POSITION STATEMENT TITLE: ISNCC COVID-19 Position Statement
Date Drafted: March 14, 2020
Date Approved by Board of Directors: April 2, 2020
INTRODUCTION
The 2019 novel coronavirus disease (COVID-19), caused by infection of severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2), is a new virus of global health significance. SARS-CoV-2 isrecognized as typical of a lineage B betacoronavirus which was identified in the samples ofbronchoalveolar lavage fluid from a confirmed patient.1 COVID-19 has a high transmission capability
as well as significant morbidity and mortality. Some patients with cancer will be at higher risk ofhealth complications from COVID-19, especially if they are immunocompromised.2 On March 11,
2020, the World Health Organization (WHO) declared COVID-19 a global pandemic. Screening,
careful self-protection and system-wide strategies are essential for the prevention and control of
COVID-19. Nurses are at the forefront of addressing the COVID-19 pandemic.
PURPOSETo advocate for COVID-19 prevention and control strategies for cancer patients, their families/
non-family caregivers, and nurses caring for them.
BACKGROUND
Since December 2019, an outbreak of coronavirus (SARS-CoV-2) infection has spread around theworld. The WHO declared the 2019 novel coronavirus disease (COVID-19) a pandemic.3 SARS-CoV-2
can spread from person-to-person by droplet and contact transmission.4 It is reported that the virus
can be transmitted when someone is exposed to high concentrations of aerosol in a relatively close
environment for a long time.5 The identification and management of patients as early as possible are
crucial to control the further spread of COVID-19 by managing the source of infection and cutting off
the transmission route.6 Older people and people with certain pre-existing conditions, including a
suppressed immune system, are at higher risks to develop COVID-19 and need more intensive care. 78

Cancer patients undergoing a range of treatments are a susceptible group at higher risk of developing
severe infections9. If infected with COVID-19, some patients may need to have their cancer
treatment suspended.10 Delaying or modifying cancer treatment is an option only after discussion withthe oncologist as such changes may have implications for treatment outcomes.
Additionally, the occupational safety of healthcare providers, especially nurses who are in close
contact with patients is a significant concern. The provision of appropriate personal protective
equipment (PPE) is essential to enable nurses to continue to provide the required nursing care. The
challenges faced by nurses continue to intensify as the potential risk of infection and the burden of
COVID-19 on health systems increase.11 COVID-19 prevention and control strategies for cancer
patients and nurses is a top priority for all health systems.

POSITIONThe International Society of Nurses in Cancer Care (ISNCC) is committed to promoting theprevention and control of COVID-19 to minimize the risk to cancer patients and nurses. ISNCC iscommitted to advocating to ensure the role of the nurse in the prevention and control of COVID19 is optimized for the benefit of cancer patients, because nurses:• are at the front-line of providing health services for people affected by cancer and incommunity and public education efforts relating to infection control;• provide evidence-based care, which includes measures to ensure infection control, as well ascomprehensive physical and psychological support for cancer patients at risk of or diagnosed
with COVID-19;• are at higher risk of exposure to COVID-19 due to the close contact they have with patientsin their day to day nursing work.
For cancer patients•
Cancer patients are in a high risk patient group and are more susceptible to be infected by
COVID-19 due to impaired immune function;•Cancer patients and their families can experience increased stress related to fear of infection,
delayed cancer treatment, and death from COVID-19;•Cancer patients diagnosed with COVID-19 can experience a range of symptoms andinfection-related responses that require appropriate clinical and supportive careinterventions.
For nurses•
Sufficient numbers of trained nurses are vital to ensure the resilience of healthcare services
when facing complex public health challenges.12•
Nurses provide a unique service to patients and are at the front line of this public healthemergency.13 Recognition of nurses’ significant contribution to addressing this pandemic isrequired by government and non-government organizations, including the allocation of
appropriate resources to support the nursing workforce.
•Nurses should be involved in the development of policies and programs relating to COVID-19.
•
Nurses’ safety is essential, including access to and appropriate use of properly fitted PPE
when caring for patients suspected or diagnosed with COVID-19.13•
Nurses can develop medical device related pressure injury with ongoing use of some PPE. It
is necessary to take related precautions to avoid this problem and implement countermeasures.
•Nurses across the world have demonstrated exceptional commitment and compassion in
their response to the COVID-19 pandemic. Proper assessment and management of thepsychological health of nurses during and after the pandemic is essential.14

RECOMMENDATIONS
For cancer patients• Minimize travel, decrease unnecessary outdoor activities, and maintain social distancing.
• Keep the home environment clean and well ventilated.
• Pay attention to hand hygiene, and wash hands with soap and water for at least 20
seconds, following WHO guidelines for clean hands. Use hand sanitizer when washinghands is not possible.
• Maintain a healthy lifestyle including getting enough sleep, exercising at home regularly,and ensuring adequate and balanced nutrition.
• Verify any clinic appointments and hospitalizations with your healthcare providers tominimize possible exposure.
• Strengthen communication with your health care staff through online means or by phonewhen possible.
• Do self-screening for any signs of infection including fever, cough, dyspnea, fatigue, myalgia,
anorexia, sputum production. Seek medical advice for any abnormal signs or symptoms.
• Acquire reliable information regarding the pandemic situation and follow local or regionalofficial guidance.
• Communicate regularly with family, friends, and healthcare professionals by phone or online means to facilitate social support• Implement strategies that will help to reduce anxiety or worries about the COVID-19
pandemic, such as obtaining reliable information, talking with health care professionals, orseeking psychological support services where required.
For nurses• Keep informed about measures to ensure prevention and control of COVID-19 by accessing
advice and evidence from relevant government and health care authorities.
• Screen cancer patients for COVID-19 before they enter healthcare facilities. Screening should
include: 1) travel history; 2) presence of COVID-19 related symptoms.
• If infection is suspected, follow procedures established by healthcare authorities andindividual workplaces.
• For patients with COVID-19, implement evidence-based care plans which ensure early
identification of deterioration and implementation of relevant clinical and supportive careinterventions.
• Ensure that all nurses have access to and are trained to use appropriate PPE including gowns,
respirators, and gloves. This includes strict adherence to protocols to avoid possible
contamination and infection when putting on (don) and taking off (doff) PPE.
• Measures should be taken to reduce medical device related pressure injury in nurses, including
proper selection of PPE, periodic assessment of surrounding skin, and application ofhydrocolloid/soft silicone/film dressings if required.
• Continue to assess the psychological status of cancer patients and implement strategies toaddress any signs of distress (i.e., anxiety, depression, and anticipatory grief) related to theCOVID-19 pandemic.
• Implement self-care strategies and seek support where required to promote the wellbeingof nurses in this evolving healthcare crisis.

REFERENCES
1. Li LQ, Huang T, AUID- Oho, Wang YQ, Wang ZP, Liang Y, Huang TB, Zhang HY, Sun WM,Wang YP. 2019 novel coronavirus patients' clinical characteristics, discharge rate andfatality rate of meta-analysis. J Med Virol 2020.
2. Liang W, Guan W, Chen R. et al. Cancer patients in SARS-CoV-2 infection: a nationwide
analysis in China. Lancet Oncol, 2020; 21(3):335-7.
3. WHO. Coronavirus disease 2019 (COVID-19) Situation Report-51.
https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep51-covid-19.pdf?sfvrsn=1ba62e57_10
4. Wang Y, Wang Y, Chen Y, Qin Q, AUID- Oho. Unique epidemiological and clinical featuresof the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control
measures. J Med Virol 2020 .
5. Cai J, Sun W, Huang J, Gamber M, Wu J, He G. Indirect Virus Transmission in Cluster of
COVID-19 Cases, Wenzhou, China, 2020. Emerg Infect Dis 2020; 26.
6. Hellewell J, Abbott S, Gimma A, Bosse NI, Jarvis CI, Russell TW, Munday JD, Kucharski
AJ, Edmunds WJ, Funk S, Eggo RM. Feasibility of controlling COVID-19 outbreaks byisolation of cases and contacts. Lancet Glob Health 2020 .
7. Coronavirus Disease 2019 (COVID-19). www.cdc.gov(accessed March 13rd, 2020).
8. National Health Commission of the People’s Republic of China main website. https://www.nhc.gov.cnhttps: //www.nhc.gov.cn(accessed March 3rd, 2020).
9. Liang W, Guan W, Chen R, Wang W, Li J, Xu K, Li C, Ai Q, Lu W, Liang H, Li S, He J.
Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol
2020; 21:335-337.
10. Zhang H, Huang Y, Xie C. The Treatment and Outcome of a Lung Cancer Patient Infectedwith SARS-CoV-2. J Thorac Oncol 2020 .
11. Adams JG, Walls RM. Supporting the Health Care Workforce During the COVID-19 Global
Epidemic. JAMA 2020 .
12. Catton H. Global challenges in health and health care for nurses and midwives
everywhere. Int Nurs Rev 2020; 67:4-6.
13. Ong S, Tan YK, Chia PY, Lee TH, Ng OT, Wong M, Marimuthu K. Air, Surface
Environmental, and Personal Protective Equipment Contamination by Severe AcuteRespiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient. JAMA2020 .
14. Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. [Mental health survey of 230 medical staff
in a tertiary infectious disease hospital for COVID-19]. Zhonghua Lao Dong Wei Sheng Zhi
Ye Bing Za Zhi 2020; 38:E001.
RESOURCES LINKS• World Health Organization (2020) Novel Coronavirus page.
https://www.who.int/emergencies/diseases/novel-coronavirus-2019• Centers for Disease Control and Prevention (2020). https://www.cdc.gov• International Council of Nurses (ICN) (2020). https://www.icn.ch/• Oncology Nursing Society: https://www.ons.org/coronavirus• National Comprehensive Cancer Network COVID19 Resources:
https://www.nccn.org/covid-19/default.aspx