April6,2020

UpdateforWeekofApril13,2020totheJointStatementonCOVID-19FromLungCancerAdvocacyGroups

AsofApril11,2020,theCentersforDiseaseControlandPrevention(CDC)reports492,416casesofCOVID-19and18,559COVID-19-associateddeaths.TheUnitedStatesnowhasthehighestnumberofconfirmedCOVID-19casesintheworld.Thesenumbersmaybeanunderestimationofthetrueburdenofthediseaseduetolackoftestingandahighproportionofasymptomaticyetinfectiousindividuals.Weurgeeveryonetocontinuetosocialdistance:itisworking!WashingtonandCaliforniaquicklyimposedstate-widesocialdistancingthroughstringentshelter-in-placeorStayatHomepoliciesoncedeathsoccurredwithintheirborders.ThegraphbelowshowsthatCOVID-19deathsarestillincreasinginthesetwostates,butnotasfastasinotherstates.DeathsinNewYorkStatearenowdoublingevery3days(whenlastweekitwasevery2days),andinWashingtonStateandsomeCaliforniacountiesdeathsaredoublingonlyeveryweek.Themostup-to-dateversionofthegraphbelowcanbeaccessedfromtheNewYorkTimeswebsitehere.

Inthisweek’supdate,weanswerthefollowingimportantquestions:

1. WhattypesoftreatmentsareavailableforCOVID-19?2. IfIsuspectIhaveCOVID-19,whatshouldIdo?3. IfIhadCOVID-19andhavenowrecovered,willIbecomeimmunetoSARS-CoV-2?

April6,2020

4. CanIfindoutifIwasnaturallyinfectedwithSARS-CoV-2,thevirusthatcausesCOVID-19,andhavedevelopedimmunity?

5. HowcanItellifinformationIreadaboutCOVID-19isreliable?

1. WhattypesoftreatmentsorvaccinesareavailableforCOVID-19?Ifyouoryourlovedone(caregiver)hasaconfirmeddiagnosisofCOVID-19,your/theirhealthcareproviderwillbetherightpersontodecidewhattypeoftreatmentisuseful.PleasedonottreatCOVID-19-relatedsymptomswithoutconsultingyourhealthcareprovider.Donottrytoprocureorhoardmedicationssuchashydroxychloroquinethatareapprovedforuseinotherconditions,asthisiscreatingashortageofthesemedicationsforpatientswithconditionsforwhichthedrugsarealreadyapproved.Currently,nospecifictreatmentorvaccineisavailableforCOVID-19.Thiscontinuestobeanareaofintenseinvestigation.SomeofthedrugsdescribedbelowmaybeavailabletoCOVID-19throughcompassionateaccess.ThisdoesnotmeanadrugisapprovedforthetreatmentofCOVID-19.Itisimportanttokeepinmindthatproperlycontrolledclinicaltrialstakealongtimetoconduct.Treatment:VariouscompoundssuchasremdesivirandhydroxychloroquinearebeingstudiedforthetreatmentofCOVID-19.Remdesivirisananti-viraldrug.Ithasbeenshowntobeactiveagainstabroadgroupofvirusessuchasfiloviruses(causeofEbola)andcoronaviruses(e.g.,SARS-CoVandMERS-CoV).SARS-CoVisthecauseofSARSandMERS-CoVisthecauseofMiddleEastRespiratorySyndrome.ThesetwovirusesarerelatedtoSARS-CoV-2,thecauseofCOVID-19.Remdesivirhasshowntoprotectagainstinfectionandtreatinfectioncausedbythesecoronavirusesinpre-clinicalmodels(experimentsinvolvinganimalmodelsofvirusinfection).ArecentpublicationintheNewEnglandJournalofMedicineshowsthatremdesivirgiventohospitalizedCOVID-19patientshelpedimprovesymptoms.Thoughpromising,itisimportanttonotethatthisstudyincludedasmallsampleofpatients.RandomizedclinicalstudieswithappropriatecontrolsarenecessarybeforeremdesivirbecomesapprovedforusewithallCOVID-19patients.Hydroxychloroquineisadrugusedtotreatmalariaandauto-immunedisorderssuchasrheumatoidarthritis.ItisknownbythenamePlaquenilintheUS.Currently,evidencesuggestingthesuccessfuluseofhydroxychloroquineinCOVID-19patientsislimited,andmostlyanecdotal.ClinicaltrialsstudyingtheeffectofhydroxychloroquineinthetreatmentofCOVID-19areongoing.DespitethePresident’songoingendorsementofhydroxychloroquineasaneffectivetreatmentforCOVID-19,concernsaboutitscardiactoxicitiesaregrowing,especiallyforpeoplewithunderlyingcardiovasculardisease.RecentguidanceissuedbyleadingheartdiseaseorganizationsrecommendscautionwhentreatingCOVID-19withthecombinationofhydroxychloroquineandtheantibioticazithromycinincertainpatients.

April6,2020

Vaccines:Historically,vaccinesagainstviruseshavebeenveryeffectiveineradicationofcommonviraldiseasessuchassmallpoxandpolio.Fromanindividualperspective,vaccinationpreventsormodifiestheseverityofadisease.Fromapublichealthperspective,avaccineeliminatesoreradicatesadiseasefromthepopulation(forexample,smallpox).SincetheSARSepidemicin2003,severalcompaniesandinstitutionshavealreadydevelopedplatformsforvaccinedevelopmentagainstcoronaviruses,whichisafamilyofvirusesthatincludesSARS-CoV-2,thecausativeagentofCOVID-19.OnJanuary23,2020,theCoalitionforEpidemicPreparednessInnovations(CEPI)wasthefirsttoannouncefundingof$12.5milliontodevelopvaccinesagainstSARS-CoV-2bythreecompanies.Sincethen,bothphilanthropicandindustryeffortshavebeenmobilizedforthedevelopmentofavaccineagainstSARS-CoV-2.AsofApril9,2020,therearecloseto80vaccinedevelopmentefforts.Itisimportanttokeepinmindthatvaccinedevelopmentisalengthyprocessandbest-caseestimatessuggestthatitwilltakeaminimumof18monthstodeliveraneffectivevaccineagainstSARS-CoV-2.Evenonceacandidatevaccineisidentified,itmustbemanufacturedatscaleforaglobalpopulation.Tospeedtheseefforts,theGatesFoundationhasannouncedthatitissupportingconstructionoffactoriestopursuedevelopmentofsevenvaccinecandidates.Othertreatments:Recently,theBill&MelindaGatesFoundationalsoannounceda$125millionpartnershipwithWellcomeandMastercardtoacceleratethedevelopmentofnewdrugstotreatSARS-CoV-2infection.TotracktreatmentsthatarebeinginvestigatedforCOVID-19,pleasecheckouttheMilkenInstituteCOVID-19treatmentandvaccinetracker.Here,youwillalsofindinformationonclinicaltrialstestingpotentialCOVID-19drugs/vaccines.

April6,2020

2. IfIsuspectIhaveCOVID-19,whatshouldIdo?

Ifyou(asapatient)oralovedone(acaregiver)exhibitsthesymptomsofCOVID-19(includingbutnotlimitedtofever,drycough,shortnessofbreath),immediatelyfollowself-quarantineprocedures.Immediatelycontactyourhealthcareprovider(couldbeyourprimarycarephysician)aboutwhetheryouneedtogettested.Yourhealthcareproviderwillbeabletoguideyouonnextsteps.TheCDCandtheAssociationofPublicHealthLaboratoriesmaintainalistoflaboratoriesthatarecurrentlyconductingCOVID-19tests.PleaserememberthatyoumaynothavesymptomsevenifyouareinfectedwithSARS-CoV-2.Socialdistancingistheonlywaytoavoidgettinginfectedwiththevirus.Asacaregiver,pleasetakeextraprecautionswhenyouneedtoleaveyourhouseorapartment.3. IfIhadCOVID-19andhavenowrecovered,willIbecomeimmunetoSARS-CoV-2?

Theansweris–wedonotknow.Whenanindividualisinfectedwithapathogen,suchasbacteriaoravirus,typicallythebodymountsanimmuneresponse.Thisistrueeveninindividualswhoremainasymptomatic.Theimmediateimmuneresponseensuresthatthepathogeniseliminatedfromthebody,andimmunologicalmemory(thebasisofvaccination)ensuresthatifthebodyencountersthepathogeninthefuture,theimmunesystemisreadytofightitoff.InthecaseofSARS-CoV-2,basedonexperiencewithothercoronavirusessuchasSARS-CoVandMERS-CoV,webelievethatdevelopmentofimmunitywillbehighlyindividual-specific.SomeindividualsmaydevelophighamountsofantibodiesagainstSARS-CoV-2whileothersmaynot.Furthermore,itisnotcurrentlyclearwhetheraone-timeinfectionwithSARS-CoV-2conferslifetimeimmunityagainstthevirus.ScientistsarestillevaluatingwhatlevelofimmunityisneededtoconferprotectionagainstfutureinfectionswithSARS-CoV-2.

4. CanIfindoutifIwasnaturallyinfectedwithCOVID-19andhavedevelopedimmunity?

TheanswerasofApril13,2020is-wedonotknow.Inordertocheckifanindividualhasbeeninfectedwithapathogen,healthcareproviderscanconductbloodtests(alsoknownasserologicaltests)tocheckforindicatorsofimmunity.Forexample,ifyoureceivedtheMMRvaccine,thedoctorcancheckifyouhaveimmunityagainstmeasles,mumps,andrubellabylookingatantibodytitersinyourblood.InthecaseofSARS-CoV-2,thegoalistodevelopsuchabloodtestthatwillhelpidentify:• WhichindividualshavebeennaturallyinfectedwithSARS-CoV-2andhaverecoveredfrom

theinfection(eventhoseindividualswhowereasymptomatic)• WhichindividualshavedevelopedimmunityagainstSARS-CoV-2aftertheyreceiveda

vaccinewhenthevaccinebecomesavailable

April6,2020

Currently,scientistsarestudyingwhichantigensoftheSARS-CoV-2willbethemosteffectiveingeneratingimmunity.Severalgroupsaredevelopingbloodtests,andonetesthasbeenFDAapproved(butisnotyetpubliclyavailable).Thereishopethatsuchtestswillbecomeavailablewithinthenextfewmonths(andprobablysoonerinsomeplaces),andwillbeusefulinguidinghowquicklynormalactivitiescanresume.

5. HowcanItellifinformationIreadaboutCOVID-19isreliable?IntheeraofCOVID-19wheninformationisevolvingrapidly---withnewinformationbeingavailabledaily---itisimportanttodependontrustedandreputablesourcesofinformation.Youwillencounterseveralsourcesofinformationsuchas:

• Print(newspaperssuchasNewYorkTimeswhichalsohaveonlineversions)• Online-onlyplatformssuchasSlateandBuzzfeed• Journalarticlewebsites• Personalblogsandstories

Itisincrediblyimportanttoverifysourcesofyourinformationtoensurethatwearenotspreadingfalseinformationwhichcannotonlycauseunnecessarypanicbutcanbedownrightharmful(suchasmisinformationregardingdrugs).Agoodresourcethatprovidesguidelinestoevaluatehealthinformationcanbefoundhere.

Resourcesandwebsites:

1. IASLC’sGuidetoCOVID-19andLungCancer2. TheNationalCancerInstitutehasaspecialwebsiteforCOVID-19andemergency

preparedness.COVID-19:WhatPeoplewithCancerShouldKnow-3. WearefollowingupdatesprovidedbytheWorldHealthOrganization(WHO)andtheUS

CentersforDiseaseControlandPrevention(CDC)4. JohnsHopkinsCOVID-19ResourceCenter5. InteractivemapofUSCOVID-19casesbystate6. TheOne-TwoPunch:CancerAndCOVID-19(animportantperspectiveforcancer

patients)7. Youcanfindinformationspecifictoyourstateorcityortownonyourhealth

department’swebsite.• Directoryofstatedepartmentofhealthwebsites• Directoryoflocalhealthdepartmentwebsites

8. AmericanMedicalAssociationresourcesforhealthcareproviders.9. Ifyoucannotavoidairtravel,checkout“DirtiestPlacesonAirplanes:HowtoAvoid

Germs”

April6,2020

GO2FoundationforLungCancer(AmyMoore,PhD-amoore@go2foundation.org)LUNGevityFoundation(UpalBasuRoy,PhD,MPH-ubasuroy@lungevity.org)LungCancerFoundationofAmerica(KimNorris-KNorris@lcfamerica.org)LungCancerResearchFoundation(CristinaChin,LMSW,MPH-cchin@lcrf.org)LungCAN(KimberlyLester-kimberly@lungcan.org)