Lymphedema in times of Covid-19
It’s been almost two years since the first lockdown and you’re probably tired of hearing the “C-word”. However, it is important to consider the impact of Covid-19 on the care and quality of life of patients with lymphedema to help us face current and future challenges.
While non-urgent consultations and treatment had to be postponed during the first lockdown, patients had to find a way to continue the management of their lymphedema. Wearing compression garments, taking care of the skin, applying bandages, doing exercises and self-massage are components of decongestive lymphatic therapy which could be performed by the patients themselves.  Unfortunately, according to a survey filled out by 203 Turkish patients having lymphedema, 52,2% decreased or skipped doing the recommended exercises and 29,6% did not do the recommended exercises at all. Only 14,8% did regularly self-bandaging and 20,2% decreased or skipped wearing compression garments. 46,8 did not even wear compression garments.
Another concern was that 4,9% of the patients needed a new compression garment, but could not receive one and 26,1% did not renew the compression garment when needed.  This might indicate that we should invest more in the education and motivation of self-management of lymphedema.
Besides the lack of applying the different self-management methods 37,1% of the patients who had an infection in the lymphedema area did not go to the hospital. 70% reported to have had sleeping problems and 78,3% felt anxious of stressed during Covid-lockdown. These depressed feelings were more commonly reported in patients with secondary lymphedema. 63,1% indicated to have gained weight during the first lockdown.  The famous ‘Covid-kilos’… However, patients should be sensitized about the negative impact of obesity on lymphedema.  In April we will organize a whole webinar around this topic. More information can be found on this link.
Patients also wondered if they were more at risk of getting infected by the covid-19 virus or if they would develop more severe symptoms when being affected by the Covid-19-virus. Until now there is no evidence that patients with lymphedema are more vulnerable to the covid virus, except when the chest is involved or when having generalized immune deficiency. Furthermore, it is important to consider other comorbidities. [4,5].
Of course, it’s still important to take precautions and follow the guidelines on hygiene. To avoid getting infected patients should wash/disinfect their hands regularly. The latter can be more challenging for patients wearing compression gloves since it’s not always easy to put on and off the compression glove
Following tips might help:
- Wash your compression garments regularly according to the instructions of the manufacturer. 
- You can put a plastic glove over your compression garment when going outdoors. It is, however, important to realize that this will only protect your garment from being contaminated and not yourself. 
- Wash your non-swollen hand before removing the compression garment.
- If you have a spare compression garment take it with you in case you think the one you wear is contaminated. 
- Use hand sanitizer on the part of your fingers which are not covered by the garment. 
Not only the patients but also the health care provider had to face some challenges. During the lockdown they had to learn to provide advice through telehealth consultations and to decide which conditions were urgent to be seen and/or treated face-to-face. A triage of patients with lymphatic and venous disease was developed for the health care providers to help them decide on the urgency.  Furthermore, guidelines for continuing lymphedema management during the pandemic were made. 
Besides patient care scientific research has also suffered during the Covid-19 lockdown. A study in patients with head and neck lymphedema even had to finish earlier because of the pandemic. 
On the other hand, Covid-19 also gave rise to new research questions like the possibility of using the thigh as an alternate site for the vaccine injection when having lymphedema at both arms. 
Many challenges and consequences have been and will be faced, but just like the virus patient care can evolve and change as well.
1. The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology. Lymphology, 2020. 53(1): p. 3-19.
2. Borman, P., et al., The Impact of COVID-19 Lockdown on Patients with Lymphedema. Lymphat Res Biol, 2022.
3. Greene, A.K., D. Zurakowski, and J.A. Goss, Body Mass Index and Lymphedema Morbidity: Comparison of Obese versus Normal-Weight Patients. Plast Reconstr Surg, 2020. 146(2): p. 402-407.
5. Noble-Jones, R., et al., Guidelines for managing people with lymphoedema remotely: a post-COVID-19 response document. Br J Nurs, 2021. 30(4): p. 218-225.
6. Parsi, K., et al., Triage of patients with venous and lymphatic diseases during the COVID-19 pandemic - The Venous and Lymphatic Triage and Acuity Scale (VELTAS) : A consensus document of the International Union of Phlebology (UIP), Australasian College of Phlebology (ACP), American Vein and Lymphatic Society (AVLS), American Venous Forum (AVF), European College of Phlebology (ECoP), European Venous Forum (EVF), Interventional Radiology Society of Australasia (IRSA), Latin American Venous Forum, Pan-American Society of Phlebology and Lymphology and the Venous Association of India (VAI) This consensus document has been co-published in Phlebology [DOI: 10.1177/0268355520930884] and Journal of Vascular Surgery: Venous and Lymphatic Disorders [DOI: 10.1016/j.jvsv.2020.05.002]. The publications are identical except for minor stylistic and spelling differences in keeping with each journal's style. The contribution has been published under a Attribution-Non Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0), (https://creativecommons.org/licenses/by-nc-nd/4.0/). Phlebology, 2020. 35(8): p. 550-555.
7. Pigott, A., et al., Head and neck lymphoedema-research challenges during the COVID-19 pandemic. Br J Community Nurs, 2021. 26(Sup10): p. S6-s15.
8. Quak, E., et al., Subdiaphragmatic Lymph Nodes Uptake on 18F-FDG PET/CT After COVID-19 Vaccination in the Thigh. Clin Nucl Med, 2022. 47(3): p. 275-276.
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