Optimization in understanding, management and prevention of coronavirus disease 2019 infection in hematological disorder

Since the onset of coronavirus disease 2019 (COVID-19) pandemic, there is a dramatic shift of protocol for the understanding and management in hematological diseases. Thanks to the high cooperation of medical community that helped in rapid dissemination of the knowledge base. As there are very rapid changes in the course of the pandemic, it is essential to understand and modify the guidelines for management of hematological cases accordingly.

Understanding of the pathophysiology of coagulation in COVID-19 infection is a key element in the management and prevention of infection. The article titled “Coagulation changes in COVID-19 infection and its implication in management” has elegantly described the mechanisms of coagulopathy which is crucial for effective management of the hypercoagulable state induced by COVID-19 infection. The process involves activation of fibrinolytic system by the viruses leading to increase in cytokine load, activation of coagulation cascade, and fibrinolysis. Understanding the mechanism is crucial as it is likely to be helpful to effectively manage acute respiratory distress syndrome – one of the dreadful complications in COVID-19 infection.

Telemedicine has emerged as a new conduit of communication and management during this pandemic; there are several advantages of telemedicine for patients, clinicians, and health-care delivery system. In the article titled “Telemedicine in hematology; long-term implications of a short-term experience during COVID-19 pandemic,” authors have carefully and vividly highlighted various concerned issues. The patients are expected to have reduced exposure to different microorganisms. As the communication with the health-care provider is easier than physical visit to the hospital, patients are more compliant for the follow-up. For clinicians, monitoring the chronic cases in remote areas is more easily accomplished. A flexible pattern of teleconsultancy can be adopted. Telemedicine is also immensely beneficial in the era of COVID-19 pandemic as the most common and easiest way for disseminating knowledge among the peer group. For the health-care provider, ability to expand services without expanding physical spaces and reducing patient cramming in the limited clinical infrastructure is an immense boon. However, there are some drawbacks including confidentiality, legal aspect such as consent, penalties, and liabilities. inability to perform physical examination, procedures and lack of infrastructure to name a few. However, it can be presumed that telemedicine is and will be an integral part of the hematology consultancy even after cessation of the pandemic.

The most important aspect of prevention of COVID-19 disease transmission and infection is proper vaccination. Fortunately, several vaccines have been developed on emergency basis and most of these are clinically very much effective in preventing the occurrence of the disease. Most importantly, these vaccines prevent severity of breakthrough infections. However, these vaccines may not mount adequate response in immune compromised patients. As these cases are common in hematology practice, a close vigilance is of utmost importance. Moreover, the immune response is different in different categories of hematological disorders, therefore, type of vaccine selection is crucial for effective immunization. In the review titled “vaccination for the novel coronavirus disease (Covid-19) in hematological disorders,” authors have vividly explained the strategy for vaccination in a wide spectrum hematological disorder. A detail queries with solutions of vaccination strategies regarding timing, special situations such as pregnancy and lactation, coadministration with other vaccine (if required), adverse reaction(s), and others have been incorporated for a ready reference. This compact guide will surely be of immense help in choosing the appropriate immunization against COVID-19 disease in hematological cases, depending on their nature of the disease.

With so many advances during the past 1½ years in respect of pathophysiology, management, and prevention of COVID-19 disease, we are now gaining confidence to tide over the COVID-19 pandemic. The pathophysiology of hypercoagulable state of COVID-19 infection is no longer a mystery. Most vaccines are effective in prevention of the severe illness and several guidelines have been developed for the optimal management. In a resource restricted countries like India, it is heartening to note that the medical fraternity has managed to contain the pandemic and able to limit the calamity by effective usage of telemedicine. In spite of such advances, new challenges are regularly appearing such as variant strains, vaccine breakthrough infection, to name a few. Thus, although we have conquered the initial onslaught, many hurdles are still remaining for effective containment of the dreaded COVID-19 pandemic.