Transmission of COVID-19 among cancer patients in China

By Dr. Ananya Mandal, MDMar 25 2020

Researchers from Zhongnan Hospital of Wuhan University in China in collaboration with those from the National Cancer Centre Singapore, have come up with a study that reveals the transmission of the SARS-CoV-2 or novel coronavirus among patients with cancer in China. Their study titled, “SARS-CoV-2 Transmission in Patients With Cancer at a Tertiary Care Hospital in Wuhan, China,” was published in the latest issue of the JAMA Oncology.

What was this study about?

For this study, the team looked at the infection rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among patients with cancer admitted at a single hospital in Wuhan China. They wrote that since 2019 December, a novel coronavirus disease called COVID-19 emerged in Wuhan, Hubei, China. Since then, it has spread to over 173 nations and territories and has resulted in a pandemic that was declared by the World Health Organization (WHO) on March 11, 2020. Typically the SARS-CoV-2 infection leads to coronavirus disease 2019 (COVID-19) in susceptible individuals.

Novel Coronavirus SARS-CoV-2 This transmission electron microscope image shows SARS-CoV-2, the virus that causes COVID-19, isolated from a patient in the U.S. Virus particles are shown emerging from the surface of cells cultured in the lab. The spikes on the outer edge of the virus particles give coronaviruses their name, crown-like. Credit: NIAID-RML

The authors wrote that the infectivity of the virus is high with human to human transmission by droplet spread. They explained that there was a 41.3 percent rate of hospital-acquired coronavirus spread among 138 patients admitted to Zhongnan Hospital of Wuhan University. They speculated that this could be because of the source of infection is the hospital environment. They added that persons with cancer need to visit the hospital frequently for check-ups as well as for treatment. These patients typically have a suppressed immune system due to the chemotherapy and radiation therapy that they need to undergo, which puts them at a higher risk for COVID-19 infection.

This study was conducted to see the incidence or occurrence of SARS-CoV-2 infection in cancer patients visiting the tertiary cancer institution in Wuhan. The outcomes of such infections were also recorded.

What was done?

For the study, the team looked at all the medical records of 1,524 patients who were admitted to the Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University between December 30, 2019, and February 17, 2020. For each of the patients, detailed records of their backgrounds, age, sex, type of cancer, treatments they underwent, and clinical features of the patients during and after treatment were recorded. For each of the patients, the updated COVID-19 Diagnostic Criteria, 5th Edition (Supplement), was used to diagnose COVID-19 in the patients.

What was found?

The study revealed that the infection rate of cancer patients with SARS-CoV-2 was 0.79 percent. Overall, 12 out of the 1.524 patients studied developed COVID-19 infection. They also saw that on February 17, 2020, there were a total of 41,081 patients admitted in the hospital without cancer in Wuhan, and the rate of cases of COVID-19 among them was 0.37 percent or 152 patients.

They noted that the median age of the patients who developed cancer was 66 years ranging from 48 to 78 years. Of the 12 patients who developed COVID-19, eight were over the age of 60 years. Of these 12 patients, the majority (58.3 percent or 7) had non-small cell lung cancer, and 41.5 percent or five patients were being treated with either chemotherapy or immunotherapy or radiation therapy.

Looking at the outcome of the infected persons, they wrote that three of the 12 (25 percent) developed SARS, and one required ICU care. After the study cut off of February 17, the team followed up the patients and found that by March 10, 2020, 6 of the 12 were discharged, and there were three deaths.

The team analyzed the risk factors of getting COVID-19 among the patients and found that patients with non-small cell lung carcinoma and those over the age of 60 years had a higher risk of COVID-19 compared to those aged less than 60 years. The comparative risk was 4.3 percent among the former and 1.8 percent among the latter.

Implications

The authors concluded that those with cancer, due to their immunocompromised state may be more susceptible to SARS-CoV-2 infection. They wrote, “patients with cancer from the epicenter of a viral epidemic harbored a higher risk of SARS-CoV-2 infection compared with the community.” They reiterated that less than half of these patients were undergoing active anti-cancer treatment at the time of their acquiring COVID-19. They wrote, “our findings imply that hospital admission and recurrent hospital visits are potential risk factors for SARS-CoV-2 infection.”

To combat this, the team also suggested that aggressive measures must be taken to decrease the frequency of hospital visitors for cancer patients, especially during an epidemic of viral infection. For these patients, “proper isolation protocols must be in place to mitigate the risk of SARS-CoV-2 infection,” they wrote. They plan to study the effects of this viral pandemic in a larger sample of cancer patients to confirm their findings.