One of the doctors on the board of the ARD Foundation, Dr. Antonio Buzaid aswers questions about the coronavirus and how the disease impacts the treatment of cancer patients.
ARD Foudation: What is this virus called, and what is the name of the disease responsible for this pandemic?
Dr. Buzaid: This new coronavirus is called SARS-CoV-2, and the disease it causes is an infection called COVID-19 (from the English abbreviation for “Coronavirus Disease”). Since this virus is a variant of the SARS-CoV, which was responsible for the respiratory syndrome that lead to over 8 thousand deaths all over the world in 2002, it received the name of SARS-CoV-2 (severe acute respiratory syndrome – coronavirus 2).
ARD Foundation: When did this all start?
Dr. Buzaid: The disease was first identified in Wuhan, China, on December 1, 2019. On March 11, 2020, the World Health Organization declared the outbreak a pandemic. By March 29, 2020, there were at least 601,706 confirmed cases of this diseases in over 200 countries, including the United States (with over 85 thousand cases), continental China (with over 81 thousand cases), Italy (with over 80 thousand cases), Spain (with over 56 thousand cases), and Germany (with over 43 thousand cases).
ARD Foundation: What is a zoonosis?
Dr. Buzaid: Zoonosis is a medical term used to describe infectious diseases transmitted to humans through animals. In the case of COVID-19, the animal carrier of SARS-Cov-2 is the bat, which apparently does not develop any illness from the virus and is simply a carrier for it.
ARD Foundation: What are the most common symptoms?
Dr. Buzaid: The most common symptoms include fever, cough, fatigue, and sore throat. Over 80% of patients have a mild or almost asymptomatic form of the disease. There are many patients who are asymptomatic and carry the virus, making them potentially infective. This makes controlling the pandemic difficult. It is for this reason that social distancing is important.
ARD Foundation: How serious can this disease get?
Dr. Buzaid: The fatality rate tends to vary between 0.5 to 4% (depending on the number of cases tested positive, and how many symptomatic or asymptomatic cases are included in the analysis). Despite this, patients with cancer or other comorbidities are at a higher risk of developing complications (with the risk of death due to respiratory failure). According to a report released by the WHO on February 28th, the fatality for cancer patients in China was of 7.6%. Similar or worse numbers were reported for other comorbidities, such as cardiovascular diseases (13.2%), diabetes (9.2%), hypertension (8.4%) and chronic respiratory diseases (8%). These numbers contrast with the 1.4% fatality rate of patients without any comorbidity.
ARD Foundation: Are all cancer patients at risk?
Dr. Buzaid: The data we’ve received from China and other countries does not stratify the death risk in relation to different types of cancer. Despite this, patients who had cancer and are now “cured until proved otherwise,” are probably at a much lower risk than patients who are still undergoing treatment, especially those undergoing chemotherapy. It is important to emphasize that chemotherapy suppresses the immune system more than other forms of treatment, and this also influences the risk of developing complications. However, we have instructed our patients to wear masks (they can be regular surgical masks) in places that are heavily crowded such as grocery stores, pharmacies, clinics, or hospitals; we also instructed them to wash their hands frequently (or to use hand sanitizers composed of 70% alcohol) after touching any surface or object. Social distancing is extremely efficient.
ARD Foundation: Can patients and survivors take a test to verify if their immune system is compromised?
Dr. Buzaid: Not on principle, for those who have undergone chemotherapy tend to fully recover (or nearly fully recover) their immune system. However, the COVID-19 tests must be performed on those patients who have symptoms, even if they are mild. For patients who are currently undergoing chemotherapy, it is routine to check their blood count to evaluate their white cells. In addition, we’ve been using medication that stimulate the production of white blood cells more frequently to reduce the level of immune suppression and, as a result, the risk of infection for chemotherapy patients.
ARD Foundation: Should we change the way we follow up with oncology patients during this pandemic?
Dr. Buzaid: Yes. To reduce the risk of exposure of our patients, we are continuing treatment only with those who really need to be treated at this very moment. This is applicable to chemotherapy as well as to elective surgeries. For those who only need a routine check-up visit, we’re asking them to delay their exams and consultations to two months from now.