Guide in deal­ing with the Covid-19 pan­dem­ic, espe­cial­ly for can­cer patients

Cur­rent infor­ma­tion for patients and relatives

Cat­e­go­ry: Pre­ven­tion
Author: Women’s Clin­ic Char­ité Berlin

Facts about Covid-19 infection

A new virus is going around the world

The nov­el coro­na virus was most like­ly trans­mit­ted from ani­mals to humans. And as has often hap­pened in nature, this virus can lead to seri­ous ill­ness­es in humans. One speaks of a zoono­sis. This term is derived from the Greek words zoon (liv­ing being) and nosos (dis­ease). Zoonoses are infec­tious dis­eases that are caused by bac­te­ria, par­a­sites, fun­gi, pri­ons (degen­er­ate pro­teins) or virus­es and can be mutu­al­ly trans­mit­ted between ani­mals and humans.

There are var­i­ous oth­er coro­na virus species: these include MERS (Mid­dle East Res­pi­ra­to­ry Syn­drome) and SARS (Severe Acute Res­pi­ra­to­ry Syn­drome). The lat­ter trig­gered an epi­dem­ic in 2002/2003 with around 800 deaths. In these epi­demics and pan­demics (2002/2003), too, bats most like­ly trans­mit­ted the pathogen to humans via an inter­me­di­ate host — the path that researchers now sus­pect with SARS-CoV­‑2.

Virus­es — what are they?

Virus­es are not liv­ing beings! They have no nucle­us and no metab­o­lism of their own. This is how they dif­fer fun­da­men­tal­ly from bac­te­ria. While bac­te­ria have a nucle­us and can repro­duce inde­pen­dent­ly, virus­es always need a host. In oth­er words, a liv­ing cell into which you can implant your genet­ic mate­r­i­al (RNA or DNA). Only then can they spread with the help of their host — plant, ani­mal, human. Some­thing else is impor­tant to know: Virus­es are very small. Small­er than bac­te­ria or cells. There­fore, they can only be rec­og­nized with the help of cer­tain sci­en­tif­ic methods.

But as small as they are, they can be dan­ger­ous. Because in humans they are look­ing for cer­tain cells in which they can spread. There they insert their genet­ic mate­r­i­al and can repro­duce in this way. For the rea­sons described, antibi­otics are not effec­tive against virus­es, as against bac­te­ria. Spe­cial vac­cines must be devel­oped against virus­es which, with the help of the virus’ own genet­ic infor­ma­tion, enable our body — our immune sys­tem — to rec­og­nize virus­es and elim­i­nate them from the body. This is a long and com­pli­cat­ed process. That is why it takes so long mean­while Coro­na lasts before a vac­cine can be found, devel­oped, test­ed and brought onto the market.

The influen­za vac­cines, which are new­ly devel­oped every year, are the main mod­els for suc­cess­ful vac­cines against virus­es. These vac­ci­na­tions have been estab­lished for decades and pro­tect mil­lions of peo­ple from infec­tion with the dan­ger­ous flu virus every year. Var­i­ous research groups are work­ing on the devel­op­ment of a vaccine.

Vac­ci­nate — but when

Vac­ci­na­tion even dur­ing can­cer ther­a­py that has already start­ed After the diag­no­sis of can­cer, it is gen­er­al­ly rec­om­mend­ed to check the vac­ci­na­tion sta­tus of the patient at an ear­ly stage and, ide­al­ly, to refresh the respec­tive vac­ci­na­tions before start­ing therapy.

• So-called live vac­cines such as measles, mumps, rubel­la, yel­low fever or vari­cel­la should not be admin­is­tered dur­ing ongo­ing can­cer ther­a­py (chemother­a­py), as the immune sys­tem can be weakened.
• So-called dead vac­cines are gen­er­al­ly also allowed dur­ing ongo­ing can­cer ther­a­py (chemother­a­py). Exam­ples of dead vac­cines are vac­cines against tetanus, diph­the­ria, whoop­ing cough (per­tus­sis), polio, meningo­coc­ci, pneu­mo­coc­ci, TBE, influenza.
• Annu­al influen­za vac­ci­na­tion is indi­cat­ed for all can­cer patients.

Does the vac­ci­na­tion even work if I am under­go­ing can­cer ther­a­py? As stud­ies show, the immune response to a vac­ci­na­tion at the begin­ning of a chemother­a­py cycle is some­what lim­it­ed, but usu­al­ly still good enough. In addi­tion, the suc­cess of the vac­ci­na­tion with some vac­ci­na­tions can be checked by check­ing the titer in the blood.

What is a live vac­cine and what is a dead vaccine?

• The live vac­cine con­tains “liv­ing”, but in the lab­o­ra­to­ry mod­i­fied and strong­ly weak­ened (atten­u­at­ed) pathogens, which, because they are alive, can repro­duce in the body of the vac­ci­nat­ed. (Exam­ples: measles-mumps-rubel­la vac­ci­na­tion, the rotavirus vac­cine and the chick­en­pox (vari­cel­la) vaccination.
• In con­trast, dead vac­cines con­tain “killed” pathogens or frag­ments of pathogens or cer­tain sur­face pro­teins or inac­ti­vat­ed bac­te­r­i­al poi­sons (tox­ins). Dead vac­cines can­not mul­ti­ply (exam­ples: vac­cines against tetanus, diph­the­ria, whoop­ing cough, polio, meningo­coc­ci, pneu­mo­coc­ci, hepati­tis B, hepati­tis A).

Spe­cial and gen­er­al risk fac­tors for coro­na infections

Can­cer patients can be par­tial­ly at risk

The fol­low­ing infor­ma­tion is pub­lished in cur­rent infor­ma­tion from the DKG and the DGHO, espe­cial­ly for can­cer patients (source: DGHO, July 6th, 2020):

Spe­cif­ic risk fac­tors for patients with blood and can­cer diseases

In gen­er­al, can­cer patients have a high­er risk of devel­op­ing pneu­mo­nia from an infec­tion with res­pi­ra­to­ry virus­es than non-can­cer patients. This prob­a­bly also applies to infec­tions caused by SARS-CoV­‑2.

Poten­tial risk fac­tors that play a role in oth­er SARS infec­tions include

• severe immuno­sup­pres­sion
• Neu­tropenic phase
• Lym­pho­cy­tope­nia <0.2 x 109 / L.

Patients with hered­i­tary immun­od­e­fi­cien­cies or under cur­rent can­cer ther­a­pies are also to be clas­si­fied as per­sons at risk. Par­tic­u­lar atten­tion should be paid to these risk fac­tors, espe­cial­ly giv­en the fact that many patients with severe COVID-19 dis­ease were old­er and lym­pho­cy­tope­nia was fre­quent­ly observed.

Gen­er­al risk fac­tors, includ­ing for patients with blood and can­cer diseases

Many can­cer patients also have one or more of the gen­er­al risk fac­tors for a severe course of COVID-19. These include:

• Age ≥65 years
• Liv­ing in a nurs­ing home

Spe­cif­ic dis­eases, espe­cial­ly with pro­nounced symptoms:

• Chron­ic lung dis­ease, or mod­er­ate or severe bronchial asthma
• Severe heart disease
• Immuno­sup­pres­sion
• Obe­si­ty / over­weight (BMI ≥40)
• Dia­betes mellitus
• Chron­ic renal insuf­fi­cien­cy on dial­y­sis / renal impairment
• Liv­er disease
• Cur­rent can­cer therapies

Sum­ma­ry assessment:

If patients belong to one of these risk groups, the treat­ing doc­tors will pay par­tic­u­lar atten­tion to the usu­al hygiene mea­sures. If nec­es­sary, those affect­ed must then be treat­ed in sep­a­rate rooms with increased pro­tec­tive mea­sures. Can­cer ther­a­py can gen­er­al­ly only be inter­rupt­ed in the case of severe infections.

Gen­er­al prin­ci­ples and hygiene rules for can­cer patients

Pro­tect your­self safe­ly — keep your distance

As described above, the coro­na virus­es are main­ly trans­mit­ted by droplet infec­tion. Tiny com­po­nents of the droplets, so-called aerosols, can also infect oth­er peo­ple through the air. On the oth­er hand, it is still unclear whether virus­es can also be trans­mit­ted via smear infec­tions such as door han­dles, shop­ping carts or oth­er sur­faces that have been touched by infect­ed peo­ple. It is there­fore extreme­ly impor­tant to observe the hygiene rules drawn up by the gov­ern­ment, sci­en­tists and doc­tors. This also and espe­cial­ly applies to can­cer patients and their rel­a­tives and friends.

Here are the most impor­tant rules that can­cer patients must adhere to under all circumstances:

• Avoid close con­tact with mul­ti­ple peo­ple, espe­cial­ly peo­ple who do not come direct­ly from your home environment.
• If you have to leave the apart­ment, please keep a dis­tance of at least 1.5 meters from oth­er people.
• Avoid large crowds.
• Pay atten­tion to the hygiene con­cepts of the orga­niz­ers and ask for detailed infor­ma­tion on this.
• Wear a face mask consistently.

Main­tain good body and hand hygiene:

• No shak­ing hands!
• No hugs!
• Thor­ough­ly dis­in­fect all objects that you have to touch
• Reg­u­lar hand wash with soap for at least 30 sec­onds. Take advan­tage of hand dis­in­fec­tion options when you are in med­ical facil­i­ties. Find out more about the hygiene con­cepts on site.

Fur­ther pre­cau­tion­ary measures

Vac­ci­na­tions

• This much has been cer­tain for a long time: vac­ci­na­tion is the only effec­tive way of pre­vent­ing many virus infec­tions. Of course, this only applies if spe­cial vac­cines exist, e.g. against the sea­son­al flu virus­es. Since they are always chang­ing, you have to vac­ci­nate again every year!

• Research groups around the world are research­ing the devel­op­ment of effec­tive and safe vac­ci­na­tion pro­tec­tion for the coro­na virus (SARS-CoV­‑2).
• Then you can also have fur­ther vac­ci­na­tions. And this is espe­cial­ly true for all peo­ple who have either chron­ic ill­ness­es or acute ill­ness­es of the immune system.
• The StiKo, a state insti­tu­tion, writes on its web­site what is cur­rent­ly recommended.

Rec­om­men­da­tions of the Stand­ing Vac­ci­na­tion Commission

The rec­om­men­da­tions of the STIKO are usu­al­ly pub­lished once a year in the epi­demi­o­log­i­cal bul­letin of the RKI (Robert Koch Insti­tute) and on the RKI web­site. Detailed rea­sons for the rec­om­men­da­tions have been pub­lished since 2004. Fur­ther state­ments by STIKO on indi­vid­ual vac­ci­na­tions can be found under the head­ing “Mes­sages”. On the vac­ci­na­tion pages of the RKI there are also a num­ber of FAQs on gen­er­al top­ics about vac­ci­na­tion and indi­vid­ual vac­ci­na­tions. The FAQs sum­ma­rize fre­quent­ly asked ques­tions from cit­i­zens and doc­tors that have been answered by the Robert Koch Insti­tute. The pub­li­ca­tion of the answers is intend­ed to pro­vide broad infor­ma­tion on the var­i­ous aspects of vac­ci­na­tion for cit­i­zens and the pro­fes­sion­al com­mu­ni­ty. These are not the rec­om­men­da­tions pub­lished by STIKO.

(Source: RKI)

And, when things get going again soon: Trav­el­ing as a can­cer patient — the rules

What do I have to con­sid­er if I want to travel?

If the treat­ment of the can­cer was a long time ago, there is usu­al­ly no rel­e­vant increased risk of infec­tion com­pared to non-can­cer patients or healthy peo­ple. Nev­er­the­less, the vac­ci­na­tions and hygiene mea­sures offi­cial­ly rec­om­mend­ed for the respec­tive coun­try of trav­el should be tak­en. In gen­er­al, it is advis­able to also refresh the polio, rabies, hepati­tis B and A vac­ci­na­tions. How­ev­er, patients under­go­ing chemother­a­py can have an increased risk of infec­tion. In addi­tion, cer­tain vac­ci­na­tions (live vac­cines such as yel­low fever) that may be rec­om­mend­ed can­not be car­ried out. There­fore, please dis­cuss this with your doc­tor at an ear­ly stage. In addi­tion, there are usu­al­ly oth­er impor­tant aspects, such as blood tests, that must be tak­en into account dur­ing or after chemotherapy.

The urgent advice:

There­fore, please dis­cuss all ques­tions about trav­el with your doctors

How do I know my symp­toms are from can­cer and which are from COVID-19 or anoth­er viral disease?

This can be dif­fi­cult in indi­vid­ual cas­es, so we ask you to report all symp­toms to your doc­tors, even if you may not asso­ciate them direct­ly with can­cer, can­cer ther­a­py or a viral dis­ease pleur­al effu­sions) or can­cer ther­a­pies occur (e.g. polyneu­ropa­thy, taste dis­or­ders with pacli­tax­el). In addi­tion, var­i­ous oth­er viral (flu virus­es) and bac­te­r­i­al dis­eases (e.g. pneu­mo­coc­ci) can cause var­i­ous forms of pneu­mo­nia. There­fore, please go to your doc­tors imme­di­ate­ly so that they can ini­ti­ate the appro­pri­ate treat­ments with the help of dif­fer­en­tial diagnoses.

Strength­en­ing strength — pro­mot­ing well-being!

These are the most impor­tant rules for all can­cer patients. The treat­ments demand a lot of strength from every­one. With good prepa­ra­tion, vari­ety in life and care­ful treat­ment of your­self, every­one can do a lot to ensure that the treat­ments work well and lead to the goal. Trav­el can also sup­port this. You don’t have to go on a trip around the world right away. There are many obvi­ous des­ti­na­tions in our coun­try where you can relax very well.

Your doc­tor will be more than hap­py to give you good trav­el advice.