Media Release

Mangaluru, Apr 18: In the past three months the world has been going through severe apprehension due to the pandemic of coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus that emerged during November end last year at Wuhan City of Hubei province of China has now spread to the rest of the world. As on April 6 in India, 4,067 cases were detected, of which 110 succumbed to the infection.

Coronavirus induced disease is transmitted by inhalation or contact with infected droplets and the incubation period (time from inhalation to symptoms of illness) ranges from 2 to 14 days. The clinical features of COVID-19 are varied, ranging from an asymptomatic state to acute respiratory distress syndrome and multi-organ dysfunction. The common clinical features include fever (not in all), cough, sore throat, headache, fatigue, myalgia and breathlessness. Conjunctivitis has also been described. Thus, they are indistinguishable from other respiratory infections like the common flue. The only way corona can be distinguished from flu and other seasonal respiratory ailments is by the use of viral-specific sophisticated tests (RT-PCR or antigen-based) from the swabs/washings collected from the nasopharyngeal and/or throat region of the suspected individuals.

What makes corona dangerous is that in a subset of patients, by the end of the first week the disease can progress to pneumonia, respiratory failure and death. This progression is associated with extreme inflammation especially in the lungs. The median time from onset of symptoms to shortness of breath was about 5 days, hospitalization 7 days and acute respiratory distress syndrome (ARDS) 8 days. The need for intensive care admission was in 25–30% of the affected patients. Complications witnessed included acute lung injury, ARDS, shock and acute kidney injury. Recovery starts in the second or third week. The median duration of hospital stay in those who recovered was 10 days. Adverse outcomes and death are more common in the elderly and those with underlying co-morbidities like asthma, diabetes, hypertension, kidney ailments, HIV, tuberculosis and cancer (50–75% of fatal cases). The fatality rate in hospitalized adult patients ranges from 4 to 11%.

Coronavirus and its impact on patients with cancer

Cancer, a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body is today the world’s second-most killer disease. When compared to a healthy individual cancer itself may weaken the immune system and are immune-compromised’. The primary role of the immune system is to help fight infection. From a terminological perspective ‘immune-compromised’ refers to individuals whose immune system is considered weaker, more impaired, or less robust than that of the average healthy adult. Further, chemotherapy and radiation used to control cancer can severely debilitate the immune system. Individuals with compromised immune systems are at a higher risk of getting infections, including viral infections such as COVID-19.

Patients with cancer may be at a greater risk of being immune-compromised depending on the type of cancer they have, the type of treatment they receive, other health conditions, and their age. The risk of being immune-compromised is the highest during the time of active treatment for cancer, such as during treatment with chemotherapy. There is no specific test to determine if a person is immune-compromised, although findings such as low white blood cell counts or low levels of antibodies (also called immunoglobulins) in the blood are likely to indicate an immune-compromised state. Coronavirus affects people with very severely debilitated immune system and it is in this context that care needs to be taken by patients undergoing treatment for cancer and also the survivors who have completed their treatment. Patients with cancer who are at high risk to develop life-threatening illness if infected by coronavirus include:
1. People with cancer who are undergoing active chemotherapy or radiotherapy
2. People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma at any stage of treatment
3. People having immunotherapy or others continuing antibody treatment for cancer
4. People having other targeted cancer treatment which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
5. People who have had bone marrow or stem cell transplants in the last six months, or who are still taking immunosuppressive drugs.

In addition to immunosuppression, several factors/co-morbidities are likely to be linked with a poorer prognosis in patients with cancer affected coronavirus infection. They are:
6. Above the age of 60
7. Having pre-existing cardiovascular disease
8. Having pre-existing respiratory disease
9. Having pre-existing diabetes
10. Having pre-existing hypertension
11. Having pre-existing kidney disease
12. Smoking habits

The most important fact that needs to be understood is that more of these individual factors a cancer patient has, the more likely they are to develop a serious illness with coronavirus especially if treated with systemic anti-cancer therapies.

Dr Suresh Rao, the director of Mangalore Institute of Oncology said that reports from China suggest that patients with cancer and survivors of cancer may be at higher risk of health complications from COVID-19 and that this is not surprising given that this group of individuals is often immune-compromised. Preliminary observations from Wuhan with 18 cancer patients showed that when compared with other patients who did not have cancer, people affected with cancer had a higher incidence of severe complications, including the need for intensive care, mechanical ventilation (being on a breathing machine) or death.

Dr Rao said that cancer hospitals world over have devised a strategy to treat patients diagnosed with cancer during this period. At MIO, treatment is carried out as per risk factors of cancer progressing versus giving a period of rest and delay in treatment. Multiple biological factors decide the growth of tumours and pattern of spread. Dr Rao also said that people affected by cancer should strictly follow the general public health recommendations issued by the World Health Organisation (WHO) and followed by the Government of India like:

1. Avoid close contact with people who are sick
2. Avoid touching your eyes, nose, and mouth
3. Stay home when you are sick
4. Cough or sneeze into a tissue, then throw the tissue into the trash bin
5. Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing
6. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty
7. Avoid cold food like ice creams, cold juices and stale food and preferably have warm and healthy dishes rich in vitamins, minerals, complex carbohydrates and proteins.