The FINANCIAL — The global pandemic of the coronavirus disease, called COVID-19, continues to have a serious impact on many people, including cancer patients, their families, and caregivers. State and local authorities, as well as health officials, continue to adjust their recommendations as the number of COVID-19 cases changes in different parts of the country.
Some cancer patients might be at increased risk of serious illness from an infection because their immune systems can be weakened by cancer and its treatments. Most people who were treated for cancer in the past (especially if it was years ago) are likely to have normal immune function, but each person is different. It’s important that all cancer patients and survivors, whether currently in treatment or not, talk with a doctor who understands their situation and medical history.
It’s also important that both patients and their caregivers take precautions to lower their risk of getting COVID-19. The US Centers for Disease Control and Prevention (CDC) has specific recommendations for people at risk for serious illness from COVID-19 infection.
While the situation continues to change, knowing some basic facts about what you can do to help protect yourself and others from getting sick can be very empowering.
What is COVID-19?
COVID-19 is the name of the illness caused by a new type of coronavirus that has led to a large outbreak, which was first reported in China in December 2019. The name of this coronavirus is “SARS-CoV-2.”
Coronaviruses are a family of viruses that can cause common colds, as well as more serious respiratory diseases such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).
How does the virus spread?
According to the CDC, the most common way for the virus to spread is during close contact with another person:
- When somebody who is infected coughs, sneezes, talks, raises their voice (such as when shouting or singing), or even breathes, they can create respiratory droplets that contain the virus.
- These droplets might reach the mouths or noses of people who are in close contact (within about 6 feet), which could lead to an infection.
But there are other ways the virus might spread as well:
- Some small droplets and particles can linger in the air for minutes to hours. They might travel farther than 6 feet or might remain in the air even after the infected person has left, and they might be able to cause new infections, especially in enclosed spaces that aren’t well ventilated. This form of spread, known as airborne transmission, isn’t thought to be as common as spread through close contact.
- Respiratory droplets can also land on surfaces, which people might then touch. This could potentially lead to an infection if a person then touches their mouth, nose, or eyes. However, this is not thought to be a common way for the virus to spread, according to the CDC.
Some people who are infected but do not have symptoms (that is, are asymptomatic) may still be able to spread the virus. Because of this, it’s important that everyone follow the CDC’s and other health departments’ recommendations on how to protect yourself and others.
How can I protect myself and others from getting COVID-19?
According to the CDC, there are things all of us can do to help lower the risk of being infected (and infecting others):
- Wash your hands often with soap and water for at least 20 seconds because it’s one of the best ways to kill germs on your hands and prevent the spread of germs to others. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol.
- Avoid touching your eyes, nose, and mouth with unwashed hands, because if you picked up the virus, you could infect yourself by allowing the virus to enter your body.
- Avoid close contact – being within 6 feet (about 2 arms’ length) of people who don’t live in your household, and any people who are sick.
- Cover your mouth and nose with a cloth face cover when around others. (See below for more details.)
- Cover your cough or sneeze with a tissue, then throw the tissue in the trash, or cough or sneeze into your elbow. Then wash your hands right away.
- Stay home (except to get medical care) if you are sick.
- Clean and disinfect frequently touched surfaces daily using a regular household cleaning spray or wipe. Always read the directions of the products closely to make sure you are using them correctly. Cleaning and disinfecting products should not be used directly on skin, taken by mouth, or inhaled into the lungs, and bleach should not be used on food.
- Because travel increases your chances of getting infected and spreading COVID-19, staying home is the best way to protect yourself and others from getting sick. The CDC recommends avoiding all non-essential international travel to places where COVID-19 risk is high, which includes most other countries at this time.
If you are a cancer patient, survivor, or caregiver, talk to your cancer care team about whether there are any additional precautions you should take.
People are encouraged to take advantage of telehealth services, if they are available, and “see” their doctors without going in person for an office visit. Medicare has temporarily expanded its coverage of telehealth services. Some health insurance providers are doing the same.
It’s important to keep in mind that some people who are infected with the virus might not have symptoms, but they could still spread the virus to others. Because of this, it’s important that everyone follow the CDC’s recommendations on how to protect yourself and others.
Should I wear a face mask?
The CDC recommends that you wear a cloth face cover (something that covers your nose, mouth, and much of your face) or a face mask if you go out in public, especially in places where you might be close to other people.
Cloth masks and gaiters (cloth coverings that wrap around the nose, mouth, and neck) should have at least two layers of fabric. The CDC does not recommend wearing a mask that has a one-way valve or vent because when you breathe out, it allows droplets to go through the mask and possibly spread the virus. The CDC also does not recommend the use of a face shield alone, without a face cover.
The face cover is meant to help protect other people, because you could spread the virus if you are infected and don’t have symptoms. At the same time, when someone else wears a face cover, it can protect you, too. Together, this can help slow the spread of COVID-19.
Many other authorities and businesses are also recommending face covers, and some are now requiring them. It is best to check with your local authorities to see if your area has specific guidelines about wearing a face cover in public.
It’s important to understand that wearing a face cover or mask is not a substitute for social distancing. It’s still very important to stay at least 6 feet away from others, even while wearing a face cover or mask, and to continue to wash your hands frequently.
If you want to make a cloth cover or mask at home and aren’t sure how, the CDC has instructions on how to make basic sewing and non-sewing versions including specific standards the mask should meet. Friends and family might also be able to help you find or make masks.
Remember to wash your hands before putting on your face cover, to not touch your face while wearing the cover, and to wash your hands right after taking it off.
The CDC does not recommend that people in the general public wear surgical or N95 masks. These are in short supply in many areas and should be saved for healthcare workers who need them when caring for people who are sick.
Are there different recommendations for cancer patients and caregivers?
The CDC does not have specific recommendations on masks for people who have or have had cancer and their caregivers. But for many people being treated for cancer, especially with treatments like chemotherapy or stem cell (bone marrow) transplants that can weaken the immune system, doctors often recommend patients wear a mask to help lower exposure to germs that might cause infections. If you’re not sure if you or your caregiver should be wearing a mask, contact your doctor or another member of your cancer care team.
What about eye protection?
While the CDC recommends the use of eye protection (goggles or face shields) for health care workers (doctors, nurses, technicians, dentists, and others) in certain settings, it is not recommended at this time for the general public instead of a face cover. A recent review of published studies suggested wearing eye protection might help reduce the spread of the coronavirus in the community, although more research on this is still needed.
Will the flu vaccine protect me against COVID-19?
Even though the influenza (flu) vaccine will NOT protect you against COVID-19, it is very important that cancer patients talk to their doctor about the benefits and risks of getting the flu shot.
The flu and COVID-19 are both caused by viruses that can spread easily and can cause serious illness in older people, those with weakened immune systems, and others with certain medical conditions. These infections share many of the same symptoms, so it can be hard to tell which one you might have without having specific tests.
People who live with or care for someone at high risk of getting the flu should also get the flu vaccine.
The overlap of this year’s flu season on top of the COVID-19 pandemic could cause a significant burden on healthcare systems, so getting the flu vaccine could help lessen this.
What are the symptoms of COVID-19?
The most common symptoms of COVID-19, which may appear 2-14 days after being infected, are:
- Shortness of breath
- Muscle aches and pains
- Sore throat
- New loss of smell or taste
- Feeling very tired
- Nausea or vomiting
- Runny nose
Contact your doctor or local health department if you have any of these symptoms.
If you or the person you’re caring for has any of the following serious signs and symptoms of COVID-19, get medical attention right away:
- Trouble breathing
- Constant pain or heaviness in the chest
- New confusion or being hard to wake up
- Bluish lips or face
Some people with COVID-19 might have signs or symptoms of blood clots such as bluish toes (also referred to as “COVID toes”), swelling of the lower leg, chest pain, shortness of breath, or stroke symptoms (slurred speech, weakness or numbness of an arm or leg). The reasons for this are being still studied, but it’s important to tell your doctor right away if you are having any of these symptoms.
COVID-19 generally does not seem to affect children as much as it does adults, but children can become infected with the coronavirus, and some can even develop serious illness. Just like adults, children who have certain medical conditions are at a higher risk for these severe symptoms. A rare but serious syndrome that is linked to COVID-19 in children, called multisystem inflammatory syndrome in children (MIS-C), has also been reported. Children with this syndrome can have symptoms such as a fever and rash similar to Kawasaki disease, as well as severe body inflammation, which might be related to the coronavirus. The CDC is keeping track of this syndrome to learn more about it and its relationship to the coronavirus infection.
It’s important to know that some people who are infected with the virus might not have symptoms, but they could still spread the virus to others. Because of this, it’s important that everyone follow the CDC’s recommendations on how to protect yourself and others.
What else do cancer patients and caregivers need to know about COVID-19?
Doctors are still learning about the possible risks of COVID-19 infection for cancer patients. But they do have a lot of information regarding the risk of infections in general for cancer patients.
Avoiding being exposed to the virus that causes COVID-19 is especially important for cancer patients, who might be at higher risk for serious illness if they get infected. This is particularly true for patients who are getting chemotherapy or a stem cell (bone marrow) transplant, because their immune systems can be severely weakened by the treatment.
The pandemic is also affecting the way many people get medical care, including patients with cancer. Depending on the COVID-19 situation where you live, this may mean a delay in having cancer surgery or care that’s meant to keep cancer from returning. Some people may need to reschedule appointments.
Cancer care teams are doing the best they can to deliver care to their patients. However, even in these circumstances, it isn’t life as usual. It’s important to keep in contact with your cancer care team to determine the best course of action for you. This may involve talking to your care team virtually (online or over the phone) and not physically going to the clinic.
Many clinics and infusion centers have made changes to allow you to come in safely for an in-person visit as well as treatment. These might include screening for COVID-19 symptoms ahead of your visit, proper spacing of waiting room and infusion chairs, spacing out appointments to limit the number of people in the waiting room at one time, requiring people to wear a face cover, and cleaning all surfaces frequently. It’s important to know who to call to reach your cancer care team to find out how to proceed.
You might have other options for getting your cancer medicines as well. For example, some people might be able to switch to oral medicines instead having to go in for infusions. For some people, another option might be to get infusions of their cancer medicines at home. However, there are safety issues to consider with home infusions, and it’s important to discuss these with your health care team before deciding on getting treatment this way.
The issues with getting cancer treatment and testing during this pandemic will take some time to resolve, and even then, there will likely continue to be changes in the way cancer patients receive their care.
In the meantime, doctors need to learn more about cancer patients and COVID-19. Registries such as the COVID-19 and Cancer Consortium and studies such as the NCI COVID-19 in Cancer Patients Study are actively collecting data. Early studies from registries in the US and around the world have looked at outcomes for cancer patients who develop COVID-19 with symptoms, as well as if certain anti-cancer treatments change these outcomes. These initial study results are helpful, but it is very important to gather more data and analyze it over a longer time to better understand the effects of COVID-19 on current and former cancer patients. Contact your doctor if you are interested in participating in a registry or study.
Why can’t someone come with me for my doctor visits/treatments?
While some medical visits are now being done online or over the phone, things like physical exams, lab or imaging tests, and treatments (such as surgery, radiation therapy, or chemotherapy) still need to be done in person.
Many doctor’s offices, treatment centers, hospitals, and other facilities have ‘no visitor’ policies in place at this time, meaning that only the person being treated is allowed to enter. This is to help protect the people in these places, many of whom might be vulnerable if they were to be infected with COVID-19.
At the same time, these policies can create a great deal of anxiety for both cancer patients and their loved ones. The caregivers who usually accompany patients are an important source of support for them, and they can often be invaluable in both giving information to the health care team and in helping to make sure that patients understand what’s being told to them.
While it might not be possible for caregivers to attend all of these in-person visits right now, there are still some ways to stay involved and informed about what’s going on:
- Ask if the patient can have the caregiver on a phone call during the visit so the caregiver can listen to the conversation and ask/answer questions.
- Ask for a family consult with someone from the health care team after the visit so the caregiver knows what was discussed.
- Ask if the center might allow more frequent telehealth visits so the caregiver can be present.
- If you have an online portal, ask if you can submit questions and get answers there.
- Ask if you can get a copy of the progress note that the healthcare provider writes up after each visit – either a physical copy on the day of the visit or in some other format (for example, via an online portal).
Should people still get screened for cancer during this pandemic?
In many places affected by the pandemic, elective medical procedures, including cancer screening, have been put on hold to conserve medical resources and reduce the risk of spreading COVID-19 in healthcare settings. Some states and other authorities have begun to re-open businesses and ease restrictions, while these remain in place in other places. Likewise, some health systems are starting to schedule cancer screening tests and exams again. So, what should you do if you’re due (or overdue) for a cancer screening?
Decisions about getting screened depend on many factors, and they may not be the same for every person. Some important things to consider include your risk of getting a certain type of cancer, how long it’s been since you were last screened for it, how common COVID-19 is in your community, and your age and overall health.
Talk to your health care provider about the risks and benefits for you of being screened now, and whether or not it might make sense to postpone it at this time. Remember that cancer screening can save lives, so it’s important to not just forget about it. Getting back on track with cancer screening at some point should still be a priority.
Screening tests are different from tests your doctor might order if you have symptoms that could be from cancer. If you’re having symptoms you’re concerned about, contact your health care provider about the best course of action for you at this time. Do not put off getting medical care if you have signs or symptoms that might be from cancer.
Which people are at higher risk for serious illness if they get COVID-19?
According to the CDC, the risk for severe illness from COVID-19 increases with age, with older adults at highest risk. People with certain medical conditions are also at increased risk:
- Chronic kidney disease
- Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema
- Having a weakened immune system after getting an organ transplant
- Obesity (having a body mass index [BMI] of 30 or higher)
- Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
- Sickle cell disease
- Type 2 diabetes
Many other medical conditions might also increase the risk of severe illness from COVID-19, including having a weakened immune system after a stem cell (bone marrow) transplant, or after getting other drugs that weaken the immune system (such as cancer chemotherapy drugs). Being overweight (a BMI more than 25 but less than 30) might also increase the risk of severe illness.
Can I get COVID-19 from a blood transfusion?
According to the American Red Cross, there is no evidence that this new coronavirus can be transmitted through a blood transfusion.
Donating blood is still possible for those who are healthy and feel well, and it’s greatly needed, according to the Red Cross. The COVID-19 outbreak and resulting social distancing has led to canceled blood drives and dramatic blood shortages in many parts of the country.
The US Food and Drug Administration (FDA) has information on donating blood and other things you can do to help during this pandemic.
Can I get tested to see if I’m infected (or was infected in the past)?
Tests for the virus that causes COVID-19 can be done on samples taken by swabbing inside the nose or throat or on saliva samples. The testing field is changing almost daily, as the FDA continues to allow new tests onto the market. But not everyone needs to be tested for COVID-19.
The CDC has issued guidance for state and local health departments and for doctors on how to prioritize who should be tested, because testing resources are still limited in some places. But it’s up to each health department and doctor to use their best judgment when deciding if someone needs to be tested, based on things like:
- If the person is having symptoms
- If the person has had close contact with someone known to have COVID-19
- If the person is likely to be exposed to the virus (as is the case for many health care workers)
- If the person is in the hospital or is at higher risk for complications if they’re infected
If you are having symptoms that might be from COVID-19 or have been exposed to someone who has it, call your doctor or health department to discuss whether you need to be tested.
Testing is also now available in some areas (often in a drive-thru setting) without the need for a doctor’s order. If you feel you should be tested, your state or local health department may have information on testing places available in your area.
The results of your test might change what you need to do (such as isolating yourself from other people if the test is positive), but they might not change your treatment. For example, if you have mild (or no) symptoms, you may not need treatment even if the test is positive.
If you do get tested and are negative for COVID-19, it doesn’t guarantee that you are not infected, as testing is not always 100% accurate. It also doesn’t mean that you can’t be infected at a later date. It’s still important to do what you can to lower your risk of infection, such as continuing to practice social distancing.
Are at-home tests an option?
For most of the COVID-19 tests in use, the samples need to be obtained by a health care professional. But the FDA is now allowing the samples for some tests to be collected at home:
- Most at-home tests use swabs to collect samples from inside the nose
- Some tests use samples of saliva
With most at-home tests, once the samples are collected, they need to be shipped to a lab for the actual testing, so the results won’t be available right away. The FDA is now allowing the use of one at-home test that does not need to be sent to a lab, and that gives results within about half an hour. However, this test isn’t likely to be widely available until at least the spring of 2021.
At-home tests still require a doctor’s order before they can be done. For some tests, you can answer questions about your symptoms and exposures on the test’s website, which a doctor will then review to see if you are eligible for testing.
What about antibody (serology) tests?
These tests look at a person’s blood for specific antibodies (immune system proteins) that would show that the person has been exposed and had an immune response to the virus. Antibody tests do not look for the virus itself, so they can’t be used to tell if someone is currently infected. They can only tell if a person has been exposed to the virus at some point.
It’s not clear how useful the results of antibody testing are at this time. While many different antibody tests are now being used, the results from some of them might not be as accurate as others. And even with an accurate test result, experts aren’t yet sure if having a positive test means that you can’t be infected again.
Is there a vaccine against the new coronavirus?
There are no authorized or approved vaccines available yet in the U.S. against the virus that causes COVID-19. Many pharmaceutical companies are working on vaccines. Some vaccines have shown promising results so far in clinical trials and will be evaluated shortly by the FDA.
Once authorized or approved, the vaccines might be available soon for people at higher risk (such as health care workers, first responders, and people with certain medical conditions).
Since the supply of vaccines will most likely be limited at first, the CDC is working on recommendations as to who should receive the vaccines early. States will use these recommendations to guide their distribution of the vaccines. However, it will likely still be some time before vaccines become widely available.
The CDC and FDA have more information about COVID-19 vaccines, including the approval process, safety, the different types, and benefits. Contact your state health department for information about their COVID-19 vaccine delivery plans.
Are there medicines to treat (or prevent) COVID-19?
Remdesivir (Veklury) is the only drug approved by the FDA to treat adults and children hospitalized with COVID-19 disease. It works by stopping the coronavirus from making copies of itself and tends to shorten the recovery time in some people. Side effects of remdesivir can include abnormal liver tests and reactions when the drug is given, such as low blood pressure, sweating and chills.
While remdesivir is the only drug currently approved by the FDA to treat COVID-19, several other drugs have received emergency use authorization (EUA). An EUA is not the same as a full FDA approval, which requires a more thorough review of safety and effectiveness. Drugs that have been given an EUA are available, but they are still being studied in clinical trials.
- Bamlanivimab is a monoclonal antibody, which is a manmade version of an immune system protein. Once infused into the blood (via IV), it attaches to the virus and stops it from infecting human cells. The FDA has issued an EUA to allow the use of this drug in adults and older children with mild-to-moderate COVID-19 who are at higher risk for severe illness or hospitalization. This includes people who are 65 or older and people with certain chronic (long-term) medical conditions.
- Casirivimab and imdevimab are also monoclonal antibodies. They are given into the blood together (via IV), after which they attach to the virus and stop it from infecting human cells. The FDA has issued an EUA to allow the use of this combination in adults and older children with mild-to-moderate COVID-19 who are at higher risk for severe illness or hospitalization. This includes people who are 65 or older and people with certain chronic (long-term) medical conditions.
- Baricitinib is a drug called a Janus kinase inhibitor, which can help reduce inflammation in the body. (Inflammation can lead to some of the more severe symptoms of COVID-19.) The FDA has issued an EUA to allow the use of this drug along with remdesivir in adults and children hospitalized with COVID-19 who need oxygen or are on a ventilator. (Baricitinib is already FDA-approved [under the brand name Olumiant] for use in treating rheumatoid arthritis.)
- People who have fully recovered from COVID-19 have antibodies against the virus in the liquid part of their blood (known as plasma), and studies are looking to see if these antibodies might help fight COVID-19 infection in people who now have the disease. The FDA has issued an EUA for this type of treatment (known as convalescent plasma). They also have more information about how this treatment might work, who can donate plasma, and where they can go to do this.
There are also some other medicines that might be helpful in treating symptoms from the disease.
For example, drugs called corticosteroids, such as dexamethasone and prednisone, have shown some promise in helping people who are hospitalized with severe COVID-19, but more research is needed to be sure. These drugs are already widely used for many other conditions. While they might help some people who are hospitalized, there’s no evidence at this time that these drugs can help prevent or treat less severe cases of COVID-19.
Many other drugs that might help treat or prevent COVID-19 are now being studied in clinical trials.
What about chloroquine and hydroxychloroquine?
The drugs chloroquine and hydroxychloroquine, which are already used to treat malaria and some other conditions, are also being studied as possible treatments for COVID-19. Because they are already available to treat other diseases, some doctors are trying them in certain patients with COVID-19. These medicines can sometimes cause serious side effects, such as heart rhythm problems, so they should only be taken under the close supervision of a doctor. In fact, the FDA has cautioned against the use of these drugs to treat COVID-19 unless a person is taking part in a clinical trial. According to the FDA, “Hydroxychloroquine and chloroquine have not been shown to be safe and effective for treating or preventing COVID-19.” Clinical trials are still needed for doctors to truly know if these drugs are safe and effective.
Despite claims now appearing online and in social media, it’s important to know that there are no supplements or other treatments available online or in stores that have been proven to prevent, treat, or cure COVID-19.
The World Health Organization (WHO) has a list of mythbusters to debunk some claims you may have heard about how the new coronavirus may be transmitted or treated.