COVID-19 and Cancer

August 13, 2021 by Green Bay Oncology

Does Cancer put me at higher risk for COVID-19?

If you have cancer currently, your body is probably more susceptible to COVID-19 infection and more likely to become seriously ill from COVID-19 if you get it. This appears to be true whether you’re currently receiving cancer treatment or not. Having a previous history of cancer that’s either in remission or cured doesn’t appear to carry the same risk.

How is COVID-19 transmitted?

Are masks helpful?

Masks reduce (but do not completely eliminate) the number of droplets expelled by people when they breathe or speak. They also appear to reduce (but not completely eliminate) the number of droplets you inhale from others. The type of mask, how tightly it fits, and its condition affects how well (or poorly) it does all these things. Single-layer cloth masks provide the least protection, and professionally-fitted N95 masks provide the most protection.

Should I be wearing a mask?

If you live in an area with a high rate of active COVID infection, wearing a mask while indoors with other people is recommended whether you’re vaccinated or not. But if you’re vaccinated and the area you live in has a low rate of active COVID infections, then wearing a mask while indoors with others probably isn’t necessary.

Should I take the vaccine?

Yes.

Should I still get the vaccine even if I’ve had COVID-19 before?

Yes.

Is the vaccine dangerous?

There appear to be very few short-term risks. Though longer-term risks won’t be clear for some time, nothing in how the vaccine is made (or what it’s made from) is thought to pose significant long-term dangers to humans.

Should I prefer one vaccine manufacturer over another?

At present, all the provisionally-approved vaccines are reasonably effective and reasonably safe against COVID-19. There are some slight differences among them in the exact degree of protection and also in the potential side effect profile, but the differences seem very small. It’s unclear at this time if there are differences in the long-term protection provided by the different vaccines.

Can the vaccine make me sick?

Most people experience a few days of inflammatory symptoms (e.g. fatigue, fever, soreness) after any vaccine of any kind, and the COVID-19 vaccine is no exception. Though serious illness and death from the COVID-19 vaccine do occur (as they do with all vaccines), these severe bad effects are extremely rare.

Can I still get COVID-19 if I get the vaccine?

Yes, but the risk you’ll get it (or get seriously ill from it) will be much lower if you’re vaccinated.

Will the vaccine still work if I have cancer or am getting chemotherapy or radiation therapy?

If you’re on any medications that suppress your immune system (such as steroids, immune suppressants, and many cancer chemotherapies) then the vaccine may be less effective–but it still appears to offer significant protection, as post-vaccination infection rates in at-risk individuals are low, and vaccinated individuals who do get COVID anyway seem to have a much lower rate of severe illness resulting from the infection.

Should I be concerned about the Delta (and other) variants?

Every living thing is constantly growing and adapting and viruses are no exception. We have to remember that new variants (or entirely new viruses) might rewrite the rules at any time–just like COVID-19 did in 2020. So yes, new variants are a concern and could change the rules for what’s safe (and what isn’t). It isn’t yet clear how effective the current vaccines are against the DELTA variant, or whether previous COVID infection offers any protection from it.

Why do the recommendations keep changing? Why can’t the experts get it right?

There was a time in history when “the facts” were that the earth was the center of the galaxy. But as we learned more, we had to admit our initial impression was wrong and that the earth in fact orbits the sun. An honest expert who weighs new data as it comes in will very often have to admit that things aren’t as we initially thought. With COVID-19 for instance, airborne transmission wasn’t initially thought to be important so masks weren’t recommended – but a lot of unhelpful things like scrubbing public surfaces regularly were. We’ve learned more since then, and have had to change our thinking. Having to change our minds is often a sign that science is doing its job well, and providing new knowledge at a fast rate.

Should I be afraid?

Though we think it’s unwise to live without sensible precautions and without regard for a global pandemic that’s taken millions of lives, we also think it’s unwise to live paralyzed by fear. Humans should never expect permanent health or freedom from all illness, but we shouldn’t lose sight of how fortunate we are. Our world has significant hazards, but our society suffers less from premature illness and death than any humans in history ever have. Many of our most common ailments are the result of excess, rather than deprivation.

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Filed Under: Blog Tagged With: cancer treatment, coronavirus, COVID-19

Has COVID-19 lost us the war on cancer?

September 21, 2020 by Jerry Mitchell Winkler, M.D.

For several months in the spring of 2020, clinics and hospitals across the United States temporarily suspended routine cancer screening during the early phase of the COVID outbreak. Patients we’d reminded by mail and phone not to forget their mammograms or colonoscopies or PAP smears were suddenly told to cancel them and sit tight.

Most places have now resumed routine cancer screening, but the pause understandably raised lots of questions:

“Did the delay put me in danger?”
“Will there be a spike in advanced cancer cases now?”
“If this was so important, why was it delayed in the first place?”

A recent article in the Milwaukee Journal Sentinel suggested the delay might have cost us the chance to cure people. But there’s reason to doubt this.

Cancer screening depends on—and only works for—cancers that grow and spread slowly in the early stages. The most common types of breast, colon, lung, and cervical cancer take a few years to become dangerous. This long lead time is the very reason screening is possible. It’s also why it’s hard to see how a 3-6 month screening delay could be enough to allow a significant number of early-stage cancers to become incurable.

Right now you’re probably asking, “don’t some cancers appear more quickly and spread more aggressively than the usual type?”

Yes, there’s an exceptional minority of cancers that can appear and spread rapidly, sometimes within a few months. But screening doesn’t work for these aggressive cancer sub-types, and it never has. Cancer screening was never designed with this tragic minority in mind, since we have so little power to alter their clinical course.

I’m not worried about the brief interruptions in cancer screening we experienced earlier this year, since services have mostly resumed and we’re able to get back on track. I’m more worried that many of us will conclude cancer screening couldn’t have been important in the first place, if we can safely pause it—and that patients won’t reschedule. I fear that public skepticism and reactive rhetoric might interfere with cancer screening long enough to matter.

If we lose the war on cancer over this, it’ll be because we surrendered what cancer screening had already won for us.

Filed Under: Blog Tagged With: cancer diagnosis, cancer screening, coronavirus, COVID, COVID-19, pandemic

COVID Testing in Brown County: Why You Should Bother

May 19, 2020 by Green Bay Oncology

The Wisconsin Department of Health Services has recommended COVID testing for all persons who live and work in Brown County.

The testing centers have a pretty convenient registration and drive-through process, but it’s still about a half hour of your life spent waiting.

“But I feel fine, and I’ve barely been out of my house! I don’t need a test!” you might be saying. And you’re right…you personally don’t need one, just like you personally don’t need census data.

But it’s still important to do it.

Asymptomatic testing ain’t about you. The data isn’t for you. It’s for the health departments and the epidemiologists who are still trying to get a better estimate of what the virus has done, is doing, and can do.

After everything COVID has already cost us all – the fear, the disruptions, the jobs, the isolation and boredom, and the growing mistrust in our public servants – another ask for the greater good seems like a lot.

But think back to all those numbers you heard early in the pandemic about transmissibility, the high number of asymptomatic carriers, and the estimated death rate…all those numbers you used to decide how scared (or not) to be, and how seriously (or not) to take the isolation recommendations. Those figures didn’t come from nowhere. They came from countries that were already grappling with COVID-19 and had some clumps of data to work with.

Yes, some of the numbers we’ve heard haven’t always been very accurate. But the only way they get more accurate is with better measurement, and that means a lot more data points…like yours.

Better numbers will hopefully help us make smarter decisions about when we can go back to something like normal life, and what we do (and don’t) need to do when COVID breaks out again. Maybe it’ll be less than we’ve done, maybe it’ll be more.

But wouldn’t it be better not to have to guess?

FAQ – Testing in Brown County

Filed Under: Blog Tagged With: coronavirus, COVID-19, testing

No Illusions

April 4, 2020 by Jerry Mitchell Winkler, M.D.

Though I’m an oncologist and not an infectious disease expert I’m getting bombarded with questions about the pandemic. Patients and staff are asking me and every one of my partners similar things, over and over:

How long until things go back to normal?

How much danger am I in?

Is it all going to be ok?

Though I’m supposed to have all the answers, I haven’t felt too sure of anything lately. It must show on my face, because recently one of my patients (a young woman living with incurable breast cancer) asked “how you doing there, doc?”

“Honestly, I’m not sure,” I said. “My regular routine is wrecked, I don’t feel as safe as I used to, and I don’t know what’s coming.”

“Welcome to my world,” she said, with a wry smile.

I suppose like everyone else in my privileged corner of the planet, where war is remote and epidemics are rare, I’ve been fooled into believing that the world is a safe place, that nature wants the best for us, and that we have control.

Somehow I’ve mistaken privilege for entitlement.

But the pandemic has stripped those illusions from me, just as cancer stripped them from my patient long ago. I’ve had to accept that there’s no such thing as safe – only safer. I’ve had to admit that I don’t have as much control as I’d like. And I’ve had to consider the very real possibility that I or someone I love might not survive.

And even if we and all our loved ones come through safely, somehow I doubt we can ever go back to the sleepy (and false) security of before. We may well divide our lives into distinct sections: “Before COVID” and “After COVID”, just as many patients have distinct lives before and after cancer.

And maybe we’re better off living without illusions of safety.

If life becomes more precarious, maybe it’ll also be more precious. Maybe in facing the truth of our mortality we’ll learn a deeper compassion for all survivors, everywhere – since every human breathing is a survivor of something. And if I’m spared, perhaps the me that comes after will have learned to live with more dignity and courage.

Maybe my patient will teach me.

Filed Under: Blog Tagged With: Breast Cancer, Cancer, coronavirus, COVID-19, Survivor