Published on March 12, 2020

Active community spread of the novel coronavirus (COVID-19) is now occurring across America. Due to inadequate testing, we do not know who is infected and who is not. Unlike other countries, such as Korea and Singapore, tracking and monitoring to control the spread of the virus is not happening in the U.S. As a result, avoiding exposure is enormously challenging.

I outlined some key steps for preventing exposure to the virus, such as social distancing, hand-washing, and other techniques in two previous blogs (“Coronavirus and Myeloma Patient Safety” and “Coronavirus (COVID-19) Update: Elbows or Shoes, But No Handshakes!”).

In addition, excellent, up-to-the-minute coronavirus information is available at the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) websites. The CDC’s directory of state and local health departments can provide local guidance. And 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.

Today, I will provide answers to questions myeloma patients have asked. This specific guidance is intended to help keep everyone as safe as possible.

Frequently Asked Questions for myeloma patients

Q. Are myeloma patients especially vulnerable to the novel coronavirus?
A. Myeloma patients are more vulnerable than the average person for several reasons:

• Myeloma patients have suppressed immune systems and can have difficulty fighting off any new infection. In addition, many myeloma treatments further suppress the immune response. 
• Other factors, such as age, and health issues, such as diabetes, heart disease, and the like, can increase vulnerability.

Q. What if I recently had an ASCT (autologous stem-cell transplant)?
A. In the recovery phase from an ASCT, patients are especially susceptible to infection and should limit contacts that risk exposure to coronavirus.

• Any fever or suspicious symptoms must be carefully evaluated.
• Discuss your situation with your doctor.
• Be aware that even in the remission phase post-ASCT, there is reduced immunity for the first 6 to 12 months.

Q. During the coronavirus outbreak, what is the best way to work with my doctor?
A. It is very important to set plans with your doctor for the coming few weeks.

• If possible, defer any elective, major new therapy, such ASCT, for the next two months or so.
• If possible, avoid visits to larger centers or busy doctors’ offices, except for essential treatments. In that case, try to pick a quieter time to go.
• Make sure you have a supply of all needed medicines.
• Get advice by telephone or online for all routine questions. 
• If feasible, get needed lab work at a local lab and forward results to your doctor.
• Make sure you have the security code to check your lab results online.
• Have a plan of action if you develop fever, dry cough, or additional tiredness, which may indicate possible coronavirus infection. Identify the nearest, best emergency room in advance.
• The IMF InfoLine is available to answer questions and concerns by phone or email.  

Q. How can I avoid exposure to coronavirus?
A. Stay home as much as possible for the next 2 to 3 weeks.

• Monitor contacts with family and friends closely. Make sure no one has had contacts that could expose others to infection.
• Avoid all public meetings and crowded places. If you do go out, pay close attention to all the rules for social distancing, clean surfaces around you, and frequently wash your hands. Remember, food can be delivered to avoid busy restaurants.
• If concern over possible exposure emerges in your social group, demand testing to clarify the situation as quickly as possible. This is in everyone’s best interest .
• Be aware that recent data suggest that patients with early disease CAN transmit infection. So,  be especially cautious if there is any question of infection.
• Emphasize to younger, healthy family members that they must also NOT get infected since they can be a buffer for more vulnerable family members.

Q. What about travel?
A. ALL NON-ESSENTIAL TRAVEL SHOULD BE AVOIDED! 

• Right now, refunds and vouchers are available to defer travel to later in the year or even next year.
• Avoid contact with anyone having recent travel to affected areas.

Q. What have we learned about how to treat coronavirus infections?
A. In patients with more serious disease we have learned quite a lot.

• With aggressive, supportive care measures, patients can be managed to recover, although it is clearly very challenging. 
• The most dangerous shock syndrome that can occur with the coronavirus can be successfully treated (in a similar manner to that used against the cytokine release syndrome (CRS) that can accompany some CAR T-therapies). This is quite encouraging. Patients now have recovered and been discharged from hospitals in China, Italy, and elsewhere. 
• This emphasizes the need for a careful triage system to ensure the sickest patients get the necessary level of care to protect lives.
• It is hoped that the experimental anti-viral therapy from Gilead Sciences, called remdesivir, can be made available in a trial fashion when appropriate. Promising results have been reported. Researchers are also testing Roche’s rheumatoid arthritis drug Actemra, which inhibits inflammation, against COVID-19. 

Some good news

Korea and Singapore have shown that it is possible to contain the spread of the coronavirus. Already, the number of new cases has decreased dramatically using strict public health measures. In these countries, the crisis is passing into the recovery phase.

Bottom line

These are challenging times. In the U.S., we will have to be truly resilient to get through the next month and manage as best possible the serious impact of the ongoing community spread of the coronavirus.

This is not the time to be cavalier, but to be prudent and cautious, and try to stay as safe as possible by limiting any possible exposure to coronavirus.

Please be safe. The IMF will provide ongoing updates. 

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®.