look at how Covid-19 pandemic affects ongoing care of children with SCA under regular follow up.
This is really where prevention is many times better than cure, meaning that staying home, observing social distancing, wearing face-mask and sanitizing hold supreme for this high risk group.
Usual measures of avoiding situations that precipitate crises, such as dehydration, exposure to cold, excessive physical exertion and infections should be optimised.
COVID-19 prevention measures are indeed very good for SCA as they also reduce transmission of other common airborne and hygiene related diseased.
Adherence to preventive medications like folate, penicillin-V and hydroxyurea that reduce risk of crises is not negotiable during pandemic.
Those that may be lagging behind on essential vaccines must also update their status as priority.
While administration of flu vaccine is recommended, its interaction with COVID is still under scrutiny and will be clearly as more research findings become available.
Don’t miss regular clinics
Whereas regular follow up is important, visits will need to be more widely spaced for stable patient during the pandemic to minimise exposure to other persons.
Innovations in health care provision by providing non-contact consultations are now also becoming increasingly available.
Aga Khan University Hospital has, for example, introduced tele-consultations, tele-laboratory and tele-pharmacy; meaning a patient can consult their doctor, have laboratory tests done and medicines delivered from the comfort of their homes.
Other measures include issuance of longer duration prescriptions or multiple refills for stable patients.
COVID pandemic has unfortunately caused such a major scare that many patients with chronic diseases have abandoned essential follow up with dire consequences to their health.
This situated is completely avoidable if above outlined measures are followed.
It is indeed possible to minimised COVID exposure risk without compromising pre-existing well-being from pre-existing conditions. – Prof William M Macharia – Consultant Paediatric Haemato-Oncologist at Aga Khan University Hospital