Evidence: Due to evolving knowledge of COVID-19 and standards regarding PPE usage, and the risk of severe outcomes that immunosuppressed persons face, it is not recommended that healthcare providers care for both COVID-19 patients and immunosuppressed patients at the same time during their shift.
COVID-19 is a new (novel) coronavirus, in the same family as SARS, MERS, and the common cold. Currently, it is thought to be spread through airborne or droplet contact. There are no treatments or vaccines for COVID-19. COVID-19 is thought to be more severe in the elderly, those with underlying health conditions, and those who are immunosuppressed.
Immunosuppression is the intentional or idiopathic prevention or interference of the immune response. Persons who are immunosuppressed (immunocompromised) can include those with congenital immunity deficiencies, HIV, cancer, solid-organ or stem cell transplant, autoimmune disorders, or who are undergoing radiation or chemotherapy.
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The Oncology Nursing Society states that “Based on the limited data from COVID-19 and other related coronaviruses, older adults and those with underlying medical conditions that make them immunocompromised may be at greatest risk for severe outcomes.”
Fred Hutchison Cancer Research Center in Seattle released a statement for cancer patients and their caregivers. In it, they note that patients currently undergoing chemotherapy, immunotherapy, radiation therapy and those with blood cancers or post-stem cell transplant are at highest risk for contracting a severe case of COVID-19. Even those who have had cancer in the past but are not currently undergoing treatment are at some risk, because the after-effects of cancer can be long-term.
A small study from China, recently published in the Lancet, confirms this. A prospective cohort was established to monitor COVID-19 among cancer patients. Out of 575 hospitals, 18 patients met criteria for inclusion in the study. Although the study was limited in size, demographics, and type of cancer, analysis showed that patients with cancer were observed to have a higher risk of severe events, including ICU admission, invasive ventilation, and death.
The updated CDC recommendations encourage clustering patients with COVID-19 together in the same unit (or same area) in order to preserve PPE and decrease potential transmission of the virus. Patients with confirmed COVID-19 may be housed in the same room (cohorted). These recommendations also state that dedicated staff should care for these patients — and only these patients – during their shift.
Of note, evidence does not support the use of ‘protective isolation’ or other ‘reverse isolation’ measures when caring for non-stem cell transplant immunosuppressed patients. Staff should continue to utilize good hand hygiene and isolate immunosuppressed patients appropriately for transmission-based organisms.
COVID-19 Fact Sheet and Implications for Patients With Cancer from the Oncology Nursing Society (March 4, 2020)
Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings from the Center for Disease Control and Prevention (CDC)
Coronavirus: what cancer patients need to know from Fred Hutchison Cancer Research Center (March 6, 2020)
Liang, W., Guan, W., Chen, R., Wang, W., Li, J., Xu, K., … He, J. (2020). Cancer patients in SARS-CoV‑2 infection: a nationwide analysis in China. The Lancet Oncology, 21(3), 335 – 337. doi: 10.1016/s1470-2045(20)30096 – 6