Not Business as Usual: COVID-19 Anxiety in the World of Cancer

Not Business as Usual: COVID-19 Anxiety in the World of Cancer

Guest Commentary

Mar 19, 2020

Dr. Nausheen AhmedBy Nausheen Ahmed, MD

I started my month of inpatient transplant on March 4—just a few weeks ago, but so much has happened since then that it feels like a different decade. I remember walking down the familiar hallways of the stem cell transplant unit in the cancer center after rounds that first day, glad that my patients were stable, rounds were quick, and the day went smoothly. Nice!

While having lunch at my desk that day, out of habit I quickly scrolled through Twitter and Facebook to see the latest updates. Nothing new in the U.S., but I noted a lot of buzz about the novel coronavirus in China and Europe. “What’s going on in the world these days? If only people would wash their hands as often as we do at the hospital!” I mumbled. I remember feeling scared, yet safe. Like I was in my own bubble immune from everything happening elsewhere. After all, there were no cases in the Ohio at that time!

I was conflicted. Part of me felt the news about this virus was blown out of proportion and would quiet down in a few weeks, but another part of me was whispering, “Oh goodness! We are in trouble! Things could explode out of proportion anytime!!” In the coming days, I heard vague chatter of meetings by hospital administrators about the hospital’s plans to deal with COVID-19: visitation restrictions, screening of visitors and patients, dealing with employees who may be sick. The most consistent message, however, was the motto of “business as usual.”

Little did I know that a week later, things would not be business as usual at work. The first cases of COVID-19 were diagnosed in my city, and suddenly it became real. I did not get sick, but life changed around me. Social isolation was the new norm. No handshakes. No meetings. Conferences postponed or virtual. Speakers requested to postpone talks. Students and international visiting observers requested to postpone or cancel rotations. Every day brought on a new wave of social restriction. Everyone was affected, some more than others. I remember the awe and shock of the students/trainees on my team who had to cancel rotations. While we all understood the greater purpose, none of us were emotionally ready for all the changes and how they would personally affect us.

Then came the day that the schools in Ohio announced that they would close for 3 weeks. While we all understood in our hearts that this was prudent, as a parent I was beyond anxious. As a health care worker and a mother, what was I supposed to do? How do you find childcare when social distancing is recommended, crowds are discouraged, and elderly grandparents should ideally distance themselves? Some of our staff have the flexibility to work from home, but as anyone with children can tell you, concentrating when they’re at home can be a challenge. For nurses, residents, trainees, physicians, and staff whose work requires them to be onsite, the childcare issue is a nightmare. Let’s face it, this is a tough situation on all counts. And it could get worse!

Colleagues without children are also facing anxiety with the new norm. Being unable to do the regular activities we’ve all taken for granted—going to the gym, meeting up with friends on the weekends, or even just being able to go to the grocery and knowing you’ll be able to find the food (and toilet paper) you need—can be pretty inconvenient and isolating. This contributes to a feeling of fear and even panic. With the travel restrictions, cancelling trips and changing vacation plans add to the worry for everyone, even as we know this is very important and has to be done.

We, as health care workers and caregivers, have the luxury of being healthy, for the most part. However, on daily rounds, I could not help but wonder how anxious our patients and their families must be. With new waves of social restriction policies being imposed, very rightfully so, we must not forget how our patients are affected. Our patients not only experience anxiety about contracting the virus, but also may experience depression from prolonged social isolation. Our patients with cancer are going through a tough period getting chemotherapy, receiving a transplant, or being admitted for a complication. The anxiety of being in a hospital room with limited physical support from loved ones can be daunting. They are worried about neutropenia and their risk of getting infected with COVID-19. They are afraid of going through a transplant in the midst of a pandemic. They are lonely and isolated when no visitors allowed while they are in the hospital. They have to grapple with the possibility of a lockdown affecting their access to medical care. Our patients and their caregivers are so brave, but all this worry and fear adds up!

This current moment asks for some personal sacrifices and readjusting of our lives, at least in the coming months. At the same time, we must also reflect on the emotional toll these changes can take on our patients, colleagues, and loved ones. After talking with family and friends, I realized that the most important thing is to remind ourselves that we are all in this together. The sacrifices we make are to protect each other.

On a very personal level, it is not just compliance with preventative and precautionary measures that will help us through this pandemic, but also helping and caring for our colleagues and patients with cancer to emotionally and physically cope with this evolving situation.

We cannot predict how the extent or duration of the pandemic and the lifestyle changes we have to make to help improve our community’s chances of surviving COVID-19, but we can support each other through this difficult time.

I am reminded of the famous words by my mentor Dr. Marcos de Lima: “This is not business as usual, my friends.”

Dr. Ahmed is a BMT and Cellular Therapeutics fellow at Seidman Cancer Center/Case Comprehensive Cancer Center. Follow her on Twitter @NausheenAhmedMD.

ASCO has developed and compiled resources to support oncology professionals during the COVID-19 pandemic. Resources include evidence-based answers to Frequently Asked Questions (FAQs) about clinical care of patients with cancer, a centralized collection of links to credible sources, the latest decisions about impacted ASCO meetings and programs, and oncologist-vetted information for patients. This page will be updated regularly as the COVID-19 public health situation evolves.

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