This post is reviewed and updated every day. It was first published on March 3.
Merry Jennifer Markham, MD, FACP, is the Interim Chief of the University of Florida (UF) Division of Hematology & Oncology, an Associate Professor in the UF College of Medicine, and the Associate Director for Medical Affairs at the UF Health Cancer Center. She specializes in the treatment of gynecologic cancers. Dr. Markham is the chair of ASCO's Cancer Communications Committee. Follow her on Twitter at @DrMarkham.
The American Society of Clinical Oncology (ASCO) is aware that people with cancer and cancer survivors, particularly those with compromised immune systems, are likely worried about the potential impact of COVID-19 on their health. Patients should talk with their oncologists and health care teams to discuss their options to protect themselves from infection.
What is COVID-19?
COVID-19, or coronavirus disease 2019, is a respiratory illness caused by a novel (or new) coronavirus that was first identified in an outbreak in Wuhan, China, in December 2019.
Coronaviruses are a large family of viruses that can cause mild illnesses, such as the common cold, to more severe diseases, such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). Because the novel coronavirus is related to the SARS-associated coronavirus (SARS-CoV), it has been named SARS-CoV-2.
The disease can spread from person to person, through small droplets from the nose or mouth that may spread when a person coughs or sneezes. Another person may catch COVID-19 by breathing in these droplets or by touching a surface that the droplets have landed on and then touching their eyes, nose, or mouth. While research on COVID-19 is still emerging, the primary belief is that the disease is mainly spread through contact with these respiratory droplets that are spread through the air or land on surfaces we all touch.
Symptoms from COVID-19 can be mild to severe and can include fever, cough, and shortness of breath. Other symptoms may include aches and pains, nasal congestion or runny nose, sore throat, or diarrhea. Some people who are infected may not develop symptoms, however.
What can I do to avoid getting COVID-19?
There is not currently a vaccine to prevent COVID-19, although research studies are being performed to develop one.
The most important way to protect yourself is to avoid being exposed to COVID-19. Stay at home as much as possible and avoid areas where people gather. Avoid unnecessary travel, and follow guidance on travel restrictions issued by the U.S. Centers for Disease Control and Prevention (CDC) or the World Health Organization (WHO).
Another critical way to protect yourself is to wash your hands often with soap and water for at least 20 seconds, about the amount of time it would take to hum the Happy Birthday song from beginning to end twice. If soap and water is not available, use hand sanitizer that contains at least 60% alcohol. The best way to clean your hands, though, is through soap and water.
In addition to washing your hands frequently, it’s important to:
Avoid touching your eyes, nose, and mouth.
If you must cough or sneeze, use a tissue. Then throw the tissue away. Or, cough or sneeze into your elbow rather than your hand.
Avoid close contact with people who are sick.
Cleaning frequently touched objects and surfaces with household cleaning spray or wipes. These surfaces and objects include doorknobs, counters, toilets, keyboards, tablets, phones, and more.
Wearing a surgical face mask will not protect you from becoming infected with a virus. However, if you are sick with a respiratory illness, such as influenza or COVID-19, wearing a face mask may help prevent the illness from spreading to those around you.
Some people with COVID-19 have no symptoms and don’t know they have the virus, or they may not have yet developed symptoms. Because of this, the CDC recommends wearing cloth face coverings when you are in public places where social distancing is difficult, such as grocery shopping. Cloth face coverings won’t necessarily protect you from developing COVID-19, but they may help prevent the spread of the virus in the community. The face covering should cover the nose and mouth.
There is no evidence that taking vitamin C, even at high doses, can help to prevent COVID-19.
Are there special precautions that people with cancer should take?
People with cancer, people who are in active cancer treatment, older patients, and people with other serious chronic medical conditions, such as lung disease, diabetes, or heart disease, may be at higher risk for the more severe form of COVID-19. The same rules apply for people with cancer as for those without cancer: Be sure to wash your hands well, and wash them frequently. Avoid touching your face, and avoid close contact with people who are sick.
People who are at higher risk of getting very sick from COVID-19 should avoid cruise-ship travel and all other non-essential travel during this time of COVID-19 outbreak. In some areas, the local or state government may have issued a “shelter in place” order or such an order may be coming soon. For people with cancer who live in areas with this type of restriction, you should not leave your home unless absolutely necessary. For those people who live in areas where there is not yet a “shelter in place” restriction issued by the government, stay at home as much as possible to reduce exposure to other people. Avoid social gatherings and keep a distance of at least 6 feet between other people if you must leave your home.
Be sure to have enough essential medications, both prescription and over-the-counter, to last for at least 1 month. Create or update an emergency contact list that includes family, friends, neighbors, and community or neighborhood resources who may be able to provide information or assistance to you if you need it.
In order to stay connected to your support system, make plans to connect with your family and friends virtually, through video chat or phone calls. Some examples of technology that can be used for video or other live chats are FaceTime, Zoom, Google Hangouts, and social media platforms, such as Instagram and Facebook.
If you are scheduled for cancer treatments during the COVID-19 outbreak, have a discussion with your oncologist about the benefits and risks of continuing or delaying treatment. If you are not scheduled for cancer treatment but are scheduled for an appointment with your oncologist, it may be possible for the doctor to conduct the visit using videoconferencing or telemedicine. Be sure to check with your cancer care team to see if this is recommended for you.
Finally, it is always important to have your health care wishes in writing, in case you are too sick to make decisions for yourself. This way, your family and your medical team will know what is important to you and what your wishes are. If you have not yet done this, now is a good time. Cancer.Net has valuable information on this topic. Because some hospitals and clinics are limiting visitors, and some are allowing no visitors, having your health care wishes in writing is more important than ever. Here are some examples of important questions to ask yourself, to discuss with your loved ones, and to write down:
What level of quality of life would be unacceptable to me?
What are my most important goals if my health situation worsens?
If I am unable to speak for myself, who is the person in my life who I would want to speak for me?
Who should not be involved in making decisions for me?
If my heart stops, do I want to have CPR (cardiopulmonary resuscitation) done?
Will anything change with my cancer-related medical visits?
Due to the COVID-19 pandemic and the increased risk of exposure to the virus by going out in public, many hospitals and clinics have changed their visitation policies. Some may allow 1 visitor per patient, and others may allow no visitors. Before heading to your medical appointment, check with the clinic or hospital for their current visitor policy.
Your cancer care team may switch some of your appointments to telemedicine. During a telemedicine appointment, you stay at home and visit with your doctor or other health care team member through video conferencing or by telephone. Your doctor’s office will let you know what system they are using for telemedicine appointments.
Your doctor may recommend delaying some treatments for supportive care, such as bone-strengthening treatments, for example, denosumab (Xgeva) or zoledronic acid (Zometa), or intravenous iron supplementation. They will only recommend delaying treatments if they feel it is in your best interest to do so. Cancer screening tests, such as mammograms or colonoscopies, and other tests, such as bone density tests, may also be delayed to reduce your risk of exposure to the virus.
Oncologists may recommend stretching out the length of time between cancer treatments using medications, such as chemotherapy or immunotherapy. Or they may recommend delaying starting these treatments, based on your cancer diagnosis and the treatment goals.
What should I do if I think I may have COVID-19?
Contact your doctor if you have a fever and other symptoms of a respiratory illness, such as cough and shortness of breath, particularly if either of these 2 conditions applies to you:
You have been in close contact with a person known to have COVID-19.
You live in or have recently traveled to an area known to have an outbreak of the disease.
Call ahead before visiting your health care professional or the emergency department and let them know that you think you may have COVID-19. Your health care professional will ask you questions about your symptoms, travel history, and exposure to find out if you should be tested for COVID-19. They will then give you instructions on how to get tested in your community. There is not a U.S. Food and Drug Administration (FDA)-approved at-home test for this virus.
If it is possible that you have COVID-19, you should stay at home and isolate yourself while you are being tested and waiting for your test results. Staying home when you are sick is the best way to prevent transmitting the novel coronavirus and other respiratory viruses, such as the flu, to other people.
If you are receiving cancer treatment that suppresses the immune system and you develop a fever and respiratory symptoms, call your oncologist as you usually would if you develop a fever while on treatment. Be sure to follow their guidance on when to come into the office or hospital and when it’s safer to stay home.
And again, be sure to wash your hands often.
Are there any treatments available for COVID-19?
Scientists are working very hard to develop and test treatments for COVID-19. Clinical trials are research studies that involve people. Working very quickly, researchers and physicians have developed clinical trials to find effective treatments for this disease. Clinical trials for potential COVID-19 treatments are now open in some locations in the United States as well as in other countries. If you have been diagnosed with the coronavirus disease and you join a clinical trial for patients with COVID-19, you may be able to receive these medications. Also, by joining a clinical trial, your participation will help scientists find the most effective and safe treatment for the illness. The Beat19 study, for example, is designed to collect symptoms from people who may have COVID-19 to help researchers learn the course of the disease and help find a treatment.
Convalescent plasma is the liquid portion of blood that can be collected from people who have recovered from COVID-19. This plasma may have antibodies to SARS-CoV-2. Convalescent plasma is not an approved treatment for COVID-19, but it is being studied in clinical trials as a possible treatment.
Hydroxychloroquine and chloroquine are being evaluated in some countries as a treatment or as a prevention for COVID-19. However, these medications are not approved for this use. Clinical trials are required to evaluate the safety and efficacy of these medications.
A version of chloroquine (chloroquine phosphate) is used as an additive to clean fish aquariums. Consuming this fish tank additive has led to at least 1 death and other overdoses. Do not consume this product—it can kill you.
Another myth that is on the internet is that drinking bleach can cure coronavirus disease. This is absolutely not true. Drinking bleach can kill you.
Where can I get the latest information about COVID-19?
Staying up to date on the latest information on the COVID-19 outbreak is important. The CDC and your local and state health departments will have ongoing information about whether the disease has been diagnosed in your community.