April 2, 2020

As we all adjust to physical distancing to prevent the spread of the coronavirus, we can enhance our resilience by maintaining social connections and continuing to engage in activities. It turns out that we are not the first to experience this type of self-isolation. We are reliving history. On July 27, 1377, a quarantino (quarantine) of 40 days was implemented (https://www.history.com/news/quarantine-black-death-medieval) in Dubrovnik. It was done to halt the spread of bubonic plaque devastating Europe, especially in Venice, a center of commerce at the time. The 40-day isolation was an extension from 30 days (trentino), which had proved insufficient. Shipped goods and mail were also quarantined and fumigated using various techniques. 

All of this DID help. And the world did get through those times.

New COVID-19 Information and Recommendations This Week 

• Iceland: Data being gathered in Iceland (https://www.cnn.com/2020/04/01/europe/iceland-testing-coronavirus-intl/index.html) continues to be important. So far, approximately 17,900 people (5% of the total population) have been tested for COVID-19 infection. Initial results reveal that 1% of the Icelandic population are positive and of these 50% had NO symptoms. The intent is to test approximately 13% of the population (about 50,000 people). 
• Asymptomatic spread: The current evidence strongly supports the idea that asymptomatic individuals are able to spread the virus, as shown in both German (https://www.nejm.org/doi/full/10.1056/NEJMc2001468) and Asian studies (https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e1.htm). During early infection there is a high level of virus shedding from the throat region. 
• Contact tracing: In Iceland, the spread of virus by asymptomatic individuals has triggered aggressive contact tracing to identify all who may have been infected, impose self-isolation, and limit further spread. This protocol has been working to limit the number of new cases, which has been demonstrated to work in Asia (https://science.sciencemag.org/content/367/6482/1061). It has also allowed identification of specific sources of infection, such as Italy, Austria/the UK, and even on the West coast of the U.S. The identification of particular sub-mutations of COVID-19 is providing additional understanding related to the varying severity of disease patterns observed.

Myeloma Patient Safety Recommendations 

This week, these remain very much the same as you will find on the IMF Myeloma Patient Safety and the Coronavirus page (https://www.myeloma.org/covid19-myeloma-patients). In addition, on Tuesday we presented a detailed informational briefing (https://www.myeloma.org/node/2597) for myeloma Support Group Leaders across the U.S. to answer their most urgent new questions.

As we have seen in the news each day, detailed management suggestions continue to evolve. 

This week’s highlights: 

• Masks: these can reduce the spread of COVID-19 by infected individuals who may not even  know they are infected. Dr. George Gao, Director General of the Chinese Center for Disease Control and Prevention, said in an interview (https://www.sciencemag.org/news/2020/03/not-wearing-masks-protect-against-coronavirus-big-mistake-top-chinese-scientist-says) that he believes that not using masks is a big mistake. And today, it was reported (https://www.statnews.com/2020/04/02/coronavirus-cloth-masks-recommendation/?)that the White House is expected to recommend all Americans wear cloth masks to prevent the spread of coronavirus. An April 1 National Academy of Sciences report (https://www.nap.edu/read/25769/chapter/1) on the bioaerosol spread of COVID-19 says that virus aerosolization can occur from patient conversation and normal breathing.If you must interact with the healthcare staff or individuals in public places, it is important that they are wearing masks. If not, you need to be duly cautious. 
• Risks of serious consequences from infection: data continue to show that important factors are:
  • Age: especially above age 70 years (https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30257-7/fulltext?). 
  • Underlying diseases: such as diabetes, chronic lung/kidney/cardiovascular disease, and poorly defined “immune compromised” situations. 
  • For myeloma patients: autologous stem-cell transplant (ASCT) is a risk especially for the engraftment or recovery phase, when COVID-19 infection could delay blood-count recovery. Certainly, ASCT is a procedure to defer for now. Also, complex CAR T-cell replacement therapies need to be placed on hold.

Myeloma Management

• Typical myeloma therapies do not appear to be harmful in themselves and may actually be helpful not only in controlling the myeloma but also having anti-inflammatory properties (https://ecancer.org/en/journal/article/1022-associations-between-immune-suppressive-and-stimulating-drugs-and-novel-covid-19-a-systematic-review-of-current-evidence), even anti-viral properties. Some agents, such proteasome inhibitors and Selinexor or XPO 1 inhibitor analogs, have anti-viral activity (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5487384/). Doses of myeloma therapy agents need to be monitored closely to avoid low blood counts, especially white blood cells. Simply shifting to slightly reduced dosages can be an easy interim adjustment to be safe.
• Be aware that there may be overall medication shortages (https://www.nbcnews.com/think/opinion/coronavirus-medication-shortages-will-be-felt-patients-covid-19-some-ncna1172371) coming, which is a concern. Stock up as best you can on all ongoing medications that you need. For example, request a two- or even three-month supply of key medicines you need regularly.

Honoring Health Care Teams and All of Those on the Crisis Frontlines 

The coronavirus frontline teams are courageous and deserve all our respect and thanks. In this time of extraordinary crisis, they are literally putting their lives on the line every day. Thank you, thank you, thank you! 

Enhancing Resilience

To move forward each day, we need to focus our energies to handle these new challenges. It can be hard to remember that we will get through this. As you may have noticed, despite the pandemic, spring is in full bloom. Artist David Hockney has been recording a series of stunning springtime blossoms (https://www.bbc.com/news/entertainment-arts-52109901) from his home in Normandy in the UK and he has shared them online as a “respite from the news.” These marvels can inspire us to connect and be social, while we physically distance, and strive to be kind and do the best for everyone.

Stay home. Be safe. We will continue to keep everyone informed and up to date.

Translations:

Arabic (https://s3.us-west-1.wasabisys.com/imf-d8-prod/2020-04/Durie_covid19_ARABIC_0402.pdf)  Dutch (https://s3.us-west-1.wasabisys.com/imf-d8-prod/2020-04/Durie_covid19_DUTCH_0402.pdf)  French (https://s3.us-west-1.wasabisys.com/imf-d8-prod/2020-04/Durie_covid19_FRA_0402.pdf)  Italian (https://s3.us-west-1.wasabisys.com/imf-d8-prod/2020-04/Durie_covid19_IT_0402.pdf)  German (https://s3.us-west-1.wasabisys.com/imf-d8-prod/2020-04/Durie_covid19_DE_0402.pdf)  Russian (https://s3.us-west-1.wasabisys.com/imf-d8-prod/2020-04/Durie_covid19_RUS_0402.pdf)  Spanish (https://s3.us-west-1.wasabisys.com/imf-d8-prod/2020-04/Durie_covid19_ES_0402.pdf)  Turkish (https://s3.us-west-1.wasabisys.com/imf-d8-prod/2020-04/Durie_covid19_TUR_0402.pdf)