Published on March 21, 2020
Q. How do I decrease my risk of exposure to the coronavirus?
A. The number one recommendation is to stay home now and avoid social contacts outside the home. Behave as if you have the virus and/or new people you meet have the virus, because we just don’t know enough about this disease right now.
- Monitor contacts with family and friends closely. Make sure no one has had contacts that could expose others to infection.
- If it is urgent for you to go out, pay close attention to all the rules for social distancing: remain 6 feet away from others; clean surfaces around you; and frequently wash your hands.
- Have groceries delivered.
- 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. Should I continue with my myeloma treatment?
A. This is a very important question. Most myeloma treatments can reduce the body’s immunity and increase the potential for infection. Points to keep in mind:
- Myeloma treatment is important to control your disease and avoid any potential relapse.
- The balance between risks of added infection versus stopping treatments should be discussed carefully with your doctor.
- In general, the value of ongoing treatment far outweighs the risks of stopping.
Q. Should I undergo an autologous stem-cell transplant (ASCT) at this time?
A. This is NOT a good time to undergo an ASCT.
- Although in 2020 an ASCT is a very safe procedure, there is a period of 2 to 3 weeks when blood counts are very low in the recovery phase and there is a significant risk of new infection. Right now, it’s is best to avoid this period of risk by deferring ASCT for the time being. If hospitals and outpatient centers are overwhelmed by coronavirus patents (which they may well be very soon), ASCT patients will not have access to ideal care.
- However, this is a major decision and should be discussed carefully with your doctor to review ongoing treatment options and plans for the future.
Q. Will I lose access to some of the myeloma drugs I need?
A. Most likely, not in the short term. Supply chains have been continuing and large pharmacy retailers have drugs on hand. However, it is a good idea to stock up on anything needed on an ongoing basis, since supplies could run out in the longer term. There are concerns about availabilities of so-called active ingredients that come from China and may be processed through India. Important to be alert and to plan ahead.
- If you are in a clinical trial, it might have to be interrupted due to the outbreak. However, the FDA announced it could issue waivers enabling participants to continue in the trial without traveling to the site.
Q. How should I work with my doctor?
A. Work with your doctor’s office remotely (not going into the doctor’s office), using telephone, emails, or telemedicine, which is basically like Skyping or Face Timing with your doctor. This eliminates the risk of virus exposure in the doctor’s office.
Q.Can I have coronavirus if I do not have a fever?
A. Yes. Keep in mind:
- 10% or more of patients do not have a fever.
- Myeloma treatments, such as steroids (dexamethasone and prednisone), as well as many of the newer immune therapies, can suppress a fever even in the face of infection. So, pay attention to other changes, such as a cough or increasing tiredness.
- In the early stages of infection, there is no fever. So, if there is concern about possible exposure, it is still reasonable to request testing. Testing in the family setting is very important to make sure everyone is safe.
- Some patients have reported diarrhea or gastrointestinal distress at the onset of infection.
Q. Are packages delivered to my home safe?
A. A recent study evaluated how long coronavirus can survive and be potentially infectious on the surface of packages. On average, it can last a few hours or so, depending on the type of material:
- Cardboard (and copper): 4 to 8 hours
- Plastic and stainless steel: as long as 72 hours
- This means that the virus cannot survive long-distance travel in adverse conditions in a plane (for example, from China) or in a cross-country truck. But it can survive from a local delivery source.
- The major concern is about who is delivering the package. Here are a few suggestions:
- Have packages delivered and placed by the door or entryway.
- If possible, do NOT have contact with the person delivering the package. An electronic receipt is fine. But, do not touch computer or iPad screens directly. This is a key aspect of social distancing.
- Wipe down the packages with disinfectant wipes before you bring them into the house. If available, wear gloves. Minimize contact with your outer garments which can be placed separately by the door.
- Open the package and immediately discard outer materials along with gloves.
- Wash hands thoroughly before proceeding.
Q. How do I implement social distancing when I go to the store for groceries?
A. The same study that evaluated coronavirus on surfaces assessed how long the virus can hang around in the air. If someone has coughed or sneezed, the resulting virus droplets can persist in the air for as long as three hours. Be aware that infection droplets can gather on garments.
- If possible, go to the grocery store when it first opens to minimize risk of recent suspended droplets in the air or onto surfaces. Many stores are now setting special times at the start of the day for those over 65 or at special risk to go shopping in small numbers to allow social distancing. Do maintain that distancing as much as possible.
- If possible, wear gloves for selecting items.
- Avoid direct contact with store employees, who, unfortunately have broad exposure risks .
- Use your own bags for the groceries.
- Follow the procedures noted above when you get home, washing your hands carefully before proceeding with activities in the home. I suggest individually wiping items before placing in your refrigerator/freezer or cupboard for storage.
- A helpful article summarizes people and occupations with the highest risk of infection and of potentially transmitting the COVID-19 to you. Health care providers are at the largest risk—nurses, medical assistants, dentists, dental hygienists, and pharmacy receptionists, as are others working in close contact with the public—teachers, barbers, retail workers, waiters, cashiers, and many others discussed in this article.
- The key point is that it is truly difficult to avoid potential exposure if you are out and about in public.
Q. What about activities like visiting my grandchildren or taking a walk?
A. Now is NOT the time to visit with your grandchildren. There is too much risk of possible exposures. It is best to use Skype for now and keep everyone safe, which is the top priority. But talking a walk if fine and, I think, so important. Experts agree. Just make sure to respect social distancing.
Q. How can I improve my resiliency and decrease my stress during these challenging times?
A. Paying attention to the measures outlined above can help keep you as safe as possible in these difficult times. In addition:
- Tap into your inner strength to maintain an emotional balance. This can help reduce stress. Here is a good resource for mental health support.
- I’ve been inspired by the images shared by people living with myeloma on the IMF “Wall of Resilience.” What helps make them strong? Nothing medical. Instead, they focused on the simple enjoyment of daily life: family and friends, and the pleasures of cooking, dancing, hiking, running, boating, biking, and simply relaxing.
- While it’s critical for people living with myeloma to strictly observe social distancing for the time being, that doesn’t mean you cannot maintain social connections. Skype, Face Time, email, phone calls, help us all from feeling too lonely.
- Deep breathing and mindful meditation can calm anxious nerves.
After decades of treating myeloma patients, and counting them among my dearest friends, I know they are profoundly courageous and resilient. Please stay safe and be well. The IMF is here for you. We will get through this together.
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®.