March 31, 2020
Cancer patients are uniquely vulnerable to infectious diseases like COVID-19, which is caused by the coronavirus. For this reason, leaders of The University of Kansas Cancer Center have determined necessary precautions for patients of our cancer center. Taking these steps will reduce the risk of infection.
To protect our patients and staff from infection, we have implemented the following guidelines for all of our locations:
- Cancer patients and caregivers should avoid all domestic and international travel involving public transportation. Review the CDC-recommended travel precautions.
- Cancer patients and caregivers should not participate in any local, regional and/or national meetings, conferences and other large gatherings. Instead, we encourage you to participate in these events using virtual technology, if possible. Meetings and events organized by the cancer center are currently being rescheduled.
- To reduce the risk of infection, only employees of the cancer center, health system and medical center who are involved in patient care may enter our patient care facilities. Vendors and guests who are not accompanying patients may not enter until further notice.
- For ongoing quality, efficiency and convenience, we are transitioning some appointments to telehealth visits. Learn more about our telehealth services.
Patient, staff and visitor guidelines
To protect our patients and staff from infection, we have implemented the following guidelines:
All patients and staff at cancer center facilities in the Kansas City area
- We have implemented temperature screenings upon entry into our facilities.
- We have reduced points of entry at some locations to direct all arriving visitors to a screening station where someone will take your temperature.
- Every person arriving at our facilities – including employees – must receive a temperature screening before entering.
Patient screening process at registration/arrival
Our staff will ask:
- If you have any symptoms, including fever, cough and difficulty breathing
- If you have you traveled recently or have been in close contact with a person known to have COVID-19
Outpatient visits at our cancer center clinics throughout the health system
For most patients, no visitors are allowed. Exceptions include:
- 1 parent or guardian for patients younger than 18
- 1 support person for patients with disabilities or impairments
We encourage family and friends to return home to await news of their loved one or wait outside in their vehicle.
Anyone who has a fever or other cold or flu-like symptoms will not be allowed in our facilities. Unless you have a scheduled pediatrics appointment, no one under age 14 will be allowed in the clinic until further notice.
Thank you for your understanding and patience as we work to protect the health and safety of our patients, staff and visitors during this unprecedented time.
Bench To Bedside: COVID-19
Dr. Jensen: Dr. Hawkinson, thanks so much for joining us this morning.
Dana Hawkinson: Hi, thank you.
Dr. Jensen: Could you first tell us about the current state of the virus, not only here locally, but nationally, perhaps. What are the risks? What do we know? What do we don't know? And how are things changing?
Dana Hawkinson: Yeah. As a quick overview of novel coronavirus, or SARS-CoV-2, obviously most people know this, this was a virus, an infection that was discovered originally in December 2019 in China. There were multiple infections there continued to be widespread infection, and now it's reached around the globe.
Dana Hawkinson: At this point in time, there is not a lot of, or any, local spread in the United States. There are some communities that have had person to person and community spread, but this number and these infections are changing day by day. So a lot of what we're saying is, at this point in time at the current state.
Dana Hawkinson: This virus is similar to the SARS virus, which was originally discovered in 2002. It has about 70 to 80% homology with that virus. That means it's really similar. In most people, in 80% of people, it causes very mild illness in which you don't need hospitalization. It doesn't really seem to affect children or patients under the age of 19. In fact, I think it's about 2% of cases or less from the published reports.
Dana Hawkinson: But in general if we're talking about other patient populations, such as anybody with underlying co-morbid illnesses such as heart failure, diabetes, underlying lung disease, and of course any neoplastic or oncologic disease, certainly they can develop and progress to severe disease in a higher probability than other patients who don't have those underlying diseases.
Dr. Jensen: So, Dr. McGurk in regards to cancer patients, which ones would you say are at greatest risk for major complications for COVID-19? I suspect that the many of the patients that you care for fall into that category.
Dr. McGurk: Yes, very much so. And so many of our therapies compromise the immune system and particularly in the blood cancers where it's the immune system itself, and parts of it, that are cancerous, and so we suppress the immune system on purpose. And that sets our patients up for risk for infections, including this organism as well.
Dr. McGurk: Many of our patients who are of advanced age, and that in and of itself appears to be a risk factor for the acquisition and becoming quite ill in a threatening way with this virus, and patients who have received in general, beyond those particular populations, bone marrow transplant, blood cancer patients, but even solid tumor patients who are actively receiving, or relatively recently have received, chemotherapy, those are vulnerable populations of patients in particular with this virus.
Dr. Jensen: So Dr. Hawkinson, what is your general advice for cancer patients in regards to exposure to this virus and how to prevent that?
Dana Hawkinson: Yeah. First of all, I want to say I echo everything that Dr. McGurk has said. It's all absolutely true. As far as protecting yourself, again, individual vigilance has been most important and that includes appropriate hand washing. Certainly in populations that are older or have the underlying cancer diagnoses, are on chemotherapy. Trying to social distancing, keeping yourself not necessarily isolated or quarantine, but trying to avoid areas where there's mass groups or mass gatherings. This includes anything from possible sports events to bus stations, to airports, sometimes even grocery shopping or.
Dana Hawkinson: churches. It's important to understand those risks and in doing so also because we are touching surfaces all the time, door handles, railings, and this disease is really caused by droplets but also fomites, which are inanimate objects such as high touch surfaces. We touch those surfaces and then we're touching our eyes, our nose, or mouth. That is the main ways that we are able to contract this disease.
Dana Hawkinson: So staying vigilant in hand hygiene. Trying to avoid putting your hands in your eyes, nose, mouth. Social distancing as much as possible. Those are really the main ways that we can stay healthy, especially if we do have underlying malignancy or chemotherapy or otherwise immunocompromised state.
Dana Hawkinson: And again at this point in time locally, it doesn't seem like there's community spread, but things can change rapidly in the next week, in the next two weeks, three weeks, and so it's important to stay vigilant on the news, keeping up with the accurate websites, such as the CDC, and the Kansas Department of Health, and local health departments for their news and advisories on travel and other things to do to protect yourself.
Dr. Jensen: So that advice sounds very similar to what we're giving to the general public. I'm sure that one of the specific questions a cancer patient has is around their appointments and coming in to see the physicians. Is there any advice around that situation that either one of you have? Say in the first case where someone is just concerned about being exposed to the virus, and in the second case where they may be exhibiting symptoms that caused them to be concerned?
Dana Hawkinson: Yeah, I'll just start by saying as an individual you are probably more at risk of complications or problems by not seeing your physician. So if you think there are issues, absolutely call the clinic, absolutely call the physician, and try to get some guidance at that point. Because there are other things out there as well. And again, locally there's not a lot of community spread. The disease rate is not high for COVID-19. But there are certainly other things that are still important and can cause severe illness.
Dana Hawkinson: Influenza activity around here is still very high. We diagnose multiple cases of influenza every day here at the health system, both in the inpatient setting and outpatient setting. So individually, I would say, continue to be vigilant, talk with your provider, get good guidance, and by all means, if it's safe and you've talked with your provider, please come into your clinic visit because missing a clinic visit could be even worse. And I'll let Dr.McGurk speak on the global issues with [crosstalk 00:07:08].
Dr. McGurk: I completely concur. That's exactly right. And that is the straightforward, sensible advice, to contact the treating team, the healthcare team. There are, as Dr. Hawkinson just mentioned, the majority of our patients who have respiratory viral symptoms, and it's common that this time of year, we see these patients every day in our cancer center and our bone marrow transplant clinic, are influenza, respiratory syncytial virus, parent influenza, and some of these viruses can be very aggressive in our population of patients. And we have effective treatments for some of them, not all of them. And so it's always critically important that we know about that and we can guide our patients in terms of coming in, taking special precautions, for example, in coming to clinic to minimize exposure to others, regardless of what type of virus it is, and then isolating those patients as soon as they come in so that we can investigate what's going on with them.
Dr. Jensen: Okay. Cameron, it looks like we have a question from our audience.
Cameron: Yes we do. The audience wants to know, can you have the flu and coronavirus at the same time?
Dr. Jensen: Dr. Hawkinson.
Dana Hawkinson: So initial reports, and anecdotal reports, and the data would suggest that with other infections, other viral infections, you certainly can have co-infections and sometimes those percentages of people that have co-infections can be fairly high. With COVID-19, and other infections such as influenza, it doesn't seem like there is a high rate of co-infection. So at this point in time, what we are telling patients is if you have tested positive for influenza, you're positive for influenza. There's at this point in time, no need to further test for COVID-19.
Dr. Jensen: So another question I think that we get pretty often is, what about traveling, or attending sporting events, or concerts, or large crowds, or things like that? What approach should cancer patients in particular take in regards to those types of events?
Dr. McGurk: We're currently, and be interested to hear what Dr. Hawkinson says about this approach, we're currently being very prudent and very conservative in our cancer center and recommending that our patients, and particularly those who are most vulnerable, patients in active treatment or relatively recent treatment, all of our patients with blood cancers that they not travel unless it's absolutely essential, and then that we help coordinate that effort for them. That they stay away from a large crowds of patients. That they even consider doing this particular time avoiding church. Going to the grocery store in the off hours.
Dr. McGurk: But as Dr. Hawkinson pointed out earlier, when they go to that grocery store, being mindful of what they're touching, keeping their hands away from their face, taking Purell, for example with them and washing their hands frequently. So some practical measures with regard to even our staff, our physicians. As you know, Dr. Jensen we've canceled and rescheduled a number of really important meetings that people worked all year long, because if our healthcare providers become ill, first and foremost, they won't be able to care for the patients that we need to be caring for. But secondly, they may have an asymptomatic phase and they can spread that virus potentially.
Dr. McGurk: So I think we're pulling out all the stops in our institution to mitigate a rapid expansion of this virus in our community. And part of that, self-imposed traveling restrictions, not just in our patients and their families, but also on our faculty, and not having large groups of people get together. This has been a very important issue over the last couple of weeks.
Dr. Jensen: So Dr. Hawkinson, could you talk a little bit about the steps that have been taken at our institution to really ensure that any patient that would come here to be treated for coronavirus is not only has the infrastructure and the support that they need, but also what we've done to protect our staff and our other patients from becoming infected with the virus.
Dana Hawkinson: Yeah. We have had a multidisciplinary approach at the health system for many years now to dealing with emerging infectious diseases. So we have had multiple service lines available to help to formulate plans. This includes emergency management, the emergency department, the supply chain, making sure we have enough supplies and resources to be used. We have protocols for bringing patients in in a controlled manner, getting the patients to the correct isolation or precaution rooms, and then thereby keeping our other patients safe as well as our healthcare providers.
Dana Hawkinson: And so we take that with utmost importance and we feel that we have worked on these processes and procedures for the past few years. We've tried to smooth them out as much as possible. We've been hoping for the best and preparing for the worst. And we continue to streamline these processes and this includes not only the hospital, but also the clinics, including Westwood Clinic as well.
Dr. Jensen: So sounds like we have a question from our audience.
Cameron: Yes, the audience wants to know, what should you do if you think you might be infected?
Dr. Jensen: Dr. Hawkinson.
Dana Hawkinson: What should we do if we think that you might be infected with COVID-19? The first thing to do is probably call your primary care provider, or your treating team, especially if you are one of the cancer center patients. Call the treating team first. Get some information from them.
Dana Hawkinson: At this point in time the testing is certainly done through the state and so any testing would be performed through the state and we would get the testing performed, should you need it. There are still screening criteria which we need to abide by, but I think the first thing to do is call the treating team, get information from them, and then they are able to relay it to the infection prevention team and we will determine should we be testing for COVID-19, or is it another illness?
Dana Hawkinson: And as Dr. McGurk pointed out, there are certainly other respiratory viruses still going on. There are still other illnesses out there. And so I think getting that information from your treating team, from your treating physician, is probably the first step.
Dr. Jensen: Okay. It looks like we have an additional question.
Cameron: Yes. Where should you go for more information about the coronavirus?
Dana Hawkinson: Well, the best places to go are accurate and informative websites. The best is probably CDC, so cdc.gov. Another important one is probably your State Health Department, whether it's Kansas Department of Health Environment or Missouri State Health Department. I would say start there because we all know that there's plenty of information out there on the internet, but those are probably the most reliable resources for COVID-19.
Dr. Jensen: So I think one of the most encouraging things that I've heard about the COVID pandemic is that there's been one report out of China, one report out of Seattle, that infection control protocols within healthcare systems work against this virus. And in the two reports that I'm referring to, and while this is early, there's been no transmission to healthcare workers that have taken the appropriate precautions, either in China or in Seattle, and so I think that that's an extraordinarily positive development.
Dana Hawkinson: Yeah. It certainly reinforces the fact that simple measures help constrain this virus. Simple measures such as hand washing, proper equipment, the gloves, the gowns, the droplet precautions. Again, it's important for us to keep our healthcare workers safe so they can treat ill patients and also keep other patients safe. And so I would agree 100% with what you said.
Dr. Jensen: So it sounds like we have another question.
Cameron: Yes. The audience wants to know, what are your considerations for the rural community regarding coronavirus?
Dana Hawkinson: The considerations for the rural community in COVID-19? Well, again, I think at this point there is not a large, or any, community spread around this area. The rural community still seems to be safe. Obviously being rural you are not interacting with many other people in general, so I think it's just a matter of keeping an eye on your own health and continuing to monitor for any community spread or activity of the virus at this point in time, and just monitoring.
Dr. Jensen: What about the prospects for a vaccine against COVID?
Dana Hawkinson: I know people are working on it. Labs are working on vaccination, as well as therapeutics. There are no treatments for this virus. At this point in time, that's probably at least one to two years away, I would suspect for a vaccine. For other therapies, those are currently in trials, either anecdotally or through government trials as well. But at this point in time, there's really nothing else to use other than supportive care.