AFES A.S.-O.N.E.: ASEAN Survey Of Needs in Endocrinology in the Time of the COVID-19 Pandemic
Keywords:survey, Southeast Asia, COVID-19, endocrine care, SARS-CoV-2
Abstract*Visual Abstracts prepared by Dr. Francis Xavier Mislang
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 endocrine-related
research in the AFES countries.
Methodology. The AFES ASEAN Survey Of Needs in Endocrinology (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 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.
WHO Coronavirus Disease (COVID-19) Dashboard, Johns Hopkins University. Available at https://coronavirus.jhu.edu/map.html.
Rhee EJ, Kim JH, Moon SJ, Lee WY. Encountering COVID-19 as endocrinologists. Endocrinol Metab. 2020;35:e1.
Gupta R, Ghosh A, Singh AK, Misra A. Clinical considerations for patients with diabetes in time of COVID-19 epidemic. Diabetes Metabol Syndr. 2020;14(3):211-2. https://www.ncbi.nlm.nih.gov/pubmed/32172175. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102582. https://doi.org/10.1016/j.dsx.2020.03.002.
CDC COVID-19 Response Team. Preliminary estimates of the prevalence of selected underlying health conditions among patients with Coronavirus disease 2019 - United States, February 12-March 28, 2020. Morbidity and Mortality Weekly Report. 2020; 69(13):382-6. Available at https://www.cdc.gov/mmwr/volumes/69/wr/mm6913e2.htm.
Bornstein S, Rubino F, Khunti K, et al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol. 2020; 8(6):546-50. https://www.ncbi.nlm.nih.gov/pubmed/32334646. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7180013. https://doi.org/10.1016/S2213-8587(20)30152-2.
Hussain A, Bishwajit B, Moreira NCdV. COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract. 2020;162:108142. https://www.ncbi.nlm.nih.gov/pubmed/32278764. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144611. https://doi.org/10.1016/j.diabres.2020.108142.
Bloomgarden ZT. Diabetes and COVID-19. J Diabetes. 2020;12(4):347-8. https://www.ncbi.nlm.nih.gov/pubmed/32162476. https://doi.org/10.1111/1753-0407.13027.
Li M-Y, Li L, Zhang Y, Wang XS. Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues. Infect Dis Poverty. 2020;9(45). https://www.ncbi.nlm.nih.gov/pubmed/32345362. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186534. https://doi.org/10.1186/s40249-020-00662-x.
Pal R, Banerjee M. COVID-19 and the endocrine system: Exploring the unexplored. J Endocrinol Invest. 2020;1-5. https://www.ncbi.nlm.nih.gov/pubmed/32361826. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195612. https://doi.org/10.1007/s40618-020-01276-8.
Kaiser UB, Mirmira RG, Stewart PM. Our response to COVID-19 as endocrinologists and diabetologists. J Clin Endocrinol Metab. 2020;105(5):1299-1301. https://www.ncbi.nlm.nih.gov/pubmed/32232480. https://www.ncbi.nlm.nih.gov/pubmed/PMC7108679. https://doi.org/10.1210/clinem/dgaa148.
Puig-Domingo M, Marazuela M, Giustina A. COVID-19 and endocrine diseases. A statement from the European Society of Endocrinology. Endocrine. 2020; 68(1):2-5. https://www.ncbi.nlm.nih.gov/pubmed/32279224. https://www.ncbi.nlm.nih.gov/pubmed/PMC7150529. https://doi.org/10.1007/s12020-020-02294-5.
United Nations Population Division Live Estimates, as of May 22, 2020.
COVID-19 Worldwide Dashboard - WHO Live World Statistics. Available at https://covid19.who.int/gclid=CjwKCAjw2a32BRBXEiwAUcugiGlzLlwiCfk0eZ2argIiuSC2UTcX9vvBXgJPj366sBMXiuOeWs8MyBoCY2UQAvD_BwE.
Oxford COVID-19 Evidence Service – CEBM. Available at https://www.cebm.net/covid-19/.
Ramachandran A, Snehalatha C, Shetty AS, Nanditha A. Trends in prevalence of diabetes in Asian countries. World J Diabetes. 2012;3(6):110-7. https://www.ncbi.nlm.nih.gov/pubmed/22737281. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3382707. https://doi.org/10.4239/wjd.v3.i6.110.
Ministry of Health. Indonesia Basic Health Research 2018.
National Health and Morbidity Survey (NHMS) 2015. http://iku.moh.gov.my/index.php/research-eng/list-of-research-eng/iku-eng/nhmseng/nhms-2015.
IDF Atlas 9th ed, 2019. https://www.diabetesatlas.org/en/.
Latt TS, Zaw KK, Ko K, et al. Diabetes Metab Syndr Obes. 2019;12:291-8. https://www.ncbi.nlm.nih.gov/pubmed/30881072. PMCID: PMC6407671. https://doi.org/10.2147/DMSO.S156270.
Food and Nutrition Research Institute. 8th National Nutrition Survey (NNS), 2018.
2019 National Data.
Thai National Health Examination Surveys (NHES), 2018.
National Survey 2012, National Hospital of Endocrinology- Hanoi, Vietnam.
Leow MK, Kwek DS, Ng AW, et al. Hypocortisolism in survivors of severe acute respiratory syndrome (SARS). Clin Endocrinol(Oxf). 2005;6(2):197-202. https://www.ncbi.nlm.nih.gov/pubmed/16060914. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188349. https://doi.org/10.1111/j.1365-2265.2005.02325.x.
Muniyappa R, Gubbi S. COVID-19 pandemic, coronaviruses, and diabetes mellitus. Amer J Physiology Endocrinol Metab. 2020;318(5):E736-41. https://www.ncbi.nlm.nih.gov/pubmed/32228322. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191633. https://doi.org/dp10.1152/ajpendo.00124.2020.
Philippine Society of Endocrinology, Diabetes and Metabolism. Position statement on COVID-19 infection and diabetes. J ASEAN Fed Endocr Soc. 2020;35(1). https://doi.org/10.15605/jafes.035.01.02.
Indonesian Society of Endocrinology. Position statement on how to manage patients with diabetes and COVID-19. J ASEAN Fed Endocr Soc. 2020;35(1):49-51. https://doi.org/10.15605/jafes.035.01.03.
Arcellana AE, Jimeno CA. Challenges and opportunities for diabetes care in the Philippines in the time of the COVID-10 pandemic. ASEAN Fed Endocr Soc. 2020;35(1):55-7. https://doi.org/10.15605/jafes.035.01.04
Jimeno CA, Anonuevo-Cruz MC, Uy AB, et al. UP-Philippine General Hospital Division of Endocrinology, Diabetes and Metabolism CONSENSUS RECOMMENDATIONS FOR IN-PATIENT MANAGEMENT OF DIABETES MELLITUS AMONG PERSONS WITH COVID-19. J ASEAN Fed Endocr Soc. 2020;35(1):14-25. https://doi.org/10.15605/jafes.035.01.05.
Hamdy O, Gabbay RA. Early observation and mitigation of challenges in diabetes management of COVID-19 patients in critical care units. Diabetes Care. 2020. https://doi.org/10.2337/dc20-0944.
Simoni M, Hofmann MC. The COVID-19 pandemics: Shall we expect andrological consequences? A call for contributions to Andrology. Andrology. https://www.ncbi.nlm.nih.gov/pubmed/32302464. https://doi.org/10.1111/andr.12804.
Brancatella A, Ricci D, Viola N, Sgro D, Santini F, Latrofa F. Subacute thyroiditis after SARS-CoV-2 infection. J Clin Endocrinol Metab. 2020. https://doi.org/10.1210/clinem/dgaa276.
Yang W, Wang C, Shikora S, Kow L. Recommendations for metabolic and bariatric surgery during the COVID-19 pandemic from IFSO. Obes Surg. https://www.ncbi.nlm.nih.gov/pubmed/32291701. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7155392. https://doi.org/10.1007/s11695-020-04578-1.
Filetti, S. The COVID-19 pandemic requires a unified global response. Endocrine. 2020;68(1):1. https://www.ncbi.nlm.nih.gov/pubmed/32253680. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7133773.
Reyes MVT. Research in the time of COVID-19 pandemic: Challenges to research ethics committees. J ASEAN Fed Endocr Soc. 2020;35(1): 29-32. https://doi.org/10.15605/jafes.035.01.07.
How to Cite
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to firstname.lastname@example.org or email@example.com.
A written agreement shall be emailed to the requester should permission be granted.