What are my mother's health risks during COVID-19?
April 14, 2020 12:14 PM Subscribe
My 80-year old mother is scheduled to start chemotherapy at the end of the month. She lives in NYC, in Manhattan. Please help me understand her risk of contracting and dying from COVID-19.
My mother will be in quarantine during the three months of her treatment only emerging from her apartment during her chemotherapy sessions 4 cycles of TC, and possibly for testing for low white blood cells (still confirming that). Right now the plan is for her to walk 15 blocks to her treatment wearing a mask and gloves. She is a normal weight, healthy and active. She was a heavy smoker for 17 years during her teens to early 30s, but has not had any pulmonary issues. Her only underlying condition is stage 1 breast cancer — no evidence of spread. Unfortunately the type of cancer is quite aggressive with a 15% chance of reoccurrence within the next 5 years so the three oncologists consulted all agree that chemotherapy is necessary, and that it needs to be done now and cannot be postponed or it will lose efficacy.
Forgive these basic questions —
1. Will her immunocompromised state make it easier for her to catch COVID-19? For example, is she more likely to catch it from passing someone on the street or a package under treatment than right now pre-treatment?
2. If she catches COVID-19, is she more likely to die from it because of her chemotherapy? Is her catching COVID-19 a death sentence?
3. You are not my doctor or her doctor, but if you are a doctor or medical professional, would you consider foregoing chemotherapy treatment at this time as the risks of COVID-19 are too great for her age group?
4. What questions would you ask the facility and her doctors that are treating her in terms of safety and contingency planning?
My mother is still on the fence about proceeding with the chemotherapy. We would love to have a sophisticated risk assessment of metastasis vs. dying from COVID-19, and theoretically I assume that is being done by her oncologists. However, two of the oncologists shook our hands a week before NYC was put under lockdown (!!!) and reassured us that COVID-19 would not be an issue for NYC (the third was post lockdown and a virtual call). I am thus having difficulty trusting their risk assessment as I think they are primarily focused on her cancer treatment, which is understandable. Thank you for any input!
My mother will be in quarantine during the three months of her treatment only emerging from her apartment during her chemotherapy sessions 4 cycles of TC, and possibly for testing for low white blood cells (still confirming that). Right now the plan is for her to walk 15 blocks to her treatment wearing a mask and gloves. She is a normal weight, healthy and active. She was a heavy smoker for 17 years during her teens to early 30s, but has not had any pulmonary issues. Her only underlying condition is stage 1 breast cancer — no evidence of spread. Unfortunately the type of cancer is quite aggressive with a 15% chance of reoccurrence within the next 5 years so the three oncologists consulted all agree that chemotherapy is necessary, and that it needs to be done now and cannot be postponed or it will lose efficacy.
Forgive these basic questions —
1. Will her immunocompromised state make it easier for her to catch COVID-19? For example, is she more likely to catch it from passing someone on the street or a package under treatment than right now pre-treatment?
2. If she catches COVID-19, is she more likely to die from it because of her chemotherapy? Is her catching COVID-19 a death sentence?
3. You are not my doctor or her doctor, but if you are a doctor or medical professional, would you consider foregoing chemotherapy treatment at this time as the risks of COVID-19 are too great for her age group?
4. What questions would you ask the facility and her doctors that are treating her in terms of safety and contingency planning?
My mother is still on the fence about proceeding with the chemotherapy. We would love to have a sophisticated risk assessment of metastasis vs. dying from COVID-19, and theoretically I assume that is being done by her oncologists. However, two of the oncologists shook our hands a week before NYC was put under lockdown (!!!) and reassured us that COVID-19 would not be an issue for NYC (the third was post lockdown and a virtual call). I am thus having difficulty trusting their risk assessment as I think they are primarily focused on her cancer treatment, which is understandable. Thank you for any input!
Even if she can walk 15 blocks now, you might want to look at backup plans in case the chemo induces fatigue.
Hang in there. I'm sorry you two are going through this.
posted by kate4914 at 1:31 PM on April 14, 2020 [6 favorites]
Hang in there. I'm sorry you two are going through this.
posted by kate4914 at 1:31 PM on April 14, 2020 [6 favorites]
My husband is undergoing cancer treatment during all this. Different demographic and different cancer, as you might guess. His oncologist is basically locked in a struggle with her hospital where she has to aggressively defend her case for her patients to get in-hospital treatment and scans. So although your mom’s oncologists are not infectious disease experts (hence the bad predictions about COVID-19), I bet they are now having to defend their decisions to the infectious disease folks. And you should be able to ask about this! You might even be able to talk to an ID doctor yourself. If the oncologists don’t say something like, “we’ve had to pause treatment for a lot of our patients because of COVID but it's important for you mom to come in because $REASONABLE_REASONS” I would be cautious. But I bet they have OK reasons.
The atmosphere and precautions at the cancer center where my husband goes (in Boston) have changed dramatically over the past 4-6 weeks. A radiation oncology nurse gave me a hug in early March and I was a bit surprised. Now I’m not allowed in that part of the building. In mid-March they were handing out green plastic beads for Saint Patrick’s Day at the infusion center - two weeks later there were no decorations anywhere. Our favorite admin was furloughed because so few patients are coming in to the cancer center.
FWIW my husband hasn’t gotten COVID-19 but he’s recently been hospitalized (intubated, even!) for opportunistic infections. I have really been more worried about him needing a ventilator during a surge period than about him getting COVID per se. Chemotherapy, radiation, etc. are dangerous even without a pandemic.
posted by mskyle at 1:35 PM on April 14, 2020 [1 favorite]
The atmosphere and precautions at the cancer center where my husband goes (in Boston) have changed dramatically over the past 4-6 weeks. A radiation oncology nurse gave me a hug in early March and I was a bit surprised. Now I’m not allowed in that part of the building. In mid-March they were handing out green plastic beads for Saint Patrick’s Day at the infusion center - two weeks later there were no decorations anywhere. Our favorite admin was furloughed because so few patients are coming in to the cancer center.
FWIW my husband hasn’t gotten COVID-19 but he’s recently been hospitalized (intubated, even!) for opportunistic infections. I have really been more worried about him needing a ventilator during a surge period than about him getting COVID per se. Chemotherapy, radiation, etc. are dangerous even without a pandemic.
posted by mskyle at 1:35 PM on April 14, 2020 [1 favorite]
My Love has chemo every two weeks. His Cancer is his cancer not your moms but like mskyle above, the protocols have changed. We do treatment at Emory in Atlanta. He now gets blood drawn, sees the doctor and starts infusion in the same room. No moving office to office. I cannot go with him anymore. I drop him off and pick him up because getting Chemo wears him out. This week his chemo is delayed because a tech tested positive. I’m a bit concerned they will keep the infusion center closed.
His drugs include some that make getting an infection more likely. But we have been taking precautions well over a year as is, we just tightened down more. His outside interactions with others is very limited, mostly just medical staff.
We know the risks, but if he does not do chemo, his tumors grow, so he will go until they make him stop or his tumors outgrow the chemo.
posted by ReiFlinx at 2:30 PM on April 14, 2020 [1 favorite]
His drugs include some that make getting an infection more likely. But we have been taking precautions well over a year as is, we just tightened down more. His outside interactions with others is very limited, mostly just medical staff.
We know the risks, but if he does not do chemo, his tumors grow, so he will go until they make him stop or his tumors outgrow the chemo.
posted by ReiFlinx at 2:30 PM on April 14, 2020 [1 favorite]
> Is her catching COVID-19 a death sentence?
COVID-19 is an extremely dangerous disease for older people with existing medical conditions, and I don’t want to play down the risk, but it is not a death sentence.
Most studies have found about 85% of people over 80 years old with confirmed COVID-19 infections recover from the disease. This March 30th paper in The Lancet estimates that, if you account for undetected infections, about 92% of all infected people in this age group may survive the infection.
This April 3rd CDC report found that, of the 264 immunocompromised people in their sample who tested positive for the coronavirus, 141 (about 53%) were not hospitalized for it, and only 41 (about 15%) were admitted to intensive care.
Your mother, being in both risk groups, has a higher risk than either group as a whole. You are right to be extremely cautious. Preventing an infection should be a very high priority. But I hope it also gives you some comfort that many people who catch COVID-19, even in the highest risk groups, do recover from the disease.
posted by mbrubeck at 2:35 PM on April 14, 2020 [7 favorites]
COVID-19 is an extremely dangerous disease for older people with existing medical conditions, and I don’t want to play down the risk, but it is not a death sentence.
Most studies have found about 85% of people over 80 years old with confirmed COVID-19 infections recover from the disease. This March 30th paper in The Lancet estimates that, if you account for undetected infections, about 92% of all infected people in this age group may survive the infection.
This April 3rd CDC report found that, of the 264 immunocompromised people in their sample who tested positive for the coronavirus, 141 (about 53%) were not hospitalized for it, and only 41 (about 15%) were admitted to intensive care.
Your mother, being in both risk groups, has a higher risk than either group as a whole. You are right to be extremely cautious. Preventing an infection should be a very high priority. But I hope it also gives you some comfort that many people who catch COVID-19, even in the highest risk groups, do recover from the disease.
posted by mbrubeck at 2:35 PM on April 14, 2020 [7 favorites]
I know someone getting chemo in Manhattan right now. Luckily most hospitals with chemo/cancer facilities here are strictly separated from ICU etc facilities. The reports from my friend are that they have an aggressive cleaning process, screening for fever etc before entry, masks everywhere. So in terms of the facilities, they're doing their absolute best to keep things safe for patients, and I would not be worried about that part of the experience.
posted by ch1x0r at 5:51 PM on April 14, 2020 [1 favorite]
posted by ch1x0r at 5:51 PM on April 14, 2020 [1 favorite]
My uncle has pancreatic cancer and tested positive for covid-19 while hospitalized for a different infection a couple of weeks ago now. The hospital released him home since his case was mild.
Granted, he is now in hospice care, but that is a decision the family was considering before the virus, since the balance between how well his chemo was working and how sick it was making him had been changing.
He is in his mid 70s and had a mild case of covid while immunocompromised and ill. So that is one possible outcome.
Wishing you and your mother well as she begins treatment.
posted by Lawn Beaver at 7:10 PM on April 14, 2020 [1 favorite]
Granted, he is now in hospice care, but that is a decision the family was considering before the virus, since the balance between how well his chemo was working and how sick it was making him had been changing.
He is in his mid 70s and had a mild case of covid while immunocompromised and ill. So that is one possible outcome.
Wishing you and your mother well as she begins treatment.
posted by Lawn Beaver at 7:10 PM on April 14, 2020 [1 favorite]
Here is a pretty good recent summary of what epidemiologists and health researchers know about this issue so far. Unfortunately, it's hard to apply population-level information to an individual person's risk, but hopefully this will help explain the evidence as well as the gaps in the evidence.
posted by acridrabbit at 2:21 PM on April 15, 2020
posted by acridrabbit at 2:21 PM on April 15, 2020
Response by poster: I cannot thank you enough for your thoughtful and detailed responses! They have been tremendously reassuring to my mother and me. For those of you with loved ones under treatment, or who are under treatment currently, I wish you and yours best of luck during this difficult time.
posted by cardamom at 5:46 AM on April 16, 2020 [1 favorite]
posted by cardamom at 5:46 AM on April 16, 2020 [1 favorite]
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I have been going to the cancer center for infusions, and they are extremely careful to keep things as safe as possible. They seem to have changed the protocols some every time I go in. I would ask the center what they have put in place to keep people safe. My own center has stopped all nonessential appointments, for instance, so the waiting rooms are pretty empty. They have hand sanitizer stations all over the place. They also give masks to everyone who comes in the building. They seem to go back and forth on allowing people to accompany patients. I've gotten calls saying I have to go in by myself, then arrived to find people who brought in friends or family members.
You might want to consider joining smartpatients.com. They have communities for different diseases - so you could join the breast cancer community (mine includes patients, caregivers, and relatives) and ask people what their doctors are saying. I'm sure there are lots of threads about this right now - it's mostly what people are talking about on the board for my cancer.
This is a hard time to be a cancer patient. Best of luck to you and your mom.
posted by FencingGal at 1:15 PM on April 14, 2020 [4 favorites]