The 2019 novel (new) coronavirus, named SARS-CoV-2, causes the disease COVID-19, a respiratory illness. The spread of COVID-19 is disrupting life — for those who have been infected with the virus as well as those who haven’t — on a global scale.
As with many public health issues, the coronavirus outbreak may pose special risks for some cancer patients. To answer some of your common questions and provide insight, we spoke with Sarah Hammond, MD, an infectious disease specialist at Dana-Farber and Brigham and Women’s Hospital, and Craig Bunnell, MD, MPH, chief medical officer at Dana-Farber. They address some of the specific challenges cancer patients may face at this time, how to protect yourself, and more.
The situation regarding COVID-19 is rapidly evolving; for the latest information, be sure to seek out reputable sources of information, such as the CDC.
What steps should patients take to protect themselves and others from the virus?
The advice for patients with cancer is basically the same as for the general population:
- Wash hands frequently with soap and water for at least 20 seconds, especially after being in a public place or after blowing your nose, coughing, or sneezing. If soap and water aren’t readily available, use a hand sanitizer that contains at least 60% alcohol.
- Avoid touching your face as much as possible.
- Avoid contact with people known to be infected with the virus or with those showing symptoms of infection.
- Stay home as much as possible. If someone in your household has tested positive for the coronavirus, keep the entire household at home.
- When out of the house, stay at least six feet away from other people and cover your mouth and nose with a cloth face cover. The cover is meant to protect other people in case you are affected. Do not use a face mask meant for a healthcare worker.
- Clean and disinfect frequently touched surfaces such as doorknobs, light switches, countertops, handles, phones, keyboards, and faucets daily. Most common EPA-registered household disinfectants are adequate.
- Use public transportation only when necessary and wash hands after using any public facility.
Are all patients with cancer at equal risk for infection? What does it mean to be immunocompromised?
Patients with a weakened immune system — in other words, patients who are immunocompromised — may be at increased risk because their defenses against infection are lowered. This includes patients with blood-related cancers such as leukemia, lymphoma, or multiple myeloma, which directly affect cells of the immune system, and those undergoing chemotherapy treatment.
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.
The increased risk does not necessarily end at the conclusion of treatment. Research is under way to better understand if long-term cancer survivors remain more susceptible to infection.
As a general rule, as patients get further out from the time of their treatment, their immune system gradually reconstitutes.
Does coronavirus infection produce different symptoms in cancer patients than in others?
For the most part, the symptoms of COVID-19 are the same in cancer patients as the general population.
One exception might be patients being treated with steroids or other medications to treat leukemia or lymphoma, which can suppress the development of fever. As a result, patients with COVID-19 who are taking these types of medications may not register a fever — or as high a fever — as others with the infection.
What should I do if I have symptoms of COVID-19?
Call your treatment center to report your symptoms. This allows staff to gather the appropriate information and determine what evaluation is necessary and where that evaluation should take place.
Many centers are testing symptomatic patients offsite to ensure their infection status is known in advance. Traditionally, patients who come down with respiratory infections during cancer treatment have been given a mask upon arrival and directed to specific rooms outside of general waiting areas. With the spread of COVID-19, many cancer centers are now directing symptomatic patients to rooms with negative pressure that don’t expel air into other rooms.
What precautions should cancer patients should take when they come in for treatment?
At their treatment center, patients should try to continue to stay six feet away from others and to follow the same hygiene measures — frequent handwashing, avoiding touching one’s face, etc. — described above. To protect others, patients should wear a cloth covering over their nose and mouth. Many cancer centers are giving face masks to patients to wear while on the premises.
Upon arriving for an appointment, patients are routinely asked about any health problems or symptoms they are experiencing. It’s important to be careful and honest in answering these questions so that everyone at the treatment center can be kept safe.
Many centers are instituting no-visitor policies, with very limited exceptions, or recommending that patients bring only one other person with them to appointments if there is no medical need for more, to limit potential exposure to the virus.
If I test positive for COVID-19 while undergoing cancer treatment, do I need to stop treatment until I recover?
This depends on a variety of factors, including the type of cancer, the type and stage of treatment, and the severity of COVID-19 symptoms. It isn’t unusual for patients who develop the flu, for example, during cancer treatment to have a pause in treatment, and the same approach may be appropriate for some patients with COVID-19.
Physicians in China and Italy, which have been particularly hard-hit by COVID-19, are beginning to publish guidelines for managing cancer patients during a time of coronavirus spread based on their experience.
What if I have the respiratory symptoms of COVID-19 — coughing or difficulty breathing — but not the others, such as fever or fatigue?
It’s standard procedure at cancer centers to test patients with respiratory symptoms for a wide panel of infectious viruses. This continues to be the case.
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 anything I can do to strengthen my immune system?
As a general rule, it’s important not to let yourself get run-down — to get plenty of sleep, drink enough fluids, and eat a balanced diet with plenty of fruits and vegetables.
I am a caregiver. How can I prepare my home?
If you’re caring for someone who is at a higher risk for serious illness from COVID-19, the CDC encourages you to plan ahead as much as you can:
- Contact the patient’s healthcare 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 their/your home to remove germs. A good practice is to routinely scrub frequently touched surfaces including tables, doorknobs, and light switches. When cleaning these items, look to use detergent or soap and water prior to disinfecting.
More general advice for caregivers of patients with cancer
For people caring for family members or others with cancer, it is especially important to take precautions. Because some cancer patients have lowered immune system function, they may be especially susceptible to contracting COVID-19. Practicing good hygiene is an important part of keeping them safe from infection.
General Information on the Coronavirus (COVID-19)
What is a coronavirus?
Coronaviruses are part of a large family of viruses that are common in many different species of animals. These various strands can ultimately be transmitted to humans and can cause a range of different illnesses, including COVID-19, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and even the common cold.
It’s important to remember that while COVID-19 is a disease caused by the coronavirus, not every coronavirus causes COVID-19.
How does the virus spread?
The virus spreads by respiratory droplets released when an infected individual coughs or sneezes. The droplets can land in the mouths or noses of people who are nearby or be inhaled into the lungs.
It can also spread by virus particles on surfaces: When an individual touches such surfaces and then touches their face or mouth, the particles can gain access to the individual’s airway and lungs. A recent study found that the virus can remain on plastic and stainless steel surfaces for several hours.
What are the symptoms of COVID-19?
According to the CDC, these symptoms may appear 2-14 days after exposure (based on the incubation period of MERS-CoV viruses):
- Shortness of breath
If you develop emergency warning signs for COVID-19, the CDC encourages you to get medical attention immediately. Emergency warning signs include*:
- Trouble breathing
- Persistent pain or pressure in the chest
- New confusion or inability to arouse
- Bluish lips or face
*This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.
How can I protect myself?
You can be proactive by practicing the following preventative actions:
- Avoid close contact with individuals who are sick.
- Wash your hands often, and for at least 20 seconds, with soap and water, especially after being in a public place or after blowing your nose, coughing, or sneezing. If water is not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
- Practice good respiratory hygiene by covering your mouth and nose with a tissue when coughing or sneezing and then throw the tissue away. Perform hand hygiene.
- Always wash your hands before touching your eyes, nose, or mouth.
- Make it a habit to wash your hands when you come home and ask others entering your home to Purell or wash hands upon entering.
Practice social distancing
Without an approved vaccine to prevent COVID-19, it’s up to each individual to take steps to avoid exposure to the coronavirus and to reduce the chances of spreading it to others.
One of the best ways to protect yourself and others from COVID-19 is known as social distancing. This involves avoiding mass gatherings or settings where large numbers of people are present, and maintaining a distance of at least six feet from others when possible. This can significantly reduce the potential for mass transmission of the virus — a scenario that could overwhelm hospital facilities needed to treat patients seriously ill with COVID-19.
Do I need to practice social distancing even if I don’t have symptoms or even if I’m young and healthy?
Yes — people who are infected but show no symptoms can still transmit the virus.
General tips for protecting others
- Stay home if you’re sick or have tested positive for the coronavirus, except to get medical care if needed, even if you are not displaying symptoms.
- If you have symptoms of COVID-19 — dry cough, fever, body aches, fatigue, difficulty breathing — call your healthcare provider to see if you need to be tested for the disease.
- When out in public, wear a cloth mask over your nose and mouth.
- Cover your mouth and nose when you cough or sneeze or use the inside of your elbow.
- Throw used tissues into the trash.
- Wash your hands with soap and water or with a sanitizer.
- Clean and disinfect frequently touched surfaces daily — including keyboards, tables, doorknobs, light switches, countertops, handles, desks, phones, toilets, faucets, and sinks.
What treatments work for the virus?
Numerous potential treatments for COVID-19 are currently in clinical trials, but until these are completed it isn’t clear what the best treatment is. Investigators at Dana-Farber and Brigham and Women’s Hospital are actively studying treatments, including the antiviral drug remdesivir, the antibody drug sarilumab, and others.
What about travel?
The CDC provides recommendations on postponing or canceling travel. A list of destinations with travel notices is available here.
Coping with uncertainty
Here are some basic tips to help you cope, paying particular attention to your emotional health and well-being. Whether you are a patient, caregiver, staff member or a recently bereaved family member, these tips can help you manage uncertainty, anxiety and fear.