COVID-19 coronavirus and cancer

The intent of this page is to gather information relevant to COVID-19, the disease caused by SARS-CoV-2 virus. If you are viewing this page on a cellphone or tablet, consider loading up the desktop version of this page so that a table of contents for the page is displayed for you.
This page is a gathering point for many different topics related to COVID-19. Some are cancer-specific, others are not. If you are a health care professional looking for clinical guidance, you may want to go directly to information for health care professionals, potential treatments, or to the testing sections. The literature on COVID-19 and cancer is just beginning to emerge; we will attempt to keep pace in the scientific evidence section.
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=COVID-19 and Cancer Consortium (CCC19)=
On March 17th, a registry was launched to capture information about US-based cancer patients who have been affected by COVID-19. Please check out the website with link to survey tool here.
Institutions and organizations participating in the consortium include:
*Aurora Health
*City of Hope
*Cleveland Clinic
*Dana-Farber Cancer Institute
*Duke University
*Emory University
*Intermountain Health
*Johns Hopkins University
*Mayo Clinic
*Mount Sinai/Tisch Cancer Institute
*NCI Bethesda
*Northwestern University Lurie Cancer Center
*The Ohio State University
*Stanford University
*University of California, Davis
*University of California, San Diego
*University of Connecticut
*University of Miami/Sylvester Comprehensive Cancer Center
*University of North Carolina
*University of Washington/Seattle Cancer Care Alliance/Fred Hutch
*Vanderbilt University Medical Center
*Washington University in St. Louis
*West Cancer Center
=General information relevant to cancer patients=
*Cancer.gov: Coronavirus: What People with Cancer Should Know (official website of the National Cancer Institute)
*Cancer.net: Coronavirus 2019: What People With Cancer Need to Know
*Fred Hutch: What cancer patients need to know
*What Cancer Patients, Survivors, and Caregivers Need to Know about the Coronavirus
*What Cancer Patients Need to Know about Coronavirus COVID-19 (Salud America!)
*UK CLL forum guidance on COVID-19 for patients with CLL (Twitter @Ukcll, 3/12/2020)
=Information for healthcare professionals=
==Oncology==
*ASCO Coronavirus Resources
*ESMO multidisciplinary expert consensus
*ONS Interim Guidelines during the COVID-19 Pandemic
===Guidance for Treatment of Patients with Cancer and Containment of COVID-19: Experiences from Italy===
Curigliano G, ASCO Daily News 3/17/20
*Cancer patients stratified into two groups
**(A) Patients who completed treatment or whose disease is under control
**(B) Patient undergoing treatment (neoadjuvant or adjuvant curative treatment or treatment for metastatic disease)
*For patients receiving active treatment (B), living in epidemic zones or not, identified specific pathways in order to guarantee timing of treatment with curative intent and, when possible, also for patients with metastatic disease
*Four "Hub Cancer Centers" have been designated in the Lombardy area where cancer can be transferred to receive surgery or active chemotherapy/radiotherapy, biologic therapy, and immunotherapy
**Hub Center should guarantee an appropriate diagnostic-therapeutic pathway that reduces the risk of COVID-19 infection for all patients
**Hub Center should establish checkpoint areas screening for early detection of potential infectious persons with protocols for testing and transferring to COVID-19 hospitals if warranted
Treatment Pathways for Patients With Cancer in the Face of COVID-19
Setting 	Strategy	Measures
Patients "off treatment" 	
#Prevention
#Delay visits and follow-up appointments in the absence of active disease
#Phone contact or telemedicine consultation	
#Community mobilization
#Health education and increased COVID-19 awareness through social media campaigns
#Inform patients in the epidemic areas by phone
#Suggest protection supplies
Patients with early stage cancer in a curative setting (neoadjuvant treatment, surgery, and adjuvant treatment)	
#Prevention
#Treat cancer with the best of care in Hub Center within a "COVID-19 free" clinical pathway	
#1-4 listed above
#Limit close contacts
#Cancer team uses PPE
#Close monitoring for potential toxicity and for COVID-19 symptoms
#"COVID-19-free" clinical pathway
Patients with metastatic disease 	
#Prevention
#Treat cancer with the best of care in "Hub Hospital" within a "COVID-19 free" clinical pathway	
#All measures listed above
#Delay treatment if not compromising disease control
#If oral therapy is needed, provide drug supply in 2-3 courses with home monitoring
#Use telemedicine for toxicity management
===Guidance for immune checkpoint inhibitors and COVID-19===
Courtesy of Dr. Douglas Johnson (VUMC)
*The effects of immune checkpoint inhibitors (ICI), including anti-PD-1, anti-PD-L1, and anti-CTLA-4 agents on COVID-19 infections have not been determined.
*While these agents do not produce an immunocompromised state (in contrast to cytotoxic chemotherapy), there is theoretical concern that they could potentiate pulmonary inflammation induced by the virus.
*Patients who urgently need therapy should initiate ICIs; delaying therapy until after the pandemic could be considered in patients without an urgent indication to start therapy (e.g. stage III melanoma patient to receive adjuvant therapy, indolent/slowly progressive renal cell carcinoma).
*In patients who develop a dry cough while receiving ICI, both ICI-pneumonitis and COVID-19 infection (as well as other infectious etiologies) should be considered. Viral testing should be performed to rule out COVID-19 infection. The presence of a fever may suggest a viral (or bacterial) origin, while lack of a fever may suggest ICI-pneumonitis. However, radiographic presentations and symptoms may overlap.
*All patients receiving ICI with presumed pneumonitis should be tested for COVID-19 and isolated until testing is negative. If COVID positive, consider adding hydroxychloroquine 400 mg q12h on day 1, then 200mg daily days 2-5 per institutional guidelines. If no response in 48-72 hours, consider tocilizumab.
*In patients diagnosed with COVID-19, we would recommend postponing resumption or initiation of ICI therapy for approximately 2 weeks after clinical resolution of symptoms or after first negative viral test.
*In critically ill patients who are receiving ICI and are diagnosed with COVID-19, steroids (e.g. prednisone 1mg/kg) could be considered although the role of steroids is highly questionable (given their potentially detrimental effects on viral clearance in other coronavirus infections). (? Role of tocilizumab -studies ongoing?)
===Guidance for immune cellular therapy===
*Fred Hutch recommendations
**The IMTX program will continue to offer commercial CAR T treatments and enroll patients in cellular immunotherapy clinical trials where there is demonstrated benefit.
**Decisions on other cellular immunotherapy clinical trials will be made on a case by case basis and the IMTX program may delay enrollment to clinical trials with significant inpatient resource utilization.
===Guidance for lung cancer patients===
Courtesy of Nagla Abdel Karim, MD, PhD (Professor of Medicine, Augusta University-Georgia Cancer Center) in discussion with colleagues who are oncologists in Milan-Italy:
#Newly diagnosed patients especially of small cell lung cancer; neoadjuvant, adjuvant and metastatic disease with appropriate performance status remain a priority to treat and receive growth factors support with myelosuppresive therapies.
#Clinical trials patients remain of priority too, however follow up or lab based visits; consider tele-oncology to prevent too many visits that might risk patients’ during the epidemic.
#Maintenance patients can be off treatment for 2 months (break of therapy if possible as long as the disease is stable).
#Patients admitted with severe neutropenia should not be discharged with the severe neutropenia, but remain until their counts recover.
#Follow up patients should either follow through tele-oncology or postpone clinic visit for 3 months (in Italy they were postponed for 3 months, but here, I would like to propose a tele-oncology format).
===Guidance for myeloproliferative neoplasms===
*ASH: COVID-19 and Myeloproliferative Neoplasms: Frequently Asked Questions
===Guidance for transplant===
*American Society for Transplantation and Cellular Therapy (ASTCT) Interim guidelines for COVID-19 management in hematopoetic cell transplant and cellular therapy patients
*Mayo Clinic recommendations (Vincent Rajkumar's original Twitter thread):
#We recommend DELAY the whole transplant process (collection, & storage) for all newly diagnosed patients until the corona epidemic is over.
#If myeloma patients are already on transplant schedule, we recommend offer to delay the whole process (collection and storage) until the corona epidemic is over. If patients are already on site, collect cells but delay the transplant.
#For patients who need the transplant for progressive disease, or very high risk disease and expected early relapse and cannot wait to delay, proceed with transplant.
*Fred Hutch recommendations
Transplant type	Delay 	Consider delay 	Proceed with transplant
Allogeneic 	1. Intermediate-risk AML in MRD-negative CR1 tolerating consolidation2. ALL in MRD-negative CR1 tolerating maintenance/consolidation 3. MDS without excess blasts (RA, SLD, etc) tolerating transfusions 4. Myelofibrosis/MPN/CMML with low blast count without evidence of rapid disease progression, tolerating transfusions	1. MDS-EB2. CMML-1 and 2	1. High-risk AML in CR12. AML and ALL beyond CR1 3. Secondary AML (evolved from MDS, MPN, etc)
Autologous 	1. Multiple myeloma (consider stem cell collection only depending on extent of prior treatment)2. Low-grade lymphoma (Follicular lymphoma, Mantle cell lymphoma, etc) 3. Autoimmune diseases (MS, scleroderma, etc) 	 	Aggressive lymphomas (DLBCL, etc)
===Podcasts===
*Plenary Session 2.43
*Plenary Session 2.44 - ICU management of COVID-19 with Dr. Benjamin Singer and Dr. Vinay Prasad
*Uromigos Episode 8: COVID-19 and Cancer Patients
==Critical care/ICU==
*GiViTI 3/10/2020 COVID-19 meeting about intensive care patients - patient characteristics and management recommendations (Posted at: criticalcarenorthampton.com link to original document)
*Critical care resources for non-ICU clinicians (propofology.com)
*Royal London Hospital COVID Intubation SOP (Twitter @DrJEMcK, 3/14/2020; link to Powerpoint file)
*COVID-19 intubation tutorial (Youtube)
==Radiology==
*Example, CT chest with fibrosis/ARDS (Twitter @danortizmd 3/15/2020)
*COVID-19 severe ARDS (Twitter @curijoey 3/14/2020)
*Many chest x-ray examples from patients with COVID-19 from Spain (Twitter @ChestImaging 3/28/2020)
==Surgery==
*American College of Surgeons COVID-19 Guidelines for Triage of Cancer Surgery Patients 3/24/2020
==PPE (personal protective equipment)==
*Improvised reusable elastomeric respirator, Surgical Innovation Fellowship, Boston Children's Hospital (Youtube)
*"Addressing COVID-19 Face Mask Shortages" (Stanford) - with statistics about performance of N95 masks' filtration efficiency after disinfection
*3M technical bulletin 3/20/2020 recommended against "Disinfection of Filtering Facepiece Respirators"
**Microwave generated steam, ultraviolet irradiation, and moist heat damaged components of respirators such as elastic straps and plastic surrounding metal nose clips and staples
==Other==
*DEA COVID-19 Information Page
*ABIM Coronavirus Updates
*AMA COVID-19 FAQ
*University of Washington COVID-19 Resource Site
*COVID-19 infographic about Italian experience by Twitter @FOAMecmo
*IDSA COVID-19 resource center
*Johns Hopkins Coronavirus COVID-19 (SARS-2-CoV) management information
*Proposed initial diagnostic and management workflow for potential COVID-19 cases given limited testing capacity (Twitter @srrezaie, 3/8/2020)
*MGH Grand Rounds Video: A Coordinated, Boston-wide Response to COVID-19 (3/12/2020)
*Dr. Sachin Shah at UCSF COVID-19 references
*Coronavirus tech handbook (shared Google Doc of clinical care)
*Notes (3/8/2020) from infectious disease physician Martha L. Blum, MD, PhD from Infectious Disease Association of California (IDAC) Northern California Winter Symposium on Saturday 3/7/2020:
Infectious Disease Association of California (IDAC) Northern California Winter Symposium on Saturday 3/7/2020 (expand for more information)
**In attendance were physicians from Santa Clara, San Francisco & Orange Counties who had all seen and cared for COVID-19 patients, both returning travelers and community-acquired cases. Also present was the Chief of ID for Providence, who has 2 affected Seattle hospitals. Erin Epson, CDPH director of Hospital Acquired Infections, was also there to give updates on how CDPH and CDC are handling exposed health care workers, among other things. Below are some of the key take-aways from their experiences.
**The most common presentation was 1 week prodrome of myaglias, malaise, cough, low grade fevers gradually leading to more severe trouble breathing in the 2nd week of illness. It is an average of 8 days to development of dyspnea and average 9 days to pneumonia/pneumonitis. It is not like Influenza, which has a classically sudden onset. Fever was not very prominent in several cases. The most consistently present lab finding was lymphopenia (with either leukocytosis or leukopenia). The most consistent radiographic finding was bilateral interstitial/ground glass infiltrates. Aside from that, the other markers (CRP, PCT) were not as consistent. Co-infection rate with other respiratory viruses like Influenza or RSV is <=2%, interpret that to mean if you have a positive test for another respiratory virus, then you do not test for COVID-19. This is based on large dataset from China. So far, there have been very few concurrent or subsequent bacterial infections, unlike Influenza where secondary bacterial infections are common and a large source of additional morbidity and mortality.
**Patients with underlying cardiopulmonary disease seem to progress with variable rates to ARDS and acute respiratory failure requiring BiPAP then intubation. There may be a component of cardiomyopathy from direct viral infection as Intubation is considered “source control” equal to patient wearing a mask, greatly diminishing transmission risk. BiPAP is the opposite, and is an aerosol generating procedure and would require all going into the room to wear PAPRs.
**To date, patients with severe disease are most all (excepting those whose families didn’t sign consent) getting Remdesivir from Gilead through compassionate use. However, the expectation is that avenue for getting the drug will likely close shortly. It will be expected that patients would have to enroll in either Gilead’s RCT (5 vs 10 days of Remdesivir) or the NIH’s “Adaptive” RCT (Remdesivir vs. Placebo). Others have tried Kaletra, but didn’t seem to be much benefit.
**If our local MCHD lab ran out of test kits we could use Quest labs to test. Their test is 24-48 hour turn-around-time. Both Quest and ordering physician would be required to notify Public Health immediately with any positive results. Ordering physician would be responsible for coordinating with the Health Department regarding isolation. Presumably, this would only affect inpatients though since we have decided not to collect specimens ordered by outpatient physicians.
**At facilities that had significant numbers of exposed healthcare workers they did allow those with low and moderate risk exposures to return to work well before 14 days. Only HCW with highest risk exposures were excluded for almost the full 14 days (I think 9 days). After return to work, all wore surgical masks while at work until the 14 days period expired. All had temp checks and interview with employee health prior to start of work, also only until the end of the 14 days. Obviously, only asymptomatic individuals were allowed back.
**Symptom onset is between 2-9 days post-exposure with median of 5 days. This is from a very large Chinese cohort. Patients can shed RNA from 1-4 weeks after symptom resolution, but it is unknown if the presence of RNA equals presence of infectious virus. For now, COVID-19 patients are “cleared” of isolation once they have 2 consecutive negative RNA tests collected >24 hours apart.
**All suggested ramping up alternatives to face-to-face visits, tetemedicine, “car visits”, telephone consultation hotlines. Sutter and other larger hospital systems are using a variety of alternative respiratory triage at the Emergency Departments. Health Departments (CDPH and OCHD) state the Airborne Infection Isolation Room (AIIR) is the least important of all the suggested measures to reduce exposure. Contact and droplet isolation in a regular room is likely to be just as effective. One heavily affected hospital in San Jose area is placing all “undifferentiated pneumonia” patients not meeting criteria for COVID testing in contact+droplet isolation for 2-3 days while seeing how they respond to empiric treatment and awaiting additional results.
**Feel free to share. All PUIs in Monterey Country so far have been negative. Martha L. Blum, MD, PhD
=Potential treatments=
Note: there are NO APPROVED TREATMENTS for COVID-19 other than convalescent plasma. All other treatments here should be considered experimental!
==Chloroquine==
==Convalescent plasma==
* Shen C, Wang Z, Zhao F, Yang Y, Li J, Yuan J, Wang F, Li D, Yang M, Xing L, Wei J, Xiao H, Yang Y, Qu J, Qing L, Chen L, Xu Z, Peng L, Li Y, Zheng H, Chen F, Huang K, Jiang Y, Liu D, Zhang Z, Liu Y, Liu L. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. JAMA. 2020 Apr 28;323(16):1582-1589. link to original article link to PMC article EuroPMC
** Case report of 5 patients with COVID 19 treated with convalescent plasma containing neutralizing antibody
==Favipiravir==
==Hydroxychloroquine and Azithromycin==
*Gautret et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents – In Press 17 March 2020. Link to original article. 
**Inclusion Criteria
***Age >12 years
***PCR-documented SARS-CoV-2 carriage in nasopharyngeal sample at admission
**Treatment
***Hydroxycholorquine 200mg PO TID x 10 days
***Clinician option to add Azithromycin 500mg PO on day 1 followed by 250mg PO daily on days 2-5
**Results
***20 patients treated with hydroxychloroquine had a significantly higher rate of viral nasopharyngeal clearance (PCR negative) at 6 days post-treatment than control (70% vs 12.5%, p= 0.001)
***Subset of 6 patients treated with hydroxycholorquine plus azithromycin had 100% viral nasophranygeal clearance at 6 days compared with hydroxychloroquine alone (57.1%) and control (12.5%)
*Molina et al. No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19 Infection. M´edecine et Maladies Infectieuses – 28 March 2020. Link to original article. 
**Despite a reported antiviral activity of chloroquine against COVID-19 in vitro, authors found no evidence of a strong antiviral activity or clinical benefit of the combination of hydroxychloroquine and azithromycin for the treatment of hospitalized patients with severe COVID-19.
==IVIG==
* Cao et al. High-Dose Intravenous Immunoglobulin as a Therapeutic Option for Deteriorating Patients With Coronavirus Disease 2019. Open Forum Infect Dis , 7 (3), ofaa102 2020 Mar 21. Link to original article DOI EuroPMC
** Case report of 3 patients in China with COVID-19 treated with IVIg
==Lopinavir and Ritonavir==
*Cao et al. A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19. Link to original article. link to PMC article EuroPMC.
**Inclusion Criteria
***>18 years old
***RT-PCR confirmed SAR-CoV-2 in a respiratory tract sample
***Pneumonia confirmed by chest imaging
***O2 < 94% on RA or PaO2:FiO2 < 300 mmHg
**Treatment
***Lopinavir-Ritonavir 400 mg - 100mg PO twice per day
**Results
***No difference in time to clinical improvement between Lopinavir-Ritonavir (99 pts) vs standard treatment alone (100 pts) (16 days vs 16 days [HR 1.31, 95% CI 0.95-1.85])
***No difference in time to clinical deterioration between Lopinavir-Ritonavir (99 pts) vs standard treatment alone (100 pts) (HR 1.01, 95% CI 0.76 - 1.34)
==Prazosin==
==Remdesivir==
*Holshue et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med 2020; 382:929-936. link to original article link to PMC article EuroPMC 
**Case report of 1 patient with clinical improvement after Remdesivir
*Grein et al. Compassionate Use of Remdesivir for Patients with Severe Covid-19. N Engl J Med 2020. Link to original article DOI.
**61 patients who received at least 1 dose of compassionate use remdesivir; 53 patients with analyzable daata.
**36 patients (68%) had improvement in oxygen support need
**17 of 30 patients (57%) mechanical ventilation were extubated
**7 patients (13%) died
==Statins==
==Tocilizumab==
*Xu et al. Effective Treatment of Severe COVID-19 Patients with Tocilizumab. ChinaXiv:202003.00026. Link to original article. 
**Inclusion Criteria
***Severe or critical pneumonia
****Severe defined as any of the following: RR>30, SpO2<93% on RA, or PaO2/FiO2 < 300 mmHG
****Critical defined as any of the following: respiratory failure which required mechanical ventilation, shock, or need to be admitted to ICU combined with other organ failure
***RT-PCR confirmed SARS-CoV-2 by throat swab
**Treatment
***Tocilizumab 400 mg IV x1
**Results
***20 patients treated with tocilizumab all had resolution of fevers within 1 day of treatment, 15 (75%) lowered their oxygen requirements, 19 (90.5%) clinically improved and were discharged from hospital
=Scientific Evidence on COVID-19 Occurrence in Cancer Patients=
==General cancer==
*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 Mar;21(3):335-337. Epub 2020 Feb 14. link to original article link to PMC article EuroPMC.
**As of Jan 31, 2020, authors collected 2007 cases (417 cases were subsequently excluded due to insufficient records) from 575 hospitals (appendix pp 4–9 for a full list) in 31 provincial administrative regions. All cases were diagnosed with laboratory-confirmed COVID-19 acute respiratory disease and were admitted to hospital. Only 18 (1%; 95% CI 0·61–1·65) of 1590 COVID-19 cases had a history of cancer, which was higher when compared with the incidence of cancer in the overall Chinese population (0·29%).
**Among cancers identified, lung cancer was the most frequent type (five [28%] of 18 patients).
**Compared with patients without cancer, patients with cancer were older (63·1 vs. 48.7 years), more likely to have a history of smoking (22% vs. 7%), and more severe baseline CT manifestation (94% v.s. 71%), but had no significant differences in sex, other baseline symptoms, other comorbidities, or baseline severity of x-ray.
**Patients with cancer were observed to have a higher risk of severe events (a composite endpoint defined as the percentage of patients being admitted to the intensive care unit requiring invasive ventilation, or death) compared with patients without cancer (seven [39%] of 18 patients vs 124 [8%] of 1572 patients; Fisher’s exact p=0·0003).
**Patients who underwent chemotherapy or surgery in the past month had a numerically higher risk (three [75%] of four patients) of clinically severe events than did those not receiving chemotherapy or surgery (six [43%] of fourteen patients)
*Two Editorials Addressed to this: 
**Wang H, Zhang L. Risk of COVID-19 for patients with cancer. Lancet Oncol. 2020 Mar 3:S1470-2045(20)30149-2. link to original article link to PMC article EuroPMC
***Of the 16 patients who had known treatment status, only four had undergone surgery or chemotherapy within the previous month; 12 had recovered from initial cancer treatments (eg, surgery or chemotherapy) and had no obvious immunosuppression. Hence, the correlation between the COVID-19 infections and cancers in the 12 cancer survivors was questionable.
***Liang et al. reported patients with cancer had worse outcomes from COVID-19, but the median age of these patients (63·1 years) was significantly higher than for those without cancer (48·7 years), suggesting that older age is associated with worse COVID-19 outcomes.
**Xia Y, Jin R, Zhao J, Li W, Shen H. Risk of COVID-19 for cancer patients. Lancet Oncol. 2020 Mar 3:S1470-2045(20)30150-9. link to original article link to PMC article EuroPMC
***Instead of the showing a higher percentage of COVID-19 patients having cancer, the incidence of COVID-19 in patients with cancer would be more informative in assessing whether or not patients with cancer have an increased risk of COVID-19.
***Authors also criticized the limitations of: small sample size, large amount of heterogeneity, various cancer types with different biological behaviours variable disease courses (from 0–16 years), and diverse treatment strategies and felt that the cohort was not ideally representative of the whole population with cancer.
***The significant smoking history in the 18 patients with cancer could be a possible confounder given that data has shown that tobacco use significantly increases the gene expression of angiotensin converting enzyme 2 (the binding receptor for severe acute respiratory syndrome coronavirus 2) which could explain the elevated susceptibility to COVID-19 in smokers. The association of smoking with COPD is also another independent risk factor in COVID-19 cases.
*Yu et al. [Not Peer-Reviewed]: https://doi.org/10.1101/2020.02.22.20025320
**Between Dec 30, 2019 to Feb, 17 2020, studied a total of 1,524 cancer patients managed at Zhongnan hospital of Wuhan University
**Among them, the three commonest cancer diagnoses were gastrointestinal (N = 394,35.9%), thoracic (N = 326, 21.4%), and head and neck cancers (N = 204, 13.4%).
**The authors estimated that the infection rate of SARS-CoV-2 in cancer patients from single institution at 0.79% (95% CI = 0.3–1.2) which was higher than the cumulative incidence of all diagnosed COVID-19 cases that was reported in the city of Wuhan over the same time-period (0.37%, 41,152/11,081,000 cases, data cutoff on Feb 17, 2020).
**Thus, the authors found that cancer patients had an estimated 2-fold increased risk of COVID-19 than the general population.
**Interestingly, only five of these patients were ongoing treatment at the time of contracting the virus, suggesting that hospital visitation was the likely factor contributing to the elevated incidence in cancer patients.
**Moreover, the observed the incidence of severe COVID-19 was not higher than in the general population (Note: This is contradictory to the finding of Liang et al.)
*Zhang H, Huang Y, Xie C. The Treatment and Outcome of a Lung Cancer Patient Infected with SARS-CoV-2. Journal of Thoracic Oncology (2020). Link to original article. 
**Case report of 57 year-old Chinese male with EGFR+ advanced lung adenocarcinoma on osimertinib and undergoing radiation therapy one month prior to developing COVID-19. He was treated with Lopinavir-Ritonavir with clinical improvement and clearance of serial RT-PCR's. He continued his osimertinib throughout COVID-19 clinical course with repeat chest imaging after discharge showing stable lung cancer lesions.
==Lung cancer==
*Lung Cancer Study Group, Chinese Thoracic Society, Chinese Medical Association; Chinese Respiratory Oncology Collaboration. [Expert recommendations on the management of patients with advanced non-small cell lung cancer during epidemic of COVID-19 (Trial version)]. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 3;43(0):E031. Chinese. link to original article EuroPMC
**A guideline for the optimal management of patients with advanced lung cancer was proposed to distinguish the symptoms of COVID-19 and the side effects of antitumor drugs.
**A questionnaire survey was conducted on the lung cancer group of the Chinese Thoracic Society, Chinese Medical Association; the lung cancer group of the Chinese Society of Clinical Oncology Youth Committee; and the Chinese Respiratory Oncology Collaboration.
**Based on the 321 validated questionnaire survey results the following recommendations were made:
#Patients with advanced NSCLC should be treated as outpatients if possible at the nearest medical center
#Patients who need to be hospitalized for antitumor treatment should be tested negative for COVID-19 infection
#Close attention should be paid to identification of COVID-19-related symptoms and adverse reactions caused by the malignancy or antitumor treatments.
#Stronger personal protection should be made for advanced NSCLC patients
#An intentional postponing of antitumor treatment should be considered according to patient performance status.
#Treatment strategies should be made according to different types of advanced NSCLC patients and efficacy and toxicity of drugs.
=Hematological Manifestations of COVID-19=
==Cytopenias==
*Guan et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Feb 28. link to original article link to PMC article EuroPMC. 
**Of 1099 cases of COVID-19 in China, 83.2% presented with lymphopenia (absolute lymphocyte count less than 1500/mm^3) and 36.2% presented with thrombocytopenia (less than 150,000 per mm^3)
*Lippi et al. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clinica Chimica Acta 506 (2020) 145-148. Link to original article. 
**Meta-analysis of 9 studies with 1779 patients with COVID-19
***Platelet count was significantly lower in patients with more severe vs non-severe COVID-19 (weighted mean difference [WMD] -31 x 10^9/L)
***Variable clinical definitions of severity in 9 included studies
****3 studies with mortality as primary outcomes: platelet count significantly lower in non-survivors vs survivors (WMD -48 x 10^9/L)
****6 studies with variable definitions of severity not including mortality: platelet count remained significant lower in severe vs non-severe COVID-19 (WMD -29 x 10^9/L)
==Abnormal Coagulation==
*Tang et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18:844–847. Link to original article. 
**Retrospective review 183 cases of COVID-19 in Wuhan, China
***Non-survivors had significantly higher D-dimer (2.21 vs 0.61 µg/mL), higher fibrin degradation product (7.6 vs 4 µg/mL), and longer PT (15.5 vs 13.6) than survivors
***Non-survivors had a significantly higher rate of DIC (71.4% vs 0.6%) vs survivors
=Reports of medical center experiences=
Content moved to its own page here.
=Patient/community experiences=
Content moved to its own page here.
=Testing=
*YouTube video on how to collect a nasopharyngeal swab
*University of Washington Virology "Licensed medical practitioners from anywhere in the US can order #SARSCoV2 #CoronavirusUSA testing from @UWVirology. We continue to add capacity and can test hundreds more people daily." (Twitter @UWVirology 3/9/2020)
*FDA FAQs on Diagnostic Testing for SARS-CoV-2 - lists acceptable swab/media, that single swab may be adequate
*% of detection of SARS-CoV-2 in Different Types of Clinical Specimens, JAMA 3/11/2020
*Guidelines and patient criteria for COVID-19 testing by MA state public health vs. commercial laboratories 3/13/2020
*Drive-through testing experience in New Rochelle, NY: "There were big electronic signs saying KEEP WINDOWS CLOSED so we had to communicate through a closed car." (Twitter @sarahrosen 3/18/2020)
=Hematology/Oncology meetings=
An extensive list is available at The Cancer Letter website.
==Canceled==
*AMIA Informatics Summit (3/23/2020 to 3/26/2020, Houston, TX) - CANCELED
*SGO (Society of Gynecologic Oncology) 2020 Annual Meeting on Women’s Cancer, (3/28/2020 to 3/31/2020, Toronto, Canada) - CANCELED (may be rescheduled for in-person or virtual meeting)
*European Haemophilia Consortium (EHC) Youth Leadership Workshop (4/3/2020 to 4/5/2020, Amsterdam, Netherlands) and World Haemophilia Day (4/24/2020, Brussels, Belgium) - CANCELED
*ASCO Annual Meeting (5/29/2020 to 6/2/2020, Chicago, IL) - CANCELED
==Postponed==
*1st Translational Research Conference: Chronic Lymphocytic Leukaemia (3/20/2020 to 3/22/2020, Paris, France) - POSTPONED until November 17-19, 2020
*NCCN Annual Conference (3/20/2020 to 3/22/2020, Orlando, FL) - POSTPONED until TBA
*Summit on National and Global Cancer Health Disparity (4/3/2020 to 4/4/200, Seattle, WA) - POSTPONED until Fall 2020
*AACR Annual Meeting (4/24/2020 to 4/29/2020, San Diego, CA) - POSTPONED until TBA
==Rescheduled as virtual meeting==
*ENETS Conference for the Diagnosis and Treatment of Neuroendocrine Tumor Disease - VIRTUAL MEETING
==Still happening as planned==
*None
=General information=
==Trackers==
*COVID-19 Coronavirus tracker for United States and Canada, with case-by-case descriptions (1point3acres.com)
*Johns Hopkins CSSE Worldwide Coronavirus Tracker
*United States COVID-19 state-by-test testing results - COVID tracking project (covidtracking.com)
*Australia COVID-19 tracker (covid19data.com.au)
==Number of cases/epidemiology==
*ArcGIS charts and maps about COVID-19 cases, with multiple options to break down by country
*Animated bar chart race of COVID-19 cases outside China from 1/27/2020 to 3/11/2020 (gohkokhan.com)
*COVID-19 Projections (number of cases, total hospital beds and ICU beds needed vs. actual beds, state-by-state estimates)
*COVID-19 cases per 10 million people
*Clusters of disease spread in South Korea, "Patient 31" (Reuters, 3/3/2020)
*Cases per country as of 3/12/2020
*Italy vs. United States number of cases offset graph through 3/13/2020
==Misc information==
*John Campbell Youtube Coronavirus videos
*CDC.gov COVID-19 Coronavirus information
*Estimate of mortality rate by age (Twitter @DorsaAmir, 3/7/2020)
*Influenza vs. COVID-19 mortality rate by age (Twitter @AshokKumarSheo8, 3/7/2020)
*Ars Technica summary of COVID-19 information (Arstechnica.com, 3/8/2020)
*Response to COVID-19 in Taiwan Big Data Analytics, New Technology, and Proactive Testing (JAMA 3/3/2020)
*Coronavirus: Why You Must Act Now (Medium, Tomas Pueyo, 3/10/2020)
*COVID-19 Update; 3/14/2020. A Message From Concerned Physicians by Howard Luks MD (Medium 3/14/2020)
*UCSF Expert panel discussion 3/10/2020, notes by Jordan Schlain MD
*Dermatologist's guide to COVID-19 handwashing (Twitter @RoxanaDaneshjou, 3/15/2020)
*COVID-19 presentation slides by Michael Lin MD/PhD PDF 3/13/2020 (Twitter @michaelzlin 3/14/2020)
*Fei Zhou et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 11. link to original article link to PMC article EuroPMC
Category:General reference pages