Updated Joint Statement on Coronavirus (COVID-19) from Lung Cancer Groups

LUNGevity and four other lung cancer organizations are issuing regular  joint statements on coronavirus to help people understand what is known about the disease, find reliable sources of information, and be aware of its potential impact on vulnerable populations, including those with lung cancer.

LUNGevity       GO2 Foundation           Lung Cancer Foundation of America

Lung Cancer Research Foundation        LungCAN

 


April 2, 2020, Special Update - COVID-19 and Surgery: How long can I wait?

This update has been written in collaboration with Dr. Brendon Stiles. He is a thoracic surgeon at New York-Presbyterian Hospital and an Associate Professor of Cardiothoracic Surgery at Weill Cornell Medicine.

Download the update

That question must be on the mind of many lung cancer patients as they consider treatment during the COVID-19 pandemic.  We are currently in the middle of an unprecedented crisis that has left hospitals short on resources and personnel.  That has led to shutting down “elective” surgical cases (surgeries that are not considered to be of medical emergency) at many hospitals, particularly in places such as New York City that are COVID-19 hot zones. 

Are cancer cases truly “elective”?  And how long can patients and their surgeons actually wait? 

We don’t have a lot of data making a strong case for waiting or not waiting.  Some lung cancer-specific data suggests that the decision should be made based on how “quickly” the lung cancer grows. It takes on average 13.2 years for a lung adenocarcinoma to get to 1 cm in size and 14.4 years to get to 3 cm.  While other subtypes of lung cancer and other cancers may move much more quickly, this would obviously suggest that there is some time allowable prior to treatment for many cancers.  In that context, postponing surgery a few weeks or months may outweigh the risks of exposure to COVID-19.

It is, however, unclear what is the appropriate waiting time for each individual patient.   Most studies have suggested that for early-stage lung cancer, there is some risk of tumor progression that comes with delayed treatment.  That said, the risk appears to be small and not particularly predictable.  At this time, for hospitals that still have resources, the American College of Surgery recommends surgical resection as soon as feasible for patients with solid or predominantly solid cancer over 2 cm in size, while it recommends deferring lung cancer resection even in these hospitals for tumors less than 2 cm or for those that are predominantly ground glass. 

In the current situation, patients with early-stage lung cancer should also consider alternatives to surgical resection.  This is particularly true in areas that are the most affected by COVID-19, where surgery may not be an option for an extended period.  Outpatient centers likely have less exposures than inpatient where we know there are many COVID patients.  Also, patients spend less time in radiation treatment facilities.  Finally, radiation (at least early on) preserves lung function and doesn’t risk immediate decrease in lung capacity, which may put patients at risk for more complications should they become infected. Good data is available on the efficacy of stereotactic ablative radiotherapy (SABR or SBRT) for the treatment of early-stage lung cancer.  It is also worth noting that radiation, particularly stereotactic, doesn’t preclude surgery down the road. 

It is not clear how data on treatment delay can be applied to patients with later-stage disease.  Certainly patients with clear-cut stage II or III lung cancer could be started on outpatient chemotherapy or chemoradiation with surgery pushed down the road several months if needed

March 30, 2020, Update to the Joint Statement

Download the updated statement for the week of March 23, 2020.

As of March 30, 2020, cases of the virus surge in countries around the world. The United States now has the highest number of COVID-19 cases globally. The CDC has issued a travel advisory for the New York tri-state area, which has the highest number of cases in the country. 

In this week’s update, we discuss lung cancer treatment and clinical trials in the era of COVID-19. The information presented in this update, though current, is a work in progress built on very little data. Implementation across institutions and trial sites will vary based on availability of resources and healthcare workers.

Also, please don’t forget to check out the Resources list.

Lung cancer treatment and COVID-19

The oncology community is currently balancing treatment decisions for lung cancer patients, in light of the COVID-19 pandemic. Two factors are being used to decide what’s best for our patients:

  • Whether a delay in cancer diagnostic tests or treatment presents more risk than potential COVID-19 exposure in the clinic
  • Whether a difference in treatment approach can help reduce clinic visits and interactions with others

The CDC continues to recommend social distancing to help decrease transmission of COVID-19 within the community. Social distancing measures, such as cancelling public gatherings and avoiding crowds, can slow the spread of the virus and spread cases out over a longer period of time, which can help hospitals provide care while avoiding being overwhelmed by patients. Social distancing helps “flatten the curve” in the spread of an infectious disease. This is especially critical because hospitals and health systems are working at full capacity. Flattening the curve ensures that systems are functional and people who require care the most can get the attention they need. The CDC recommends a distance of 6 feet or 2 meters as the minimum distance between individuals as part of COVID-19 mitigation strategy.

Currently, lung cancer patients may need to engage with the oncology care system for the following reasons:

  • clinic visits
  • tissue and liquid biopsies
  • surgical procedures 
  • infusion sessions for chemotherapy or immunotherapy (or both)
  • refill targeted therapy drugs
  • radiation treatments
  • hospital admissions
  • blood draws for laboratory tests, and
  • imaging tests to check if treatments are working

Also, family members may sometimes accompany patients when they are visiting their doctors.

Recent studies out of China suggest that hospital admissions and repeated clinic visits increase the risk of COVID-19 exposure for patients. Further, a JAMA Oncology study reported that the infection risk for cancer patients in a tertiary care institution was 2-fold higher than the cumulative incidence observed in the city of Wuhan over the same time period. In light of these data and the rapidly evolving COVID-19 pandemic, the oncology community has come up with the following suggestions for cancer treatment. Please be advised that these recommendations are subject to change.

Small Cell Lung Cancer (SCLC):

If you have a confirmed diagnosis, you may not wish to delay treatment (such as chemotherapy and radiation). You and your doctor should discuss what’s right for you.

Early stage non-small cell lung cancer (NSCLC) (Stage I to IIIB):

  • If you have already had surgery, your doctor may decide to not start with adjuvant chemotherapy and/or radiation.
  • If you have not yet had surgery, you and your doctor may decide to wait on the surgery or your doctor may suggest stereotactic body radiation therapy (SBRT).
  • If you are currently having chemo-radiation, your doctor may decide to continue with your treatment or wait on additional treatment.

Advanced stage non-small cell lung cancer (NSCLC) (Stage IIIC-IV):

  • If you are on a targeted therapy (pill), you may continue with your treatment as planned. Make sure to check with your doctor and pharmacist to ensure an adequate supply of your cancer medication.
  • If you are already on immunotherapy or chemotherapy, your doctor may decide to continue with your treatment, space out infusions, or postpone treatment. They may decide to have you receive infusions at your local clinic or even home infusion, as needed.
  • If you are already undergoing radiation therapy, your doctor may choose to hold off on additional treatment, reduce the number of treatments, or keep you on treatment as planned, based on your individual health situation.

Several recent forums have discussed the management of lung cancer during the COVID-19 pandemic. Topics that are currently being addressed by lung cancer providers/thought leaders include:

  • How to determine whether pneumonitis is resulting from checkpoint inhibitor or COVID-19 infection
  • Should immunotherapy be withheld from patients whose tumors do not have known driver mutations (as determined by molecular testing)?
  • Spacing out or postponing infusions for patients on pemetrexed or immunotherapy maintenance
  • Reducing the number of fractions used in radiation therapy
  • Uncertainty regarding how COVID-19 treatments in clinical trials (such as remdesivir and hydroxychloroquine) may interact with immunotherapy drugs and tyrosine kinase inhibitors
  • The growing role for liquid biopsies in places where surgical biopsies are not currently practical (use of mobile phlebotomy too)
  • Challenges of spacing out chemotherapy schedules in light of current reimbursement
  • Growing role for telemedicine (effective for managing patients but loss of doctor-patient bond)
  • Educating others on their care teams to overcome lung cancer nihilism and stigma

All treatment decisions should be made jointly by you and your doctor. Do not change your treatment plan or doctor’s visit without consulting your doctor first.

Telehealth or remote consults may be an option for checking in with your doctor. Also, there may be the option to be referred to a “COVID-19-free” hospital or treatment center.

Clinical trials and COVID-19

Clinical trials continue to be a source of lifesaving therapies for lung cancer patients. The COVID-19 pandemic has affected the conduct of clinical trials due to the following reasons:

  • Questions related to safety of patients traveling to trial sites and undergoing trial-related procedures
  • Potential shortage of healthcare providers to conduct trial-related activities
  • Interruptions to the supply chain of the drug(s) being tested

The US Food and Drug Administration (FDA) has recently issued guidance to help clinical trial sponsors figure out the best approaches to ensure that trials can proceed within resource-constrained settings. A clinical trial sponsor in this case is defined as any entity (for example, a pharmaceutical company) involved in the development and testing of drugs and other interventions in clinical trials. Below we have summarized key points from the FDA guidance that are important from the patient perspective.

For clinical trials that are already ongoing:

  • Sponsors should consider each circumstance, assess the potential impact on the safety of trial, and modify study conduct accordingly. Decisions regarding this could include continuing trial recruitment, continuing use of the new drug(s) for patients already involved in the trial, and the need to change patient monitoring schedules throughout the trial. Clinical trial participants should be kept updated on any changes that a sponsor decides to implement.
  • Sponsors, doctors involved in the trials, and Institutional Review Boards (IRBs) may decide that the protection of a patient’s safety, welfare, and rights would be best served by continuing or by discontinuing use of the investigational product or participation in the trial. However, such decisions will depend on the specific circumstances of the clinical trial and the patients enrolled.
  • Given that trial participants may be unable to come to investigational sites due to protocol-specified visits, sponsors should assess whether alternative methods for safety evaluations could be implemented when necessary and feasible. Additionally, in deciding to continue or discontinue use or administration of the new drug(s), sponsors should consider whether the safety of participants can be ensured by implementing the alternative approach of monitoring such as local scans and blood tests. Sometimes, patients may require additional safety monitoring.

Several sponsors already have different measures in place to allow conduct of clinical trials and avoid as much disruption as possible, such as:

  • Allowing patients to have blood draws and CT scans at local cancer centers and clinics
  • Shipping drug supplies to patients, especially for targeted therapy (pills) trials
  • Remote consent
  • Mobile phlebotomy

If you are part of a clinical trial, we recommend you discuss your trial participation immediately with your research team.  If you were considering enrolling in a clinical trial, you may want to discuss with your treating physician what options are available for you. Any decision about trial participation should be made jointly by you and your healthcare team.

Resources and Websites

  1. IASLC’s Guide to COVID-19 and Lung Cancer – https://www.lungcancernews.org/iaslcs-guide-to-covid-19-and-lung-cancer/
  2. The National Cancer Institute has a special website for COVID-19 and emergency preparedness. Coronavirus: What People with Cancer Should Know - https://www.cancer.gov/contact/emergency-preparedness/coronavirus
  3. We are following updates provided by the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC), which can be found here:
  4. Johns Hopkins Coronavirus Resource Center is one of the best places to get current updates. https://coronavirus.jhu.edu/
  5. Interactive map of US COVID-19 cases by state - https://www.politico.com/interactives/2020/coronavirus-testing-by-state-chart-of-new-cases/
  6. The One-Two Punch: Cancer and Coronavirus (an important perspective for cancer patients) - https://www.forbes.com/sites/miriamknoll/2020/03/20/the-one-two-punch-cancer-and-coronavirus/#73744a4358e6
  7. You can find information specific to your state or city or town on your health department’s website.
  8. The American Medical Association is also maintaining a resource website for healthcare providers. You can find more information here: https://www.ama-assn.org/delivering-care/public-health/covid-19-2019-novel-coronavirus-resource-center-physicians
  9. If you cannot avoid air travel, check out this handy article on “Dirtiest Places on Airplanes: How to Avoid Germshttps://time.com/4877041/dirtiest-places-on-airplanes/

March 23, 2020, Update to the Joint Statement

Download the updated statement for the week of March 23, 2020.

As cases of the virus surge in countries around the world, with Italy being particularly hard hit, many nations are taking extreme steps to mitigate the outbreak, including whole country lockdowns. Here in the United States, the President declared a national emergency on March 13, 2020. Several states have declared shelter-in-place to minimize non-essential activities and mitigate transmission. President Trump has declared California, New York State, and Washington State to be major disaster areas.

In this week’s update, we discuss the following topics related to COVID-19:

Origin of SARS-CoV-2

SARS-CoV-2 is the seventh coronavirus known to infect humans. SARS-CoV, MERS-CoV, and SARS-CoV-2 can cause severe disease, whereas HKU1, NL63, OC43, and 229E are associated with mild symptoms. There has been a lot of speculation on the origin of SARS-CoV-2. Scientists have now sequenced the genetic material of the virus isolated from different patients. These sequencing results clearly establish that SARS-CoV-2 is not a genetically engineered virus, meaning it is not manmade.1

The researchers provide two scenarios for the origin of SARS-CoV-2. In one scenario, the virus evolved to its current pathogenic (disease-causing) state through natural selection in a non-human host and then jumped to humans. This is how previous coronavirus outbreaks have emerged, with humans contracting the virus after direct exposure to civets (SARS) and camels (MERS). The researchers proposed bats as the most likely reservoir for SARS-CoV-2 as it is very similar to a bat coronavirus. In the other proposed scenario, a non-pathogenic version of the virus jumped from an animal host into humans and then evolved to its current pathogenic state within the human population. For instance, some coronaviruses from pangolins, armadillo-like mammals found in Asia and Africa, have similarities to SARS-CoV-2. A coronavirus from a pangolin could possibly have been transmitted to a human, either directly or through an intermediary host such as civets or ferrets.

Which age groups have severe responses to COVID-19?

Initial data on COVID-19 suggested that when stratified by age, the elderly were the most likely to develop a more severe form of COVID-19. Recent data released by the CDC demonstrated that this is not the case anymore.  As shown in the figure below, almost all age groups are susceptible to a serious form of COVID-19 that requires hospitalization.2

COVID-19 severity by age group

This is especially important to keep in mind given that younger people have been more resistant to social distancing.

How long does SARS-CoV-2 survive outside the body?

A recent study found that the SARS-CoV-2 virus (which causes COVID-19) can survive up to four hours on copper, up to 24 hours on cardboard, and up to two to three days on plastic and stainless steel. The researchers also found that this virus can hang out as droplets in the air for up to three hours before they fall. But most often they will fall more quickly.3

The researchers were able to detect viable viral particles for at least 72 hours on the four surfaces studied. This suggests that transmission of SARS-Cov-2 is possible through aerosols and fomites (solid objects and surfaces that are able to carry pathogens and transmit infections).

We recommend that after you bring articles into your home, you do the following:

  • Wash your hands after carrying delivered items into your home.
  • After accepting a package that’s in a cardboard container, put it aside or in the garage and let it sit for a day or two before opening (if possible).
  • After opening a package, wipe down all articles that have solid surfaces with chlorine wipes or disinfect with an alcohol-based solution.
  • At this time, there is no guidance on how to disinfect edible items such as fruits and vegetables.
  • Follow cleaning and disinfecting procedures listed on the coronavirus.gov website

Community transmission of SARS-CoV-2 by asymptomatic individuals

Data from initial cases of COVID-19 suggested that most transmissions were occurring through individuals who showed signs and symptoms of COVID-19. This is, however, not the case. It is now estimated that as many as 31% of new COVID-19 infections are being caused as a result of transmission through asymptomatic individuals—those who have been infected with SARS-CoV-2 but don’t shown signs and symptoms of the disease.4 This is an especially important aspect of SARS-CoV-2 transmission and reinforces why we need to practice stringent social distancing to flatten the curve.

COVID-19 patients may present with non-respiratory symptoms even before they have respiratory symptoms

Individuals infected with SARS-CoV-2 may present with gastrointestinal symptoms such as anorexia (83.8%), diarrhea (29.3%), vomiting (0.8%), and abdominal pain (0.4%).5 These gastrointestinal symptoms may show up even before respiratory symptoms of COVID-19. Furthermore, a small sample of patients presented with only gastrointestinal symptoms. If you have unexplained gastrointestinal issues, we suggest that you talk to your doctor promptly.  Also, conjunctivitis may be present in a small subset of patients as well. 6

Prepare your legal documents

Given the uncertainty over availability of medical care during the COVID-19 emergency, we suggest everyone review their legal documents and ensure they have a current Durable Power of Attorney and Advance Directive. This virus can progress very rapidly and seriously interfere with breathing, which means you cannot be certain that you will be able to make your wishes known verbally if you get severely ill. Discuss your wishes with your family and ensure everyone knows where to find these important documents.

If you haven’t completed these legal documents, some estate planning attorneys may be willing to help prepare and witness them via video conferencing so that you do not have to leave your home.

If you are not sure how to get started, please review the resources available at https://theconversationproject.org/

Can I take ibuprofen when I have COVID-19?

Short answer: yes.  Long answer: we’re not sure.

On March 18, the World Health Organization (WHO) posted an article suggesting that patients who have COVID-19 avoid taking ibuprofen, based on observations of patients in France.7 However, later the same day, WHO changed their stance and said patients who have COVID-19 should not avoid taking ibuprofen.8

This is a good example of how quickly information is evolving during this pandemic. It’s difficult for doctors to know whether to act on information that is based on the experience of only a few (or even one) patient.

Resources and websites:

  1. The National Cancer Institute has a special website for COVID-19 and emergency preparedness. Coronavirus: What People with Cancer Should Know - https://www.cancer.gov/contact/emergency-preparedness/coronavirus
  2. We are following updates provided by the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC), which can be found here:
  3. Johns Hopkins Coronavirus Resource Center is one of the best places to get current updates. https://coronavirus.jhu.edu/
  4. Interactive map of US COVID-19 cases by state - https://www.politico.com/interactives/2020/coronavirus-testing-by-state-chart-of-new-cases/
  5. The One-Two Punch: Cancer And Coronavirus (an important perspective for cancer patients) - https://www.forbes.com/sites/miriamknoll/2020/03/20/the-one-two-punch-cancer-and-coronavirus/#73744a4358e6
  6. You can find information specific to your state or city or town on your health department’s website.
  7. The American Medical Association is also maintaining a resource website for healthcare providers. You can find more information here: https://www.ama-assn.org/delivering-care/public-health/covid-19-2019-novel-coronavirus-resource-center-physicians
  8. If you cannot avoid air travel, check out this handy article on “Dirtiest Places on Airplanes: How to Avoid Germshttps://time.com/4877041/dirtiest-places-on-airplanes/

References

  1. Anderson K, Rambaut A, Lipkin W, Holmes E, Garry R. The proximal origin of SARS-CoV-2. Nature Medicine. 2020.
  2. CDC. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020.
  3. van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020.
  4. Nishiura H, Kobayashi T, Suzuki A, et al. Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19). Int J Infect Dis. 2020.
  5. Pan L, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. American Journal of Gastroenterology. 2020.
  6. AAO. Alert: Important coronavirus updates for ophthalmologists. https://www.aao.org/headline/alert-important-coronavirus-context. Published 2020. Accessed March 23, 2020.
  7. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020.
  8. ScienceAlert. Updated: WHO Now Doesn't Recommend Avoiding Ibuprofen For COVID-19 Symptoms. https://www.sciencealert.com/who-recommends-to-avoid-taking-ibuprofen-for-covid-19-symptoms/amp?fbclid=IwAR0f9eZt8u9s_xfiY06bJ0Sei2NasHQj_b_eosKGjBeJiJXi5LXQV3EIj7w. Published 2020. Accessed March 23, 2020.

March 16, 2020, Update to the Joint Statement

Download the updated statement for the week of March 16, 2020.

The World Health Organization officially declared the COVID-19 outbreak a pandemic on March 11, 2020. As cases of the virus surge in countries around the world, with Italy being particularly hard hit, many nations are taking extreme steps to mitigate the outbreak, including whole country lockdowns. Here in the United States, the President declared a national emergency on March 13, 2020.

In this week’s update, we discuss four important topics related to COVID-19.

1. Social distancing and why it matters for COVID-19

COVID-19 is caused by the virus SARS-CoV-2. Individuals infected with SARS-CoV-2 appear to shed the virus from their respiratory tract (e.g., when coughing) even when symptoms may be very minor. Individuals infected with SARS-CoV-2 appear to shed the virus from their respiratory tract during the prodromal period.1 The prodromal period is part of an infectious disease cycle. It is defined as the period during which the symptoms felt by an infected individual may not be very specific or severe. The infected person can still perform usual functions and can therefore continue to be infectious. An infected individual can shed virus with very minor signs and symptoms.2 This explains why we are seeing widespread transmission in the community (this didn’t happen with SARS).

The reproductive number (R0)– the number of secondary infections generated from one infected individual – is estimated to be between 2 and 2.5 for COVID-19 virus.3 This means that a single infected person infects 2.5 people, which is higher than for the influenza virus. Approximately 3 to 5 days after infection, a person starts shedding virus and can infect others. Therefore, within a month, a single case can lead to 244 new cases.

The CDC now recommends social distancing to help decrease transmission of COVID-19 within the community.4 Social distancing measures, such as cancelling public gatherings and avoiding crowds, can slow the spread of the virus and spread cases out over a longer period of time, which can help hospitals provide care while avoiding being overwhelmed by patients. Social distancing helps “flatten the curve” in the spread of an infectious disease. This is especially critical because hospitals and health systems are working at full capacity. Flattening the curve ensures that systems are functional and people who require care the most can get the attention they need. The CDC recommends a distance of 6 feet or 2 meters as the minimum distance between individuals. 5

Flattening the curve

In case you are interested, we invite you to take a look at the CDC’s community transmission mitigation strategy document (cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf).

2. Appointments with your oncologist: virtual or in-person?

It may be a good idea to consider rescheduling or switching to a virtual appointment if your treating physician or cancer center provides this option. Note that virtual appointments are not appropriate for infusions for chemotherapy or immunotherapy, or potentially critical scans. If you have an oncology visit due in the next couple of months, please contact your treating physician as soon as possible to discuss what’s the right approach for you and whether they anticipate any drug shortages due to supply chain disruption.

Several hospitals are now limiting the number of visitors and/or people accompanying patients to no more than one at a time.  In Seattle, the area hardest hit with cases, some hospitals are implementing the following measures to avoid being overwhelmed6:

  • People with routine appointments are being screened for symptoms. Those who are sick are required to wear a mask or may not be allowed to enter the clinic. 
  • Elective surgeries are being postponed.
  • Patients who have flu-like symptoms or other concerns are asked to CALL their doctor rather than going directly to the Emergency Department or Urgent Care.
  • If you are having difficulty breathing, please do go to the Emergency Department.

3. COVID-19 testing: where we are now

We are seeing transmission in the community, so it’s likely the virus is more widespread in the United States than we imagine. However, we don’t have hard data because testing was not implemented in the earlier days of the epidemic in the US.7 Right now, most people need to have symptoms before they can be tested.  As more test kits are distributed, testing will hopefully expand.  Drive-through testing has been made available in a few locations but is not yet widely available. As we have stated previously, the symptoms of COVID-19 infection include fever, dry cough and shortness of breath. If you suspect that you have been infected, you should call your doctor or local health department to determine next steps. The availability of tests varies on where you live.

The CDC is maintaining an updated list of where tests are currently being performed in the US.8

Additionally, state health departments are a valuable resource, providing hotlines and websites with information about what to do if you are concerned that you or a loved one might be infected (links in the references).

4. Voices from the community

Please check out Janet Freeman-Daily’s article where she describes her experience as a lung cancer survivor with a cough and the difficulties she faced to get tested for COVID-19. Janet lives in the Seattle, WA area, a COVID-19 hotspot.

Fred Hutchinson Cancer Research Center in Seattle published a helpful blog post, “Coronavirus: what cancer patients need to know.”

Resources and websites:

  1. The National Cancer Institute has a special website for COVID-19 and emergency preparedness. Coronavirus: What People with Cancer Should Know - https://www.cancer.gov/contact/emergency-preparedness/coronavirus
  2. We are following updates provided by the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC), which can be found here:
  1. Johns Hopkins Coronavirus Resource Center is one of the best places to get current updates. https://coronavirus.jhu.edu/
  2. You can find information specific to your state or city or town on your health department’s website.
  1. The American Medical Association is also maintaining a resource website for healthcare providers. You can find more information here: https://www.ama-assn.org/delivering-care/public-health/covid-19-2019-novel-coronavirus-resource-center-physicians
  2. If you cannot avoid air travel, check out this handy article on “Dirtiest Places on Airplanes: How to Avoid Germs”: https://time.com/4877041/dirtiest-places-on-airplanes/

References

  1. Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395(10223):514-523.
  2. Hoehl S, Berger A, Kortenbusch M, et al. Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China. N Engl J Med. 2020.
  3. WHO. Coronavirus disease 2019 (COVID-19) Situation Report – 46. 2020.
  4. CDC. Implementation of Mitigation Strategies for Communities with Local COVID-19 Transmission Coronavirus Disease 2019 (COVID-19) Web site. cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf. Published 2020. Accessed March 15, 2020.
  5. CDC. IInterim US Guidance for Risk Assessment and Public Health Management of Persons with Potential Coronavirus Disease 2019 (COVID-19) Exposures: Geographic Risk and Contacts of Laboratory-confirmed Cases. Coronavirus Disease 2019 (COVID-19) Web site. https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html. Published 2020. Accessed March 15, 2020.
  6. UW. COVID-19 (formerly called Novel Coronavirus). https://www.uwmedicine.org/coronavirus. Published 2020. Accessed 2020, March 15.
  7. Lambert J, Saey TH. Social distancing, not travel bans, is crucial to limiting coronavirus’ spread. Science News2020.
  8. CDC. Testing in U.S. Coronavirus Disease 2019 (COVID-19) Web site. https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html. Published 2020. Accessed March 15, 2020.

March 9, 2020, Update to the Joint Statement

Download the updated statement for the week of March 9, 2020.

As advocacy organizations dedicated to serving the needs of lung cancer patients, all of us are closely monitoring the latest developments related to the outbreak caused by the novel coronavirus, SARS-CoV-2, and the resulting disease, COVID-19.

In this update, we have included additional information on facts about COVID-19, symptoms, testing, information about populations at risk of serious infection, and what you should do to protect yourself from COVID-19.

We are following updates provided by the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC), which can be found here:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen
https://www.cdc.gov/coronavirus/2019-ncov/index.html

Facts about SARS-CoV-2/COVID-19

  1. This novel virus presents a unique threat to vulnerable populations, including the elderly and those with weakened immune systems, including cancer patients. Early studies conducted on lung cancer patients undergoing surgery suggest that this virus readily infects the lungs and can potentially cause pneumonia, making lung cancer patients particularly susceptible.1
  2. Research suggests that the overall clinical consequences of COVID-19 may ultimately be similar to those of a severe seasonal influenza or a pandemic influenza.2
  3. SARS-CoV-2 is very infectious. Infected individuals may not show symptoms of COVID-19 but are still considered infectious.3

Symptoms of COVID-19

Symptoms may appear 2-14 days after exposure and may include:

  1. Fever
  2. Tiredness
  3. Dry cough
  4. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually.
  5. Some people become infected but don’t develop any symptoms and don't feel unwell.

Can I get tested for COVID-19?

As of today, the CDC recommends testing symptomatic individuals. Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested.4

Who are at increased risk of developing a serious form of COVID-19?

  1. Recent data suggest that certain populations may be at higher risk of getting very sick from infection with SARS-CoV-2. These groups include:
    • People with cancer.5 Though the numbers are very small (5 out of 18 patients included in the study), research suggests that lung cancer patients may be susceptible to a more serious form of the infection
    • People with lung disease,6 such as COPD (chronic obstructive pulmonary disease)
    • People with hypertension (high blood pressure)7
    • People with diabetes7
    • People with heart disease6
    • People with kidney disease8
    • Older adults, defined as those above the age of 606,8
    • People in active cancer treatment or whose immune systems may be compromised by chemotherapy or steroids9
  2. If you have more than one of the risk factors described above, you may be at an even greater risk of developing a serious form of COVID-19.

What you can do:

  1. If you or a loved one are in one of the high-risk groups described above:
    • Stay at home as much as possible.
    • Make sure you have access to several weeks of medications and supplies in case you need to stay home for prolonged periods of time.
    • When you go out in public, keep away from others who are sick, limit close contact and wash your hands often.
    • Avoid crowds, especially in poorly ventilated spaces.
    • Stay up to date on CDC Travel Health Notices (https://wwwnc.cdc.gov/travel/notices).
    • Plan now for what you will do if you, or people you rely on for support, become ill
  2. We encourage everyone to follow best practices for public health, such as staying home when ill, handwashing with soap and water (or using a hand sanitizer), and respiratory etiquette including covering the mouth and nose during sneezing and coughing.10 Many of the steps you would take to protect yourself from catching the flu also apply for protecting yourself against COVID-19.
  3. Regarding travel within the United States, at this time the CDC is encouraging limited travel restricted only to essential travel. We encourage all people to evaluate the need for non-essential travel and to take appropriate precautions if travel is required. Please check with your doctor before making international travel plans. Again, the CDC is maintaining a page that outlines current travel advisories: https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html

What you should not do:

Do not read or share information about COVID-19 from websites that are not maintained by reputable public health organizations (for example, the CDC). When in doubt, check your facts with what’s posted on the CDC or WHO website.

Treatment and Vaccines:

  1. As of now, there are no treatments for COVID-19. All treatments involve simply reducing the symptoms of the infection.
  2. As of now, there are no vaccines to prevent a COVID-19 infection.

Resources and websites:

  1. You can find information specific to your state or city or town on your health department’s website.
  2. The American Medical Association is also maintaining a resource website for healthcare providers. You can find more information here: https://www.ama-assn.org/delivering-care/public-health/covid-19-2019-novel-coronavirus-resource-center-physicians
  3. If you cannot avoid air travel, check out this handy article on “Dirtiest Places on Airplanes: How to Avoid Germs”: https://time.com/4877041/dirtiest-places-on-airplanes/

References:

  1. Tian S, Hu W, Niu L, Liu H, Xu H, S. X. Pulmonary pathology of early phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer. Journal of Thoracic Oncology. 2020.
  2. Fauci AS, Lane HC, Redfield RR. Covid-19 - Navigating the Uncharted. N Engl J Med. 2020.
  3. Nishiura H, Linton NM, Akhmetzhanov AR. Serial interval of novel coronavirus (COVID-19) infections. Int J Infect Dis. 2020.
  4. CDC. Evaluating and Reporting Persons Under Investigation (PUI) Summary of Recent Changes. Coronavirus Disease 2019 (COVID-19) Web site. https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html. Published 2020. Accessed March 8, 2020.
  5. Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335-337.
  6. CDC. People at Risk for Serious Illness from COVID-19. Coronavirus Disease 2019 (COVID-19) Web site. https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html. Published 2020. Accessed March 8, 2020.
  7. Guan W, Lian W, COVID-19 on behalf of China Medical Treatment Expert Group for COVID-19. Comorbidity and its impact on 1,590 patients with COVID-19 in China: A Nationwide Analysis. medRxiv. 2020.
  8. Liu Y, Sun W, Li J, et al. Clinical features and progression of acute respiratory distress syndrome in 2 coronavirus disease 2019 medRxiv. 2020.
  9. Center FHCR. Coronavirus: what cancer patients need to know. https://www.fredhutch.org/en/news/center-news/2020/03/coronavirus-what-cancer-patients-need-to-know.html. Published 2020. Accessed March 8, 2020.
  10. Del Rio C, Malani PN. 2019 Novel Coronavirus-Important Information for Clinicians. JAMA. 2020.

March 3, 2020, Joint Statement on Coronavirus COVID-19 from Lung Cancer Advocacy Groups

We understand and appreciate the severity of the new coronavirus epidemic (also known as COVID-19) that’s spreading globally. As advocacy organizations dedicated to serving the needs of lung cancer patients, all of us are closely monitoring the latest developments related to the outbreak caused by the novel coronavirus, SARS-CoV-2, and the resulting disease, COVID-19.

This is a rapidly evolving situation and we are following updates provided by the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC), which can be found here:

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen https://www.cdc.gov/coronavirus/2019-ncov/index.html

Facts about SARS-Cov-2/COVID-19

  1. This novel virus presents a unique threat to vulnerable populations, including the elderly and those with weakened immune systems, including cancer patients. Early studies conducted on lung cancer patients undergoing surgery suggest that this virus readily infects the lungs and can potentially cause pneumonia, making lung cancer patients particularly susceptible.1
  2. Research suggests that the overall clinical consequences of COVID-19 may ultimately be similar to those of a severe seasonal influenza or a pandemic influenza.2

What you can do

  1. First and foremost, we encourage everyone to follow best practices for public health, such as staying home when ill, handwashing with soap and water (or using a hand sanitizer), and respiratory etiquette including covering the mouth and nose during sneezing and coughing.3 Many of the steps you would take to protect yourself from catching the flu also apply for protecting yourself against COVID-19.
  2. Regarding travel within the United States, at this time there are no restrictions on travel. However, the situation may change rapidly. We encourage all people to evaluate the need for non-essential travel and to take appropriate precautions if travel is required. Please check with your doctor before making international travel plans. Again, the CDC is maintaining a page that outlines current travel advisories: https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html

What you should not do

Do not read or share information about COVID-19 from websites that are not maintained by reputed public health organizations (for example, the CDC). When in doubt, check your facts with what’s posted on the CDC or WHO website.

Resources and websites

  1. You can find information specific to your state or city or town on your health department’s website.
  2. The American Medical Association is also maintaining a resource website for healthcare providers. You can find more information here: https://www.ama-assn.org/delivering-care/public-health/covid-19-2019-novelcoronavirus-resource-center-physicians
  3. If you cannot avoid air travel, check out this handy article on “Dirtiest Places on Airplanes: How to Avoid Germshttps://time.com/4877041/dirtiest-places-on-airplanes/

References

  1. Tian S, Hu W, Niu L, Liu H, Xu H, S. X. Pulmonary pathology of early phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer. Journal of Thoracic Oncology. 2020.
  2. Fauci AS, Lane HC, Redfield RR. Covid-19 - Navigating the Uncharted. N Engl J Med. 2020. 3. Del Rio C, Malani PN. 2019 Novel Coronavirus-Important Information for Clinicians. JAMA. 2020.

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