The outbreak of the novel coronavirus COVID-19 has officially become a pandemic, according to the World Health Organization. The new classification emphasizes the likelihood that the disease will be a problem in your community. If you’re being treated for cancer, what should you do to protect yourself from this coronavirus? We asked five experts to answer the most pressing questions.
Which cancer patients are at highest risk for infection or complications?
Those most vulnerable are people with blood cancers, such as leukemia or lymphoma, and those receiving heavy-duty chemotherapy or undergoing bone marrow or stem cell transplants, according to Brandon Hayes-Lattin, MD, medical director of the division of hematology and medical oncology at Oregon Health and Science University in Portland.
“There is a bit of clinical judgment in figuring out which patients are in the highest risk category,” Dr. Hayes-Lattin says. “Those with low white blood cell counts are particularly high risk, whereas patients who have a history of cancer or are on endocrine or targeted therapies are not.”
It’s best to talk with your oncologist or medical team about your particular risk since it depends on your cancer type and treatment type. For some individuals, the cancer and treatment together are a double whammy.
“Those with leukemia and lymphomas are already high risk because those diseases are immunocompromising, and then we’re hitting them with the heaviest duty chemotherapy we have,” explains Gregory Poland, MD, a professor of medicine at the Mayo Clinic in Rochester, Minnesota, and director of the Mayo Clinic's vaccine research group.
Your risk also depends on factors besides your cancer and treatment types, explains David Quinn, MD, medical director of the University of Southern California Norris Comprehensive Cancer Center and an associate professor of medicine at Keck Medicine of USC in Los Angeles.
“The other issue is what the other health issues of our cancer patients are,” Dr. Quinn says. Those who smoke or have lung conditions such as COPD have greater risk for complications, he says. Older adults, especially those who are already medically frail or living in skilled nursing facilities, are also higher risk.
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What should patients be doing to protect themselves from the virus?
By this time, “wash your hands” sounds like a broken record, but it really is the single most important piece of advice public health experts have to offer. The trick is doing it well. Dr. Poland recommends a video in which he teaches late night personality Jimmy Kimmel how to wash your hands correctly — and many on set were surprised how poorly they had cleaned their hands.
The key points are to use warm water and soap and to scrub all of your hands and lower arms for at least 20 seconds before rinsing.
In addition, avoiding crowds, large gatherings, and sick people in general is an important strategy, Hayes-Lattin says.
“The other piece of advice for everyone, including cancer patients, is staying healthy, getting good sleep, maintaining good nutrition, maintaining exercise, and avoiding smoking,” Hayes-Lattin says. The healthier your body is to start with, the stronger it will be if it needs to fight an infection.
What about hand sanitizer?
Nothing can replace the benefits of washing hands, but hand sanitizer is a “distant second best,” Poland says. “If your hands are visibly soiled, or if you actually have mucus on them, hand sanitizer cannot penetrate that and neutralize the virus,” he says. “Plus, people don’t use hand sanitizer properly and often don’t use enough of it.”
But if you don’t have access to soap and water, hand sanitizer containing at least 60 percent alcohol offers some protection if you use a half dollar–sized amount—not just a dime-sized amount—and ensure it covers all areas of your hands and fingers.
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What about wearing a mask?
While the average healthy person does not benefit from a face mask — and this does not appear to be an airborne virus (the mask may merely help protect you from droplets from other people’s coughs and sneezes) — wearing a standard surgical mask while out and about can serve two purposes for high-risk patients, Poland says. First, it can serve as a behavioral cue to remind you to practice good hygiene and to distance yourself from others. Others also may be more likely to stay away from you while you’re wearing a mask.
Ideally, though, for “somebody who is significantly immunosuppressed during a pandemic, it’s a good idea to stay indoors and away from people,” Poland says. “If they are older in age or have other conditions, they’re layering risk upon risk.”
And what about the N95 respirators you may have read about? All the experts interviewed recommended against it. “You can’t buy an N95 mask off the shelf and fit it properly yourself if you don’t have training,” Poland says.
What should friends, family and household members do to protect you?
Number one, they should all get their flu shots if they haven’t already done so, Poland says. Next, all household members and visitors need to practice respiratory etiquette: sneezing or coughing into a tissue or the crook of their arm and then immediately washing their hands.
Third, if possible, the immune-compromised person should have their own room with an open window, Poland says. Finally, any frequently touched surfaces, such as doorknobs or countertops, should be regularly wiped down.
“An additional strategy is that you don’t want people coming into the home who are sick in any way or who haven’t gotten a flu vaccine,” Poland says. And as hard as it may be, “you want to maintain a no-handshake, no-hugging, no-kissing, policy,” he says.
If children live in the home, there’s no getting around the fact that they are more likely to transmit any infections, especially ones they bring home from school, Poland says. Although COVID-19 does not seem to affect children as much as adults, scientists do not yet know if children transmit it as much as adults. But children can still bring home other illnesses, particularly influenza, so it’s helpful to take the time to regularly teach and reteach them proper hand-washing and respiratory etiquette.
If no children live with you, avoiding visits might be worth considering. “These are value judgements,” Poland says, but “in a patient who just had a heavy dose of chemotherapy, I probably wouldn’t let, for example, grandkids into the house during [the next two weeks] because of the risk.”
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What should I do if I develop respiratory symptoms?
For very high-risk patients, any infection, COVID-19 or otherwise, may be life-threatening, so Poland recommends these patients take their temperature every day. If you notice even a mild fever, “that’s a reason to call your doctor and be evaluated,” he says.
Developing a dry cough is another red flag, Quinn says. Anyone who has a fever or cough should put on a mask to protect others and call their primary care office if they suspect they might have a respiratory illness.
“Do not just show up” at a cancer center, Quinn says, because you risk exposing others there to your illness. If you’re severely ill, you may need to go to the emergency department or call for an ambulance, but the “majority of coronavirus patients, including those with cancer, can be managed at home,” he says.
Do I need to avoid all travel and only stay at home?
Whether you travel or go out into the community depends on several factors, including your own risk level and possibly where you live.
“If you’re in Boston or Seattle, you need more layers of protection than you do in [a small town in] Kansas because your risk is quantifiably higher,” Poland says. Your risk is also higher if you go to mass gatherings or anywhere people touch many surfaces.
It’s difficult to tell people to stay completely shut in at home and keep out all visitors, and only extremely high-risk patients likely need to consider doing so. You should talk to your oncologist and medical team about whether you need such isolation.
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Should I continue my cancer treatment?
Yes. “If you have appointments, keep them,” Quinn says. However, if you’re sick or have respiratory symptoms, call your oncologist or treatment center’s office first and notify them of your symptoms so they can give you instructions and be prepared for your visit. Quinn says his clinic, for example, is using extra wipes on chemotherapy chairs between patients and paying extra attention to surfaces such as door handles that get touched more often.
Where can people go for the best information, to learn more, or monitor the situation?
The experts interviewed recommended the following sources: The Centers for Disease Control and Prevention page on the coronavirus, the patient site Cancer.net from the American Society of Clinical Oncology, the pages for your local county and state health department, and the World Health Organization.