COVID-19 FAQ for Cancer Patients, with Infectious Disease Expert Dr. Shahid

[Music] my name is Edna Shahed I'm one of the transplant infectious diseases medical directors of living Cancer Institute my specialty within infectious diseases is specifically towards immunocompromised hosts and their infections what is a virus Varis is a one of the micro microbes which are present in the environment their structure is very small than a bacteria and they are different when they get inside the body they attack the body differently than a bacterial bar says can live within us and we won't know for all our lives some of the viruses get integrated to our chromosomes we're exposed from the environment from the other hosts which are humans and others to different viruses all four alive some of them cause infections right away others cause an infection and stay dormant in our body for some time others are with us for all of our lives so it's one of the many smart creatures that are created with different varieties of forms and shapes what is a corona virus is Kovan 19 the only one current Mars is a special class of viruses and the current pandemic is with corona virus - we are a common cold that we see during the year around is also corona virus so there are many different kinds of corona viruses there are four different kinds of human coronaviruses and that means that the normal host is human the beginner think about corona viruses that have caused illness due to humans is because they are not human coronaviruses their animal coronaviruses such as SARS and so the coronavirus scooby 19 which is the disease caused by SAR scooby 2 which is the name of the virus is caused by a peculiar animal type of kernel virus that somehow fine you know as you know how but you find there found their way to the human body how is the corona virus Tsarskoe b2 transmitted from one person to the other the virus SARS go v2 is being transmitted from direct contact with a sick person sometimes when we are getting sick we may not report any symptoms and the peculiar thing about a viral infection specifically ghovat 19 is that we may not be symptomatic at all and may still have the virus so it's human to human transmission at this time it is usually the cough or the bodily respiratory secretions that transmitted from one person to another mostly it's a droplet but sometimes the virus is spread into the air and can be inhaled that's called aerosolization of a virus some there early reports that it may also be aerosolized like TB so that's why they've got the discussion of n95 is occurring we do know that the virus is also secreted in the stool whether it is fecal oral transmission that is through the mouth we do not know that yet and whether it is transmitted through blood that is also not known so basically most commonly direct contact with an infected human being what is community transmission so when we try to figure out every geologically where the virus is coming from it was related to travel meaning in my community there is nobody with virus so somebody who came from outside brought the virus to but once again that travel changes quite rapidly if person within the community start to give it to each other so right now we're in a community transmission situation that person who never traveled anywhere God the infection from somebody else so and gave it to somebody else so we're spreading within our community without traveling in and outside of the community why is this virus causing a pandemic when other viruses have not the human body has never seen this virus and they're it's a huge so you know we have earned our right to live on earth because we have seen our art mankind has seen so many viruses gone through so many pandemics and that immunity is passed on is built in this this particular virus our body has never seen and so it when the body receives this virus it is [Music] responding with is such a strong immune response that the body collapses and the virus is clever enough where it can attack Trent in many different ways meaning it can come from direct contact meaning it can direct from our size so it's a very highly transmissible virus and it is attacking a host that has never seen the virus the number that is thrown out there for everyone infected person they will infect up to four people around them so the infectivity rate the infection rate are what we call attack rate is very high can you spread it when you're not symptomatic that's correct what are the symptoms of kovin 19 of the common symptoms that been described specifically with ghovat 19 is fever along with a cough and shortness of breath these are the majors studies coming up from China Nikki these are the major presenting symptoms some of the other symptoms that have been associated is also a less commonly is awake body ache when sometimes GI symptoms associated with respiratory symptoms as well so cough and then exposure to somebody who's known jeffco it is a huge risk factor knowing that the virus can infect very easily so having an exposure somebody's sick around you you develop these symptoms seek medical help is there a specific type of cough to look out for it is allergy season so usually the allergy season is associated with a lot of sinus symptoms and a post nasal drip and runny eyes this is mostly a dry cough and slightly different from the allergies because the other symptoms associated with allergies are not seen with go at 19 how high of a fever should I look out for fevers have been variable some people would have very mild or great temperature others would have a very high temperature and so obviously it would very people who would end up being in the hospital the ones that I see are going to be much sicker with much higher fever so the fever would be above your body temperature you would know you would have a fever but more than one hundred point four would be sort of a red flag that hey this is officially in fever do I have other symptom that my coughing I'm I'm short of breath that should point towards Kovac 19 infection I have some of these symptoms and think I might have it what should I do next I would say that seek medical attention when I say just call do not I would recommend if you're not severely ill I would prefer that you do not go to a medical facility per se so if you are mildly sick stay home your health care providers are available for you we have phone their virtual visits that being offered to provide support and guidance but staying home hydrating yourself supporting yourself with antipyretic such as Tylenol would be the first thing if somebody is wanting to get testing done testing is available based on the community that you're living in but the guidance is that you stay away from the medical facility as much as possible if you're not too sick and obviously practice caution so that you do not infect people within your house within your community and if you are working in a workplace so be mindful of that so staying home right now and seeking help via ways where you don't have to physically be there if you have any questions is the right way to go right now I'm a cancer patient should I reach out to my primary care provider or my oncologist before treatment for kovin 19 if you are in treatment I would reach out to the oncologist and the primary care that all the cancer centers you know are very much wired and very much want to know oncology you know as you know the fact about the myeloma Doc's want to know if you're ill only because the myeloma patient are at increased risk of infection not only because of their underlying myeloma but because of some of the therapies that might be receiving select your provider no they will guide you they were probably ask you to stay home but it would be important to let your oncologist know because they may want to break in therapy they may want to do something different in your treatment plan if you're currently receiving chemotherapy so please do reach out to them as well it would be very important what percentage of people with Cova 19 develop mild or severe symptoms if I'm addressing a community where most of the folks are in would have underlying cancer please note that the data about Kent oncology patients and hematology patients is not very well known there is the fever is the predominant symptom however know that in certain studies have been published fever develop later on during the course of the illness rather than the very first symptom coughed upon first so the absence of fever especially when you're receiving immunotherapy or chemotherapy is not a rule out for the coolant 19 infection can you have the virus but get tested too early for it to show on the test yes that's a very good question that points towards the variability in the incubation period if you got exposed to somebody for example yesterday and you want to get tested today that test is not going to explain the truth picture in this scenario you will still be in the incubation period and the Excite infection can occur seven to ten days after some time it has been in certain studies have been prolonged till twenty-one days so so I prefer the patients are not getting tested when they're asymptomatic because that would not be a true picture for tomorrow and so also we knew once we talked about the percentage of patients to your previous question we know that the variability can be up to 70 to 80 percent of the patients develop with fever so they'd would have some symptoms the fever is not going to be the primary symptom but I would recommend unless we're in a surveillance study don't get tested if you don't have any symptoms what is the mortality rate of covered 19 the mortality rate has been pretty much variable between different age groups we know that the mortality in the Chinese case studies or in China was anywhere between four to five percent now when we moved to Italy the mortality was up to seven to eight percent because the population of Italy is mostly older and the older people were affected the mortality in kids 1-0 in certain studies so we know that the mortality depends on the age bracket that one is in overall mortality that has been described as one percent but I do think that age becomes thus far a very important factor to assess the risk of infection does testing affect the mortality rate it would be interesting if we had the availability of testing obviously the mortality is going to go down because now you're capturing patients who are symptomatic but aren't sick enough in areas where they are not testing the mortality looks much higher because you are only testing a few people and many of those are dying so if we have to almost always stay in context of context the practices of testing in the given area what are ways I can decrease my exposure to the Cova 19 causing virus there are certain lifestyles and there's certain practices that were pointed towards the lifestyle would be I would point towards - everybody knows about social distancing very important it is very important for us to avoid going to our neighbours house saying hi to people that we know even we want to hug them we want to get a you know kiss our relatives that we haven't met so social distancing try to stay in the house and avoid social situations where you have to interact with not only preventing yourself but also doing a huge favor to the community the other practice is medical distancing that's a term that we are using so that the patients as much as possible obviously their limitations and cancer patients they can stay away from a healthcare setting this is also to prevent exposure in areas where we don't have a lot of control for social distancing in a clinic situation in an infusion center so it becomes important the medical distancing if your health allows it and social distancing and in terms of trying to prevent contact once you are in a given area making sure that your mouth is covered if you are in contact in a situation where there potentially sick people and hand hygiene we know that it can live on circuses for many days so touching things it is very important every time you come inside the house wash your hands with soap and water for a good 20 seconds and that 20 second is actually washing hands not just the whole process it's actually rubbing your hands with soap and water so hand hygiene making sure the surfaces are clean and protecting your Airways if you in a situation you're possibly exposed to infected people would be very important should I wear a mask if I need to go out so yes so it is very important the the usage of masks would not only depend on your immuno immunocompromised State everybody's going to be different some people are going to be neutropenic others are not going to be neutropenic some people are going to have community spread in the community others may not so it not only depends on your own current immune system but also what is the level of community sprint so I would say that hand hygiene and covering your mouth and nose is advisable if you are immunocompromised and if there is community spread do I need to sanitize my groceries we do know that if somebody was sick around the groceries that you bought and potentially contaminated your groceries we do know that the it can live into plastic like surfaces for up to three days so again very important to be able to wash your hands making sure you dispose of disposal very carefully the cardboards and the plastics that could have you could have utilized in a contaminated potentially contaminated area and as far as going to infusion and appointments every institution is going to be implementing their policies their patients who aren't going to be screened at the door so that potentially there is no interaction between a sick patient and an ill and sick patient means a patient potentially in fact in sick with ghovat 19 and others so there is that protection but again watching covering your face if indicated washing your hands keeping a distance are still some practices that we can employ in the medical settings as well should I get food and medicine delivered I completely agree think about the sort of medications that can be delivered think about the groceries that they can be delivered be mindful that if somebody was sick was handling your grocery or your medication the surfaces can be contaminated so wash your hands any way any modalities that you can use to avoid to get out especially in a community spread setting it would be very important I'm in Charlotte North Carolina there is the mandatory stay at home order in our County starting today so reach out to the local community that you're in to figure out the spread but anything you can do to avoid it potential exposure would go a long way does gargling with antiseptic help do zinc lozenges have any benefit there's a report that came out that people who did Listerine goggles they had a decrease viral load I don't think it has an antiviral activity I think it could it could it decrease the viral load in a given specimen for that particular study it may have but I believe that normal hygiene that you do I would just employ that I do not know what if I can scientifically say that that's going to prevent an infection if you're immunocompromised and someone in your family needs to go to work what precautions can you take to stop the virus from coming inside the house the practice has to be remembered the full mites and remember that your body can carry your your clothing your bag your anything that you Gary can have carry the virus on the surface so the way I I personally do it in my house my work shoes are different than my shoes that are entered within the house no shoes inside the house review all the things that you be mindful of everything that she carried to work it could be a key it could be a cell phone it could be your laptop it could be a bag that that went out and came in if would be your clothing as you can see I'm wearing scrubs we're not allowed to wear a white coat so anything that can carry the bars on its surface there could be a body clothing plastic anything shoes get rid of it I don't wear these clothes to the house I take a shower that's the first thing that I do enter enter the house then I see anybody's face in the house so these are practices that you can do to prevent virus from coming inside the house because we do know that it lives on the surfaces what is viral load and how does it affect your level of risk viral lord means the quantity of the virus in any given specimen which specimen would be your sputum could be blood could be urine the study that I was your that was pointed out the gargles and the stirring garbles showed that there was decreased number of bars in the the oral specimen but it was negative so that's what I was trying the amount of virus could have been decrease but it's not the it's not the absence of ours was there so I that's what I was referring to and then there is one study it's interesting you brought that viral load in that some state today study came out actually yesterday regarding the amount of virus could be the same in symptomatic people or asymptomatic people who are infected so what I'm trying to say is that a person can potentially again in fact even if they're asymptomatic so again it's important social distancing because the virus in quantities could be as much in your body if you're asymptomatic if even if you were symptomatic is it safe to order takeout food I have been cautions about it because again its handling of the food the person so anything which is he did fresh liquid warm food is fine but again how the container was makes me nervous if you are if you are I would say aware of this specific place that you eat and you know how they handle how they do things I think it's probably ok with warm freshly cooked food but I personally discourage it because of the full night and the handling is there any way I can boost my immune system to fight this virus healthy lifestyle healthy lifestyle meaning social distancing doesn't mean that we close ourselves inside the house we still can live a very active lifestyle we can be taking walks we can work out we can eat healthy we have time to eat healthy now so I think try to not buy into the stress that an anxiety around it seek out to places that provide support and proper information and living to help these lifestyle there is no tonic or medication that I can say our multivitamin or a pill but I do think need them the mental stress component the lifestyle component would go a long way in in mentally fighting this physically and emotionally fighting this on pandemic can n95 masks be disinfected and reused if they are heated yes yes so we are in the process of we are actually our healthcare system is also looking at the UV light which is a special level which is germicidal is looking in trying to use the n95 it obviously this is a standardized process but it is true and it is happening so we can prevent you know healthcare workers from getting sick and also patients getting sick because if one healthcare worker gets sick they can expose many many patients so yes that is true can you get Kovac 19:00 twice does it mutate like the flu so if you look at the studies what has been done what is described as reinfection in in the Chinese reports what happens is immunocompromised patients they tend to show the virus in their respiratory secretions for a very long time so what is thought that the immunity would stay for four to five months but then again you can get the virus but but if you saw somebody got a swab today and they got infected today and we repeated the swab and three weeks after it's likely not three infection that does prolong shedding the immunity may stay for three to four to five months but then you can get reinfected so so obviously there are vaccines with trials which are upcoming and are underway we wouldn't know how long would it take for it to find an efficacious vaccine but the thought about reinfection we have to understand prolonged shedding in immunocompromised patient followed by the infection that may comes that may come once after what are some of the potential treatments being studied for covered 19 patients for example hydroxychloroquine and is it through myosin so hydroxychloroquine is being used on in many institution there is the data regarding visits or my sinews and dual therapy is only a handful of patient a patients and so I do think that there is beneficial effect of hydroxychloroquine I'm not in favor of combination therapy with acids or myosin based on the data that has been presented there are trials for room desapear available here in the US many institutions are struggling to get into the trials because of the limited sites availability the there is a study at the approved to study the convalescence Sarah we do know that the hypothesis is there if this is efficacious or not we do not know that would that be a therapeutic entity in the future we do not know that yet we there is some hypothetical risk of worsening lung infection with the convalescent Sarah so so that's a work in progress what is convalescent plasma or convalescent serum convalescent serum is the immunity that the infected patient developed wildly happy infection what we do is you take away tick take there do the furry sis procedure on the patient was recovered from Corbin at 19 you collect their antibodies and give it to the person who is currently infected with commit 19 so the thought is that the convalescent serum has the antibodies against koban 19 and would five decrement 19 in the currently infected patient so that is the hypothesis it has been done in other viral infections but they're different most of their convalescent serum has not been studied in Colonel our situation so this is work in progress and would it be beneficial we do not know I hope that it is our be currently instituting here in our system we are exploring the current data to see whether this would be beneficial or not is tousle ism AB a potential treatment for hospitalized kovat 19 patients the core mobility off mortality equal mobility means the burden of infection of Kovach 19 is because of this marked inflammatory response that comes within Tsarskoe b2 infection so the body releases this huge surge of cytokines that attack all body systems the heart the lung the the kidneys and the horse circulatory system so similar situation is seen in patients who receive Guardi because the body releases this huge surge of cytokines when they receive that product dose Elizabeth has been used for what we call cytokine release syndrome CRS in the Carty patients there have been reports in from China and then followed by China in Italy where dose Elizabeth was used in patients with severe pneumonitis associated with clove in nineteen interestingly now there is data that also does Elizabeth might be helpful in patients with myocarditis means inflamed heart with Koba 19 so what it points towards this gourd 19 causing this huge inflammatory response and dose ELISA map being inhibitor of aisle six receptor would prevent that from happening that's the hypothesis there are some early reports we are I do believe that there is a role of dissidence a map in in Ovid 19 and we are employing and currently sketching up a criteria and guideline in our institution how to best use it is REM DES aveer a potential treatment for kovat 19 REM desapear is an antiviral it's an antiviral drug that has been used for with a specific antiviral activity and it hasn't of our elective against other viruses it has been tested in trial with good outcome in mild to moderate Kovach 19 infection it is available it was available for compassionate use in the US and also in her clinical trial currently it is an [Music] expected access program it is slightly hard to get it would be my first choice if it were to treat a patient file to mark Draco at 19 the supply is definitely limited I wouldn't say supply the access is definitely limited and so it is an antiviral using room disappear doesn't stop us from using tousle is a map which is more towards the cytokine release syndrome disappears more specifically in a double rule guide whatso aiming towards barn replication within the human body if I'm a cancer patient with severe kovat 19 should I go to a research center hospital for better access to potential treatments I would say yes I reach out to your oncologist and also trying to get to a bigger institution where there is access to clinical trials would be the right thing but remember that mild disease does not require treatment so if you are doing well this being having myeloma or any underlying malignancy if you do have a milder disease does not need treatment however if you feel like things are not moving in the right direction there is increasing shortness of breath and you're feeling unwell then trying to get to an institution where there might be potential clinical draws available would be the right thing to do what over-the-counter medications should I have stocked in case I get a mild case of kovin 19 the main treatment is going to be supportive gear then what is what is supportive gear making sure that your body is hydrated making sure your temperatures are controlled currently it is recommended to use acetaminophen tylenol rather than an anti-inflammatory agent the data is unclear about the anti-inflammatory agent there was some suggestion that we should avoid and dine Cemetery agents such as motrin believe ibuprofen but at this time I would recommend hydration having enough supply of Tylenol if you do develop a cough making sure you have some cough medicine but again main main emphasis would be on hydration and controlling temperatures with Tylenol if covered 19 is seasonal and it leaves in the summer and comes back in the fall or winter will we have a cure by then the treatment access would be better but the fact scene is not going to be ready or efficacious it takes a couple of years honestly to know what we do ended mutations you have to always remember the virus mutates when will things get back to normal or the new normal there would be a new normal and I in my humble opinion I think six to eight weeks at least you have to give it time and then the new norm would be a different norm and it should be because we don't know what the temperature effect is gonna be like for sure and we know that then the temperatures are gonna drop again so we have to see how it goes what other considerations should we keep in mind what I would recommend make sure that we take care of our mental health in in in in the current chaos the news that the the information and the misinformation around it making sure taking time for self care making sure finding that place where you are have have a free space to think would be very important so that we can we can come from a place of mindfulness from a base of tolerance for others compassion for others and compassion for ourselves [Music]