By now, most cancer patients and their caregivers know the basic precautions they can take to minimize the risk of contracting the 2019 novel coronavirus (COVID-19). They may also have determined whether it’s safe to travel for treatment, and learned what protocols MD Anderson has put in place to protect them once they’re here.
But how does all of this affect patients who’ve had stem cell transplants? Are there any special considerations they should be taking into account while going about their daily lives?
We spoke with our stem cell transplant chair Richard Champlin, M.D., for insight into this unique patient population. Here’s what he had to say.
What are the risks of COVID-19 for stem cell transplant recipients?
These patients are more sensitive to infection than any other group, because the treatment itself destroys their own immune system, and replaces it with a donor’s. This is by design, of course, but it generally takes them a whole year to recover. And during that time, these patients have a severe immune deficiency, so even regular respiratory viruses — such as colds — are a problem.
We’re expecting a surge in cases of COVID-19 in the next few weeks, making it a major risk for our patients. Fortunately, not many stem cell transplant recipients have been infected with COVID-19 yet, but it’s going to happen more as the virus moves through the general population.
What are the most critical times for stem cell transplant recipients to avoid infection?
The first three months after a transplant are the most critical period. That’s why we have very strict rules about our patients staying within a 30-minute drive of MD Anderson. We want to monitor them very closely during those first 100 days, so we can treat them immediately if they start showing any signs of infection.
The immune system can’t respond effectively to threats for the first six months after a transplant, which is why recipients don’t start getting immunizations until then. They’re the same type of shots that babies get, only the adult versions, and they get three sets of them over a 1-year period.
The immune system is slowly recovering day by day, but we’re most concerned about COVID-19 during the first six months.
What can stem cell transplant recipients do to minimize their risk of COVID-19 exposure?
Double down on social distancing. Really take it seriously. Stay at home, and avoid contact with other people, especially large groups.
Before COVID-19, we were more liberal about letting patients get out and about after a transplant. We still advised them to avoid crowds, of course, but they could go to the grocery store or even to an outdoor sporting event, provided it was held in an open-air stadium. Now, we want them to hunker down and avoid contact, even with small groups of people.
Also, don’t travel, especially by airplane, and avoid cruises. If you absolutely must travel, do it by car. Planes themselves are not the issue: it’s the crowds at the airport that are more of a concern, whether in baggage claim or the waiting areas.
We realize that everyone needs some form of companionship. But we urge our stem cell transplant patients to minimize physical contact. We all exchange germs whenever we shake hands. So bump fists or elbows instead.
And finally, wash your hands frequently, and try not to touch your face. The virus can’t permeate the skin, but it can be transmitted through the eyes, nose and mouth. So, don’t rub those.
What extra steps is MD Anderson taking to protect these patients?
We are trying to limit their clinic visits so they spend the least amount of time possible around other patients and people who may have virus.
For the first three months after a transplant, patients typically return to the clinic twice a week for check-ups. So, we’re reviewing our options for telemedicine or remote interactions.
When should stem cell transplant recipients be tested for COVID-19?
We recommend that transplant patients be tested at the first sign of a respiratory infection. So, if you’re showing symptoms, contact your physician and get tested. If you have it, you need to be watched very carefully.
If you’re not showing any symptoms, don’t get tested. Taking a test when you’re asymptomatic won’t help you. We wouldn’t treat you any differently. And even if you’re negative today, you could still catch it tomorrow or next week.
What else should stem cell transplant recipients know?
The next few weeks are going to be a challenging time for all of us, because we expect the number of COVID-19 cases to surge. The virus is expected to be with us for at least the next year, and it poses a serious health threat.
We expect that it’s going to behave much like the flu, in that it mutates over time. It’s likely that the virus will look very different immunologically next year from the one that is circulating now. So, even if you contract the virus today and recover, you might be immune to that strain, but not the one that pops up six months from now, because it looks very different to your immune system.
Flu vaccines and antivirals like Tamiflu have markedly reduced the risks of dying from that disease, if patients are treated properly. And scientists are working very aggressively to develop a vaccine for COVID-19, too, as well as drugs to treat the infection.