Covid-19 disrupted the fight against existing diseases, and once we forget SARS-CoV-2, it will continue to exist. Carlos Rodriguez Galindo (Reus, 1962), Director of Global Pediatric Medicine at St. Jude Children’s Research Hospital (USA), dedicated to improving the care of children with cancer, especially in developing countries. Like many other researchers, he quickly realized that the coronavirus would change everything.
He explained to SINC: “Due to personnel constraints and the health system, we are beginning to see a huge impact in all the programs we have worked with.” “The government has diverted resources from childhood cancers and used hospitals reserved for these patients. Hospital beds and sent nurses and doctors to the main nursing department for covid-19.”
At that time Rodríguez and his collaborators decided to start polling, More than 300 professionals from 79 countries/regions answered this question to map and monitor the situation.the result is Recently posted on The Lancet Child and Adolescent Health They showed that the pandemic reduced diagnoses on the entire planet and interrupted treatment, especially in the least developed countries.
We talked to Rodríguez about the progress they have made in the field in recent years, how the pandemic has put them at risk and what the consequences will be.
Does covid-19 have a greater impact on children with cancer?
We have a global registry and more than 1,600 cases have been reported [de niños con cáncer infectados por SARS-CoV-2] This gives us a preliminary understanding of what is happening. We see that it has a great impact on them, but the mortality rate is not as high as we expect in immunosuppressed patients. We worry that the death rate worldwide is very high, but this is 3.5%: higher than that of children without cancer, but not as good as the elderly.
So, what is the biggest risk that the pandemic poses to these patients?
The main impact is not infection, but how infection affects health systems, especially those in countries with relatively fragile resources. The care of children with cancer has been severely disrupted: due to lack of resources, transportation or access to hospitals, the number of dropouts has increased; chemotherapy, radiotherapy, and surgery have been stopped. Diagnosis has also decreased, and we are waiting to see its impact.Many people will die but never arrive [al médico] And we know that others will do this in two or three months, which will also increase the mortality rate.
In recent years, in countries with limited resources, the diagnosis and survival of children with cancer have improved. How will the pandemic affect this?
We will know in a year, but it will definitely have an impact. In the past three to four years, a global campaign has been launched to prioritize childhood cancer in the health system. Many governments have mobilized resources, and I believe the environment is very positive for making progress on this issue.
I don’t want to understate it, but in global health, the past two decades have marked a dichotomy between infectious diseases such as AIDS and malaria and chronic non-communicable diseases such as diabetes, hypertension and cancer. In order to give priority to the latter, gradual steps have been taken, and the plan has prompted the government to formulate health policies to protect cancer patients, including funding for pediatrics. This is a journey that takes many years. I think one of the impacts of covid-19 will be that the system will once again realize that we are very vulnerable to infectious diseases, and resources and social, political attention will return to them. I worry that this long-term transition will disappear. In addition, in a fragile health system, a roadside bomb like this will dismantle everything, and all fragments must be put back in place.
How can we begin to reduce the impact of the pandemic on children with cancer?
We try to protect the team, keep the investment and adapt. We shifted our focus to ensuring that the childhood cancer health system can survive covid-19. We continue to work with the government: for example, in November, Peru enacted a child cancer subsidy law to protect children and even families, and pay parents when they have to leave work to take care of their children. Despite the pandemic, they realized the importance of investing in this, and we have seen many countries remain loyal to their previous developments, but I don’t know how far they will continue to develop.
Last year’s concept lifetime About infectious diseases. This requires treating health as a global thing. Should it also apply to cancer?
I think so. Generally speaking, cancer is not a global priority, because governments all know that there are other places. Integrating the health system into any cancer plan is essential. In the field of pediatrics, we try to ensure that the global cancer plan is well integrated with the plan to reduce maternal and infant mortality to ensure resource sharing, and we educate junior doctors so that they can help both parties.
80% of childhood cancers occur in resource-limited countries, and their number is rising. why?
Because the vast majority of the world’s child population lives in countries with limited resources. In addition, the number of children has not increased in Europe and the United States, but has increased in other parts of the world. There is a phenomenon of epidemiological change: in the poorest places, the mortality rate under five years is very high, but as the prevention of maternal and infant mortality, education, nutrition and vaccination systems continue to improve, the healthy population is also increasing. many. . This has also led to an increase in childhood cancer cases, simply because the competing causes of death have decreased.
Has the diagnosis in these countries improved?
There are better systems, but 50% of children with cancer worldwide are not diagnosed. This number is difficult to estimate, but we believe that about 400,000 children suffer from cancer each year, and only 200,000 children are diagnosed with cancer.That half disappeared [sin diagnóstico] Almost all countries are doing this in developing countries.
A year ago, they calculated Invest in childhood cancer From a materialist perspective, this will bring huge rewards and save 11 million children’s lives.
We are trying to convince governments that supporting childhood cancer is an investment, and within 20 or 30 years after these children enter the labor market, the return can be multiplied by two to three times. We try to incorporate these economic parameters into any health policy so that the government understands its importance and that investment in children is not only good for them, but also good for the health system.
It is important to define the problem well. In pediatrics, we try to manage our language during the years of loss of life due to disability, mortality or morbidity. Childhood cancer patients live for many years, so its impact is much greater than when we compare it with adults with cervical cancer. Information about future investments is very important to us: children have a long lifespan. When we included all cancers in the list, childhood was among the top five because many years of life were lost due to non-investment.
Rodríguez-Galindo: “When we included all cancers on the list, childhood was among the top five because many years of life were lost due to non-investment.” / Provided by interviewee
Then covid-19 arrived.
In the article, we see that almost one-third of the centers have reported a reduction in the number of confirmed cases, and the country we are talking about already has great limitations in detecting cases. Where we have worked in Guatemala for many years, such as where the National Center for Childhood Cancer was established in Guatemala, we can only see 60% of the population. Among countries with limited resources, it is one of the most advanced.
Fewer diagnoses, give up treatment… Do you think your results can be inferred to other diseases and populations?
Absolutely. There are not many studies on adult cancer, but in the early stages of the Dutch pandemic, it was found that the number of adults diagnosed as adults dropped sharply. These adults later relapsed but suffered from the disease more severely. I think this has been proven even in Europe, and I believe it will have an impact in other chronic diseases such as diabetes and cardiovascular disease.
Do you think children have been forgotten in this pandemic?
[Piensa]. This is a complex issue, but I think that when there is a social or health crisis, sometimes we do not focus on the unique needs of children, which is very important.I don’t know if the child is forgotten [en la pandemia], But the impact on them may be greater. From a health point of view, they can tolerate this disease much better than adults, but if we consider other effects, such as emotion, lack of socialization, suspension of classes, etc., then this effect will be within a year or two. Show up. I think there will be a generation of children who will notice this.
Suspension of classes, lack of socialization… Will all this have a long-term impact?
obviously. I am not a sociologist, nor an educator, and I don’t know how to evaluate this impact or the impact on a whole generation of children: I can only say that the impact on children with cancer is huge if we can treat it worldwide Taking measurements, I think that for children with other diseases that have not been analyzed, children with chronic needs, learning, nutrition, and psychomotor development, is this the same or higher… the impact can be catastrophic.
What lessons can we learn from the pandemic?
We need to be prepared and humble, not to underestimate our vulnerability. We cannot allow this to happen again. The second pandemic in the next five years will have disastrous consequences in many ways, and prevention is the safest way to establish a cancer plan in the future.
We learned to prioritize. This is what we learned from our colleagues who know how to do this in a catastrophic situation. Maintain close contact with global institutions and health systems so that we can raise our hands when necessary and ensure that children with cancer are not forgotten. There is not much interest in childhood cancer, and people tend to forget about so many priorities. The vulnerability of these patients cannot be resolved overnight.