The Coronavirus and Cancer
By Dr. C.H. Weaver M.D. updated 4/1/2020
What is 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. Several thousand people in the US now have documented infections. The US government has made the following recommendations.
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. Chinese government released updated data on March 12 reporting an overall mortality rate of 0.4% which is less than initially reported. (1) Deaths in the U.S. are approaching 5,000 mostly in NY and in "at risk" individuals.
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 is the best 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.
What are the symptoms of COVID-19?
Common symptoms include:
- Shortness of breath
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.
Key Facts Cancer Patients Know
Take Preventive Measures
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.)
- Avoid cafeteria-style eating and public transportation - wash hands after using any public facility.
- Complete list of countries impacted thus far.
Is There a Vaccine?
Not yet but researchers are working to develop one. Cancer patients do however need to get a “Flu shot” In the U.S we are still in the midst of flu season and patients with cancer are at higher risk, especially if they are receiving immunotherapy, steroids and immunosuppressive which reduce immunity. Many individuals with blood cancers have diminished immunity even if they are not currently on therapy.
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 with a test available through the Centers for Disease Control and now commercial laboratories. As of April 1 over 1 million people had been tested for the virus in the U.S.
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, and those undergoing chemotherapy treatment 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 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.
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.
Products from China?
The production of many medical products, medications and household items of course occurs in China. Currently there is no reason to suspect that packages from China can contain active COVID-19 and medications and other products appear safe The CDC has said there is no evidence supporting the transmission of the disease through imported goods. Currently, it’s only known that the spread of the disease outside of China happens between person to person although there is an active investigation of an individual with COVID-19 in Sacramento and no known contact with an infected individual.
The COVID-19 story will continue to evolve on a daily basis – here is a more in-depth resource where updates are posted daily.
What if I was Considering Elective Surgery?
Amer College of Surgeons Updated March 13, 2020
COVID-19: Recommendations for Management of Elective Guided by the trajectory of cases in Italy and other countries, it is very likely that the U.S. health care infrastructure and resources, particularly as it relates to care of the most critically ill patients, are likely to be strained over the coming weeks. Social distancing, crowd avoidance, and other techniques do help to flatten the curve of the dissemination of Coronavirus Disease 2019 (COVID-19), but beyond that, it is appropriate to be forward thinking regarding those patients who will, nevertheless, become infected.
The American College of Surgeons (ACS) has additional comments on this issue. Following a careful review of the current situation, we recommend the following:
- Each hospital, health system, and surgeon should thoughtfully review all scheduled elective procedures with a plan to minimize, postpone, or cancel electively scheduled operations, endoscopies, or other invasive procedures until we have passed the predicted inflection point in the exposure graph and can be confident that our health care infrastructure can support a potentially rapid and overwhelming uptick in critical patient care needs.
- Immediately minimize use of essential items needed to care for patients, including but not limited to, ICU beds, personal protective equipment, terminal cleaning supplies, and ventilators. There are many asymptomatic patients who are, nevertheless, shedding virus and are unwittingly exposing other inpatients, outpatients, and health care providers to the risk of contracting COVID-19.
We are aware that surgeons who practice in hospitals in geographic COVID-19 hot zones are already getting an advisory from the Centers for Disease Control and Prevention (CDC) on how to prepare. If you practice in an area that's not a hot zone, we still recommend that you refer to the CDC website for guidance. Visit the section entitled "Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States."
We recommend you read the entire document, but for your convenience, a portion of that information is excerpted below:
- Reschedule elective surgeries as necessary.
- Shift elective urgent inpatient diagnostic and surgical procedures to outpatient settings, when feasible.
- Limit visitors to COVID-19 patients.
- Plan for a surge of critically ill patients and identify additional space to care for these patients. Include options for:
- Using alternate and separate spaces in the ER, ICUs, and other patient care areas to manage known or suspected COVID-19 patients.
- Separating known or suspected COVID-19 patients from other patients ("cohorting").
- Identifying dedicated staff to care for COVID-19 patients.
Time is of the essence. Please be vigilant and take a leadership role in your practice setting so that these recommendations begin to take hold immediately.