AFES A.S.-O.N.E.: ASEAN Survey Of Needs in Endocrinology in the Time of the COVID-19 Pandemic

Abstract

Objectives The COVID-19 pandemic has made a major impact on hospital services globally, including the care of persons with diabetes and endocrine disorders. The aim of this study is to describe the epidemiology of COVID-19 in the ASEAN Federation of Endocrine Societies (AFES) member countries; to describe challenges, changes and opportunities in caring for patients with endocrine diseases, as well as in fellowship training programs, and endocrinerelated research in the AFES countries. Methodology The AFES A SEAN S urvey O f N eeds in E ndocrinology (AFES A.S.-O.N.E.) was an open-ended questionnaire that was sent to the presidents and representatives of the AFES member countries by email. Responses from Societies were collated and synthesized to obtain perspectives on the emergent issues in endocrinology in the Southeast Asian region during this pandemic. Results The burden of COVID-19 cases varied widely across the AFES member countries, with the least number of cases in Vietnam and Myanmar, and the greatest number of cases in either the most populous countries (Indonesia and the Philippines), or a country with the highest capability for testing (Singapore). The case fatality rate was also the highest for Indonesia and the Philippines at around 6%, and lowest for Vietnam at no fatalities. The percentage with diabetes among patients with COVID-19 ranged from 5% in Indonesia to 20% in Singapore, approximating the reported percentages in China and the United States. The major challenges in managing patients with endocrine diseases involved inaccessibility of health care providers, clinics and hospitals due to the implementation of lockdowns, community quarantines or movement control among the member countries. This led to disruptions in the continuity of care, testing and monitoring, and for some, provision of both preventive care and active management including surgery for thyroid cancer or pituitary and adrenal tumors, and radioactive iodine therapy. Major disruptions in the endocrine fellowship training programs were also noted across the region, so that some countries have had to freeze hiring of new trainees or to revise both program requirements and approaches to training due to the closure of outpatient endocrine clinics. The same observations are seen for endocrine-related researches, as most research papers have focused on the pandemic. Finally, the report ends by describing innovative approaches to fill in the gap in training and in improving patient access to endocrine services by Telemedicine. Conclusion The burden of COVID-19 cases and its case fatality rate varies across the AFES member countries but its impact is almost uniform: it has disrupted the provision of care for patients with endocrine diseases, and has also disrupted endocrine fe...

COVID-19 endocrinopathy with hindsight from SARS

“…As this COVID-19 pandemic evolves, an increasing number of infected patients are observed to be afflicted with a range of different endocrine disorders worldwide. Thus, collaborations between experts from different countries are crucial as the collective wisdom and best practices shared across geographical boundaries can help tackle this pandemic better, such as illustrated by a recent survey of clinical endocrinologists (113). This raises the following important research questions that demand further investigations:…”

The pituitary gland in the COVID-19 pandemic: A narrative review of the literature

“…Management included organization readjustments and clinical adaptation of the usual practices. [6][7][8][9][10]46,[59][60][61] A summary of the principles and salient practice points for the management of pituitary disorders during the COVID-19 pandemic is presented in Table 5. Some practical aspects are highlighted below.…”

“…Patients with pituitary disorders should be classified as needing emergent, urgent, or elective care to guide timely intervention [6] Use virtual/telemedicine care to assess and follow stable patients with pituitary disorders [6][7][8][9] Patients with chronic stable pituitary disorders are to be followed less frequently with access to care when needed [6] Patients with pituitary disorders on corticosteroids should be counseled on steroid management if they are infected with COVID-19 or sick after the COVID-19 vaccination [46] Laboratory samples could be collected by the patient at home when possible, e.g., salivary samples instead of blood samples for cortisol assays. However, one visit for laboratory samples collection may be necessary for most patients after proper virtual assessment [9,47] Medical therapy to be utilized when it is an option in place of surgical intervention during the epidemic peak [6] Surgical intervention should be done timely without delay when needed to treat pituitary tumors-maintaining the patients' and healthcare personnel's safety to be ensured through proper COVID-19 screening and applying proper isolation before intervention [48] Known case of pituitary insufficiency on daily HC HC dose was not changed during the infection as the patient was asymptomatic…”

“…They reported that the burden of COVID-19 cases and its case fatality rate varies across the AFES member countries, but its impact is almost uniform: It has disrupted the provision of care for patients with endocrine diseases. [7] Telemedicine and innovations have been operational across the AFES countries to cope with the resulting disruptions.…”

“…The care typically involves a multidisciplinary team working in concert to deliver timely, often complex, disease investigation and management, including pituitary surgery. [6][7][8][9][10] COVID-19 has brought about major disruption to the services, limiting access to care and testing, and dramatically reducing the ability to undertake transsphenoidal surgery safely. Therefore, we have reviewed the global literature on the pituitary and COVID-19 to provide a concise thematic account of the subject.…”