Two years in and it's becoming clearer than ever that the fault lines of COVID-19 run deeper than we thought. COVID-19 doesn't just impact those infected, but its ripples have been disrupting continuum of care other chronic illnesses—sometimes a matter of life and death.

A study, for instance, published in the medical journal Lancet Oncology, conducted across 41 cancer centers in India found that between March and May of 2020, new registered cancer patients decreased by 51 percent.

The situation hasn't improved since.

"In our own experience, we used to see 200 cases of breast cancer at the Apollo Hospital once a year, and out of them 50 percent would be early where I would do only breast conservative surgery," says Dr Ramesh Sarin, Senior Consultant, Surgical Oncologist, Indraprastha Apollo Hospital, New Delhi.

"Now we have seen only 100 patients in the last one year. (Which means) some of them are still sitting at home with the cancer in their body," she adds.

Explaining this further, Dr Tejinder Kataria, Chairperson, Radiation Oncology, Cancer Institute—Medanta, Gurugram, tells FIT, "the patients who were having symptoms could not come for their checkups, or have the diagnosis made, because of the travel restrictions that were put in at the time. That was one part."

"Second was the patients who were already on treatment had a difficult time commuting to and back to the hospital. Third is that the other state migration," she adds.

Some patients, she says, waited for over six months to even get diagnosed, which is enough time for the cancer to be too far gone.

Cancer, she goes on to say is curable if caught early. Especially in the case of some cancers like breast cancer, which she explains, "can be cured 90 percent of the time if diagnosed early."

The key word, however, is early.

Another analysis of thirty-four observational studies published in medical journal BMJ found that, every month's delay in treatment — whether surgery, radiation therapy (such as chemotherapy or immunotherapy), or medication— led to an increase of 6 percent to 13 percent in the risk of fatality.

Dr Sarin goes on to talk about one of her patients.

"Of course we will treat her, but chances of having a normal life are few," she adds.

"One week is alright, two weeks is okay, three weeks is okay, but you can’t be waiting for three months and three years. It’s not a sensible thing to do," Dr Sarin reiterates.

Cancer patients, especially those on immunosuppressants have been categorised as high-risk from the beginning of the pandemic.

The fear of catching COVID is also one of the main reasons that has been keeping patients from going out and getting their treatment, or even diagnosis.

But doctors that FIT spoke to report that in their experience, their cancer patients who got covid didn't develop any more severe illness than others.

Dr Kataria has also made similar observations, saying, "So fortunately for us, we've not had a more difficult time with the (cancer) patients who got COVID. And that is what the data is showing from across the countries in the world. Also, we have not seen an increase in the complications because of the COVID and the additional treatment utilization (for cancer patients)."

According to Dr Kataria it could be that the low natural immune response of the cancer patients kept them from developing complications and symptoms that are a result of aggressive immunogenic response like cytokine storms.

Both Dr Kataria and Dr Sarin, however, emphasise on keeping a closer observation of COVID positive cancer patients and delaying surgeries and chemotherapy until they've tested negative.