key: cord-0810195-boaresfp
authors: Ferrari, Daris; Violati, Martina; Codecà, Carla
title: Cancer patients in COVID-19 outbreak: something more than Suram fortress
date: 2020-05-29
journal: Med Oncol
DOI: 10.1007/s12032-020-01381-x
sha: 044e89eae45a5345e2dfaef8d80bce7fc713e077
doc_id: 810195
cord_uid: boaresfp

nan

were sent to the Emergency Department with the aim of maintaining the cancer area COVID-19-free. Considering the period from February 26th to April 30th, 630 first and mandatory control visits were performed, and 1360 chemotherapy cycles administered on 405 patients. A total of 1015 patients (and much more relatives) passed through our outpatient ward while the viral storm was raging outside. We identified 30 suspected patients, who underwent NPS, but only two were found positive. While a patient had a mild respiratory syndrome with ground-glass bilateral lung opacities at Computed Tomography (CT) scan, resolving in few days, the other one went through a tumultuous course and died in 2 days. Death was due to the occurrence of severe respiratory failure complicated by diffuse pulmonary thromboembolism. Thoracic CT scan demonstrated the presence of diffuse pulmonary arterial filling defects and typical bilateral pneumonitis, usually accompanying COVID-19, as we know now. Neither hydroxychloroquine nor enoxaparin nor mechanical ventilation was able to limit and arrest the rapid and fatal course in this case.

All healthcare personnel were subjected to NPS. Among 48 doctors, nurses and social health operators, only 2 oncologists with mild symptoms (transient anosmia e low-grade fever) were found to be positive and a quarantine period was arranged for them. It was assumed they contracted the virus during their hard work in the Emergency Department, as a support team.

While the viral weave is slowly subsiding in Italy, now we are trying to focus on our behaviors in order to understand whether our choices made perfect sense. Looking at our numbers, one death out of more than thousand patients and two members of the staff involved, we think our defensive system was indeed something more stable than the fortress of Suram.

COVID-19 may follow an asymptomatic or rapidly fatal course [2] . The outcome depends on the combination between virus attack and host response, triggered by the functional receptor Angiotensin Converting Enzyme 2 * Daris Ferrari daris.ferrari@asst-santipaolocarlo.it 1 San Paolo Hospital, Milan, Italy (ACE2), highly expressed on lung epithelial cells. T-cell activation, initiated by antigen presenting cells, flows into the action of CD4 + and CD8 + T-cells, the former able to activate B-cells and antibody production, the latter destined to kill viral infected cells [3] . The immune system alterations and the susceptibility to infections typically found in cancer patients have strongly alarmed the world of oncology; hence, many Institutions have developed their own defensive walls. We tried to prevent any complication related to COVID-19 by maintaining a high suspicion index and a series of protective measures. We cannot say accurately how successful was our intervention but, beyond any doubt, the patients themselves made the difference, thanks to their full adherence to our precepts, the stoic calm and patience they showed us every single day and the renewed struggle against cancer they are still fighting.

Author contributions All the Authors equally contributed to the concept and the writing of the paper.

Funding Not applicable.

Data availability Not applicable.

Code availability Not applicable.

Conflict of interest The authors declare they have no conflicts of interest.

Ethical approval Not applicable.

Consent for publication Not applicable.

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