Update for Week of March 16, 2020 to the Joint Statement on Coronavirus COVID-19 From Lung Cancer Advocacy Groups

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.

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

In case you are interested, we invite you to take a look at the CDC’s community transmission mitigation strategy document.

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.

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).

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 “Coronavirus: what cancer patients need to know”.

Resources and websites:

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
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:

Johns Hopkins Coronavirus Resource Center is one of the best places to get current updates. https://coronavirus.jhu.edu/
You can find information specific to your state or city or town on your health department’s website.

A list of state department of health websites can be found here: https://www.cdc.gov/publichealthgateway/healthdirectories/healthdepartments.html

A list of local health department websites can be found here: https://www.naccho.org/membership/lhd-directory

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
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:

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.
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.
WHO. Coronavirus disease 2019 (COVID-19) Situation Report – 46. 2020.
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.
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.
UW. COVID-19 (formerly called Novel Coronavirus). https://www.uwmedicine.org/coronavirus. Published 2020. Accessed 2020, March 15.
Lambert J, Saey TH. Social distancing, not travel bans, is crucial to limiting coronavirus’ spread. Science News2020.
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.