March 23, 2020 Update to the Joint Statement on #Coronavirus #COVID19 From #LungCancer Advocacy Groups

The post below is shared with permission.

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From Lung Cancer Advocacy Groups

As cases of the virus surge in countries around the world, with Italy being particularly hard hit, many nations are taking extreme steps to mitigate the outbreak, including whole country lockdowns. Here in the United States, the President declared a national emergency on March 13, 2020. Several states have declared shelter-in-place to minimize non-essential activities and mitigate transmission. President Trump has declared California, New York State, and Washington State to be major disaster areas.

In this week’s update, we discuss the following topics related to COVID-19:

 

Origin of SARS-CoV-2

SARS-CoV-2 is the seventh coronavirus known to infect humans. SARS-CoV, MERS-CoV, and SARS-CoV-2 can cause severe disease, whereas HKU1, NL63, OC43 and 229E are associated with mild symptoms. There has been a lot of speculation on the origin of SARS-CoV-2. Scientists have now sequenced the genetic material of the virus isolated from different patients. These sequencing results clearly establish that SARS-CoV-2 is not a genetically engineered virus, meaning it is not manmade.1

The researchers provide two scenarios for the origin of SARS-CoV-2. In one scenario, the virus evolved to its current pathogenic (disease-causing) state through natural selection in a non-human host and then jumped to humans. This is how previous coronavirus outbreaks have emerged, with humans contracting the virus after direct exposure to civets (SARS) and camels (MERS). The researchers proposed bats as the most likely reservoir for SARS-CoV-2 as it is very similar to a bat coronavirus. In the other proposed scenario, a non-pathogenic version of the virus jumped from an animal host into humans and then evolved to its current pathogenic state within the human population. For instance, some coronaviruses from pangolins, armadillo-like mammals found in Asia and Africa, have similarities to SARS-CoV-2. A coronavirus from a pangolin could possibly have been transmitted to a human, either directly or through an intermediary host such as civets or ferrets.

 

Which age groups have severe responses to COVID-19?

Initial data on COVID-19 suggested that when stratified by age, the elderly were the most likely to develop a more severe form of COVID-19. Recent data released by the CDC demonstrated that this is not the case anymore.  As shown in the figure below, almost all age groups are susceptible to a serious form of COVID-19 that requires hospitalization.2

This is especially important to keep in mind given that younger people have been more resistant to social distancing.

 

How long does SARS-CoV-2 survive outside the body?

The researchers were able to detect viable viral particles for at least 72 hours on the four surfaces studied. This suggests that transmission of SARS-Cov-2 is possible through aerosols and fomites (solid objects and surfaces that are able to carry pathogens and transmit infections).

We recommend that after you bring articles into your home, you do the following:

  • Wash your hands after carrying delivered items into your home.
  • After accepting a package that’s in a cardboard container, put it aside or in the garage and let it sit for a day or two before opening (if possible).
  • After opening a package, wipe down all articles that have solid surfaces with chlorine wipes or disinfect with an alcohol-based solution.
  • At this time, there is no guidance on how to disinfect edible items such as fruits and vegetables.
  • Follow cleaning and disinfecting procedures listed on the gov website

 

Community transmission of SARS-CoV-2 by asymptomatic individuals

Data from initial cases of COVID-19 suggested that most transmissions were occurring through individuals who showed signs and symptoms of COVID-19. This is however not the case. It is now estimated that as many as 31% of new COVID-19 infections are being caused as a result of transmission through asymptomatic individuals – those who have been infected with SARS-CoV-2 but don’t shown signs and symptoms of the disease.4 This is an especially important aspect of SARS-CoV-2 transmission and reinforces why we need to practice stringent social distancing to flatten the curve.

 

COVID-19 patients may present with non-respiratory symptoms even before they have respiratory symptoms

Individuals infected with SARS-CoV-2 may present with gastrointestinal symptoms such as anorexia (83.8%), diarrhea (29.3%), vomiting (0.8%), and abdominal pain (0.4%).5 These gastrointestinal symptoms may show up even before respiratory symptoms of COVID-19. Furthermore, a small sample of patients presented with only gastrointestinal symptoms. If you have unexplained gastrointestinal issues, we suggest that you talk to your doctor promptly.  Also, conjunctivitis may be present in a small subset of patients as well. 6

 

Prepare your legal documents

Given the uncertainty over availability of medical care during the COVID-19 emergency, we suggest everyone review their legal documents and ensure they have a current Durable Power of Attorney and Advance Directive. This virus can progress very rapidly and seriously interfere with breathing, which means you cannot be certain that you will be able to make your wishes known verbally if you get severely ill. Discuss your wishes with your family and ensure everyone knows where to find these important documents.

If you haven’t completed these legal documents, some estate planning attorneys may be willing to help prepare and witness them via video conferencing so that you do not have to leave your home.

If you are not sure how to get started, please review the resources available at https://theconversationproject.org/

 

Can I take ibuprofen when I have COVID-19?

Short answer, yes.  Long answer: we’re not sure.

On March 18, the World Health Organization (WHO) posted an article suggesting that patients who have COVID-19 avoid taking ibuprofen, based on observations of patients in France.7 However, later the same day, WHO changed their stance and said patients who have COVID-19 should not avoid taking ibuprofen.8

This is a good example of how quickly information is evolving during this pandemic. It’s difficult for doctors to know whether to act on information that is based on the experience of only a few (or even one) patient.

Resources and websites:

  1. The National Cancer Institute has a special website for COVID-19 and emergency preparedness. Coronavirus: What People with Cancer Should Know – https://www.cancer.gov/contact/emergency-preparedness/coronavirus
  2. We are following updates provided by the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC), which can be found here:
  1. Johns Hopkins Coronavirus Resource Center is one of the best places to get current updates. https://coronavirus.jhu.edu/
  2. Interactive map of US COVID-19 cases by statehttps://www.politico.com/interactives/2020/coronavirus-testing-by-state-chart-of-new-cases/
  3. The One-Two Punch: Cancer And Coronavirus (an important perspective for cancer patients) – https://www.forbes.com/sites/miriamknoll/2020/03/20/the-one-two-punch-cancer-and-coronavirus/#73744a4358e6
  4. You can find information specific to your state or city or town on your health department’s website.
  1. The American Medical Association is also maintaining a resource website for healthcare providers. You can find more information here: https://www.ama-assn.org/delivering-care/public-health/covid-19-2019-novel-coronavirus-resource-center-physicians
  1. If you cannot avoid air travel, check out this handy article on “Dirtiest Places on Airplanes: How to Avoid Germshttps://time.com/4877041/dirtiest-places-on-airplanes/

 

References:

  1. Anderson K, Rambaut A, Lipkin W, Holmes E, Garry R. The proximal origin of SARS-CoV-2. Nature Medicine. 2020.
  2. CDC. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020.
  3. van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020.
  4. Nishiura H, Kobayashi T, Suzuki A, et al. Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19). Int J Infect Dis. 2020.
  5. Pan L, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. American Journal of Gastroenterology. 2020.
  6. AAO. Alert: Important coronavirus updates for ophthalmologists. https://www.aao.org/headline/alert-important-coronavirus-context. Published 2020. Accessed March 23, 2020.
  7. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020.
  8. ScienceAlert. Updated: WHO Now Doesn’t Recommend Avoiding Ibuprofen For COVID-19 Symptoms. https://www.sciencealert.com/who-recommends-to-avoid-taking-ibuprofen-for-covid-19-symptoms/amp?fbclid=IwAR0f9eZt8u9s_xfiY06bJ0Sei2NasHQj_b_eosKGjBeJiJXi5LXQV3EIj7w. Published 2020. Accessed March 23, 2020.

GO2 Foundation for Lung Cancer (Amy Moore, PhD amoore@go2foundation.org )
LUNGevity Foundation (Upal Basu Roy, PhD, MPH ubasuroy@lungevity.org )
Lung Cancer Foundation of America (Kim Norris KNorris@lcfamerica.org )
Lung Cancer Research Foundation (Jan Baranski, PhD jbaranski@lcrf.org)
LungCAN (Kimberly Lester kimberly@lungcan.org)

March 16, 2020 Update to the Joint Statement on #Coronavirus #COVID19 From #LungCancer Advocacy Groups

The post below is shared with permission.

The World Health Organization officially declared the COVID-19 outbreak a pandemic on March 11, 2020. As cases of the virus surge in countries around the world, with Italy being particularly hard hit, many nations are taking extreme steps to mitigate the outbreak, including whole country lockdowns. Here in the United States, the President declared a national emergency on March 13, 2020.

In this week’s update, we discuss four important topics related to COVID-19.

 

  1. Social distancing and why it matters for COVID-19

COVID-19 is caused by the virus, SARS-CoV-2. Individuals infected with SARS-CoV-2 appear to shed the virus from their respiratory tract (e.g., when coughing) even when symptoms may be very minor. Individuals infected with SARS-CoV-2 appear to shed the virus from their respiratory tract during the prodromal period.1 The prodromal period is part of an infectious disease cycle. It is defined as the period during which the symptoms felt by an infected individual may not be very specific or severe. The infected person can still perform usual functions and can therefore continue to be infectious. An infected individual can shed virus with very minor signs and symptoms.2 This explains why we are seeing widespread transmission in the community (this didn’t happen with SARS).

The reproductive number (R0)– the number of secondary infections generated from one infected individual – is estimated to be between 2 and 2.5 for COVID-19 virus.3 This means that a single infected person infects 2.5 people, which is higher than for the influenza virus. Approximately 3 to 5 days after infection, a person starts shedding virus and can infect others. Therefore, within a month, a single case can lead to 244 new cases.

The CDC now recommends social distancing to help decrease transmission of COVID-19 within the community.4 Social distancing measures, such as cancelling public gatherings and avoiding crowds, can slow the spread of the virus and spread cases out over a longer period of time, which can help hospitals provide care while avoiding being overwhelmed by patients. Social distancing helps “flatten the curve” in the spread of an infectious disease. This is especially critical because hospitals and health systems are working at full capacity. Flattening the curve ensures that systems are functional and people who require care the most can get the attention they need. The CDC recommends a distance of 6 feet or 2 meters as the minimum distance between individuals. 5

In case you are interested, we invite you to take a look at the CDC’s community transmission mitigation strategy document (cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf).

 

  1. Appointments with your oncologist: virtual or in-person?

It may be a good idea to consider rescheduling or switching to a virtual appointment if your treating physician or cancer center provides this option. Note that virtual appointments are not appropriate for infusions for chemotherapy or immunotherapy, or potentially critical scans. If you have an oncology visit due in the next couple of months, please contact your treating physician as soon as possible to discuss what’s the right approach for you and whether they anticipate any drug shortages due to supply chain disruption.

Several hospitals are now limiting the number of visitors and/or people accompanying patients to no more than one at a time.  In Seattle, the area hardest hit with cases, some hospitals are implementing the following measures to avoid being overwhelmed6:

  • People with routine appointments are being screened for symptoms. Those who are sick are required to wear a mask or may not be allowed to enter the clinic.
  • Elective surgeries are being postponed.
  • Patients who have flu-like symptoms or other concerns are asked to CALL their doctor rather than going directly to the Emergency Department or Urgent Care.
  • If you are having difficulty breathing, please do go to the Emergency Department.

 

  1. COVID-19 testing: where we are now

We are seeing transmission in the community, so it’s likely the virus is more widespread in the United States than we imagine. However, we don’t have hard data because testing was not implemented in the earlier days of the epidemic in the US.7 Right now, most people need to have symptoms before they can be tested.  As more test kits are distributed, testing will hopefully expand.  Drive-through testing has been made available in a few locations but is not yet widely available. As we have stated previously, the symptoms of COVID-19 infection include fever, dry cough and shortness of breath. If you suspect that you have been infected, you should call your doctor or local health department to determine next steps. The availability of tests varies on where you live.

The CDC is maintaining an updated list of where tests are currently being performed in the US.8

Additionally, state health departments are a valuable resource, providing hotlines and websites with information about what to do if you are concerned that you or a loved one might be infected (links in the references).

 

  1. Voices from the community:

Please check out Janet Freeman-Daily’s article where she describes her experience as a lung cancer survivor with a cough and the difficulties she faced to get tested for COVID-19. Janet lives in the Seattle, WA area — a COVID-19 hotspot.

Fred Hutchinson Cancer Research Center in Seattle published a helpful blog “Coronavirus: what cancer patients need to know”.

 

Resources and websites:

  1. The National Cancer Institute has a special website for COVID-19 and emergency preparedness. Coronavirus: What People with Cancer Should Know – https://www.cancer.gov/contact/emergency-preparedness/coronavirus
  2. We are following updates provided by the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC), which can be found here:
  1. Johns Hopkins Coronavirus Resource Center is one of the best places to get current updates. https://coronavirus.jhu.edu/
  2. You can find information specific to your state or city or town on your health department’s website.
  1. The American Medical Association is also maintaining a resource website for healthcare providers. You can find more information here:
    https://www.ama-assn.org/delivering-care/public-health/covid-19-2019-novel-coronavirus-resource-center-physicians
  1. If you cannot avoid air travel, check out this handy article on “Dirtiest Places on Airplanes: How to Avoid Germs
    https://time.com/4877041/dirtiest-places-on-airplanes/

 

References:

  1. Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395(10223):514-523.
  2. Hoehl S, Berger A, Kortenbusch M, et al. Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China. N Engl J Med. 2020.
  3. WHO. Coronavirus disease 2019 (COVID-19) Situation Report – 46. 2020.
  4. CDC. Implementation of Mitigation Strategies for Communities with Local COVID-19 Transmission Coronavirus Disease 2019 (COVID-19) Web site. cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf. Published 2020. Accessed March 15, 2020.
  5. CDC. IInterim US Guidance for Risk Assessment and Public Health Management of Persons with Potential Coronavirus Disease 2019 (COVID-19) Exposures: Geographic Risk and Contacts of Laboratory-confirmed Cases. Coronavirus Disease 2019 (COVID-19) Web site. https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html. Published 2020. Accessed March 15, 2020.
  6. UW. COVID-19 (formerly called Novel Coronavirus). https://www.uwmedicine.org/coronavirus. Published 2020. Accessed 2020, March 15.
  7. Lambert J, Saey TH. Social distancing, not travel bans, is crucial to limiting coronavirus’ spread. Science News2020.
  8. CDC. Testing in U.S. Coronavirus Disease 2019 (COVID-19) Web site. https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html. Published 2020. Accessed March 15, 2020.

 

GO2 Foundation for Lung Cancer (Amy Moore, PhD – amoore@go2foundation.org)
LUNGevity Foundation (Upal Basu Roy, PhD, MPH – ubasuroy@lungevity.org)
Lung Cancer Foundation of America (Kim Norris – KNorris@lcfamerica.org)
Lung Cancer Research Foundation (Jan Baranski, PhD – jbaranski@lcrf.org)
LungCAN (Kimberly Lester – kimberly@lungcan.org)

@IASLC STARS program statement about #coronavirus and #COVID19

The IASLC STARS program develops new patient research advocates (PRAs) to help accelerate lung cancer research. You’ll find program info and PRA and Mentor applications at https://www.iaslc.org/Research-Education/Supportive-Training-for-Advocates-in-Research-and-Science-STARS>https://www.iaslc.org/Research-Education/Supportive-Training-for-Advocates-in-Research-and-Science-STARS.

We encourage you to apply by March 16!

Be sure to read the Guidelines and FAQs before applying. They contain useful information you’ll need to make a strong application.

The program is making contingency plans to ensure STARS will happen in some form despite concerns about the novel coronavirus and COVID-19. Here’s the official IASLC statement:

 

PLEASE NOTE A CHANGE IN PROGRAM REQUIREMENTS, AS OF 9-MARCH-2020:
Yes, you CAN still apply if you or your loved one has experienced cancer progression recently. The health and safety of the lung cancer community is our top priority. PRAs and Mentors who have or had lung cancer and who are selected for the program will need to provide a letter from their primary lung cancer physician stating that the applicant is in adequate health to travel to Singapore in August 2020 and fully participate in all required STARS activities.

Lung cancer patient and 2019 STARS Mentor Jill Feldman blogged her experience with the program here: https://lungcancer.net/living/stars-program/

Hear more about the IASLC STARS program in this video:

What is an IRB and why should patients care?

Image credit:  This Photo by Unknown Author is licensed under CC BY-ND

If you travel, please be sure you’re immune to measles

This Photo by Unknown Author is licensed under CC BY-SA-NC

 

Fellow travelers (especially those with cancer or other health issues):

Given the worldwide spread of measles, please be sure you have immunity to measles.  You might need an MMR (Measles Mumps Rubella) booster vaccine.
The global measles outbreaks have demonstrated the measles virus can be spread by travelers. You, as a traveler, can be exposed to the disease. However, if you do not have immunity, you can also expose others to the disease.  A single traveler carrying the measles virus can expose a local population even before the traveler has symptoms of the disease. It doesn’t have to be international travel — any travel to another location risks spreading the disease to a new population.
The CDC claims “If you and your travel companions have received two doses of a measles-containing vaccine (and can document both of them), you have sufficient protection against the disease. You do not need any additional measles vaccines or lab work. You are also protected against measles if you have laboratory evidence of immunity, laboratory confirmation of measles disease, or if you were born before 1957.”
In the case of Baby Boomers or those dealing with chronic or serious health conditions, I would go further.
I was born before 1956, so the assumption would be that I’m immune to measles.  However, since I have compromised lungs due to lung cancer treatment and Washington State had a measles outbreak last year, I asked my PCP about my immunity. She recommeded I have a titer to test whether I still have immunity to measles, mumps and rubella. The tests only required a blood draw, followed by a separate analysis of immunity for each disease.
My titers showed I still had immunity to measles and rubella, diseases which I had as a kid. However, I’ve never had mumps. Even though I had the MMR vaccine when I was 17,  the titer showed I had lost my immunity to mumps. Because of my level of immunity and my previous MMR, my doctor prescribed a single MMR booster shot. The cost of all three titers and the MMR booster were completely covered by my insurance (a BCBS company).
My son is in his 30’s, and had the MMR vaccine as an infant. He never had any of these diseases, although he did get chicken pox. His titers showed he was immune to two diseases, but had lost immunity to the third. His doctor recommended a single MMR booster. His insurance (Kaiser) covered the titers and MMR booster for him as well.
Please, if you plan to travel, make sure you have immunity to measles. More information is available here:

Note:
The value of vaccines is established by scientific evidence. Please don’t debate this fact in the comments.

About keto diets and cancer

Debates arise frequently in the lung cancer community about reducing sugar intake to prevent and/or treat cancer. Some people claim a ketogenic diet is an effective cancer treatment, but rarely provide objective, scientific evidence to support this claim.

A recent article explored claims about the value of ketogenic diets for cancer patients. It was published in an open access journal and written by researchers at the University of Manchester in the UK. The article found high-quality evidence regarding ketogenic diets for cancer patients is lacking:

“High‐quality evidence on the effect of ketogenic diets on anthropometry, metabolism, QoL [quality of life] and tumour effects is currently lacking in oncology patients. Heterogeneity between studies and low adherence to diet affects the current evidence. There is an obvious gap in the evidence, highlighting the need for controlled trials to fully evaluate the intervention.”

You can read the full article here:

A systematic review of the use of ketogenic diets in adult patients with cancer

Want to be a #lungcancer patient research advocate? Inaugural @IASLC STARS program application period is open!

    • Have you or a family member been diagnosed with lung cancer?
      Are you already active in providing lung cancer support and/or education to others?
      Do you want to ramp up your advocacy work and learn more about the science of lung cancer research?

    THEN …

    Apply for the brand-new STARS (Supportive Training for Advocate in Research and Science) program!  STARS was developed by the IASLC (International Association for the Study of Lung Cancer) in collaboration with international lung cancer patient research advocates and advocacy nonprofits.

    Those accepted in the program will be assigned a mentor from their own country, meet and learn lung cancer science from researchers, develop science communication skills, and attend the World Conference on Lung Cancer (WCLC) in Barcelona, Spain in September 2019.

    To learn more and to find the online application, click here:
    https://www.iaslc.org/supportive-training-advocates-research-and-science-stars

    The application period is open from March 8 to May 1, 2019. Hope you’ll apply!