Ocular oncology practice during SARS-CoV-19 related lockdown

Beta corona virus disease is a relatively new entity caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2); also known as 2019 novel corona virus disease (COVID-19) was first identified in China on December 3, 2019.1,2 In India COVID-19 was detected first time on January 30, 2020 Since, then it has spread across the globe to become one of the most serious pandemics.3 The World Health Organization (WHO) has declared COVID-19 outbreak as a public health emergency of international concern on January 30, 2020.4 By June 2, 2020, its outbreak was wide spread internationally causing 6,28,7771 infections and 3,79,941 deaths in several counties. In India, the total number of confirmed COVID19 cases exceeded 2,07615 and 5845 deaths as of June 2, 2020.5 The human-to-human transmission is confirmed. As compared with other types of corona virus like SARS & MERS, this virus has high risk of transmissibility and infectivity, despite of low mortality rate.6,7 The virus is mainly transmitted through direct contact of respiratory droplets or by touching a contaminated surface or objects via nose, mouth and eye.8 Transmission via ocular surface is also reported. The transmission due to aerosol contact with conjunctiva in unprotected eyes has also been reported.9,10 Elderly, immunocompromised patients and patients with pre-existing co-morbidities like diabetes, cardiovascular diseases, hypertension and cancer are at greatest risk of mortality. Along with cancer it has become the second leading cause of death worldwide. COVID-19 infection is likely to increase cancer related mortality to a great extent. Wenhua Liang et at. analyzed 2007 cases from 575 hospitals in China and found that patients with cancer had higher risk of severe COVID-19 infection than those without cancer.11 McGoogan WZ reported that COVID-19 fatality rate was about 5.6% among cancer patients as compared with 2.3% in general population.12 Cancer patient are prone to COVID-19 because of immunocompromised condition due to both malignancy and anticancer chemotherapy. The only way to prevent virus infection/transmission is by social distancing and isolation, to control virus epidemic, due to unavailability of effective treatment and vaccine. In Indian prospective, the complete lockdown was enforced at midnight of March 24, 2020 with total travel bans and schools and universities were indefinitely closed.13 During lockdown all routine outpatient departments across the hospitals and clinics were to be shut and only emergency services continuing to function. The COVID-19 outbreak is the leading unprecedented consequence on cancer care. It may have direct or remote consequences on patients and health care providers. The Ocular oncology practice during the COVID-19 pandemic related lockdown is quite challenging. Cases of COVID-19in India are still increasing at a great pace even during 5th lockdown, started from June 1, 2020. Recent Chinese study shows that most of the cancer patients are at a higher risk in developing severe events in COVID-19 due to immunosuppressed status.7 Many patients of ocular malignancies are also immunocompro-