CORNAVIRUS & COVID-19

Accredited Source : Merry Jennifer Markham, MD, FACP, FASCO, is Chief of the University of Florida (UF) Division of Hematology & Oncology, a Clinical Professor in the UF College of Medicine, and the Associate Director for Medical Affairs at the UF Health Cancer Center. She specializes in the treatment of gynecologic cancers. Dr. Markham is the Cancer.Net Associate Editor for Gynecologic Cancers and the past chair of ASCO's Cancer Communications Committee. Follow her on Twitter at @DrMarkham.

The American Society of Clinical Oncology (ASCO) is aware that people with cancer and cancer survivors, particularly those with compromised immune systems, are likely worried about the potential impact of COVID-19 on their health. Patients should talk with their oncologists and health care teams to discuss their options to protect themselves from infection.

**What is COVID-19?

COVID-19, or coronavirus disease 2019, is an illness caused by a novel (or new) coronavirus that was first identified in an outbreak in Wuhan, China, in December 2019.

Coronaviruses are a large family of viruses that can cause mild illnesses, such as the common cold, to more severe diseases, such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). Because the novel coronavirus is related to the SARS-associated coronavirus (SARS-CoV), the virus has been named SARS-CoV-2. The exact source of SARS-CoV-2, which causes COVID-19, is not certain but likely originated in bats.

The virus can spread from person to person, through small droplets from the nose or mouth that are produced when a person coughs or sneezes. Another person may catch COVID-19 by breathing in these droplets or by touching a surface that the droplets have landed on and then touching their eyes, nose, or mouth. The virus spreads through close contact, but it mainly spreads by airborne transmission. In an enclosed space, virus particles can remain in the air for minutes to hours and can infect people at distances of more than 6 feet (2 meters).

Symptoms from COVID-19 can be mild to severe and may appear between 2 and 14 days after exposure to the virus. The symptoms may include fever, cough, shortness of breath, chills, headaches, sore throat, and new loss of taste or smell. Other symptoms may include aches and pains, fatigue, nasal congestion or runny nose, or diarrhea. In some people, the illness may cause severe pneumonia and heart problems, and it may lead to death. Other people who are infected may not develop any symptoms.

COVID-19 can occur in both children and adults. Children with COVID-19 are also at risk for a multisystem inflammatory syndrome, with symptoms such as rash, fever, abdominal pain, vomiting, and diarrhea. Initial reports indicated that children and young adults were not as affected by COVID-19. However, people of all ages, including infants, can die from this disease. In addition, deaths seem to occur disproportionately in diverse populations, including Black and Hispanic populations.

An analysis of 928 people with cancer and COVID-19 presented during the ASCO20 Virtual Scientific Program revealed that having active, progressing cancer was associated with a 5 times higher risk of dying within 30 days compared with patients who were in remission from cancer.

Viruses commonly change over time through mutation, and several variants of the SARS-CoV-2 virus have been identified. For example, the Delta variant of the virus was identified in December 2020 in India, then in the United Kingdom, and quickly became dominant in many countries, including the United States. The Omicron variant spreads more easily than the Delta variant, but it is not known whether it is more deadly. Unvaccinated people are most at risk of getting these variants and are most at risk for severe illness and hospitalization.

**What can I do to avoid getting COVID-19?

Three vaccines have received emergency use authorization from the FDA, and one of those (Pfizer) has received formal FDA approval for ages 16 and up. Data collection from clinical trials to test the effectiveness of COVID-19 vaccines are still ongoing. These trials will give scientists valuable information that can help patients and the general public in the long run. If you would like to participate in a COVID-19 vaccine clinical trial, ClinicalTrials.gov has a full listing of available studies.

The most important way to protect yourself is to be vaccinated against COVID-19. If you are not vaccinated, stay at home as much as possible and avoid areas where people gather. Follow guidance on travel restrictions issued by the CDC or the World Health Organization (WHO).

On December 8, 2021, the FDA issued an emergency use authorization to Evusheld, a monoclonal antibody treatment containing tixagevimab and cilgavimab, for the prevention of COVID-19. Evusheld is for use in children 12 and older (who weigh at least 40 kilograms, about 88 pounds) and adults who are in a high-risk category. This authorization only applies to individuals who are not currently infected by the virus and have not been recently exposed to someone who tested positive. This drug is authorized for people who have:

• a moderate to severely compromised immune system, or

• a history of severe adverse reaction to a COVID-19 vaccine and who are unable to receive the complete vaccination series

Evusheld is not a replacement for vaccination, which is the best protection against COVID-19. Evusheld is given as 2 injections and may provide protection for 6 months.

Washing your hands for at least 20 seconds is an important way to protect yourself and prevent transmission of the virus. If soap and water are not available, use hand sanitizer that contains at least 60% alcohol.

In addition to washing your hands frequently, it’s important to:

• Avoid touching your eyes, nose, and mouth.

• If you must cough or sneeze, use a tissue. Then throw the tissue away. Or, cough or sneeze into your elbow rather than your hand.

• Avoid close contact with people who are sick.

• Regularly clean frequently touched objects and surfaces.

• If there has been a known COVID-19 exposure, then cleaning with disinfectant wipes or spray is important.

If you are not vaccinated against COVID-19 and are in public, it is important to wear a mask or cloth face covering that covers the nose and mouth. This can help prevent the spread of COVID-19 in the community, especially because some people with COVID-19 have no symptoms and don’t know they have the virus, or they may not have yet developed symptoms. You should not wear masks with exhalation valves or vents because the vents allow your own respiratory droplets to leave the mask and can put others at risk. Double masking, such as wearing a cloth mask or nylon face covering over a surgical mask, is more effective at limiting transmission of the virus than wearing only 1 mask. The CDC recommends double masking, rather than just wearing 1 mask. If you only wear 1 mask, it should be tight fitting around the nose and mouth.

Wearing a face mask does not replace social or physical distancing. If you are out in public and not vaccinated, you should do both: practice physical distancing of at least 6 feet (2 meters) from other people and wear a mask.

If you are vaccinated but living or traveling in an area with high transmission rates of COVID-19, you should continue to wear a mask when indoors in public settings. If you are at high risk for COVID-19 illness or complications due to your cancer treatment or other medical condition, you should also continue to wear a mask in these settings.

There is no scientific evidence that taking zinc or vitamin C, even at high doses, can help to prevent COVID-19. Using mouthwash and nasal rinses, or ingesting mouthwash in large amounts, also will not prevent COVID-19 and can be dangerous. Drinking or gargling with betadine or other iodine products is dangerous and does not help prevent or treat COVID-19.

**Are there special precautions that people with cancer should take?

People with cancer, people who are in active cancer treatment, older patients, and people with other serious chronic medical conditions, such as lung disease, diabetes, or heart disease, are at higher risk for the more severe form of COVID-19 that could lead to death. Studies have shown that people with active or progressing cancer may be at higher risk than those whose cancer is in remission. The same rules apply for people with cancer as for those without cancer: Be sure to wash your hands well. Avoid touching your face, and avoid close contact with people who are sick.

People who are at higher risk of getting very sick from COVID-19 should think carefully about non-essential travel during the COVID-19 pandemic, especially if the travel will involve areas with high or increasing rates of COVID-19. This is especially important for people who have not yet been fully vaccinated against COVID-19. If you are not vaccinated, stay at home to reduce your exposure to the virus, practice physical distancing, and avoid social gatherings, including smaller gatherings with family or friends who don't live with you. Wear a face covering or mask, and make your trip out as brief as possible. If you have been vaccinated and live in an area with low COVID-19 transmission rates, you are able to return to normal activities. In places with high or increasing rates of COVID-19, masking is still important. Always follow local government guidelines for masking and social distancing.

If you are vaccinated, outdoor activities are generally safe without physical distancing. If you are not vaccinated, walking or exercising outdoors is fine as long as the area is not crowded and you are able to keep a distance of at least 6 feet (2 meters) from other people.

A good rule of thumb during emergency situations such as the pandemic is to keep enough essential medications, both prescription and over-the-counter, to last for at least 1 month. Create and keep updated an emergency contact list that includes family, friends, neighbors, and community or neighborhood resources who may be able to provide information or assistance to you if you need it.

To stay connected to your support system, connect with your family and friends virtually, through video chats or phone calls. Some examples of technology that can be used for video or other live chats are FaceTime, Zoom, Google Hangouts, and social media platforms, such as Instagram and Facebook.

If you are scheduled for cancer treatments, have a discussion with your oncologist about the benefits and risks of continuing or delaying treatment. If you are not scheduled for cancer treatment but are scheduled for an appointment with your oncologist, it may be possible for the doctor to conduct the visit using videoconferencing or telemedicine. Be sure to check with your cancer care team to see if this is recommended for you.

Finally, it is always important to have your health care wishes in writing, in case you are too sick to make decisions for yourself. This way, your family and your medical team will know what is important to you and what your wishes are. If you have not yet done this, now is a good time. Cancer.Net has valuable information on this topic. Because some hospitals and clinics are limiting visitors, and some are allowing no visitors, having your health care wishes in writing is more important than ever. Here are some examples of important questions to ask yourself, to discuss with your loved ones, and to write down:

• What level of quality of life would be unacceptable to me?

• What are my most important goals if my health situation worsens?

• If I am unable to speak for myself, who is the person in my life who I would want to speak for me?

• Who should not be involved in making decisions for me?

• If my heart stops, do I want to have CPR (cardiopulmonary resuscitation) done?