Published on February 28, 2020

We have all been alarmed by news of the 2019 novel coronavirus disease (COVID-19), caused by SARS-CoV-2. The World Health Organization (WHO) has now warned that the virus has the potential to become a pandemic.

In the U.S., the first possible case of what is called “community spread” has occurred in a California patient who has been diagnosed with coronavirus of an “unknown origin.” California is monitoring 8,400 people for the virus. On Thursday, concerning allegations arose that the U.S. government sent workers without proper training for infection control or appropriate protective gear to greet evacuees from Wuhan, China. 

As new cases of the coronavirus multiply, what are myeloma patients to do? First, some basic facts:

• COVID-19 is a dangerous virus that emerged in December 2019 from a previously identified SARS virus in 2003. The likely source is the live animal market in Wuhan, China.
• According to the WHO, the most common symptoms of COVID-19 are fever, tiredness, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually. Some people become infected but do not develop any symptoms or feel unwell. 
• At least 2% of patients develop critical or life-threatening disease. Since this number does not include people with infection who do not have symptoms, the real percentage may be lower. Nonetheless, the COVID-19 is clearly more dangerous than seasonal influenza, which has a risk of critical disease of only 0.2% or less (that is 10 to 20 times less).
• As of February 27, 2020, COVID-19 has been reported in more than 40 countries and local transmission (community spread) is ongoing in Singapore, Japan, Korea, and Thailand.
• A nationwide analysis in China published in The Lancet has shown that patients with cancer and/or suppressed immune systems are at the highest risk for critical infections. Other risk factors were increasing age, smoking history, and other underlying illnesses, such as diabetes.

Practical recommendations as of February 28, 2020

It is a top priority for myeloma patients to avoid exposure to COVID-19. According to the World Health Organization, this is what we currently know about how the virus is spread: People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose, or mouth. People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets. This is why it is important to stay more than 1 meter (3 feet) away from a person who is sick.

Here are ways myeloma patients can minimize exposure and stay healthy:

• Keep abreast to the latest recommendations: the World Health Organization is posting up-to-date news on COVID-19 here. Also check your local public health department website for community alerts. 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 foreign travel: I suggest NO foreign travel for the time being, especially to Asia. Patients undergoing active therapy with immune suppressive treatments such as daratumumab, should not travel at all, as they are particularly susceptible to infection. For others, travel within the U.S., including Hawaii, continues to be fine for now, but stay alert for all details in daily news reports, which could include details of possible illness clusters.
• If you must travel:
  • Keep your personal space extra clean: Hand washing is very important. Wipe down your areas on a plane, train or automobile, bus, van or related transport.
  • Stay hydrated and remember to exercise periodically: Exercise can help you to avoid blood clots.
  • Do not focus on masks: They limit you from giving infection to somebody else but do not offer much protection for yourself.  I suggest a personal air purifier, which really helps you from picking up infection from surrounding air. (The N95 respirator face masks are essential gear for providers dealing with COVID-19.)
  • Avoid people who are clearly sick: anyone coughing, for example.
  • Always travel with a supply of antibiotics: Your doctor can provide the type that will best cover any infection they think you might be most susceptible to. Antibiotics such as cipro, clarithromycin, or amoxicillin are usually good.
• 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.
• Preparation with the 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, especially if local movement becomes restricted.

Lessons from Singapore

How Singapore handled the outbreak of coronavirus can serve as an example of both preparedness needed and the potential impact on day-to-day activities we may experience here in the U.S. Very careful containment efforts proved successful. These included the avoidance of any mass gatherings, confined meeting, work, or living spaces, along with rapid monitoring and assessment of any potential new patients or contacts. 

The Singapore story also carries a bit of good news. There were two types of clusters – one linked to Chinese tourists, the other of unknown origin. The latter had limited spread and no other cases observed. This seems to be due to a lower viral load in these instances of “community spread.” 

Bottom line: 

Stay alert to the news. COVID-19 is undoubtedly something to be avoided, and we hope the risk of exposure will remain low in the U.S. Unfortunately, a vaccine will take time to develop, so it is encouraging that Gilead Sciences is accelerating trials with a new anti-viral agent called remdesivir. 

The next two to four weeks will be key to understanding if new cases are emerging. The good news is that new cases are starting to decrease in China. In addition, the virus activity can be expected to drop off as we move into warmer weather. For example, the flu is a problem in the winter months and substantially decreases in late spring and summer. If this novel virus follows the traditional pattern, by April or May there should be a natural drop-off in infections.

Stay tuned.

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®.