Cancer patients and COVID-19: what should I know?

13 March 2020

DISCLAIMER: Information regarding this year’s coronavirus pandemic changes on a daily basis. By the time you read this, there may be updated information. Please always refer to government websites for up to date information and recommendations.

What is COVID-19 and how do I catch it?

COVID-19 is a virus which is part of the coronavirus family – viruses which often cause the common cold. COVID-19 is more severe and can cause a serious respiratory illness and pneumonia. How do people catch COVID-19? The virus is spread by droplets from sneezes, coughs or even talking. Droplets can spread this way to about 2-3 metres from an infected person. Droplets can contaminate surfaces such as buttons, handles, and hands. Touching your face, eyes, nose or mouth can transfer these droplets and transmit infection.

How bad is COVID-19?

More than 80% of patients with COVID-19 only develop mild symptoms of fever, cough and difficulty breathing. Only about 1 in 100 people die, and these fatalities are usually in older patients or those with other health problems especially heart disease or diabetes.

Does my cancer or cancer therapy make me more at risk of COVID-19?

Any person, with or without cancer, is considered to be at risk of COVID -19 if in the previous 14 days they have:

Been in contact with a person with COVID-19
Visited a high risk country (mainland China, South Korea, Italy, Iran)
Travelled overseas, particularly to a country of interest: the list of these countries is updated regularly.

COVID-19 may have a higher risk of spread to patients who have compromised immune systems due to cancer and its treatments. Many cancers suppress the immune system themselves, and the radiotherapy, chemotherapy and immunotherapy treatments we use often specifically deplete the white blood cells and antibodies that we need to fight infection.

Your immune defence may be lower than normal if you have any of the following:

Your white blood cell count (either lymphocytes or neutrophils) is low
Your immunoglobulin (healthy antibody) level is low
You have no spleen due to surgery or radiation
Your ability to cough is compromised due to pain or paralysis
Your heart, kidney, lung or liver function is reduced
You have uncontrolled diabetes or high blood pressure
Your treatment includes/included chemotherapy, radiotherapy, targeted biological agents, steroids, immunosuppressive therapies.

You can discuss your risk with your treating specialist and make a plan to prevent infection.

Are cancer patients with COVID-19 any different to non-cancer patients?

The risk of serious illness or death from COVID -19 infection may be higher in cancer patients. Other risk factors for these worse outcomes include older age, history of smoking and other medical conditions such as heart disease, hypertension, lung disease, diabetes or kidney disease. Cancer patients with COVID-19 should be cared for within facilities with rapid access to intensive surveillance and treatment. Cabrini has the capacity to look after your care needs were you to become unwell with pneumonia relating to COVID-19.

Is my suppressed immune system permanently disabled?

Not necessarily.

Many of these treatments are given over a defined time period, then they stop. The immune system then recovers over the following weeks to months. It is important to remember however that even when your blood cell counts return to normal, the function and vitality of your immune system may still be compromised. It can take up to 9 months or even longer to get over some very immune-suppressive cancer therapies.

Will my appointments be altered?

For patients receiving chemotherapy, your appointments will be scheduled as normal. For patients with an appointment for a routine review, we are looking into video appointments and will update you about these possibilities. At this time, your appointments will run as scheduled.

If you are unwell with flu or cold type symptoms, we ask that you ring and let us know, we may need to reschedule your appointment.

We would ask that all patients returning from overseas travel, who are otherwise well, arrange a delay in their appointment by at least two weeks.

Can I still bring someone to my appointment?

Having support with you at appointments is an important way of recalling all that is said in your appointments. We would ask that you do not bring more than one support member- while most people who have been affected by the virus have only very mild symptoms and many will not even know they have the COVID-19, carriers of the virus are a significant risk for those patients who have suppressed immune systems. Our practice has many patients with suppressed immune systems. At this time, we would ask that no children are bought to appointments where possible.

What about vaccines?

Vaccination is crucial to prevent many infections in cancer patients. You should have a conversation with your doctor about which vaccines to have, and which to avoid. Some vaccines are made from live viruses and are not considered safe in patients with suppressed immune systems. Important vaccinations to consider prior to cancer treatment are the influenza vaccine, pneumococcal vaccine, hepatitis B vaccine and tetanus vaccine. Vaccines to avoid due to their live viral nature include the measles vaccine, yellow fever and Zostavax® shingles vaccine. Even if you have already started or have finished chemotherapy, most of the recommended vaccinations can and should still be given. Discuss this with your treating specialist.

Is there a vaccination or antiviral treatment for COVID-19?

Currently (March 2020) there is no vaccination or antiviral treatment available for this virus.

How do I avoid catching COVID-19?

This virus is moderately contagious and has the capacity to spread rapidly through the community. There are now cases in Australia that have spread this way. According to the World Health Organisation:

All people should

Wash your hands frequently with alcohol based hand rub or soap and water.
Maintain Social Distancing – stay 1-3m away from anyone who is coughing or sneezing.
Avoid touching your eyes, nose or mouth
Practice Respiratory Hygiene
‘Cover your cough’ by turning away from others and coughing into your elbow or a tissue rather than your hand
Dispose of tissues carefully and wash your hands after coughing, sneezing or any other body fluid clean-up
If you have fever, cough or difficulty breathing seek medical attention immediately. Stay at home if you are unwell. If you have a medical appointment, call ahead to let the clinic know your symptoms so you can be directed to the appropriate treatment facility.
Stay informed regarding the virus. Follow the directions of your local health authority

Should I wear a mask?

According to the World Health Organization (WHO) there is no need for healthy people to wear face masks. There is also no evidence that COVID-19 can be spread by pets, letters, packages or food. Droplet contamination can occur via shared hard surface contact. People with a cough, fever or difficulty breathing should wear a single-use surgical mask if going out in public. If you attend hospital or a medical clinic with a cough, you may be asked to wear a mask for the protection of others. You may see medical, nursing and other hospital staff adopting ‘respiratory precautions’ (single-use surgical mask, gloves, gown and eye protection) when attending patients with suspected contagious respiratory illnesses. This is to prevent the risk of infection of staff and spread of illness between patients. If you are well, there is no need to wear a mask.

Should I stockpile medications?

It is not recommended to stockpile medications. This creates supply issues and people in severe need may miss out.

Should I cancel travel?

All travel plans should be reconsidered at this time, in particular, travel overseas, or travel involving shared space travel over a number of hours eg coach, train or plane. Discuss this with your own Specialist. If your immune system is severely compromised, or if finding yourself quarantined and unable to return home for your next treatment would be a problem, this also needs to be considered. Please ask your specialist for a travel certificate if you require one for changing travel plans.

Can I still go out to meet my friends and family?

If you are receiving treatments that suppress your immune system, or you have advanced cancer or you are over 75 years of age with a history of an illness like diabetes, heart or kidney disease, respiratory illness or cancer, we would recommend that you do not attend large gatherings such as sporting events, concerts, large parties. Family and friends who are unwell should also remain in their own homes and not risk infecting others.

How do I deal with my stress about COVID-19?

It is normal to feel stressed, worried or anxious about this issue Talk with people whom you trust such as your doctor, friends and family. If you must stay at home, be sure to maintain a good diet, sleep, and exercise. Maintain your contact with family and friends by phone, email or social media. Don’t treat your stress with alcohol, smoking or other drugs. Seek counselling if you are feeling overwhelmed. Have a plan for how to deal with your physical as well as your emotional and mental health needs. Discuss these with your doctor. Stay informed using credible sources such as WHO website, or your local health agency. Limit how you feed your worry. Avoid watching or listening to excessive media coverage that you find upsetting and agitating.

What do I do if I think I have COVID-19?

If you are unwell with fever/ cough/ shortness of breath, and particularly if you have travelled from outside the country or been in close contact with someone who has tested positive for coronavirus, you need to follow the guidance on the Department of Health website https://www.health.gov.au/health-topics/novel-coronavirus-2019-ncov