As a hematologist with an interest in infectious diseases I would like to use this
opportunity to repeat a long-standing message: community-acquired respiratory viruses
(CARV) are potential killers, especially for cancer patients . Influenza has long
been famous for causing seasonal excess mortality in all populations and is therefore
well known as a dangerous pathogen in cancer patients in particular [2, 3]. Other
CARV with complicated names such as respiratory syncytial virus (RSV), parainfluenza,
or human metapneumovirus (hMPV) have also been described as causes of pneumonia with
high fatality rates in patients with hematological malignancies inside and outside
the transplant setting [4, 5, 6]. It seems that shortly after the novel description
of a respiratory virus oncologists have previously never heard of, there is the report
of an outbreak, sometimes with fatal consequences, on a hematology/oncology unit somewhere
on the globe [4, 5, 7]. So why should this be any different for SARS-CoV-2? The characteristics
are the same, albeit probably aggravated, as for the other CARV: firstly, an infection
with SARS-CoV-2 is per se potentially dangerous, secondly, the virus is highly contagious
and has a high potential for nosocomial transmission, and lastly, clinicians are not
used to and thus not sufficiently aware of this particular pathogen.
In this issue of Oncology Research and Treatment, there is the report of an outbreak
of SARS-CoV-2 on a hematology unit together with the description of its successful
containment along with a review of a possible strategy to manage care for cancer patients
in times of COVID-19. There are several lessons to be learnt from this valuable report:
Outbreaks with CARV happen, and they happen to anyone, even to units of the highest
Outbreaks with CARV need to be recognized quickly, and effective measures need to
be taken rapidly, although they may appear radical at times.
If dealt with appropriately, outbreaks can be contained, and cancer care can be ensured
at the highest possible standard even in times of a pandemic.
The most important resource to continue cancer care in the situation of a pandemic
is enough dedicated staff.
So, what does it take to make sure all cancer patients receive optimal therapy during
the COVID-19 crisis? We need to take the virus and the disease it causes absolutely
seriously. We need to find the right balance between implementing appropriate precautions
on the one hand and causing collateral damage by denying cancer patients the tumor
therapy they need on the other hand. Recommendations should be as rational and evidence-based
as possible (as they usually are in cancer care). For this, high-quality evidence
needs to be gathered as quickly as possible, and the development of recommendations
even in times of crisis should be consensus-based with critical appraisal. The aim
is to care for our patients as safely and as effectively as we usually do, which has
led to the well-described increase in survival and quality of life in the recent years
In my impression, this is exactly what the community of hematologists and oncologists
has been striving for with an immense effort over the past weeks. All clinicians and
healthcare workers involved in either treating COVID-19 patients or working hard to
compensate potential implications on routine cancer care cannot be thanked enough.
If the efforts of everyone involved are recognized and the lessons learnt from the
SARS-CoV-2 pandemic kept in mind, the community is well prepared for any other upcoming
crisis, including safe management of the yearly mini-crisis of seasonal CARV epidemics.
Honoraria/consulting fees: Celgene, Janssen, Takeda, Amgen, Oncopeptides, Cancer Drug
Development Forum, Gilead, Merck, and BMS. Research funding: Celgene, Gilead, Novartis,
and Deutsche Krebshilfe.