March 9, 2020, Update to the Joint Statement

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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.

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