Tag: corona and immunity system

How to Think About Your Cancer Care in the Time of COVID-19

Getting the news that you have cancer is overwhelming and frightening. The COVID-19 crisis adds another layer of anxiety. But know this: you can protect yourself from COVID-19 without compromising your cancer treatment. Don’t panic. In the vast majority of cases, a diagnosis of cancer is not an emergency even though it feels like one. There is time to learn about your options and sort out what is right for you.

For now, there will be changes to how we do things. Some of the changes will feel disruptive, but many will lead to better, more patient-centered care. Minimizing your chances of exposure to the virus doesn’t require sacrificing good care.

How you interact with your cancer care team will change during this period.
In keeping with directives to shelter in place, whenever possible, your visits will be by phone or video. In-hospital appointments will be kept to a minimum to reduce your potential for exposure.

Your treatment/screening schedule may change. Your care team will reschedule or delay treatment when it is safe to do so, without compromising the effectiveness of your treatment.

Many oncology societies have issued guidance for care *. Your care team will know best about your particular situation. Your cancer care teams are still at work.

If you are newly diagnosed with invasive cancer

There are safe ways to postpone surgery. Systemic therapies (chemotherapy, hormone therapy, biologics and immuno-oncology treatments) are already a part of cancer care. Starting with that therapy before surgery (neoadjuvant therapy) is a great approach and is not only equally safe but allows us to learn how your tumor responds, if additional treatment will help, and whether aggressive surgical procedures or radiation can be avoided. We use this for breast cancer routinely. Switching the order of therapy helps tailor your treatments to response.

If you are in the middle of chemotherapy treatments, you should continue. Your doctors may take more precautions to support your blood counts. Stay home. Have others grocery shop for you. Your physicians may have you come in less often and have your caregivers/support accompany you by phone/video.

A new precancerous/high risk lesion (Ductal Carcinoma in situ (DCIS), atypical lesions, cervical neoplasia) is not an emergency. Waiting a few months is safe and active surveillance and prevention medications are possible alternatives.

If you are waiting to start radiation, your radiation oncologist will prioritize when to start. For some, waiting up to 12 weeks is safe. Shorter courses of treatment may be appropriate and just as safe.

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If you are due for routine cancer screening, don’t go in now for mammograms, lung CT, or repeat imaging for low risk findings. Waiting 3 months will not change your outcome.

If you have recently learned that you are at VERY high risk, because you have inherited a mutation that increases your risk for developing cancer, you can get a video consult, learn about options for risk-reduction and screening, and schedule appropriate screening 3 months out.

If you are a cancer survivor, follow-ups and screening can be safely put off 3 months.

If you have a new mass or a new symptom that worries you, that may be reason to go in for imaging or an exam. Cancer clinics are open to care for you. You can always start with a video-visit.

Why it is important to triage surgical cases – We still need to put the infrastructure in place and scale up the tools we need to take care of everyone safely. This includes COVID testing, personal protective equipment, beds, blood supply, and ventilators in place for safe care of cancer patients in the operating rooms and hospitals. Postponing surgical procedures using multidisciplinary approaches can also allow combined reconstructive cases to proceed safely. If everyone stays home now, we prevent our health care system from being overwhelmed, so emergent and urgent cases can proceed. As COVID testing becomes widely available, we can safely resume surgical procedures, and allow loved ones to be present. When possible, facilities will be separated for COVID and non-COVID related care.

The silver lining is that a crisis drives innovation and patient centered care. We have a strong foundation of science and clinical studies upon which to build, more effective treatments, more options and a better understanding of how to personalize care. We can safely do less for those with very low risk tumors, and more for those that need it. Even without COVID, we should be tailoring treatment to risk, biology, and evolving clinical data. When it is safe to do less, that is actually a benefit. This is a time when acting on such data is particularly important.

Many cancer research studies have been put on hold, but not all, and COVID 19 studies are starting in earnest**. Once the worst of the crisis passes, and COVID testing is in place, we need to safely re-open research studies because finding new and better ways to treat cancer is essential.

If everyone helps to do their part, we will all get through this better as a community, making sure we do what is best for you and everyone going through this incredibly challenging health pandemic.

Stay home, help flatten the curve, and know that we are here for you.

Resources

*Clinical guidance

https://www.asco.org/asco-coronavirus-information/care-individuals-cancer-during-covid-19

https://www.nccn.org/covid-19/

https://www.breastsurgeons.org/management/practice/covid19

https://www.facs.org/covid-19/clinical-guidance/elective-case/colorectal-cancer

https://www.facs.org/covid-19

https://www.ucsfhealth.org/education/breast-care-in-the-time-of-covid-19

**Research guidance

https://www.nih.gov/health-information/coronavirus

https://www.thewisdomstudy.org/

By Dr. Laura Esserman  April 28, 2020 6:30 AM EDT

Source: How to Think About Your Cancer Care in the Time of COVID-19

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Dr. Cardinale B. Smith, Chief Quality Officer for Cancer, shares information cancer patients need to know regarding COVID-19.

Is There Actually a Link Between Vaping and COVID-19?

Jack Drennan had tried to quit vaping before, but it took a global pandemic to make him finally follow through.

“I heard you get a lot sicker if you do vape and get coronavirus, so it kind of [pushed me] to quit,” says the Mississippi 20-year-old. Plus, “my mom’s on my ass [about it].”

Speculation about a link between vaping and COVID-19 has grown in recent weeks. News reports have noted that some young, hospitalized COVID-19 patients also vaped, and at a tele-town hall on March 19, a constituent asked New York Rep. Anthony Brindisi about the possibility of a connection. The National Institute on Drug Abuse wrote on its blog that people with substance-use disorders, including those who vape, could be especially hard-hit by COVID-19. In various corners of the internet, fringe theories with little-to-no scientific evidence have popped up making connections between a prior outbreak of vaping-related lung illnesses in the U.S. and COVID-19.

But is there any actual link between vaping and coronavirus? Experts say it’s impossible to say for sure.

Preliminary data show that a fairly high number of U.S. hospitalizations have been among younger adults—the same population known for vaping. At this point, though, that’s just an interesting observation; there is no real data to back up an association between vaping rates and COVID-19 rates in young adults.

The science around vaping is in general evolving. While some studies have shown that vaping can lead to lung damage and other health problems, the products have not been on the market long enough to speak confidently about their long-term effects. The science around COVID-19, which did not exist three months ago, is also still evolving. Putting the two topics together, then, makes for a lot of uncertainty.

Having a preexisting condition—especially one related to respiratory health—increases the chances that someone will experience complications from COVID-19, so it’s reasonable to think vaping could play a part. But since scientists can’t say for sure that vaping leads to lung disease or other chronic conditions, it’s also difficult to say whether it opens people up to more risks associated with COVID-19.

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Combustible cigarette-smoking is a clearer cause for concern during the outbreak, says Dr. Michael Siegel, a professor of community health sciences at the Boston University School of Public Health. Early data suggest men are more susceptible to COVID-19 than women, which could be associated with the fact that more men than women smoke—especially in China. Smoking-related conditions, such as heart and lung disease, put people at risk of more severe illnesses, Siegel says. Smoking also inhibits the body’s ability to heal from infections, he adds.

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But “with vaping, we just don’t know,” Siegel says. “We don’t have the evidence.”

Yasmin Thanavala, an immunologist at Roswell Park Comprehensive Cancer Center in Buffalo, New York, says some of her group’s animal research suggests vaping may prevent the body from healing from bacterial infections. COVID-19, of course, is a viral infection, but Thanavala says “on a theoretical basis,” a similar effect could apply. There’s not conclusive evidence to say so definitively, though.

Even assuming vaping does cause some amount of lung damage, it’s unlikely that most people who vape have been using e-cigarettes long enough to see the full brunt of it, says Dr. Steve Schroeder, a professor of medicine at the University of California, San Francisco. The exceptions, of course, are patients who got sick during a vaping-related lung injury outbreak last year, which health authorities traced mainly back to THC vape products spiked with the additive vitamin E acetate.

Daniel Ament, a 17-year-old from Michigan who needed a double lung transplant after vaping, is one such patient. “I definitely am [at higher risk for COVID-19],” he says. “[Doctors] didn’t have to tell me that.” Given his past lung injury and fragile immune system post-transplant, Ament is staying inside, wearing a mask almost constantly and visiting his doctors and therapists virtually. His whole family self-quarantined starting last week, to avoid bringing home germs.

E-cigarette users without a known lung injury should not quit if it means they’ll go back to using combustible tobacco, Siegel says. “Relapsing to smoking is the worst thing they could do.” But for recreational vapers, COVID-19 may be the final push needed to quit—and that’s a silver-lining to the situation, Siegel says.

“It’s always better not to be breathing chemicals into your lungs. I would have said that even without this particular outbreak,” he says. “It would certainly be a potential incentive to get people who are vaping to stop, just as a precautionary measure.”

By Jamie Ducharme March 23, 2020

Source: Is There Actually a Link Between Vaping and COVID-19?

Becuase the coronavirus directly attacks the lungs, it could be more dangerous for people who have weaker lungs from smoking or vaping. Learn more about this story at https://www.newsy.com/98596/ Find more videos like this at https://www.newsy.com Follow Newsy on Facebook: https://www.facebook.com/newsy Follow Newsy on Twitter: https://www.twitter.com/newsy

 

The Market’s in Panic Mode.. Stock Markets Plunge 12% Amid Coronavirus Fears

Mandatory Credit: Photo by JAMES GOURLEY/EPA-EFE/Shutterstock (10584160h)
A view of digital market boards at the Australian Stock Exchange (ASX) in Sydney, Australia, 16 March 2020. The ASX dropped more than 7 percent at the opening of trade as concerns over the coronavirus and COVID-19 pandemic grow. Australian Stock Exchange (ASX) drops at opening on coronavirus concerns, Sydney, Australia – 16 Mar 2020

(Bloomberg) — The stomach-turning ride on global financial markets took a dramatic turn Monday, with U.S. stocks plunging the most since 1987 after President Donald Trump warned the economic disruption from the virus could last into summer.

The S&P 500 sank 12%, extending losses as Trump said the economy could fall into a recessoin. Equities opened sharply lower after central bank stimulus around the world failed to mollify investors worried about the damage the coronavirus is inflicting on economies.

The negative superlatives for American stocks are piling up. The S&P wiped out its gain in 2019 and is now down almost 30% from its all-time high. The Dow Jones Industrial Average lost almost 13%, falling 3,000 points to close at at two-year low. The Russell 2000 had its worst day on record, losing more than 14%.

“This is different. The thing that is scarier about it is you’ve never been in a scenario where you shut down the entire economy,” said Steve Chiavarone, a portfolio manager with Federated Investors. “You get a sense in your stomach that we don’t know how to price this and that markets could fall more.”

While the Fed cut rates toward zero and stepped up bond buying, investors continued to clamor for a massive spending package to offset the pain from closures of schools, restaurants, cinemas and sporting events. Companies around the world have scaled back activity to accommodate government demands to limit social interaction.

Here are some of Monday’s key moves across major assets:

  • All 11 groups in the S&P 500 fell, with eight of them down at least 10%.
  • The Dow Jones Industrial Average’s tumble from its record reached 30%.
  • Brent crude dipped below $30 a barrel for the first time since 2016.
  • Treasury yields retreated across the curve with moves most pronounced on the short end.
  • Shares tumbled in Asia and Europe, where the continent is now reporting more new virus cases each day than China did at its peak as more countries lock down.
  • The yen surged, the Swiss franc rallied and the dollar fluctuated.
  • Gold failed again to capitalize on the rush to havens and reversed an earlier gain to tumble.
  • Bonds declined across most of Europe, where a measure of market stress hit levels not seen since the 2011-2012 euro crisis.

The Fed and other central banks have dramatically stepped up efforts to stabilize capital markets and liquidity, yet the moves have so far failed to boost sentiment or improve the rapidly deteriorating global economic outlook. An International Monetary Fund pledge to mobilize its $1 trillion lending capacity also had little impact in markets.

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The problem is, bad news keeps stacking up. The New York Fed’s regional gauge of factory activity plunged. Ryanair Holdings Plc said Monday it will ground most of its European aircraft while a consultant said the pandemic will bankrupt most airlines worldwide before June unless governments and the industry step in. Nike Inc. and Apple Inc. announced mass store closings.

“In normal circumstances, a large policy response like this would put a floor under risk assets and support a recovery,” Jason Daw, a strategist at Societe Generale SA in Singapore, wrote in a note. “However, the size of the growth shock is becoming exponential and markets are rightfully questioning what else monetary policy can do and discounting its effectiveness in mitigating coronavirus-induced downside risks.”

The yen rebounded from Friday’s plunge after the Fed and five counterparts said they would deploy foreign-exchange swap lines. Australian equities fell almost 10%, the most since 1992, even after the Reserve Bank of Australia said it stood ready to buy bonds for the first time — an announcement that sent yields tumbling. New Zealand’s currency slumped after an emergency rate cut by the country’s central bank.

Meanwhile, China reported Monday that output and retail sales tumbled in the past two months.

These are the main moves in markets:

Stocks

  • The S&P 500 fell 11.98% as of 4 p.m. in New York.
  • The Dow Jones Industrial Average plunged 12.93%
  • The Stoxx Europe 600 Index lost 4.9%, paring a drop that reached 10%.
  • The MSCI Emerging Market Index declined 6.3%.
  • The MSCI Asia Pacific Index decreased 3.7%.

Currencies

  • The Bloomberg Dollar Spot Index rose 0.2%.
  • The euro gained 0.5% to $1.1162.
  • The Japanese yen strengthened 1.8% to 105.94 per dollar.

Bonds

  • The yield on two-year Treasuries sank 14 basis points to 0.35%.
  • The yield on 10-year Treasuries declined 22 basis points to 0.73%.
  • The yield on 30-year Treasuries declined 22 basis points to 1.31%.
  • Germany’s 10-year yield climbed seven basis points to -0.47%.

Commodities

  • West Texas Intermediate crude fell 9.2% to $29.05 a barrel.
  • Gold weakened 4.3% to $1,463.30 an ounce.
  • Iron ore sank 2.5% to $86.10 per metric ton.

—With assistance from Claire Ballentine, Elena Popina and Elizabeth Stanton.

By Jeremy Herron and Vildana Hajric / Bloomberg

Source: ‘The Market’s in Panic Mode.’ Stock Markets Plunge 12% Amid Coronavirus Fears

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Why Is the Coronavirus Outbreak So Bad in Italy?

On Monday, Italy placed its 60 million residents under lockdown, as the number of cases of the COVID-19 virus throughout the country continues to rise.

In less than a month, Italy has gone from having only three cases of the coronavirus to having the highest number of cases and deaths outside of China, with 463 deaths and at least 9, 172 of people infected throughout all 20 regions of the country. The number of cases rose by 50% on March 8 alone. Italy also faces an above average mortality rate of 4%.

“We all must give something up for the good of Italy,” Italian Prime Minister Giuseppe Conte said in a televised address on Monday while announcing the nationwide lockdown. “There is no more time.”

The nationwide lockdown is expected to have major economic repercussions on the country, where growth was already stagnating. While the government has not specified exactly how long the ban will last, it says it will remain in place until April 3.

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Here is how the virus spread across the country — and why it is so much worse in Italy than any other European country:

How did coronavirus start spreading in Italy?

Officially it began in Feb. 20, when a 38-year-old man checked himself into a local hospital in the town of Codogno in Lombardy. He tested positive with the virus, becoming the first recorded patient with the COVID-19 virus in Italy.

Yet some health officials believe that the virus arrived in Italy long before the first case was discovered. “The virus had probably been circulating for quite some time,” Flavia Riccardo, a researcher in the Department of Infectious Diseases at the Italian National Institute of Health tells TIME. “This happened right when we were having our peak of influenza and people were presenting with influenza symptoms.”

Before the first case was reported, there was an unusually high number of pneumonia cases recorded at a hospital in Codogno in northern Italy, the head of the emergency ward Stefano Paglia told the newspaper La Repubblica, suggesting it is possible patients with the virus were treated as if they had a seasonal flu. Health facilities hosting these patients could have become sites for infection, helping proliferate the spread of the virus.

The northern regions of Lombardy, Veneto and Emilia-Romagna, have been most affected by the outbreak. 85% of infected patients are in the region which is home to 92% of deaths so far. But the virus has been confirmed in all 20 regions of the country.

Why does Italy have such a high number of cases and deaths?

Because the virus spread undetected, some officials believe this is the reason for such a high number of cases in the country. “This started unnoticed which means by the time we realized it, there were a lot of transmission chains happening,” Riccardo says, noting that this may be why Italy has seen such a high number of cases.

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Some officials also believe Italy, which has already tested over 42, 000 people, may have a higher number of cases as a result of performing more rigorous tests than their European counterparts.

Italy, however, is also reporting an above average mortality rate at 4%. The average age of coronavirus patients who have died because of the virus in Italy is 81, according to the National Health Institute. Italy, which has one the world’s oldest populations, could be facing a higher mortality rate as a result of its above-average elderly population. “Italy is the oldest country in the oldest continent in the world,” says Lorenzo Casani, the health director of a clinic for elderly people in Lombardy told TIME. “We have a lot of people over 65.”

Casani also suggests the mortality rate might be higher than average because Italy is testing only the critical cases. “We are not doing enough,” he said.

Casani says that pollution in northern Italy could be a factor in higher death rates. According to a report by the Swiss air monitoring platform IQAir, 24 of Europe’s 100 most polluted cities are in Italy. “Studies have shown a high correlation between mortality rates from viral respiratory conditions and pollution,” Casani says. “This could be a factor.”

Was the Italian government prepared for the outbreak?

The outbreak in Italy has come as a surprise to some, given the stringent measures Italy imposed to protect itself from the virus. A month before the first case was reported, the Italian Health Ministry created a task force to manage coronavirus. Italy was the first European Union country to ban flights to and from China.

The travel ban, however, may have encouraged travellers to come in on connecting flights without disclosing their country of departure. Some experts also believe the virus could have entered the country before the government took action, spreading undetected throughout the country.

How is the government responding now?

The Italian government has taken the biggest steps outside of China to curb the spread of the disease.

Under the new lockdown legislation, people can be issued fines for traveling within or outside the country without a permit, though foreigners still can travel to Italy. All public events are banned and schools have been cancelled throughout the country. Public spaces, such as gyms, theatres and cinemas, have also been closed by the government. Individuals who defy the lockdown could face up to three months in jail or a fine of $234. The new rules prohibit inmates from having visitors or day releases, which set off protests at 27 prisons throughout the country.

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Many have applauded Italy’s actions. In a tweet, the Director-General of the World Health Organization commended Italy for its “bold, courageous steps” and for “making genuine sacrifices.”

Some infectious disease and public health experts, however, have concerns about the effectiveness of the lockdown.

“These measures will probably have a short-term impact,” John Edmunds, a professor at the London School of Hygiene & Tropical Medicine told Reuters, noting that the measures were “almost certainly unsustainable.” He added, “if they can’t be sustained for the long term, all they are likely to do is delay the epidemic for a while.”

How is the Italian healthcare system handling it?

Italy’s current national health service, known as Servizio Sanitario Nazionale (SSN), provides free universal care to patients yet remains under-funded. Investments in public healthcare make up only 6.8% of the country’s gross domestic product (GDP), which is lower than other countries in the European Union including France and Germany.

“The continuous cuts—to care and to research—are obviously a problem right now,” Casani says. “We were not prepared. We do not have enough doctors for the people. We do not have an organized plan for pandemics.”

With the number of coronavirus cases on the rise, the Italian health ministry has doubled the number of hospital beds in infectious disease wards. The Governor of Lombardy Attilio Fontana has requested that universities grant degrees earlier this school year in order to increase the number of nurses in Italy. Yet some health officials fear these efforts will not be enough.

“Right now in Lombardy, we do not have free beds in intensive care units,” Casani says. He added that doctors “have to make this horrible choice and decide who is going to survive and who is not going to survive…who is going to get a monitor, a respirator and the attention they need.”

What impact will the lockdown have on the Italian economy?

The lockdown could push Italy into a recession. Berenberg bank, which before the outbreak estimated that Italy’s GDP would contract by 0.3%, now forecasts it will fall by 1.2% this year.

Lombardy, the region most affected by the outbreak, account for one-fifth of Italy’s GDP. The Italian tourism sector, which makes up 13% of the country’s GDP, is projected to lose $8.1 billion, according to the Associated Press, as a result of 32 million fewer foreign travelers.

Conte said on March 9 that the government would deploy a “massive shock therapy” in order to protect the economy. Italy’s Deputy Economy Minister, Laura Castelli said in an interview with Rai Radio 1 today that “mortgages, taxes, everything is suspended” as a result of the lockdown. The government has also created a support package of $8.5 billion for families and businesses affected by virus.

Some experts are concerned about the long-term implications of this spending.

Before the coronavirus outbreak, Italy was already struggling with a public debt that is at 134% of the country’s GDP. In the Europe Union, countries are not supposed to have debt that is higher than 60% of their country’s GDP. “With the increased spending that comes with having to support people and businesses, the deficit might explode,” says Pepijn Bergsen, a Europe Research Fellow at Chatham House.

An economic slowdown in Italy, a country in the Eurozone, will have impacts on the rest of the continent.

“It is likely there will be a Eurozone wide recession this year,” Bergsen says, citing both an Italian recession and potential future lockdowns in other European Union countries as contributing factors. “It will be difficult for authorities to come up with any measures that would avoid a recession.”

Please send any tips, leads, and stories to virus@time.com.

Here’s what you need to know about coronavirus:

By Mélissa Godin March 10, 2020

Source: Why Is the Coronavirus Outbreak So Bad in Italy?

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Giacomo Grasselli – a senior Italian government health official who is coordinating the network of intensive care units in Lombardy – explains the “critical” situation in Italy, brought about by the Covid-19 outbreak (Subscribe: https://bit.ly/C4_News_Subscribe) ——- Watch more of our explainer series here – https://www.youtube.com/playlist?list… Get more news at our site – https://www.channel4.com/news/ Follow us: Facebook – https://www.facebook.com/Channel4News/ Twitter – https://twitter.com/Channel4News
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