The coronavirus or the COVID 19 outbreak that started in 2019 December in Wuhan, China has now spread to the entire world and has been declared a Pandemic by WHO. A pandemic has four phases and India is still in the second phase, widespread community transmission has yet not occurred. While all individuals have to take basic precautions to curtail the spread of the infection, this is more relevant for few patients with a weakened immune system, which includes cancer patients on active treatment, patients on any kind of immunosuppressive therapy, and also those who are elderly and with comorbidities. (High Risk Group).
To understand how to break the chain, we need to understand a few basic facts about this infection.
COVID 19 (SARS CoV-2) is a viral infection caused by a virus that belongs to the family of SARS viruses. It causes infection by droplets coming in contact with mucosal surfaces. Has an incubation period of 2 to 15 days which means after infection, the person MAY NOT show symptoms till 2 to 15 days.
The symptoms are same as other Flu or the seasonal viral infections with Cough (Dry), Fever, bodyache. Cold or running nose is not a usual component of the symptoms for Coronavirus infection. Also if the infection is severe it may cause breathing difficulty. The severity of infection is dependent on how strongly your body immunity is able to fight the infection. This means that people with a weakened Immune system are at a greater risk of catching the infection and also the infection MAY BE more severe in them. While more than 95 % of infections would resolve after these symptoms, few may have severe respiratory distress, cardiac problems that may require ICU admissions.
What makes this virus different from others is its ability to stay on nonliving things for several hours to upto 9 days.
It spreads through droplets that means when an infected person coughs or sneezes, it causes infection when these come in contact with the mucosa (surfaces of nose, mouth and eyes) of another person, This may happen directly if these droplets fall on another person or indirectly. The indirect spread occurs when droplets that fall on the things around (which stay there for more than usual times), are touched by someone else and then comes in contact with the mucosa.
These are the general precautions to be taken for everyone including cancer patients.
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1. IF HAVING FEVER, COUGH OR COLD, WEAR A MASK.
The other seasonal flu infections are also occurring at this time so it is not possible to say if this is due to CORONA or other infections. The best is to rest, take adequate fluids, and contact your doctor if the symptoms do not resolve. Mask should be discarded properly after disinfection with hypochlorite solution after a few hours. Mask worn by normal asymptomatic people wearing will not prevent them from any infection.
If you have a travel history to or from abroad in the past 15 days or have come in contact of a person who is COVID positive or a COVID suspect, you should SELF QUARANTINE YOURSELF FOR 15 DAYS. This would prevent you from spreading the infection to other people as you me be an asymptomatic carrier of the infection. SELF QUARANTINE Guidelines from the MOHFW (MINISTRY OF HEALTH AND FAMILY WELFARE) are available and should be followed.
2.SECONDLY, AVOID TAKING HANDS TO YOUR T ZONE OF FACE (FOREHEAD, EYES, NOSE) AND MOUTH
3.HAND HYGIENE
However strictly you may follow, hands do tend to go to the face, so maintain hand hygiene by washing with soap and water for 20 seconds thoroughly to get rid of the virus if any, else use a sanitizer with 60% alcohol for sanitization. This should be done as frequently as hourly. Avoid handshakes. BETTER TO GO THE INDIAN NAMASTE STYLE IN THE CURRENT SITUATION.
4.AVOID TRAVEL FOR NON EMERGENCY THINGS LIKE SHOPPING, ENTERTAINMENT OR ENJOYMENT.
- Restrict travel to emergency work and medical care or groceries at the most.
- Avoid crowded places like malls, theatres, restaurants, functions, marriages, birthday parties, religious places, schools, colleges.
- Maintain distance when talking to anyone, avoid close contact with people around you.
- Restrict kids from playing in groups as they may not manifest the infection, but may be asymptomatic carriers themselves and can get infection home.
CORONAVIRUS infection is more relevant for a few groups of people which includes
- Elderly
- With other diseases like diabetes, hypertension, Lung diseases, Cardiac problems
- Smokers as their lungs are already damaged
- Patients who have had surgery involving their lungs, or received radiation to their lungs
- Patients on cancer chemotherapy at present or in previous 3 months
- Patients on immunosuppressive drugs
- Patients of cancer on some immune check point inhibitors (discuss with you doctor)
- Patients who are undergoing bone marrow transplant or a have undergone transplant
- Patients who have undergone any organ transplant and are taking immunosuppressive therapy
Apart from the general precautions, these are some other precautions for these patients with a diagnosis of cancer and those that are undergoing active treatment as they are at an increased risk due to the immunocompromised status.
- They have to be very strict in general precautions and refrain themselves from any travel or gathering all together.
- Visit to the hospital may be done if you are under active treatment after discussion with your treating doctor if your treatment is more essential than the risk of catching the infection as a delay in treatment could also not be desirable depending on your disease.
Do not try and delay treatment from the fear of coming to the hospital WITHOUT DISCUSSING WITH YOUR DOCTOR. - Patients who are on radiation should continue their radiation if already started with the required precautions, avoid waiting for long times in the hospital.
- Patients who are on radiation and have had a COVID Exposure or are suspected of having symptoms should discuss with their doctor and treatment can be interrupted in that case.
- Patients who have not started their radiation yet, should discuss with their radiation Oncologist if it would be fine to delay the treatment.
- Patients who have completed their treatment and are on follow up only and are having no problems or symptoms should avoid visiting the hospital for at least next 15 days till the situation becomes more clear. They should contact their treating team prior to coming to the hospital to avoid overcrowding and inconvenience to all.
It’s a matter of weighing the risk of the disease progressing without treatment versus the benefit of preventing further immunosuppression to avoid severe infection. It has to be discussed with your doctor in detail.
If there is a history of exposure and suspected COVID Infection in a cancer patient, try to contact your doctor electronically through mail or your support group as traveling to the hospital should then be restricted.
Do not panic. You may or may not develop the symptoms.
Self-quarantine yourself with conservative management.
The infection will resolve with some symptoms of cough and cold in most cases. In those who experience breathing difficulty or when symptoms are worsening or not improving after 7 days as well, contact your doctor.
What is SELF QUARANTINE – Quarantine or isolation of an exposed or suspected COVID person who is presently asymptomatic in the house. This includes avoiding close contact with other family members, segregation of bed, clothes, linen, utensils, and other useful things for a period of 15 days.
This can be done by staying in a well-ventilated single room with an attached/separate toilet. A distance of at least 1 meter to be kept from other family members. Stay away from pregnant, elderly, and children and keep taking the other precautions for nonexposed people. Should wear a surgical mask. Masks should then be disinfected before destroying by burial or burning.
