Jasul Gabriel, Paz-Pacheco Elizabeth, Jimeno Cecilia, Suastika Ketut, Hussein Zanariah, Mustafa Norlaila, Aung Aye Aye, Robles Jeremyjones, Leow Melvin Khee Shing, Deerochanawong Chaicharn, Khue Nguyen Thy, Dang Tran Huu
Division of Endocrinology, Diabetes and Metabolism, University of the Philippines College of Medicine (UPCM)-Philippine General Hospital.
Diabetes, Thyroid and Endocrine Center, St. Luke's Medical Center, Quezon City, Philippines.
J ASEAN Fed Endocr Soc. 2020;35(1):5-13. doi: 10.15605/jafes.035.01.10. Epub 2020 May 29.
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.
The SEAN urvey f eeds in ndocrinology 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.
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.
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 fellowship training and endocrine-related research across the region. Telemedicine and innovations in training have been operationalized across the AFES countries in an attempt to cope with the disruptions from COVID-19, but its over-all impact on the practice of endocrinology across the region will only become apparent once we conquer this pandemic.
新冠疫情对全球医院服务产生了重大影响，包括对糖尿病和内分泌疾病患者的护理。本研究的目的是描述东盟内分泌学会联合会（AFES）成员国中新冠疫情的流行病学情况；描述在内分泌疾病患者护理、专科培训项目以及AFES国家内分泌相关研究方面所面临的挑战、变化和机遇。
东南亚内分泌调查是一份开放式问卷，通过电子邮件发送给AFES成员国的会长和代表。对各学会的回复进行整理和综合，以获取关于此次疫情期间东南亚地区内分泌学新出现问题的观点。
AFES成员国的新冠病例负担差异很大，越南和缅甸的病例数最少，人口最多的国家（印度尼西亚和菲律宾）或检测能力最高的国家（新加坡）病例数最多。印度尼西亚和菲律宾的病死率也最高，约为6%，越南最低，无死亡病例。新冠患者中糖尿病患者的比例从印度尼西亚的5%到新加坡的20%不等，接近中国和美国报告的比例。管理内分泌疾病患者的主要挑战包括由于成员国实施封锁、社区隔离或行动管制，医疗服务提供者、诊所和医院难以进入。这导致了护理、检测和监测的连续性中断，对一些人来说，还导致了预防性护理和积极管理的提供中断，包括甲状腺癌、垂体和肾上腺肿瘤的手术以及放射性碘治疗。该地区的内分泌专科培训项目也出现了重大中断，因此一些国家不得不冻结新学员的招聘，或者由于门诊内分泌诊所关闭而修订项目要求和培训方法。内分泌相关研究也有同样的情况，因为大多数研究论文都集中在疫情上。最后，报告通过描述创新方法来填补培训空白，并通过远程医疗改善患者获得内分泌服务的机会来结束。
AFES成员国的新冠病例负担及其病死率各不相同，但其影响几乎是一致的：它扰乱了内分泌疾病患者的护理提供，也扰乱了该地区的内分泌专科培训和内分泌相关研究。AFES国家已实施远程医疗和培训创新，以应对新冠疫情带来的干扰，但只有在我们战胜这场疫情后，其对该地区内分泌学实践的总体影响才会显现出来。
