The rapid spread of the coronavirus (SARS-CoV-2) and the disease it causes (COVID-19) impacts all of us. On this page we provide some basic information about the virus and the disease with a focus on how it potentially impacts cancer patients.
July 10, 2020: A review on the biology and treatment COVID was published in the Journal of the American Medical Association (JAMA).
More articles and resources are in the tabs below.
Viruses can be thought of as seeds. The virus particles are extremely small. Much too small to be seen with the naked eye, viruses can only be seen with electron microscopes. All viruses are contain proteins and genetic material (DNA or RNA). Some also surrounded by a fatty (lipid) layer.
When a virus particle - called a virion - lands on a target cell, the virus binds tightly and enters the cell. Once inside, the virus undergoes a change in shape and begins to hijack the machinery of the infected cell. After infection, the host cell becomes a virus producing factory, releasing more viruses to repeat the cycle.
Different viruses infect different kinds of cells and different kinds of hosts. Some only infect a single species (i.e. only cats or only humans) and some can infect several different kinds of host. Even bacteria have viruses that attack them.
Coronaviruses are viruses that are known to infect several kinds of animals and to cause disease in humans and animal hosts. The virus' genetic material is RNA and the protein core is surrounded by a double lipid layer (called a bilayer). Sticking out of the lipid layer are proteins that act like magnets to bind the virus to target proteins on host cells.1
Different coronaviruses can cause human diseases ranging from mild to very severe. Previous outbreaks of severe disease caused by coronaviruses include SARS and MERS.
The current global outbreak (pandemic) is being caused by a coronavirus that has been named SARS-CoV-2. The name reflects the close relatedness between the current virus and the one that caused the SARS and MERS outbreaks.23
The SARS-CoV-2 virus is spread by droplets released when infected people cough, sneeze, or just breathe out. Those droplets can be inhaled by nearby people or can land on surfaces and then get onto the skin of other people. If the virus-containing droplets come in contact with mucous membranes, the viruses can enter the body and start a new infection in that person
The virus causes fever, pain and difficulty breathing. The breathing problems can be severe enough to require patients to be put on a ventilator to assist their breathing. In the US (as of 4/6/20) about 2.5% of confirmed cases (1 in 40 COVID 4patients), the infections are lethal.5 The actual percentage of infected people who die is almost certainly lower because many people are not tested for the virus and it is thought that about 1 in 4 infected people do not show any symptoms.678
The pandemic is ongoing and there has not been time to do any large studies on the role of cancer as a condition (also called a co-morbidity) that leads to increased severity of disease or death from COVID. Because cancer patients very often have weakened immune systems, they are at greater risk of becoming seriously ill and/or dying from other types of infections and with the information on hand, that appears to be the true for COVID. It is still not certain.91011
So far, it’s clear that two populations are especially at high risk:
- Old people (>60 years of age)
- People with suppressed immune system
We know that many types of cancer can drastically affect the immune system. Furthermore, some data is beginning to paint a picture of how exactly cancer affects cancer patients’ vulnerability to COVID19. It’s important to keep in mind that new data is constantly being published, and our current understanding can change. Also, because of the novelty of this situation, much of the epidemiological data are from countries outside of the United States.
In a hospital in Wuhan, physicians observed that cancer patients who visit the hospital for care had a significantly higher proportion who tested positive for COVID19 (Yu et al., JAMA Oncol). Here, cancer patients who are already infected with SARS-COV2 are also more likely to experience poor outcomes, severe symptoms, and death (Zheng, L, et al., Ann Oncol). Finally, they found that patients who receive antitumor treatment within 14 days of positive COVID19 diagnosis had a higher chance of experiencing severe symptoms.
In a national study conducted in the UK, they found that patients with blood cancers (e.g. Leukemia, lymphoma, and myeloma) usually suffer from more severe COVID-19, while patients of solid tumors tend to experience a less severe disease trajectory. Leukemia patients in particular seem to suffer significantly higher fatality when infected with the coronavirus. Finally, hematological patients who have recently done chemotherapy were at higher risk (Lee et al., The Lancet Oncology).
The COVID-19 situation is rapidly changing and guidelines are being developed as quickly as possible.
As described above, it is possible that cancer patients may be at higher risk of getting seriously ill from from COVID-19. That said, skipping cancer treatments (including chemotherapy, immunotherapy or radiation) could reduce the positive effect of the treatment.
It is possible to have some appointments via video or telephone. Many cancer organizations are using telemedicine to reduce the number of contacts for their patients and clinical workers.
It is important for all cancer patients to be in touch with their medical team about any scheduled appointments or treatments.
Another good idea to check the website of the treatment facility, as many have COVID-19 statements for their patients. This is a rapidly changing situation, so check back before going to any in-person office visits.
June 2020: In June, Norman Sharpless, Director of the National Cancer Institute, noted that by there is already a steep drop in the number of cancer diagnoses, even though there is no reason to believe that the cancer incidence has dropped. Elective cancer surgeries are being de-prioritized to make room for COVID-19 patients. Some cancer patients are receiving less intensive chemotherapy and radiotherapy treatments than they should. According to modeling data, Sharpless suggests that these delays in diagnosis and care could lead to an excess death toll north of 10,000 in the next two years. In order to prevent long-term disruption, government agencies such as the National Cancer Institute must temporarily but drastically change the system in place for clinical trials, such as allowing remote informed consent, in order to allow for clinical trials to more easily continue in spite of the ongoing pandemic. Furthermore, new funding must be targeted at studying the effects of COVID19 on cancer to further remediate the damage that cancer patient will endure for the coming months. (Sharpless, Science, 2020).
The COVID pandemic has affected everyone. Cancer patients have ongoing health concerns that can be made worse by the pandemic. Below is an interview with Dr. Wendy Baer, a psychiatrist at the Winship Cancer Institute. Dr. Baer discusses coping strategies for cancer patients and others during this stressful time. Additional resources are provided in the list below the video.
General COVID Information
Cancer Treatment and COVID
COVID-19 Patient Care Information (American Society for Clinical Oncology)
What people with cancer should know (U.S. National Cancer Institute)
Mental and Spiritual Health
Please visit our page on Psychosocial Effects of Cancer for information and links.
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