COVID-19 and Cancer

COVID-19 and Cancer

Is this hype or is this real?

The death rate is about 1-3% – not as high as SARS, but about ten times higher than regular influenza.

But because COVID-19 is a new mutation, and humans have no innate immunity, the total number of cases may be extreme – so it could be 1-3% of a very, very large number.

It’s not hype.

It’s real.

How will my cancer treatment be affected?

If you’re currently receiving chemotherapy for your cancer, your treatments will continue without interruption for now.

If your cancer is newly-diagnosed, further evaluation and treatment may be delayed until the pandemic crisis has passed, depending on the type and aggressiveness of your cancer.

Since all but the most urgent surgical procedures are on hold until the crisis passes, you may be offered hormone therapy, chemotherapy, or radiation therapy as initial treatment.

For cancer survivors in remission, the majority of screening, surveillance, and survivorship visits are on indefinite hold.

If you’re worried about recurrence, or have a problem related to your cancer or its treatment that requires evaluation, we’re still able to schedule a clinic visit for you at present.

Am I at high-risk to get sick from COVID-19?

Although even healthy people can become dangerously ill from COVID-19, the following types of patients are at especially high risk:

  • Patients currently receiving radiation therapy and/or chemotherapy (excluding CML patients taking oral medications)
  • Patients on chronic immunosuppression (such as steroids, anti-rejection medications, or medications for autoimmune diseases such as rheumatoid arthritis, lupus, or Crohn’s)
  • Patients who’ve ever received chemotherapy for leukemia or lymphoma (excluding CML patients who’ve taken oral medication)
  • Patients who’ve ever undergone a bone marrow or stem cell transplant
  • Patients with advanced stage CLL (> Rai stage 0)
  • Patients with untreated, advanced stage lymphoma (> stage 1)
  • Patients with any type of metastatic, non-hematologic cancer
  • Patients in remission from cancer, but who have significant heart disease, lung disease, kidney disease, liver disease, or diabetes

If any of these apply, it is even MORE important to strictly adhere to social distancing guidelines from the CDC and state health agencies – and avoid leaving home if at all possible.

Should I be wearing a mask?

REVISED: 4/3/2020

The CDC now recommends that all Americans wear a non-medical grade mask when leaving their homes.

It’s important to use a densely-woven fabric, because loose-weave fabric (such as T-shirt material) doesn’t keep you from spreading droplets.

Here’s a basic tutorial for sewing one:  

Keep in mind that the mask isn’t to protect you; it’s to protect other people FROM you. Like many thousands of others, you could have an asymptomatic COVID-19 infection – but yet still transmit it to someone else for whom it could be lethal. A properly-made cloth mask can reduce the likelihood that you’ll unintentionally harm someone else.

But masks don’t prevent airborne virus-containing particles from entering through your eyes. 

Masks don’t provide as much protection as good hand-washing, and following the social distancing and isolation recommendations from the CDC.

And you MUST NOT take these new CDC recommendations as an excuse to obtain or use a hospital-grade N95 mask for yourself, and further deplete the limited supply available for those on the front lines.

You have the freedom to keep a safe three-to-six foot distance from others, but healthcare workers don’t. Social distancing remains the most important thing the public can do to keep safe, and healthcare workers still need the N95 masks more than you do.

Use a cloth mask when you go out, not an N95. 

Chloroquine for COVID-19:

I’ve never been in a crowded theater that was burning down. I imagine it’s extremely difficult to remain calm and line up single file.

But stampeding to the exits only jams them up – and results in more people dying than if we’d taken our time.

Something similar happens when we rush to unproven treatments before there’s adequate evidence. A public clamor for unproven treatment drains the existing supply, and tramples the passionless scientific approach that’s most likely to yield good answers in the panic.

Which leads to the relevant point: it’s premature to use the antimalarial chloroquine for COVID-19. The early reports of chloroquine helping COVID-19 patients that the President alluded to last week are compelling, but far too limited to justify anything other than further study. (What to know about potential coronavirus drugs).

Look, I get it. We all want to feel hopeful that something – anything – might end this crisis soon.

But there are too many unknowns at present:

  • We don’t know what dose to use.
  • We don’t know when or how long to give it.
  • We don’t know how to safely manage the side effects (which are significant) in patients who are already severely ill.
  • We don’t even know if it was the chloroquine or something else that caused those patients to improve.

Further study of chloroquine is underway as you read this (The four most promising coronavirus treatments). If it really does work, we’ll know soon – and I sincerely hope it does. But it’s rash and dangerous for us to begin using chloroquine immediately, and people have already been seriously harmed trying it (Man dies after ingesting chloroquine in an attempt to prevent coronavirus).

UPDATED: 3/30/20

Though no new data was offered in support, on Sunday, March 29, the FDA issued emergency approval for the use of chloroquine and hydroxychloroquine in hospitalized patients with COVID-19, and only if prescribed from the Strategic National Stockpile.

The supporting documents state that existing anecdotal case reports indicate possible benefit for very ill patients, and a low risk of harm.

The approval does not allow its use for prevention, nor in asymptomatic or mild cases.