Hematologists/oncologists and their patients, like the rest of the world’s population, are now on alert to face the pandemic of COVID-19 worldwide. In fact, we are among the most concerned because our patients are potentially more vulnerable. Our patients are at higher risk of acquiring the virus because of frequent scheduled visits to clinics and hospitals, and if they catch COVID-19, they are at higher risk of serious complications and mortality because of chemotherapy, low blood counts, immunosuppression, poor general condition, and possible associated other medical problems such as diabetes, cardiac, or pulmonary disease. Patients who require extensive surgery, intensive care, and radiation therapy to the lungs are also at higher risk. Patients with acute leukemias on high-dose chemotherapy and/or post-bone marrow transplantation regimens and immunosuppressive therapies are at the highest risk for complications. For oncology professionals, learning from each other and planning to deal with the pandemic is crucial.

Awareness: ASCO and the medical oncology and hematology community are working on increasing awareness regarding the most common mild to severe symptoms and signs of COVID-19 infection (fever, cough, shortness of breath) and reducing the chances of spread to patients and the community. The spread of the coronavirus can be slowed down because we know that it affects the upper respiratory tract and is present in the saliva and upper respiratory secretions. It is spread by coughing and from salivary droplets that are often invisible and disseminated from the mouth while talking or when people touch their nose, mouth, and lips. Those droplets are deposited on surfaces such as tables, desks, doorknobs, elevator buttons, shared pens, telephones, etc. Therefore prevention is feasible and necessary.     

Instructions to staff, patients, and families: At the American University of Beirut Medical Center (@AUBMC_Official) we continue to explain over and over again—not only to our patients and their families and friends, but also to our staff and even to ourselves—the general and proper instructions to reduce the chance of acquiring COVID-19:

• Wash hands with soap and water for 20 seconds
• Use sanitizers between examinations of patients (especially if there is no soap and water)
• Do not touch your nose and lips and eyes
• Do not shake hands
• Maintain social distancing of 1 meter (6 to 8 feet) apart even in waiting and examination rooms
• Wear masks properly, when instructed to do so.
• Do not keep touching and adjusting masks (by doing so you place virus particles on your fingers and place them unconsciously on the mucosa of your eyes or nose or mouth)
• Remove and dispose of masks the correct way
• Use gloves when examining patients
• Avoid people who are ill, crowds, public transportation, cafes and restaurants, and unnecessary travel
• Stay home as much as possible
• Remain well nourished
• Do not smoke cigarettes nor hubble bubble hookah (which has become very common in Lebanon and many other countries)
• Shop for essential items at times when there are no crowds, or have a family member or friend do it for you if you are ill or in a high-risk group
• Disinfect commonly touched items

Our administration and Infection Control Committee have been working tirelessly to serve our community and protect our staff, monitor the evolving pandemic, and issue daily updates, and have been using flyers, posters, websites, and social media to disseminate information. Social distancing is considered a major step to help contain the coronavirus and halt its transmission. We reduced all our gatherings to less than 10 people with empty chairs in between persons. The hospital cafeteria is now open only to staff, seating is limited, and staff are asked to bring their own food from home.

Journalists, newspapers, magazines, and particularly television and radio stations have been dedicating prime time to raise awareness and share responsibility to contain and slow down the COVID-19 pandemic in Lebanon and the Middle East. Lebanon is a small country with a total population of 6 million inhabitants, of whom 30% are refugees. As of March 20, 2020, Lebanon had 149 confirmed cases of COVID-19 in the general population, and 0 confirmed cases among refugees. If the coronavirus spreads among refugees (who live in hyper-populated areas where it is very challenging to abide by the recommended precautions), that could potentially be a big disaster for this vulnerable group.

Clinics/Chemotherapy Units: In addition to above precautions, special measures that we are taking and that are also being implemented by many cancer centers and private hematology/oncology clinics include the following:

• Contacting patients before their appointments and asking them if they or a close family member have recently traveled to an infected area, asking them about known symptoms, and referring them to their family physician or COVID-19 clinics if necessary
• Asking comers to wear a mask if necessary
• Reducing the number of daily clinic appointments and spacing them out
• Reducing waiting time to a minimum
• Limiting the number of accompanying persons or visitors to one
• Temporarily postponing routine checkups and follow-up of patients in remission and on maintenance hormonal therapy, for example, postponing zoledronic acid infusions
• Using colony stimulating factors to reduce chances of neutropenia associated with chemotherapy

Conferences and Travel: Our administration issued strict rules to reduce the number of people allowed in meetings to a maximum of 10 people throughout the whole campus of the American University of Beirut (@AUB_Lebanon). We have started setting up and holding classes for medical students, grand rounds, divisional conferences, and tumor boards virtually using online meeting tools. Our medical, nursing, and general staff all have been staying while off duty. Our hospital has issued policies against travel unless absolutely necessary, out of concern for staff and faculty health, and as we cannot afford bringing risks to our vulnerable patients nor can we afford to quarantine large numbers of our staff if they travel to a high-risk area. Our hematology/oncology faculty and fellows, residents, students, nurses, and staff have been showing great dedication and collaboration in these challenging times. Young faculty and residents are offering to be in the front line in lieu of senior older faculty who are at higher risk for complications from COVID-19.

Sharing information for containment, prevention, and readiness must go along with support for research for effective therapy and vaccination! 

Dr. El Saghir discusses cancer care and COVID-19 on Oncology Tube.

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.