Originally published March 12, 2020. Updated May 2, 2020.
With the spread of Coronavirus increasing across the US and other countries, it is essential for breast cancer patients and individuals with underlying health conditions (eg heart, lung or kidney disease, diabetes, asthma) that compromise their immune system to be educated and proactive in taking steps to protect themselves from contracting this new disease. Breast cancer treatments like chemotherapy, targeted therapies, immunotherapy, and radiation make the immune system weaker. People who have weakened immune systems have a much higher risk of complications if they become infected with this virus. In addition to the common sense precautions we should all take to prevent infection, people who have recently completed or are still undergoing cancer treatment should be extra vigilant as they are at a higher risk of hospitalization, severe complications, and even death.
What is Coronavirus?
The coronaviruses are a family of viruses that cause illnesses ranging from the common cold to more serious respiratory diseases. Flu is caused by a different virus (influenza). There is no vaccine for this coronavirus yet and it will be several months before a vaccine is available.
The disease caused by Coronavirus, known as COVID-19, is a respiratory illness caused by a coronavirus previously only found in animals that was first identified in an outbreak in Wuhan, China, in December 2019. The disease is spread through mucus droplets from the nose or mouth that are released when an individual close to you coughs or sneezes. It is also possible that a carrier of the virus can infect others by simply exhaling close to them. The infection can also be spread by touching a surface that mucus droplets have landed on, and then touching your eyes, nose or mouth. Coronavirus can stay alive on surfaces outside the body for many days, depending on the surface (72 hrs – 5 days). The virus likes metal surfaces like door knobs, silverware and jewelry in particular (survives for 5 days).
It appears the Coronavirus is much more contagious than the Flu. People seem to be most contagious when they have symptoms, but you can also catch the virus from infected people who have no symptoms. At least 25% of people infected with Coronavirus won’t develop any symptoms at all, and can very easily unknowingly spread the virus. Those who do develop symptoms take on average 5 days to do so. For these reasons, Coronavirus is spreading much faster than the seasonal flu.
What are the symptoms of COVID-19?
Most people who become infected with coronavirus have mild respiratory symptoms, and some people will show no symptoms at all. However, symptoms can become severe in some people, and some have died from the illness.
Similar to symptoms associate with the flu or common cold, the most common symptoms of COVID-19 include fever, a dry cough and shortness of breath. The CDC recently added the following list of possible symptoms: chills, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell. Any of these symptoms can range from mild to severe.
It is the impact on the lungs that doctors are most concerned about. According to the WHO, in people who have symptoms, about 40% will have mild symptoms, while 40% will develop mild to moderate pneumonia. About 15% of patients will need to be treated in hospital because of severe breathing difficulties. 5% will need the ICU and a ventilator. Patients who have recently completed or are undergoing cancer treatment are at higher risk of developing severe symptoms.
Based on the data available so far, the risk of death from COVID-19 in the general population is estimated by some models to be as high as 1%, which is 10x more fatal than the flu (about 0.1%). The real risk will only be known after widespread testing is available and we know how many people have been infected. Better knowledge of the disease process over time will likely also lead to improved, consistent treatment protocols that could also improve outcomes dramatically, and ultimately lower mortality to one that is more in line with the flu.
Most of the deaths have been in older patients with other medical conditions – the mortality rate for 60 – 64 year olds is about 4% for COVID-19. However, a significant number of younger people have also required admission to the hospital for supportive care. We are seeing deaths in all age groups, though younger, healthy people without other medical conditions appear to be at low risk for serious complications.
How do you protect yourself? Are there ways to reduce the risk of getting COVID-19?
Unfortunately, as of this post, there is currently no universally accepted treatment for Coronavirus. The anti-malarial drug hydroxychloroquine, either alone or in combination with azithromycin (Z-pack) and zinc, was initially reported as a potential “game-changer” treatment, but the data on whether this truly helps are mixed at best, and hydroxychloroquine can have significant side-effects. Several studies have actually cast serious doubt on the effectiveness of hydroxychloroquine for COVID-19. A recent study showed the antiviral drug Remdesivir can speed up recovery from a severe infection. However, for now, the best approach by far remains prevention.
People who recently completed or are currently in treatment for breast cancer are at higher risk for complications if they become infected. These recommendations will help protect you and reduce your risk of becoming infected:
Social distancing – stay away from crowds and try to keep a distance of at least 6 feet between yourself and others when in public. The easiest way of avoiding the infection is to avoid people who are, or could be infected. Remember, many people who get infected won’t develop symptoms for several days. Cancel any non-essential doctor visits. If you can, please just stay at home.
Wash your hands with soap and warm water for at least 20 seconds multiple times a day, especially after any contact with others. Use an alcohol-based hand sanitizer (containing at least 60% alcohol) when soap and water aren’t available.
Avoid shaking peoples’ hands.
Avoid touching your face, especially your eyes, nose and mouth.
Clean and disinfect surfaces you touch daily, including household surfaces, the inside of your car, doorknobs, light switches, and your cellphone; make sure you use cleaning products that are effective in killing viruses.
Politely tell friends and family who are sick to stay away from you.
Make plans with your family or support structure in case you get sick.
Ask your employer to work from home if at all possible.
Fill your prescriptions and think ahead to make sure you’re not caught short with medications you need daily.
Catch up on groceries and Make sure you have over-the counter medications like Tylenol in the house.
Postpone all non-essential doctors’ visits like routine follow ups.
If you absolutely must leave the house, wear a cloth face mask over your nose and mouth, especially when going to stores or other areas where social distancing (6 ft) is difficult to maintain, or you will be in an enclosed area like a grocery store. You do not need to use a surgical face mask, so please do not hoard them. Our healthcare heroes on the front lines are in dire need of masks and other personal protective equipment.
What should you do if you develop symptoms?
If develop a fever, cough, or shortness of breath, please call your doctor. Most people with mild symptoms will be able to stay at home while the illness runs its course. However, if you develop symptoms you should definitely let your doctor know, by phone first before going in to see them.
If you develop a fever, don’t use ibuprofen – there is evidence that it may make this infection worse. Stick with Tylenol but be sure not to take more than the recommended dose.
What if you have surgery scheduled soon?
The decision to proceed with surgery will ultimately depend on several factors that need to balance the details of your diagnosis, the urgency of your surgery, travel requirements, and the protocols your team and hospital have in place. ‘Elective’ (non-urgent and non-emergent) surgeries have been on hold for many weeks now. Some facilities are now starting to allow elective procedures again, but this varies tremendously based on the geographic situation. It is very important for you to discuss this with your medical team. Learn more about the impact of COVID-19 on breast cancer treatment here.
This too shall ultimately pass!
Ultimately, we must keep reminding ourselves that this too shall pass. However, the above risk-reducing measures will not only protect you, but will also help decrease the spread of the virus. Social distancing is the best thing we can all do right now while we wait for a proven vaccine, and staying at home protects you and helps limit the spread of the virus as much as possible.
This is a constantly changing situation, so please be sure to check the CDC’s ongoing updates regularly.
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