Published on March 5, 2020

In my blog last week, I detailed the precautions myeloma patients should take in light of the outbreak of the novel coronavirus (COVID-19). People with myeloma have compromised immune systems and, as a result, are highly vulnerable to new infections. In recent days, there has been an increase in instances in the U.S. of “community spread,” the occurrence of cases for which the source of infection is unknown. As a result, concern about safety for myeloma patients has only intensified. 

With so much information about the coronavirus in the news, including the passage in Congress of an emergency $8.3-billion funding bill, I will focus on top-line recommendations to limit patients’ risk of exposure and ensure best outcomes for them. Then I will share the latest news reports that offer important insights into the global effort to combat the novel coronavirus. 

To reiterate last week’s guidance:

• Keep abreast of the most up-to-date news: The World Health Organization (WHO) and the U.S. Centers for Disease Control (CDC) websites are the best sources of the latest news about the coronavirus. The CDC’s directory of state and local health departments can provide additional, local guidance. The New England Journal of Medicine is publishing a free resource page featuring a collection of the latest COVID-19 clinical reports, management guidelines, and articles.
• Avoid non-essential travel
• Do not focus on masks. Masks limit you from giving infection to somebody else but are not so much protection for yourself.  (The N95 respirator face masks are essential gear for providers dealing with COVID-19.)
• Avoid people who are clearly sick; anyone coughing, for example.
• Wash hands thoroughly and frequently: Washing your hands with soap and water or using alcohol-based hand rub kills viruses that may be on your hands.
• An annual flu shot is always a good idea
• Stock up on medications, and food and water: Be prepared in case any concern develops about infection emerging among friends, family, or in the neighborhood, and local movement becomes restricted.
• Observe “social distancing”: Instead of greeting friends, family and colleagues by shaking hands, embracing, or kissing, substitute a touch the tips of elbows or tips of shoes.

Increased concern about the health and safety of myeloma patients has impacted the IMF’s immediate plans. This month’s Patient & Family Seminar in Boca Raton, Florida, has shifted from an in-person event to an online webinar format to ensure myeloma patient safety, while continuing our mission to provide patients with education and support. Bookmark this page to learn more about the March 14 webinar.

Coronavirus news updates
Several reports this week that I think shed considerable light on COVID-19:

• A comprehensive “Situation Report” compiled by WHO provides maps and figures for the total and new cases globally. Included are “Preparedness and Response” guidance, as well as recommendations, with many links and advice for the public. 
• Specific guidance for employers has been provided by the CDC, including: recommendations for sick employees to stay home; separation of sick employees; and strict restrictions on travel. 
• A Wall St. Journal roundup of numerous meeting and conference cancellations.
• Reports of serious concerns about transmission to workers on the front lines, such as workers doing health screenings and those cleaning planes and other transport or public facilities. 

Lessons from China
An examination of the current situation in China, where the novel coronavirus outbreak began, gives you an idea of what an all-out effort to contain the disease looks like. The World Health Organization’s Dr. Bruce Aylward, who just returned from the country, explained to The New York Times what China is doing to successfully control the outbreak. 

The good news is that the number of new tests per day in China has dropped from 46,000 to less than 13,000, he said. And most (75 to 80%) of the transmissions are within families, caused by one member becoming infected. Thus, managing the families and their contacts is key. Most importantly, there is little evidence of transmission from patients without symptoms. 

Based upon this pattern, a follow-up and screening protocol was established: check all contacts of symptomatic patients for two days (48 hours) before onset of symptoms. I believe this an excellent rule of thumb and, clearly, has been working well. This is what is being done for families and other “contact situations,” such as exist in restaurants and hospitals.

To avoid exposures at hospitals, China has implemented online screenings. Individuals showing any of the telltale coronavirus symptoms are referred to “fever clinics” or other special screening areas. The symptoms include:

• Fever (90% of cases) 
• Dry cough (70% of cases) 
• Tiredness/malaise (30% of cases) 
• BUT, runny nose and other cold or flu-like symptoms-- only 4% (healthcare workers can rapidly distinguish between cold and flu, and coronavirus)

Coronavirus testing in China
China has access to some sophisticated resources. The PCR (polymerase chain reaction) test used by healthcare professionals there yields results in four hours. Patients wait for results in protected areas, then are handled appropriately. With a positive result, all patients receive a chest CT scan, which shows the sometime-subtle patterns of pneumonia. (Each machine performs 200 CTs daily.)
A triage process follows:

• Severely sick patients go to the best hospitals, which are dedicated to coronavirus care. High-tech technology, including ventilators and sophisticated oxygen machines, are available. All of this is free. 
• Patients with milder disease, which can include pneumonia, are treated in dedicated gyms or stadiums, with 1,000 beds or more per location.
• In cases of clusters of family members or others, the local region is kept under observation and schools, restaurants, theaters, etc., are closed. A highly organized system of online food, medical, and academic delivery services operates around the clock. 

It remains to be seen if the U.S. will incorporate some of the methods China has used to combat COVID-19. As new cases of the disease appear across the country, our healthcare workers and institutes are just now ramping up with increased test kits and adequate new protocols. As new information emerges, I’ll provide further updates. Please contact the IMF if you have questions or concerns. 

Dr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.