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 as per reports. While all individuals have to take basic precautions to curtail the spread of the infection, and break the chain of transmission, 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.

Q.1 What is corona virus or COVID 19?

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

Q.2 What are the symptoms and are they different from the common cold?

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.

Q.3 What is the treatment for the infection? Is there any medicine that can be taken to reduce the risk of catching the infection?

As for other viral infections like the common cold, the treatment is rect and adequate hydration. Only symptomatic treatment for fever in the form of Paracetamol if fever is> 100 degree F.As of now there is no specific treatment for the infection. Nor is there any medicine to reduce the risk of catching the infection.

Q.4 Why is this virus so much of a concern if symptoms are the same as common cold and most of the patients would be fine on their own?

What makes this virus different from others is its ability to stay on nonliving things for several hours to upto 9 days. So one person infected and infect an exponential number of other people without even being in contact with them. Infectivity is also higher than the common cold. And it can cause severe infection in few patients which may need hospitalisation, and ICU admissions as well.

Q.5 How does it spread from one person to the other?

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.

Q.6 How can the infection be prevented?

These are the general precautions to be taken for everyone including cancer patients.

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. 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 few hours.

Mask worn by normal asymptomatic people wearing will not prevent them from any infection.

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 sanitisation. This should be done as frequently as hourly.

Avoid hand shakes. BETTER TO GO THE INDIAN NAMASTE STYLE IN CURRENT SITUATION.

4. SOCIAL DISTANCING

Avoid crowded places like malls, theatres, restaurants, functions, marriages, birthday parties, religious places, schools, colleges. Even in a group of people maintain a distance of atleast a meter between you and others.

Avoid travel for non emergency things like shopping, entertainment or enjoyment.

Restrict travel to emergency work and medical care or groceries at the most.

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 take the infection home.

Q.7 Why is social distancing required if someone is not infected or not having any symptoms?

Social distancing will prevent the infection from getting spread to other people as well as other non living things which can in turn spread it further. A person may be carrying the infection and not showing any signs of it in the incubation period (2-15 days).So it is very important to avoid any kind of grouping, gathering, crowded place for any reason.This is the only way to break the chain as this is a highly infectious virus. Even when visiting a doctor, please go when it is absolutely necessary and that too with minimum number of relatives, preferably only one. Try to stay away from the crowd. This will also help in preventing doctors and other health care professionals from the infection as their infection would then get transmitted to all patients and caregivers coming to see them.

Q.8 What is SELF Quarantine? How is it different from staying at home only?

If you have a travel history to or from abroad in 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.

Quarantine or isolation of an exposed or suspected COVID person who is presently asymptomatic in the house done by self is Self Quarantine.This includes avoiding close contact with other family members, segregation of bed, clothes, linen, utensils and other usable 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 metre to be kept from other family members. Stay away from pregnant, elderly and children and keep taking the other precautions as for non exposed people. Should wear a surgical mask. Masks should then be disinfected before destroying by burial or burning.

SELF QUARANTINE Guidelines form the MOHFW (MINISTRY OF HEALTH AND FAMILY WELFARE) are available and should be followed.

Q.9 What are the precautions to be taken by caregiver of an exposed or suspected COVID infected or COVID positive person?

Care of the person in isolation or Self quarantine should be taken by a single assigned person only. Linen should not be shaken or touched with skin. Disposable gloves should be worn when handling linen, and hands to be washed after removing gloves. No visitors to be allowed. In case the person being quarantined becomes symptomatic, all his family members in close contact will be quarantined for 15 days till reports become negative.

Q.10 Who are the people that are more predisposed to the infection?

CORONAVIRUS infection is more relevant for a few groups of people which includes

  1. Elderly
  2. With other diseases like diabetes, hypertension, Lung diseases, Cardiac problems
  3. Smokers as their lungs are already damaged
  4. Patients who have had surgery involving their lungs, or received radiation to their lungs
  5. Patients on cancer chemotherapy at present or in previous 3 months
  6. Patients on immunosuppressive drugs
  7. Patients of cancer on some immune check point inhibitors (discuss with you doctor)
  8. Patients taking targeted cancer treatments that affect the immune system (discuss with your doctor)
  9. Patients who are undergoing bone marrow transplant or a have undergone transplant
  10. Patients who have undergone any organ transplant and are taking immunosuppressive therapy

Q.11 Are there some more precautions to be taken by these people apart from the general precautions?

  1. They have to be very strict in general precautions and refrain themselves from any travel or gathering all together.
  2. 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.
  3. 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.
  4. Patients who have not started their radiation yet, should discuss with their radiation Oncologist if it would be fine to delay the treatment.
  5. 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.

Q.12 Are there any special food items that can be taken to prevent infection or boost immunity or help in early recovery?

There is no magic food that can help in rapid recovery. As a general rule, your diet should be balanced, healthy and hygienic. Take freshly prepared home made food. Do not eat food from outside or ordered from outside. Wash fruits and vegetables before consumption.

It’s a matter of weighing the risk of the disease progressing without treatment versus benefit of preventing further immunosuppression to avoid a 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 travelling 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 of the cases. In those who experience breathing difficulty or when symptoms are worsening or not improving after 7 days as well, contact your doctor.

It is an infection with high infectivity and only awareness, proper hand hygiene and social distancing can break this vicious circle.

Dr.Aditi Aggarwal
MD( Radiation Oncology) PDCR
Senior Consultant
Radiation Oncology
Paras Hospital Gurgaon
Ex Faculty NCI-AIIMS (Jhajjar)