Institut Curie during and after COVID-19

Interview of Pierre Anhoury - Director of International Relations at the Institut Curie

C3Medical coordinates international patient care pathways for the Direction of International Relations (DRI) at Institut Curie since 2017. This department handles more than 1200 requests and welcomes over 400 patients each year. 

We interviewed Dr Pierre Anhoury, Director of International Relations at the Institut Curie on the measures and procedures that were implemented during the COVID-19 crisis and the lessons that he has learned.

What is the specificity of the International Relations Department at Institut Curie? 
Dr Pierre Anhoury : Our Department handles requests that only concern cancer patients.  This is not classic medical tourism in which there is a commercial notion.  We analyze each case from the expected benefits perspective, following a strict ethical boundary and after consultation with the doctors from the Institut.

What particular protocols have you introduced for your international patients during the COVID-19 crisis? 
Dr Pierre Anhoury : 
During the crisis of Spring 2020, the Director General, Professor Pierre Fumoleau of Institut Curie set up a Crisis Body to coordinate the actions and the new protocols to be adhered to within the institution at this time.  He notably organized and hosted calls between 1pm and 3 pm every day with all the departments of the Institut. These conference calls, in which we all participated, allowed us to highlight the particular concerns and issues that needed to be resolved for our international patients. 

From the beginning, we counted the number of international patients present and who had to remain in France due to the closure of the airports. We had 121 international patients at Institut Curie undergoing treatment.
In a first instance, we entered into a period of explanation with the authorities as, very rapidly, the Embassies contacted us to organize the immediate repatriation of their citizens by especially dedicated aircraft.  But we were able to reassure them: we explained that we were testing their citizens and that we had immediately set up a « non-COVID-19 circuit » within the hospital, a circuit completely separated from the «  COVID-19 circuit». In the end there were no repatriations. We wanted to avoid at all costs any repatriation of our patients, which would have disrupted the course of their treatments and been harmful to the evolution of the illness.

Once this initial stage had passed, we then explained to our foreign patients that their stay in Paris would be different from now on.  We provided interpreters when necessary to be sure they understood the required hygiene the social distancing measures put in place, but also to respond to questions. 

Another measure we introduced was to postpone, where possible, any surgical operations, radiotherapy or chemotherapy sessions. We worked on a case-by-case basis and depending on the medication the patient was under, as some have more serious side effects than others; it was necessary for those patients, and only those patients, to postpone the treatments. 

All of these measures contributed to reassuring the patients and ensured they remained in a « Covid free » environment while limiting the risk of catching the virus. 

How did you continue to treat the international patients that were in their own country? 
Dr Pierre Anhoury :
We didn’t abandon them and we accompanied them as best as possible.
All airports were closed and the French Health Authority forbid us to bring foreign patients to France during the COVID-19 period, we therefore stopped this physical process. However, as you well know, cancer did not stop in the world and as in normal times, new patients or those whose state of health worsened, contacted the Institut Curie. It was impossible for us to bring these patients over to treat them so we set up a system of consultation and patient follow-up at a distance to respond to questions. 
Our objective was for the patient to begin a treatment in his own country under our guidance. For some we contacted directly their doctor, for others we found a local contact (one of our previous students residing in the country, a local doctor known by one of our doctors, etc.). 

For the patients planning to come over under their own means, we were able to thoroughly complete their files and prepare for their arrival once the borders reopened.  We identified 45 patients ready and prepared to come.  In addition to the file that we prepared, we offered a medical certificate for each patient so they could have priority to obtain a flight and to facilitate the application for a visa. 

On June 15th we got a green light to bring these patients over where possible, depending on the resumption of flights. 

What lessons have you learned from this period? 
Dr Pierre Anhoury :
We have learnt that a lot can be achieved at a distance and that it is imperative to further develop methods of telemedicine. We have even decided to launch a new video-consultation service where a foreign doctor will be able to exchange via video with a fellow expert in France. We will be launching a test service during the first two weeks of July. 

The second lesson we have learned is that we have understood progressively, learnt step by step.  We have never been confronted with this type of situation before, and may never again, but if we had to relive this kind of experience, I believe we have now taken on board good reflexes.

Finally, we have learnt a lot in terms of communication. Imagine: you say to a patient that his treatment has to be delayed for 10 days, that he is stranded in France and that this delay will cause additional expenses, this requires considerable efforts to explain, to accompany and to find the best way to optimize the additional costs. 

What measures have you put in place to welcome back new foreign patients? 
Dr Pierre Anhoury :
Since June 15th we are now once again officially authorized to welcome international patients. For the moment we are beginning to bring over only urgent cases. We require that a PCR test be carried out 48 hours before taking a flight.  Then on arrival we verify through a series of questions that the patient has no symptoms. If there are no symptoms the patient can be admitted to the hospital.  If on the other hand the patient has not done the test before arrival, we will test the patient but will require that the patient remain in a hotel for 24 hours before admission. 

Have you maintained the COVID-19 free circuit system since June 15th?
Dr Pierre Anhoury :
Institut Curie has never been a hospital at risk, but even if we have now returned to a total COVID-19 free circuit, we are still able to isolate the patients if necessary. 
The filtering system has not changed: we continue to test and to examine. 
Masks are mandatory.
We have a lounge area dedicated to welcoming foreign patients.  The patients no longer enter our offices; we go to them and welcome them in their dedicated lounge. This enables us to welcome them comfortably and to reassure.

What would you say to international patients with cancer who want to be treated at Institut Curie?
Pierre Anhoury 
I would say that they would be welcomed without delay and be treated as French patients with the same quality of care and standards. They will not be at risk as they will benefit from the same filtering system that we apply to 100% of our patients. I would add that they would be safe as our health safety precautionary measures apply to all. If they can do a PCR test two days before arrival it’s a way of reassuring the people that welcome them. 

Today we have gone back to a normal way of taking care of our patients but the additional sanitary precautions will apply to them as it does to all the others. 

How has the coordination with C3Medical worked during this period?
Dr Pierre Anhoury :
We have shared the same rules, the same method of working at a distance – with a conference call every day during the most severe period. We were all in this together, the Direction of International Relations team at Institut Curie and the C3Medical teams, to assure the surveillance of our 121 patients who were under treatment and stranded in Paris. We managed each case one by one to avoid sudden repatriation, to allow the treatment to continue and to avoid delay in the care pathway. Since the beginning of our collaboration, the C3Medical teams are present full-time in our department; we therefore worked in the same way as usual but from home, so preserving the team spirit that has always driven us from the start. 

How do you see the future activity in the coming months? 
Dr Pierre Anhoury :
Orly airport has reopened since June 25th so everything is getting back to normal slowly. There are still a lot of countries whose airports are closed and who will remain so until mid-July. We are actually working to bring over patients who are in a delicate situation; we call them and encourage them to come if it is possible.  We hope that the situation will get fully back to normal in September, for the good of our patients.