Get subscribed to our newsletter
Get interesting updates to your email inbox.
The newly emerged Covid-19 virus has changed our lives in many ways. The lockdowns imposed by many countries have closed all but essentials services to prevent community transmission of the virus, with more stringent steps threatened as case numbers and mortality data grow by the minute.
Healthcare, an essential service at any time but never more so than in a crisis such as this, has been severely affected as the primary focus is shifted to the management of the crisis and other health emergencies rather than routine care.
Many elective surgeries are being deferred or delayed and patients are being advised to avoid non-essential hospital visits and switch to tele-consultation for arising problems.
For many cancer patients this situation is a living nightmare as they face not only the threat of Covid-19, the pressure of lockdown restrictions but also intense uncertainty regarding the future of their cancer treatment and its associated outcome.
Cancer patients are facing a stark choice regarding continuing treatment or delaying it to mitigate the Covid-19 risk. Many cancer patients in India travel huge distances to receive treatment but right now they cannot access treatment even if they wish to proceed as airlines and rail services are not operating.
Understandably, patients want concrete answers about when they can start cancer treatment, what the implications are if there is a gap in their treatment on their chances of recovery and the risks for their safety if they do attend the hospital.
There is no one-size-fits-all answer to these questions.
The psychological impact on patients and their families is starting to reveal itself.
The son of a recently diagnosed patients wrote to us: “My father has been diagnosed with kidney cancer with lung metastasis 21 days ago. His immunohistochemistry sample could not be processed in this lockdown and he was advised to stay at home considering his age of 83 years. I am worried about his cancer but at the same time this infection too.”
Another patient’s family wrote: “Is it safe to visit hospital for PET-CT as I have heard that cancer patients are more prone to catch infection?” His mother has colorectal cancer and is post-surgery and post four cycles of chemotherapy. She was scheduled for PET-CT for evaluation but was frightened to approach to the hospital in the lockdown.
In ordinary times, cancer patients face uncertainty and have to fight on many fronts to deal with the economic, social, family and personal challenges that a cancer diagnosis brings. During active treatment cancer patients require frequent hospital visits, pre-operative & post-operative stays, chemotherapy sessions, laboratory tests and radiological imaging, daily appointments for radiotherapy sessions (often over weeks). Extended hospital visits mean that cancer patients, many of whom are immunocompromised as a result of the side-effects of treatment, are more likely to be exposed to infection.
Data emerging from many countries affected by the pandemic suggests that the majority of the Covid-19 patients who require hospitalisation are suffering from heart disease, respiratory disease, diabetes, hypertension or cancer.
Here we have tried to address many of the concerns of cancer to minimise the fear and uncertainly related to cancer treatment and its outcome amidst this Covid-19 crisis.
Which cancer patients are at high risk for coronavirus infection?
Cancer patients who are older (more than 70) and having one or more associated co-morbidities, i.e., cardiovascular diseases, hypertension, diabetes, and lung diseases are at high risk for coronavirus infection.
What are the symptoms of coronavirus disease in cancer patients?
Coronavirus diseases are associated with symptoms which include fever, a new persistent dry cough, difficulty in breathing, fatigue, sore throat. New evidence suggests some patients are experiencing the loss of smell and taste. Presentation of the disease is not different in cancer patients but chances of progression to severe or critical diseases are more common with cancer patients.
What are the chances of getting coronavirus infection if cancer patients come to hospital for their treatment?
Chances of getting coronavirus infection does increase with frequent hospital visits. It has been reported between 10 – 30% in reports from different hospitals in China where Covid-19 patients were getting treatment.
Should I visit the hospital?
In this present scenario, the best advice is to minimise the hospital visits for cancer patients and that tele-consultation can be a good alternative to avoid direct contact between patients and cancer care provider for the vast majority of routine appointments.
I am currently having cancer treatment. Should I continue my treatment or stop it as I have to go to hospital frequently for my treatment.
No cancer patients should halt, postpone or cancel their treatment as stated in guidelines from various cancer institutions/societies/hospitals. Patients who are in hospital must adopt the contact and droplet precautions, which means wearing a mask, covering outdoor clothes and extra sanitation steps. Hospital staff should be following the same guidelines. Discuss how to minimise visits with your healthcare provider or if any procedures can be done at home.
My cancer doctor has advised to me delay the surgery/chemotherapy/radiotherapy. Should I follow my doctor’s advice or get surgery/chemotherapy/radiotherapy done at another hospital?
There is a time limit on how long someone can delay cancer treatment without it impacting their recovery. Patients need to have a discussion with their cancer care provider about their unique circumstances. One size does not fit all. In some cases, patients may be reasonably advised to switch to other treatment modalities. If there is an issue related to transportation and stay, patients are encouraged to start the treatment at the nearest cancer centre where appropriate treatment is available rather than travel.
What precautions should cancer patients take amidst the coronavirus crisis?
Cancer patients are advised to practice social distancing, maintaining at least a two-metre distance from anyone who does not share their home. Regular handwashing with soap or alcohol-based hand rub is a necessity. If a member of your household develops Covid-19 symptoms such as cold, cough or fever they should self-isolate as much as is reasonably practical. Patients are advised to avoid crowded places and stay in well-ventilated rooms. Patients are advised not to shake hands and organise longer prescriptions for regular medicines well in advance of running out.
I have been receiving information on WhatsApp, Facebook and other sources about coronavirus prevention and treatment. How can I confirm what is real and what is fake?
A lot of incorrect information has been circulating leading to fear and uncertainty. There are trustworthy information sources available, being updated regularly as new evidence emerges and is evaluated by experts such as the World Health Organization (WHO) and the Indian Council of Medical Research (ICMR). Patients and their caregivers should use these and not rely on social media.
Also Read: Snapchat Brings ‘Lensathon’ to India
In conclusion, cancer patients and caregivers are facing difficult decisions to understand and weigh up the risk and benefits of continuing treatment in its current form in this crisis.
Although current guidelines support the continuation of treatment where possible, patients must talk to their individual cancer care provider to explore if their treatment should be reasonably modified in the ways outlined above to reduce their individual risks of exposure to Covid-19.
(Dr. Abhishek Shankar is Assistant Professor in Radiation Oncology at Lady Hardinge Medical College & SSK Hospital, Delhi. Dr. Deepak Saini is Project Officer at Cancer Control and Prevention Division of Indian Society of Clinical Oncology, Delhi. Views expressed are personal.)
Apple has updated its App Store rules to allow developers to contact users directly about payments, a concession in a legal settlement with companies challenging its tightly controlled marketplace.
According to App Store rules updated Friday, developers can now contact consumers directly about alternate payment methods, bypassing Apple's commission of 15 or 30%.
They will be able to ask users for basic information, such as names and e-mail addresses, "as long as this request remains optional", said the iPhone maker.
Apple proposed the changes in August in a legal settlement with small app developers.
But the concession is unlikely to satisfy firms like "Fortnite" developer Epic Games, with which the tech giant has been grappling in a drawn-out dispute over its payments policy.
Epic launched a case aiming to break Apple's grip on the App Store, accusing the iPhone maker of operating a monopoly in its shop for digital goods or services.
In September, a judge ordered Apple to loosen control of its App Store payment options, but said Epic had failed to prove that antitrust violations had taken place.
For Epic and others, the ability to redirect users to an out-of-app payment method is not enough: it wants players to be able to pay directly without leaving the game.
Both sides have appealed.
Apple is also facing investigations from US and European authorities that accuse it of abusing its dominant position. (VOA/RN)
Keywords: Apple, App store, Epic, Games
Instagram (often abbreviated as IG or Insta) is one of the fastest-growing social media platforms in the market. It was a huge success right from the start, with more than a million users in only two months after it was launched. With individuals from all over the world posting photographs practically every second of the day, it is also one of the most popular social media platforms available. It is a picture and video social networking website based in the United States and owned by Facebook.
Instagram was created in San Francisco by Kevin Systrom and Mike Krieger, who worked together. Systrom was employed in marketing at the time, but he would learn how to code at night. He developed a prototype app for the concept, originally called "Burbn"; people could use this app to check-in to their location. Systrom attended a party where he met individuals who worked for venture capitalist firms and persuaded them to meet with him to promote Burbn. As soon as the first meeting concluded, he stepped down from his job, and two weeks later, he had collected $500,000 in funding from companies.
Instagram (often abbreviated as IG or Insta) is one of the fastest-growing social media platforms in the market. | Photo by Claudio Schwarz on Unsplash
At this time, Systrom decided to form a team to help him further, so Mike Krieger chose to join. They concluded that the app was too similar to other preexisting mobile applications; therefore, they emphasized exclusively on visual communication. Apart from posting pictures, commenting, and liking, they removed all other services from the app. "Instagram" was chosen as the app's name since it corresponded to the fact that users were sending a kind of "instant telegram."
Instagram was launched on the 6th of October, 2010, and its popularity grew almost immediately. It quickly rose to become the most popular photography app following the launch, gaining 100,000 users in one week and reaching 1 million users within two months. Later, in 2012, it was purchased by Facebook for 1 billion dollars. Currently, it has more than 600 million active users, and the number is still steadily growing.
Keywords: Instagram, Instagram login, telegram, facebook, history, social media
India is known for its pickles, popularly called 'Achaar', even across the world. But who thought about the idea of pickles in the first place? Apparently, the idea of making pickles first came from the ancient civilisation of Mesopotamia, where archaeologists have found evidence of cucumbers being soaked in vinegar. This was done to preserve it, but the practice has spread all over the world today, that pickles mean so much more than just preserved vegetables.
In India, the idea of pickle has nothing to do with preservation, rather pickle is a side dish that adds flavour and taste to almost anything. In Punjab, parathas are served with pickle; in the south, pickle and curd rice is a household favourite, and in Andhra, it is a staple, eaten with everything. The flavour profile of pickles in each state is naturally different, suited to each cuisine's taste. Pickles are soaked in oil and salt for at least a month, mixed with spices and stored all year round. Mango season is often synonymous with pickle season as a majority of Indians love mango pickle. In the coastal cities, pickles are even made out of fish and prawns.
The Indian Achaar Image credit: Photo by Rahat Hossen on Unsplash
In other cultures, the pickling process has more to do with preservation. Cold countries, where temperatures drop to very low levels, pickle their vegetables in brine, vinegar, or salt. Sweden is famous for pickled herring, because fishing all year round is hard with all the snow and ice. The German Sauerkraut, originally composed of rice, cabbage, and wine, is now made using salt instead of wine. This gives it a sour flavour that is characteristic of the beloved German delicacy.
In Korea, kimchi is the national delicacy. It is a pickle that is made from pickled cabbages with a distinct mix of spices. Kimchi is made with various core ingredients, and is gaining popularity these days with the Korean Wave hitting the globe. It is a practice that represents the Korean winters, which are too harsh to grow anything. The Kimchi business is one of the largest in Korea, while the individual family recipes are also well-preserved as it is believed that each is unique in its own way.
The pickles made from dill and vinegar are most famous in America. It was introduced to the Americans by the Jewish immigrants. Dill pickles are best paired with sandwiches.
Keywords: Pickles, Culture, Brine, Vinegar, Preserves