Last updated: March 30, 2020
The new respiratory illness commonly referred to as “coronavirus” and officially called COVID-19 has changed life as we know it for the foreseeable future.
It can be alarming to hear news reports about the coronavirus spreading, cities shutting down, and experts telling us to stay home and limit contact with others. Adjusting to this new normal where schools and businesses are closed can be difficult, and many are worried about how their jobs and finances may be affected. For people with serious health conditions, such as breast cancer, and their loved ones, the uncertainty of this situation, the need for physical distancing, and possible delays in cancer treatments can be especially distressing.
It’s very important to know that people being treated for breast cancer may have a higher risk of severe illness if they become infected with this coronavirus. Some breast cancer treatments — including chemotherapy, targeted therapies, immunotherapy, and radiation — can weaken the immune system and possibly cause lung problems. People who have weakened immune systems or lung problems have a much higher risk of complications if they become infected with this virus. People with breast cancer that has metastasized (spread) to the lungs also can have lung problems that may get worse if they develop COVID-19.
In addition, many hospitals and healthcare providers are delaying elective surgeries, screenings, and other procedures, which are considered not urgent or not immediately life-threatening. These tough decisions are being made on a case-by-case basis to protect people with cancer from infection, and to make sure healthcare providers have the resources they need to treat people who become seriously ill from COVID-19.
The Centers for Disease Control and Prevention (CDC) says that the current risk of becoming infected with this coronavirus is still low for most people here in the United States. But the CDC expects the virus to further spread over the coming months, so it’s important to listen to health experts who recommend staying at home, limiting contact with others, and following other precautions.
If you or a loved one are receiving treatment for breast cancer, here’s what you need to know:
- What is coronavirus?
- How does COVID-19 spread between people?
- What are the symptoms of COVID-19?
- Who is at risk of getting COVID-19?
- How can I protect myself and others?
- What should I do if I develop symptoms?
- What if my breast cancer treatment is delayed?
What is coronavirus?
Coronaviruses are a large group of viruses that can cause respiratory illness in humans and animals. The new (novel) coronavirus you’ve heard about in the news is called SARS-CoV-2 and the illness it causes is called coronavirus disease 2019, which is why it’s abbreviated as COVID-19.
COVID-19: What We Know Now
Angela Rasmussen, Ph.D., is a virologist at Columbia University. She explains COVID-19 testing, preventive measures those who are undergoing breast cancer treatment might take, why handwashing is so important, and some myths about COVID-19.
The first case was diagnosed in China in December 2019 and it has since spread to almost all countries throughout the world. Some coronaviruses spread from animals to people, and that appears to be the case with SARS-CoV-2, which is thought to have originated in bats, and first infected people at a live animal market.
How does COVID-19 spread between people?
This virus mostly spreads through close contact with other people (within 6 feet) through droplets of respiratory fluids produced when a person coughs or sneezes. These respiratory droplets can travel through the air and either be inhaled or otherwise get into the noses, mouths, or eyes of people nearby.
People seem to be most contagious when they have symptoms, but it’s important to know that you can also catch the virus from infected people who have no symptoms at all. It’s also important to know that the virus can spread through fecal matter — in other words, it can live in your poop.
Respiratory droplets and fecal matter can end up on surfaces more often than you might think, and the virus can survive on these surfaces for hours or even days. When you touch these surfaces and then touch your face, you can be exposed to the virus. However, this doesn’t seem to be the main way the virus spreads — most often, it’s through close contact with others.
There is no evidence that COVID-19 spreads through food or food packaging. Still, research shows that the virus can survive for up to 24 hours on cardboard and up to 3 days on plastic and stainless steel. While the risk is low, it’s still smart to wash your hands for at least 20 seconds after handling mail, takeout containers, and packaging from groceries. If you’re worried, you can always disinfect food packages using a cleaning product that kills viruses (do not use disinfectants on food).
What are the symptoms of COVID-19?
The most common symptoms of this coronavirus include:
- dry cough
Other symptoms include:
- shortness of breath
- aches and pains
- sore throat
- trouble breathing
- chest pain or pressure
- pink eye (conjunctivitis)
- loss of sense of smell
These symptoms tend to start between 2 and 14 days after coming into contact with the virus.
Less commonly, people with COVID-19 have experienced:
- runny nose
- abdominal discomfort
“Often [COVID-19] can start out with symptoms similar to a common cold,” Halle Moore, M.D., director of breast oncology at the Cleveland Clinic, told Breastcancer.org. “Patients may experience fatigue, a sore throat, and a cough, but they will usually get a fever, as well. The illness can also progress to shortness of breath and respiratory difficulties.”
Most people who are infected with this coronavirus have mild respiratory symptoms and can recover at home in about 2 weeks. However, symptoms can become severe in certain people.
Severe symptoms that require immediate medical attention include:
- difficulty breathing or shortness of breath
- persistent chest pain or pressure
- confusion or inability to awaken
- blueish color in the lips or face
If you or a loved one experiences any of these emergency warning signs, call 911 immediately. People who are older than 60, and people who have existing serious health conditions, such as heart disease, lung disease, and diabetes, appear to have a higher risk of developing severe illness and complications from COVID-19. This includes people who are receiving cancer treatments that can weaken the immune system.
Possible complications include:
- organ failure
Who is at risk of getting COVID-19?
The CDC says that most people in the U.S. still have a low risk of becoming infected with this coronavirus, but expects the risk to increase as the virus continues to spread over the coming months People who currently have a higher risk of becoming infected include:
- those who live in communities where the virus is spreading
- healthcare workers who may be exposed to sick people
- those who have had close contact with people who have been infected
- people who have recently traveled to places where the virus is known to have spread
While people who are being actively treated for breast cancer may be at higher risk for complications from the illness if they do become infected, it’s important to know that they do not necessarily have a higher risk of becoming infected in the first place.
“For most breast cancer survivors, the risk of becoming infected is going to be similar to that of the general population,” says Dr. Moore. “For people who are on active treatments that compromise the immune system, there will also be a similar risk for acquiring the infection, but they may have a higher risk of a more severe case should they become infected. So, similar to the precautions that they take regarding other illness, patients who are on treatments that affect the immune system should also be vigilant.”
How can I protect myself and others?
The best way to avoid becoming sick from this coronavirus is to avoid being exposed to it. There are no treatments or vaccines yet, but scientists are working on them.
It’s important take precautions to lower your risk of getting sick, especially if you have a serious health problem like breast cancer. “Social distancing” or “physical distancing” practices are being recommended or enforced in many areas to reduce the spread of COVID-19.
Social distancing means limiting close contact with other people — even if they appear to be healthy — to reduce your own risk of infection, and to reduce others’ risk of infection, as well. Staying at home and not seeing your loved ones can be difficult, but it’s important to do right now for your own safety and for the greater good. Sensible social distancing practices include the following, when possible:
- stay at home
- avoid public spaces
- avoid public transportation and unnecessary travel
- avoid social gatherings
- work from home
- stay at least 6 feet away from people when out in public
- avoid physical contact like handshakes, hugs, and kisses in social situations
In addition to staying at home and practicing social distancing, here are some common sense steps you can take to help avoid being exposed to this or any harmful virus:
- wash your hands frequently using soap and water for at least 20 seconds, especially after being out in public
- use alcohol-based hand sanitizer when soap and water aren’t available
- avoid touching your face when your hands aren’t clean
- avoid contact with people who are or may be sick, especially if COVID-19 is spreading where you live
- avoid travel to places where COVID-19 is known to be spreading
- clean and disinfect surfaces you touch daily, including things you might not think of like doorknobs, light switches, faucet handles, and phones. Make sure you use a cleaning agent that is effective for killing viruses.
You can also consider wearing a face mask when you are out in public places to reduce your risk of exposure, especially in hospitals and other healthcare facilities. The World Health Organization and the CDC have said that you only need to wear a face mask if you are sick to avoid infecting other people you must come in contact with (you shouldn’t be out in public places if you are sick). But more experts are saying that face masks may provide some protection to those who aren’t sick. Medical grade face masks (called N95 respirator masks) are in short supply, and healthcare providers depend on them. So, some people are sewing their own homemade masks or using scarves to cover their faces when they go out to public places. These are not as effective as N95 masks, but can offer some protection, and will at least help remind you not to touch your face.
If you are receiving treatment for breast cancer that can weaken your immune system or cause lung problems, or if you are living with breast cancer that has metastasized to the lungs, the following extra precautions may help you protect yourself:
- be extra vigilant about hand hygiene
- make a plan with your doctor to monitor for symptoms
- remind friends and family to stay away from you if they’re sick
- make a plan with your caregiver or other loved ones in case you or they get sick
- make a plan with your employer to work from home if you’re not already doing so
- stock up on medications
- ask a friend or family member to shop for groceries for you
“The main thing you should do if you know your immune system is suppressed is try to avoid putting yourself in a position where there may be exposures, especially in areas where there may be a high prevalence of the disease,” says Dr. Moore. However, if you’re receiving treatment for breast cancer, you may need to travel to a doctor’s office or the hospital for your medical care. Together, you and your doctor can determine if you should continue treatment as scheduled or make adjustments to your treatment plan to reduce your risk of being exposed to the coronavirus in a healthcare facility. If you do need to visit a healthcare facility, just make sure you are diligent about washing your hands and not touching your face to minimize your risk of infection. It’s also OK to ask healthcare providers and caregivers to wash their hands before touching you. It’s a good idea to talk to your oncologist about any other protective measures that may be recommended for your unique situation.
“Hospitals throughout the country and state health departments are putting procedures in place to try to reduce exposure, so most hospitals have some sort of screening in place to try to quickly identify people who are at risk and provide those individuals with masks and isolation and appropriate testing,” says Dr. Moore.
The CDC says that cases of COVID-19 will increase over time, and it is likely to be a widespread problem that could last for months. Because this is a rapidly changing situation, it’s wise to pay attention to the CDC’s updates to continue assessing the risks.
“Since this is such a changing landscape, it’s important for people to visit CDC.gov or their state health department website for updated information,” says Dr. Moore. “Some hospitals and state health departments are also setting up hotlines to help keep people informed or answer questions.”
What should I do if I develop symptoms?
If you experience fever, cough, or shortness of breath, you should call your doctor. If you or a loved one experiences severe symptoms that can signal an emergency, such as difficulty breathing, persistent chest pain or pressure, confusion or inability to awaken, or blueish color in the lips or face, immediate medical attention is needed and you should call 911. Make sure to tell the 911 operator that you suspect COVID-19 so the responders can take the necessary precautions to protect themselves.
People who experience mild symptoms can usually stay home while the illness runs its course and recover in about 2 weeks. But, if you are receiving treatment for breast cancer, you should definitely let your doctor know.
“Anybody who’s on any treatment that can suppress the immune system should always call their doctor if they notice a fever or if they have severe cold or flu-like symptoms,” says Dr. Moore. “For someone who’s receiving chemotherapy for breast cancer, a fever is a medical emergency anyway, so that’s something that they need to contact their medical team for.” If you do need to seek medical care for symptoms of COVID-19, Dr. Moore says it’s very important to let your healthcare provider know about your symptoms ahead of time.
“It’s important to call ahead and not just show up to a doctor’s office with symptoms,” she says. “That way the medical team can get a better sense of the severity of the symptoms, determine whether this is something that can be managed at home, something that can be seen in the clinic, or something that needs to be treated in the emergency department. In addition, calling ahead will help the healthcare team take precautions to help prevent exposure to others.”
If you do become sick, you can take the following steps to protect others:
- Stay home, unless you need medical care
- Separate yourself from others in your home
- Cover your mouth and nose when you cough or sneeze, properly dispose of tissues, and wash your hands
- Monitor your symptoms and temperature
- Wear a facemask when around others. You can also wear a facemask if you are caring for someone who is sick..
You should follow these steps until:
- 1 week has passed since you first noticed symptoms
- your fever goes away for 3 full days without fever-reducing medicine
- your symptoms have improved
If you’ve been tested for COVID-19, you should follow these steps until you have 2 negative test results taken 24-hours apart (per CDC guidelines), your fever goes away without fever-reducing medicine, and your symptoms improve.
Not everyone needs to be tested for COVID-19. Tests are not yet widely available, and decisions about who should be tested are up to state and local health departments and sometimes individual healthcare providers. If you develop symptoms, ask your doctor if a test is available and recommended for you.
What if my breast cancer treatment is delayed?
Many hospitals and other healthcare facilities are delaying or canceling elective procedures, meaning surgeries and sometimes screenings or other treatments that are not considered urgent, emergencies, or otherwise indicated for life-threatening conditions. This can be distressing if it’s happening to you or a loved one — if you’re scheduled to have a cancer screening, surgery, or other treatment, you probably feel that it’s urgent. But these tough decisions are being made to help protect people diagnosed with cancer from being infected with COVID-19 and to make sure healthcare providers have the resources they need to treat vulnerable people who do become infected with COVID-19.
Treatment cancellations and delays are often being made on a case-by-case basis, and the policies are different and rapidly changing among healthcare facilities. If this is happening to you, know that you are not alone — many people diagnosed with cancer are having their treatments rescheduled right now.
“There is one general rule right now,” said Breastcancer.org medical adviser Brian Wojciechowski, M.D., a medical oncologist. “Any appointment should be delayed or cancelled if in the doctor’s judgment, it does not risk harm to the patient.”
Talk to your doctor about the best way to proceed to make sure you can get the best care possible in this challenging situation. At Breastcancer.org, we’re doing our best to learn about how the COVID-19 pandemic is impacting the treatment plans of people diagnosed with breast cancer so that we can better inform others about the situation. Share your story with us.
We’re all in this together
While the developing news about COVID-19 can be distressing, Breastcancer.org Founder and Chief Medical Officer Marisa Weiss, M.D., would like to remind you that we’re all in this together, and that there are common sense precautions we can all take to protect ourselves and our families.
“The COVID-19 pandemic reminds us that it’s a small world out there,” she says. “We are all interconnected in good and sometimes dangerous ways. For now, it’s wise to lay low and stay home whenever possible, especially if you’re at high risk of having complications from getting this virus.”
Please practice social distancing for the time being as recommended by the CDC, World Health Organization (WHO), and your local and state governments:
- stay home
- avoid close contact with others
- wash your hands thoroughly and often
Managing Loneliness and Anxiety During This Time of Social Distancing
Therapist Kelly Grosklags, LICSW, BDW, FAAGC, discusses ways to combat loneliness and anxiety people may be feeling during this time of social distancing because of COVID-19.
If we all do our part, we can protect ourselves, our families, and our communities from this pandemic.
We want to know how the COVID-19 pandemic is affecting your life and your treatment. Join the conversation in the Breastcancer.org Community Discussion Boards, and tell us how you’re managing this situation throughout your treatment or survivorship.
Written by: Adam Leitenberger, editorial director
Halle Moore, M.D., director of breast oncology, Cleveland Clinic
Marisa Weiss, M.D., chief medical officer
Brian S. Wojciechowski, M.D., medical adviser
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