by Dr. C. H. Weaver M.D. 9/2021

The COVID-19 pandemic has swept through the world impacting every aspect of life creating fear and anxiety while leaving a toll of health and economic devastation. As the virus cycles through society we are facing a new “normal.” The scientific biomedical community is however making progress: vaccines and now available, researchers are working to develop effective anti-viral drugs, and some medications to treat the “cytokine storm” which is responsible for the bulk of the mortality associated with the infection have been identified.

Cancer patients, their families, and caregivers are disproportionally impacted by the COVID pandemic. Although cancer patients are more likely to become infected than the general population and significantly more likely to die from COVID-19 once infected, the greater risk may be altering or foregoing cancer treatment. (1) Cancer patients should discuss their concerns about the pandemic and treatment with their doctor and work together to develop a treatment plan that optimizes cancer care and reduces the risks from COVID-19.

In general, individuals impacted by a cancer diagnosis should consider two different strategies to reduce their risk during the pandemic. The first is to ensure they take appropriate precautions to avoid unnecessary exposure to the virus. The second is to consider whether changes to their treatment strategy could be implemented to reduce their risk of infection.

Sept 1, 2021 National Comprehensive Cancer Network Update

The following groups should be considered eligible for a third dose of the mRNA COVID-19 vaccine right away based on the latest FDA/CDC decisions:

  • Patients with solid tumors (either new or recurring) receiving treatment within 1 year of their initial vaccine dose, regardless of their type of cancer therapy
  • Patients with active hematologic malignancies regardless of whether they are currently receiving cancer therapy Anyone who received a stem cell transplant (SCT) or engineered cellular therapy, especially within the past 2 years.
  • Any recipients of allogeneic SCT on immunosuppressive therapy or with a history of graft-vs-host disease, regardless of the time of transplant.
  • Anyone with an additional immunosuppressive condition or being treated with immunosuppressive agents unrelated to their cancer therapy.
  • People living in the same household with immunocompromised individuals should also get a third dose once it is available. 

The "Ask The Experts About COVID-19 and Cancer" Series

What is the 2019 novel coronavirus?

The 2019 novel coronavirus (COVID-19 is a new virus that causes respiratory illness in people and can spread from person-to-person. This virus was first identified during an investigation into an outbreak in Wuhan, China and has quickly spread throughout China and to most other countries including the United States. Hundreds of thousands of people in the US now have documented infections, and doctors and society are working to understand the disease, develop new treatments, and recommend behavioral changes to reduce the risks of transmission and infection. Individuals with weakened immune systems such as cancer patients or those on immunosuppressive medications might be at higher risk for infection and complications associated with the virus that causes COVID illness.

How does the virus spread?

It is believed that the disease is spread mainly by person-to-person contact, individuals can be infected even if they come in close contact with someone who has the virus. The virus is transmitted via respiratory droplets that are produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or can possibly be inhaled into the lungs. The main manner of spread however occurs after touching a surface or object that has COVID-19 on it and then touching one’s own mouth, nose, or eyes. According to a recent study published in the New England Journal of Medicine, SARS-CoV-2, the virus that causes COVID-19, can live in the air and on surfaces between several hours and several days. The study found that the virus is viable for up to 72 hours on plastics, 48 hours on stainless steel, 24 hours on cardboard, and 4 hours on copper. It is also detectable in the air for three hours.Although the virus can last on plastic for 72 hours, what's more important is the amount of the virus that remains. It's typically less than 0.1% of the starting virus material. Infection is theoretically possible but unlikely at the levels remaining after a few days. (2)

What are the symptoms of coronavirus infection in cancer patients?

The symptoms of COVID-19 are the same in cancer patients as the general population. Patients being treated with steroids can suppress the development of fever.

Common symptoms include:

  • Fever
  • Coughing - typically dry non-productive cough
  • Fatigue
  • Myalgia (muscle aches)
  • Head Ache
  • Shortness of breath
  • Some patients report GI symptoms (nausea, diarrhea)

Symptoms typically appear within 2-14 days after exposure, although new data suggests that some people infected with the disease are contagious even before they develop symptoms.

Take Preventive Measures - Everyday Precautions

For now patients should undergo the same preventive measures they would for other common illnesses like the common cold and influenza “the flu.” Most important is to wash your hands frequently, make sure you cover your cough and your sneezes, stay away from other individuals with respiratory symptoms, and avoid travel to places where there are documented cases of COVID. Avoid crowds and situations where you’re likely to be less than six feet from others. (Airborne spread of the virus occurs when an infected individual coughs or sneezes, releasing droplets that can travel three feet. Maintaining a six-foot distance provides a safety margin.)

  • Wash your hands thoroughly and often. This needs to be done for at least 20 seconds using soap and water. If you do not have access to soap and water, be sure to use hand sanitizer that contains 60% alcohol.
  • Avoid touching your face, nose, and eyes, especially if you have come in contact with "high-touch" surfaces in public areas, such as elevator buttons, door handles, and handrails.
  • Work to avoid crowds, and practice social distancing (a minimum of six feet).
  • Avoid all non-essential travel. This includes vacations as well as everyday trips to the store.
  • Avoid cafeteria-style eating and public transportation - wash hands after using any public facility.

Is There a Vaccine?

Effective December 2020 vaccines are available. Cancer patients are at higher risk from COVID-19, especially if they are receiving immunotherapy, steroids and immunosuppressive medications which reduce immunity. Many individuals with blood cancers have diminished immunity even if they are not currently on therapy.

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Can Testing Determine If You Have Coronavirus?

The main symptoms of COVID-19 are similar to the common cold and include fever, cough, shortness of breath, and a runny nose. It’s difficult to differentiate COVID-19 from the common cold or flu and currently the only way to tell if someone has coronavirus is through testing. Tests are now widely available and in December 2020 the FDA approved the first over the counter rapid test that doesn't require a prescription.

Are all patients with cancer at equal risk for infection?

Patients with a weakened immune system may be at greater risk of infection because their defenses against infection are lowered. Blood-related cancers such as leukemia, lymphoma, or multiple myeloma, those undergoing chemotherapy treatment, individuals with more advanced disease, and those with cancer involving the lungs are most vunerable. Patients over the age of 70 are more likely to develop severe cases of COVID-19, as are those who also have cardiovascular disease, diabetes, or high blood pressure, or are active tobacco smokers.

What should I do if I have symptoms of COVID-19?

Call your treatment center or physician first to report your symptoms. This allows your doctor to determine what evaluation is necessary and where that evaluation should take place. Many cancer centers are directing symptomatic patients to locations to specific locations for testing and evaluation.

Do I risk being exposed to COVID-19 if I come in for treatment?

The steps that hospitals and cancer clinics have taken are designed to minimize the risk of coronavirus transmission to patients, visitors, and staff. Where possible, some centers are offering virtual appointments, in which patients and physicians meet by computer link.

Is there a treatment for COVID-19?

Treatment mainly consists of supportive measures to reduce symptoms and respiratory complications similar to the Flu. Researchers are rapidly evaluating medicines in order to determine if any available medications might be helpful in eradicating the disease and new medications designed to target COVID-19 are being developed.

Preparing Your Home in the COVID-10 era

Individuals caring for someone who is at a higher risk for serious illness from COVID-19 should consider the following.

  • Contact the patient's health care provider to ask about possibly obtaining extra, necessary medications. If this is not possible, see if you can have the medications mailed to you instead of picking them up in person.
  • Be sure to have over-the-counter medical supplies on hand that can be used to treat fever and other symptoms.
  • Have enough household items and groceries available so that you limit the time you need to be outside or at the store.
  • Be sure to clean and disinfect your home to remove germs. A good practice is to routinely scrub often-touched surfaces, such as tables, doorknobs, and light switches. When cleaning these items, use detergent or soap and water prior to disinfecting.

Practice Self-Care

As a caregiver, it is important to have your own support, too. So, it is essential to take some time for yourself (and having support around you can help).

Try to delegate responsibilities. If you are feeling overwhelmed or need to take a step back, it is very helpful to talk with someone about your feelings and needs. Make sure you also practice good personal wellbeing, healthy eating, and hygiene. Try to find an outlet to address the additional stress and anxiety you may be experiencing; it's difficult to give someone else the support and time they may need if you aren't also taking care of yourself.

What is the best way to protect against COVID-19 on surfaces?

Cleaning surfaces with disinfectant or soap is very effective because once the oily surface coat of the virus is disabled, there is no way the virus can infect a host cell. It is especially important to clean surfaces brought into the home such as packages and food containers.

The "Ask The Experts About COVID-19 and Cancer" Series

References:

  1. Yu J, Ouyang W, Chua MLK et al. medRxiv, 2020 doi.org/10.1101/2020.02.22.2002532010.1101/2020.02.22.20025320. Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. Zhonghua Liu Xing Bing Xue Za Zhi 020;41:145–151
  2. Why The Death Rate From Coronavirus Is Plunging In China
  3. nejm.org/doi/full/10.1056/NEJMc2004973