What you should know about the coronavirus pandemic

The coronavirus pandemic continues to cause changes to our daily routines. But there is no reason for the general public to panic; no need to hoard food or supplies. Scientists and researchers around the globe are working to address the issue. Soon, we will return to the normalcy of our lives.

If you have cancer, however, the coronavirus (COVID-19) has the potential to further affect your already compromised immune system. Now is the time to ramp up your self-awareness.

Coronaviruses usually cause an upper-respiratory tract illness, as you’d have with a cold, but not everyone will get sick. Still, like the flu virus, some people are more at risk, and more severe issues can develop.

With COVID-19, older adults and those with underlying health conditions seem to be at higher risk. These include patients with cancer (including those who have undergone a bone marrow transplant), cardiovascular disease, chronic kidney and lung diseases, and diabetes. However, we cannot predict to what degree of danger the virus, or any influenza virus, will be to the population. A deeper understanding of the biological and epidemiologic levels is needed. [1]

“The early data from China, and reports from the ground in Italy and other sites of local transmission is that our cancer patients are going to be at increased risk,” said Dr. Steve Pergam, a clinical and infectious disease researcher at Fred Hutchinson Cancer Research Center. [2]

How to ‘flatten the curve' on COVID-19

Cancer Tutor spoke with two health care professionals on the front lines at one of the United States’ foremost cancer centers. One is an emergency room doctor, the other a nurse in the intensive care unit. Both spoke on the condition of anonymity and were not authorized to discuss the coronavirus publicly on behalf of the hospital.

“The concern for this virus is that a lot of people are asymptomatic for two weeks before feeling bad,” the ER doctor said. “Even if we’re young and healthy, even if there’s no concern for that person becoming critically ill from this virus, there’s a lot of common sense in social distancing. You could get [the coronavirus] from someone, not know that you have it, and be walking around for two weeks before you start to have flu-like symptoms. I think social distancing is smart.

“Just practice avoiding crowds. If you’re a cancer patient, still wear a mask, especially around grandchildren; they might be carriers of the virus. Be very cautious about going out into public, mixing with a lot of other people.”

As the spread of coronavirus intensifies, researchers continue to chase a vaccine. The National Institute of Allergy and Infectious Diseases announced March 16 that a Phase I trial had given a dose to its first participant. [3]

So, how did we reach the pandemic stage? One day we’re checking off our to-do lists, sitting in conference rooms, jetting around the country for business and pleasure. The next day, the president is surrounded by serious-looking faces telling us the coronavirus is “bad” rolling out a 15-day plan designed to flatten the curve of further infection.

COVID-19 Timeline

On Dec. 31, 2019, the World Health Organization’s China Country Office learned of pneumonia in the city of Wuhan in Hubei province, China. Authorities noted some of the patients were vendors in the Huanan seafood market.

A large hub that connects all regions of China via a major international airport and railways, Wuhan, China’s location played a role in the eventual spread of the coronavirus. Officials also note the outbreak came during the Chinese (Lunar) New Year, and the congregation of people celebrating enabled the virus to spread globally.

The first confirmed case of COVID-19 outside of China came on Jan. 13, 2020, in Thailand. The WHO called for active monitoring and urged other countries to prepare for the novel coronavirus. Ten days later, the outbreak had spread to Korea, Japan, and Singapore.

On Jan. 22-23, the WHO convened the Emergency Committee to examine the coronavirus outbreak. Considering COVID-19’s restrictive and binary nature, the committee decided it was too early to declare a Public Health Emergency of International Concern.

A week later, on Jan. 30, WHO Director-General Dr. Tedros Adhanom Ghebreyesus declared the outbreak a PHEIC. The committee noted that early detection (testing), isolating and treating cases, contact tracing, and social distancing measures work to interrupt virus spread.

Emphasizing that the probability to contain the outbreak is “narrowing,” Dr. Ghebreyesus on Feb. 21 urged the international community to act quickly. “We must take advantage of the window of opportunity we have to contain the outbreak,” he said. “We don’t want to look back later and regret failing to act.” The world reached 100,000 cases on March 7.

On March 11, the WHO officially declared COVID-19 a pandemic. Dr. Ghebreyesus noted, “Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear or unjustified acceptance that the fight is over, leading to unnecessary suffering and death. … We have never before seen a pandemic sparked by a coronavirus. This is the first pandemic caused by a coronavirus. And we have never before seen a pandemic that can be controlled, at the same time.” [4]

Protect yourself from the coronavirus

The U.S. Center for Disease Control suggests everyday ways to help protect yourself: [5]

Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing, or having been in a public place.
If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
To the extent possible, avoid touching high-touch surfaces in public places – elevator buttons, door handles, handrails, handshaking with people, etc. Use a tissue or your sleeve to cover your hand or finger if you must touch something.
Wash your hands after touching surfaces in public places.
Avoid touching your face, nose, eyes, etc.
Clean and disinfect your home to remove germs: practice routine cleaning of frequently touched surfaces (for example tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks & cell phones)
Avoid crowds, especially in poorly ventilated spaces. Your risk of exposure to respiratory viruses like COVID-19 may increase in crowded, closed-in settings with little air circulation if there are people in the crowd who are sick.
Avoid all non-essential travel, including plane trips, and especially avoid embarking on cruise ships.

Cancer patients with compromised immune systems take precautions with their everyday lives. “Our cancer patients are already so careful knowing they have a compromised immune system in the first place,” said the ICU nurse that Cancer Tutor interviewed said. “Already in the habit of washing their hands, getting away from sick people, staying away from crowds. If they have a fever, they’d go to the ER. They’re cautious with all of those things.

“The coronavirus attacks the lungs and causes lung inflammation, acute respiratory distress, and the possibility of respiratory failure,” the nurse added. “The big issue that hospitals are preparing for right now is the possibility of an overwhelming patient population that needs a ventilator. Most hospitals have 30 to 40 ventilators, and then if you do have a surge of people that are in acute respiratory failure and need to be on a ventilator, you’re going to have an issue with supply and demand.”

Furthermore, a study released in February – The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned? – concluded that governments are not fully utilizing technology for mapping the spread of infections. [6]

While the worldwide distribution of vaccine doses increased from 262 million in 2004 to 486 million in 2015, only 5% of the doses distributed in ’15 were shared among Africa, Eastern Mediterranean, and Southeast Asia regions, which makes up 48.5% of the population surveyed.

Nutraceuticals to improve immunity

For COVID-19, a leading cause of death is acute respiratory distress syndrome (ARDS), caused by pro-inflammatory immune cells in the respiratory tract.

These immune cells are doing what they are supposed to do: fight the infection. However, inflammation can be a life-threatening problem for some people.

Nutraceuticals – a food or dietary supplement believed to provide health benefits – have been shown to improve health, prevent chronic diseases, and support the body’s functions. [7]

In recent years, nutraceuticals have become more prevalent because of their potential nutritional, safety, and therapeutic effects.

There are nutraceuticals to combat COVID-19. These products help to reduce or shut off the body’s inflammatory immune response:

Curcumin

The primary active ingredient in turmeric
A potent anti-inflammatory, antioxidant effects
Interferes with viral cellular processes, prevents viral replication

Epigallocatechin Gallate (ECCG)

Catechin (natural antioxidant) found in green tea
Inhibits the binding of an essential viral protein to cell-surface molecules
Binds to the viral envelope, inhibits transcription of the virus

Glutathione And N-Acetyl Cysteine (NAC)

An amino acid that helps the body replenish glutathione
Glutathione is an antioxidant that strengthens cells and builds the immune system
NAC also inhibits virus replication (fights off viral infections)
Reduces inflammation in airways, acts as an expectorant

Melatonin

Helpful for anti-inflammatory effects in the body
It may be effective at increasing immune function
Decreases pro-inflammatory cytokines

Palmitoylethanolamide (PEA)

A fatty acid amide is naturally produced when the body battles inflammation
Relieves symptoms associated with influenza and the common cold

Quercetin

A flavonoid with antioxidant benefits
Helps reduce various kinds of inflammation
As an antiviral, interacts with specific viral proteins, inhibits viral entry into cells

Specializing Pro-Resolving Mediators (SPMs)

Derived from polyunsaturated fats (omega-3 fatty acids)
Critical in switching off an inflammatory response

Vitamin C

Ascorbic acid (aka ascorbate) is an antioxidant essential for the growth and repair of tissues
Strengthens the capillaries that carry oxygen, nutrients to all parts of the body
Vitamin C supplementation can prevent and treat systemic infections

Vitamin D3

May decrease pro-inflammatory cytokines in lung tissue
Triggers the release of peptides that destabilize the viral envelope
Promotes respiratory health and immune system benefits

Vitamin B3 (Nicotinamide)

Niacin is an antioxidant
Helps regulate cholesterol levels
Can potentially reduce lung inflammation by inhibiting the immune response of neutrophil infiltration into the lungs

Zinc

An antioxidant that boosts immunity by reducing oxidative stress
Vital in the function of T cells (white blood cells, a key to immunity)
May help inhibit the release of pro-inflammatory cytokines (proteins important in cell signaling)

‘Better to be safe than sorry'

“Influenza causes a huge preventable disease burden every year in all countries,” said lead author Dr. Abraham Palache. “Immunization with currently available safe and beneficial vaccines can reduce a considerable fraction of the annual influenza-associated disease and mortality burden. … Many patients suffer from preventable influenza-associated disease, including exacerbation of underlying noncommunicable diseases.”

Dr. Kathryn Edwards from the Vanderbilt Vaccine Research Program at Vanderbilt University School of Medicine in Nashville, Tennessee, added, “These data suggest that we’re not reaching the influenza vaccine targets proposed by the WHO.

“Why are the poorest countries not putting their vaccination money into influenza vaccines? To have granular data from each country and the impact of influenza in each country would be helpful to convince policymakers of the importance of influenza. Deficiencies exist in knowing the burden of the disease and its impact in every country.”

We do not know which virus will cause the next pandemic. Likewise, we cannot rapidly develop and deploy a vaccine against a pandemic virus. We can, however, do our part to stem the tide against the spread of the coronavirus.

Unfortunately, this also applies to loved ones. Hospitals are implementing one-visitor rules during the pandemic. This can be hard on family members who may be anxious to see a loved one who is near death.

“Especially in an ICU setting where they're feeling really sick and possibly at the end of their life,” noted the ICU nurse. “They don’t understand because, ‘Oh well, they’re dying or toward the end of their life, we should all be able to come into the room.’ It’s doing more harm to the patient.

“It’s a lot of family and patient education regarding [COVID-19]. It is an airborne virus and anybody that has it, you can breathe in that space and they can catch it. People always think it will never happen to me until it does, so better to be safe than sorry with most things.”