Table 1.

Expected Challenges and proposed solutions during the COVID-19 pandemic

Challenge	Proposed solutions
Reduced mobility of patients due to movement restrictions	Setting up of telemedicine/electronic app-based consultation services for follow up of patients [12] Hospital Records database services may be contacted to share the hematology specific helpline/telemedicine portals with the previously registered patients List of centers of convenience need to be compiled in the drainage area of referral centers Patients may be referred to centres of convenience closest to their homes to avoid travel during follow-ups. Referral centres can liaise with non-COVID private or public hospitals and provide protocols for the continuation of therapy [19]
Over-crowding in hospital outpatient department (OPD), inpatient and laboratory areas	Encourage on-line appointment wherever feasible Decrease the number of individuals entering the hospital by categorizing your patients in 1 of the following 3 categories based on previous hospital records/referrals: “Keep personal appointment” as it is for must-see patients- e.g. sick/acutely ill patients who are unable to obtain medical care at another center “Keep or move an appointment”, and also transition to telehealth or phone call option “Reschedule for the future” (able to move the appointment by at least weeks). Allow none or no more than one visitor per person Electronic messages may be sent to patients 1-day in advance of clinic visit to screen for COVID-19 exposure/symptoms; Those with mild symptoms of upper respiratory tract infection (URTI) may be advised strict home quarantine and to report to a nearby health facility in case of danger signs and/or fulfilment of criteria of COVID testing Install barriers or social distancing mechanisms at front desks if screening is not conducted outside of the facility Public signages, televisions, deployment of hospital staff to  Ensure 6 feet social distance at all places  Distribute triple layer medical masks as per guidelines for patients before entering the hospital premises and use hand sanitizer as frequently as possible at all stations [21] Designate separate “fever clinic/fever COVID19 screening zones” in each OPD at entry points to channel all patients potentially harbouring infections for screening Encourage home collection of investigation samples wherever feasible Limit health access to a single-point entry Consents from the patient who seek to attend the hospital explaining the risk of COVID-19 infection Stop hospital access to vendors/medical representatives, to use digital platforms instead
Small chemotherapy rooms/clinics	Re-design any current open infusion suite to a semi-private space, with at least six feet distance between patients and/or deploy barriers between patients
Reduced blood and blood product availability	Regular communication with the blood-banks to assess the supply of blood products Restrictive blood and blood product transfusion possibility; avoid prophylactic platelet transfusions. For e.g. a “no prophylactic platelet transfusion” strategy may be adopted for asymptomatic patients with chronic bone marrow failure (including during low dose oral chemotherapy or azacitidine) and to consider no prophylactic platelet transfusions for well patients without bleeding after autologous stem cell transplantation [22]. Encourage donations through NGOs, hospital staffs [23] Lower thresholds erythropoietin, thrombopoietin agonist, G-CSF to decrease the risks of chemotherapy induced cytopenias (Ref NCCN) Use prophylactic tranexamic acid in patients at risk of bleeding [24]
Managing patients with hematologic disorders with the suspected/confirmed COVID-19	Admission in the hospital isolation ward/referral to dedicated COVID-19 hospital as per the national policy [25] Keep low threshold for testing in immunocompromised patients Look and treat for co-infections Management according to national guidelines if tested positive [25] Monitor for drug interactions for therapies used for COVID-19 (chloroquine/remedisvir/lopinavir) with anti-cancer drugs or antifungals
Lack of staff preparedness and shortage of ICU beds/equipment	Dedicate separate training teams for timely training of staff for:  Screening of patients for COVID-19 related symptoms  Isolation and sampling of suspects  Rational use of personal protective equipment (PPE)/masks, donning, doffing etc  Prioritization of treatments including palliative care [26]
Limited drug availability	Treating team should liaison with the local pharmacy and chemists and ensure availability of all drugs which are anticipated to be used