Guidelines for patients diagnosed with cancer to prevent infection from coronavirus and develop COVID 19: Dr Suresh Rao
Mangaluru, Jun 4: In the past four months the world has been going through severe apprehension due to the pandemic of coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus that emerged during November end last year at Wuhan City of Hubei province of China causes respiratory disease. The disease is highly infectious and within a short period of nearly three months, it has rapidly spread from China to the rest of the world. From a clinical perspective, COVID 19 infections are indistinguishable from other respiratory infections like the common flu. The only way it can be distinguished from flu and other seasonal respiratory ailments are by the use of sophisticated tests.
Mangalore Institute of Oncology (MIO), a super specialty cancer hospital in coastal Karnataka, North Kerala and Goa region, has been taking validated and well planned preventive mechanisms to protect the patients and staff. Dr Suresh Rao, the director said, "At MIO we always believe that prevention is better than cure and conscious attempts are made to see that safety norms are in place. The processes adopted by us against the coronavirus infection are in agreement with the guidelines set by India’s premier medical advisory institution, the Indian Council for Medical Research (ICMR) and the World Health Organization (WHO). Herewith, he addressed a few pertinent aspects bothering people on COVID-19 in a question-answer pattern for a better understanding for the readers.
What is coronavirus and COVID-19?
Coronaviruses are a large family of viruses that can cause a range of illnesses in humans such as common cold and more severe forms of respiratory problems. It causes an illness called COVID-19 which can affect your lungs and airways. COVID-19 is an infectious disease caused by a new coronavirus that has led to a large outbreak.
Will everybody be affected by the coronavirus and COVID-19?
For most people, the virus will not cause serious problems. But for some people, the virus can have serious complications. Clinical observations from China, Europe, USA and India suggests that elderly patients, male gender and certain people having chronic medical conditions like cardiovascular (heart) disease, diabetes, uncontrolled hypertension (BP), affected with cancer, HIV positive, AIDS, kidney and respiratory ailments are at high risk for the infection of SARS-Cov-2 and a higher disease severity.
How does COVID-19 spread?
Transmission occurs from one person-to-another mainly through respiratory droplets released when an infected person with COVID-19 coughs or exhales. These droplets may also land on objects and surfaces. Healthy people can get infected by touching these objects or surfaces and then touching their eyes, nose or mouth.
What is the incubation period for coronavirus to cause illness?
The general health and immunity of the individual play an important role in the development of COVID-19 post-infection by coronavirus. Reports indicate that 97.5% of those who develop symptoms will do so within 11.5 days (8.2 to 15.6 days) after infection. However, the median incubation period is estimated to be 5.1 days (4.5 to 5.8 days) in people with co-morbidities and reduced immune capacity.
What are the symptoms of COVID-19?
You may develop fever, sore throat, running nose, cough or breathing difficulties. Occasionally, you may develop pneumonia which can be potentially life-threatening. In some cases, there may be no obvious symptoms present.
What is the severity of COVID-19?
While most people who fell sick recover from COVID-19, some succumb to it. The recovery time varies based on the individual and the severity of the illness. People with mild to moderate symptoms may recover in a short period. Occasionally it may lead to severe or life-threatening illnesses and can cause death. Reports suggest that the mortality ratio (the number of reported deaths divided by the reported cases) is between 3-4% and is especially more in people above the age of 60 and with co-morbidities like hypertension, diabetes, cardiac issues, cancer, tuberculosis, AIDS, lung dysfunction and kidney ailments.
What are the steps to reduce your risk of COVID-19?
1. The most important way to protect you and your family members is to avoid being exposed to COVID-19, whenever possible.
2. Wash your hands thoroughly with soap and warm water or with an alcohol-based hand sanitizer.
3. Wear a mask and in a correct way (explained later).
4. Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water.
5. Avoid touching your eyes, nose and mouth. Once contaminated, hands can transfer the virus to your eyes, nose or mouth. From there, the virus can enter your body and make you sick.
6. If you must cough or sneeze, please use a tissue, cough or sneeze into your elbow rather than your hand.
7. Avoid close contact with people who are sick. Please maintain a distance between yourself and anyone who is coughing or sneezing.
8. Clean frequently touched objects and surfaces with household cleaning spray or wipes. Studies suggest that coronaviruses may survive on surfaces for a few hours to days. So if you think a surface might be infected, clean it with a simple disinfectant.
9. Avoid all nonessential travel and please avoid people who are exposed to COVID-19.
10. If you have fever, cough or difficulty in breathing, please seek medical help and call your health care provider.
Why should people wear a mask?
From a healthcare perspective, the main idea behind the recommendations of face masks is to reduce the risk of infecting others or to decrease the possibility of being infected with any airborne infection. Coronavirus is highly contagious and commonly spreads by aerosols that are released by coughing or sneezing by the infected individuals. Also, studies show that people can spread coronavirus even if they do not have symptoms (called asymptomatic) or before they have symptoms (called presymptomatic). A person may be highly contagious just before symptoms begin.
When someone who has COVID-19 coughs, sneezes or talks, they release tiny droplets of coronavirus into the air. These aerosols (droplets of secretions carrying the virus particles) fall on surfaces commonly touched by others or can be inhaled by others as they remain suspended in ambient room air and that is how others may contract this infection. In such situations, a mask is very helpful as when an infected person coughs or sneezes, the face mask that covers the mouth and nose can block the release of virus-filled droplets into the air and will also block the inhalation by a healthy individual. This will reduce the spread of coronavirus and COVID-19.
Which type of face masks are recommended?
A simple surgical face mask or folded cloth will be effective to block droplets from a person’s cough or sneeze that may contain germs like viruses or bacteria, from entering your mouth or nose. A surgical mask or one made out of folded cloth is a loose-fitting, disposable wear that creates a physical barrier between potential contaminants in the surrounding environment and the body.
How to use the masks correctly?
The most important part to keep in mind to ensure effective utilization of face masks is to know how to use them. Here are some steps one can follow:
1. Clean hands with soap and water (for 20 seconds) or alcohol-based sanitizers before wearing a mask
2. Make sure your nose and mouth are covered by the mask and there should be no space between them
3. Avoid touching your mask when you are wearing them, and if you do so, sanitize your hands with soap and water or a hand-rub
4. While removing the mask, remove it from the back of your head and make sure you do not touch the face of the mask
5. Dispose of the masks after each use in a closed bin and do not reuse them. Sanitize your hands post-disposal
6. Do not use wet face masks
7. If you use a folded cloth, ensure the following precautions:
a. The cloth should be dry and clean.
b. Make multiple layered folding of the cloth before tying the cloth.
c. Drop the cloth for washing after returning from outside.
d. Do not touch the outer surface of the cloth with your hands.
e. Wash your hands with soap after removing the cloth.
Why should cancer patients and family members wear a mask?
For people who may need to travel to hospitals and treatment centers, wearing face masks is highly advisable when coming out of the house, throughout the travel, and even during the treatment if possible. For caregivers of cancer patients, you must wear masks whenever interacting with their affected ward, as a precaution. Please wear masks when you are outside your home, or at public places, change them frequently, and ensure safe disposal of the old ones. Face masks made of cloth are extremely important in places where it can be hard to stay 6 feet away from others (like grocery stores).
As a cancer patient, when do I need to be tested for COVID-19?
People with cancer are among those at a higher risk for complications. This is because cancer and its treatment can weaken their immune systems. The immune system protects the body against illness and infection caused by viruses like coronavirus. Some people with cancer have a weak immune system which reduces their ability to fight these infections. If you think you have been exposed to the virus or if you have a fever, cough, having breathing difficulties call your health care provider right away. They will ask screening questions to check whether or not you should be tested for COVID-19.
Will chemotherapy increase the risk of contracting COVID-19?
Certain anti-cancer treatments such as chemotherapy or radiotherapy may affect your immune system temporarily. This is because some treatment, like chemotherapy, can stop the bone marrow from making enough white blood cells. White blood cells are part of your immune system. Some types of cancer can also lower your ability to fight infection. This is usually cancer that affects your immune system like leukemia or lymphoma. If you are immune-compromised and exposed to COVID-19 then you may be at an increased risk of getting infected. COVID-19 virus is more likely to progress at a greater speed in a patient with cancer. It is best to discuss this with your doctor for intervention.
What should I do if I test positive for COVID-19?
If you have tested positive, then you will have to maintain good respiratory hygiene and follow your health care provider’s advice.
What should I do if I test negative for COVID-19?
Get plenty of rest, eat nutritious home-cooked warm food and drink lots of water. Contact your doctor if you have any questions.
Are there any special precautions for people diagnosed with cancer?
People diagnosed with cancer may be at high risk. However, there are no special steps to protect themselves against COVID-19. Please ensure to wash your hands well, and wash them frequently. Avoid crowded places as much as possible and wear a mask when you are outside.
Can I get COVID-19 from an animal source?
Possible animal sources of COVID-19 have not yet been confirmed. There are no studies that suggest pets such as cats and dogs have been infected or could spread COVID-19. Also, there is no information to suggest that the new coronavirus could be transmitted by mosquitoes. Handle raw meat, milk or animal organs with care to avoid contamination of uncooked food and avoid consuming raw or undercooked animal products.
What is the treatment for COVID-19?
To date, there is no specific treatment for coronavirus. Antibiotics do not help, as they do not work against viruses. Supportive care treatment aims to relieve the symptoms. You may need to be isolated from other people until you have completely recovered.
What do I do if I have symptoms?
The symptoms of coronavirus include:
1. A high temperature of above 37.8°C and, or a new continuous cough - This means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
2. Contact your treating doctor if you are having these symptoms. Do this as soon as possible if you have these symptoms and are feeling unwell.
3. Your doctor will suggest the necessary course of treatment depending on the symptoms.
What is the advice for people with cancer (who have no symptoms of coronavirus) staying at home (vulnerable groups)?
Some people with cancer are at more risk of being seriously ill if they develop COVID-19 infection. If you are in one of these groups, you are encouraged to follow particular measures to protect yourself. These groups of people include:
1. Having chemotherapy
2. Having radical radiotherapy for lung cancer
3. Cancer of the blood or bone marrow such as leukemia, lymphoma or myeloma who are at any stage of treatment
4. Having immunotherapy or other continuing antibody treatment for cancer
5. Having other targeted treatment for cancer which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
6. Those who have had a bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppressive drugs
If you are unsure what treatment you are having and whether you are in one of these groups speak to the team caring for you
I live with other people, what should we do?
Anyone who lives with you should reduce their contact outside their home whenever possible. But they do not have to practice the same shielding measures. They should practice social distancing (see below).
1. Spend as little time as possible with other people that you live within shared spaces, such as the kitchen or living room. Keep these areas well ventilated
2. Try to keep 2 meter (3 steps) away from people you live with. Sleep in a different bed whenever possible
3. Use separate towels in your house
4. Use a separate bathroom if possible. If you need to share a toilet and bathroom, this should be cleaned after you use them
5. Everyone should wash their hands regularly and avoid touching their face and clean frequently touched surfaces
6. Depending on your situation, it could be very difficult to stay away from the others at home. Do what you can. It is important that you feel you can support each other through this.
The decision to protect you and your family from coronavirus with shielding measures is your personal choice and circumstance. Therefore please take adequate care, be vigilant and stay healthy.