Patients with hematologic malignancies, which include cancers that affect the blood, bone marrow, and lymph nodes, have demonstrated a higher susceptibility to COVID-19 potentially because of inherent and cancer therapy–related immunosuppression.
Patients with hematologic malignancies, which include cancers that affect the blood, bone marrow, and lymph nodes, have demonstrated a higher susceptibility to COVID-19 potentially because of inherent and cancer therapy–related immunosuppression1.
Current evidence suggests that COVID-19–related morbidity and mortality is higher in patients with underlying co-morbidities, male gender, older age, and immunosuppression.2,3 The initial fatality rates reported for patients with cancer who harbored a SARS-CoV-2 infection ranged from 28% in China2 to 26% in North America and Spain.4
With the onset of the unprecedented COVID-19 pandemic, cancer care provision was upended as resource-limited oncology care systems balanced reduction of SARS-CoV-2 exposure with the prioritization of timely cancer diagnostics and treatments. Consensus guidelines that prioritized infection control and re-organization of care were quickly established to limit the negative impact of the pandemic on patients with cancer5,6 whose management involves multiple visits to healthcare facilities for doctor visits, bloodwork, imaging, social work, financial consultations, therapy administration, etc.
Due to the concern of contracting SARS-CoV-2, cancer screening has decreased7 and significantly postponed the identification of new cancer,8 with an estimated increased resultant mortality.9 Compared with the pre-pandemic era, dramatic reductions are observed in the demand for cancer services; this has still not fully recovered. Although COVID-19 is transmitted from person to person through respiratory droplets,10 under laboratory experimental conditions, SARS-CoV-2 was shown to be viable for up to 72 hours; this may be a possible vector of infection for vulnerable patients with cancer.11 There is a potential risk of SARS-CoV-2 spreading via contact with contaminated surfaces and equipment—especially in healthcare settings, creating additional concern for patients with blood cancers.
However, the viability of the virus may differ in real-world clinical environments, promoting the strict use of personal protective equipment (PPE), social distancing, hand hygiene and disinfectant protocols.12 Previously, no studies evaluating SARS-CoV-2 surface contamination in the outpatient or inpatient Hematology and Medical Oncology settings had been published. Thus, in this prospective study, we evaluated the frequency of SARS-CoV-2 on various environmental surfaces in outpatient and inpatient hematology/oncology settings within Rutgers Cancer Institute of New Jersey and Robert Wood Johnson University Hospital, an RWJBarnabas Health facility.13
Environmental sampling was done in high-touch areas in 2 outpatient clinic settings including malignant hematology and medical oncology infusion suites, as well as inpatient areas, which included the leukemia/lymphoma/CAR T-cell unit, and an inpatient unit caring for patients actively infected with COVID-19. Surfaces were sampled on Mondays, Wednesdays, and Fridays from June 17, 2020, through June 29, 2020. Areas included waiting rooms, infusion areas, bathrooms, floors, elevator banks, doors, exam rooms, computer equipment, pneumatic tubing stations, pharmacy areas, and nursing stations. Medical equipment such as intravenous poles, chemotherapy bags, vitals monitor, telemetry stations, and linen carts, in these areas were also swabbed.
A total of 204 samples were collected and characterized as: patient/public areas, staff areas, and medical equipment. In the 2 outpatient clinics and inpatient leukemia/lymphoma/CAR T-cell unit, no SARS-CoV-2 was detected on any swabbed surfaces (0 out of 130). In the inpatient COVID unit, 1 patient/public sample was positive for detection of SARS-CoV-2 in an area where a patient with recent COVID-19 infection was receiving treatment. The overall positive test rate for SARS-CoV-2 across all surfaces in the combined outpatient and inpatient hematology/oncology units was a low 0.5%.
The study revealed extremely low detection of SARS-CoV-2 on environmental surfaces across multiple outpatient and inpatient oncology areas, including an active COVID-19 floor. These data should provide reassurance and highlight the adequacy of established infection prevention and control policies, such as increased use of telemedicine, nursing-directed triage, isolation protocols, and the importance of appropriate personal protective equipment (PPE), social distancing, and disinfection protocols.
Collectively, the results of this study should alleviate concerns of infection transmission for healthcare providers and patients—especially those with blood cancers—when frequenting healthcare facilities to receive their care. We hope to reclaim cancer care when equipped with an improved understanding of SARS-CoV-2 viral transmission dynamics, ongoing infection prevention measures, and accelerated rates of COVID-19 rates of vaccination—especially for patients with cancer.
Mansi R. Shah, MD, is a hematologist/oncologist and assistant professor of medicine in the Division of Blood Disorders at Rutgers Cancer Institute of New Jersey and Robert Wood Johnson Medical School.