COVID-19 pandemic causing ‘unprecedented disruption’ in cancer research, Fauci says
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The COVID-19 pandemic likely will have a significant long-term effect on the diagnosis and treatment of cancer, Anthony S. Fauci, MD, said today during an American Association for Cancer Research virtual meeting on COVID-19 and cancer.
“There have been significant reductions in cancer screening that stemmed from the total lockdown that we and other nations experienced,” Fauci, director of the National Institute of Allergy and Infectious Diseases, said in the meeting’s keynote address.
Fauci cited data from NCI Director Norman E. “Ned” Sharpless, MD, who wrote in an editorial that the reductions in routine cancer screening could lead to 10,000 or more excess deaths from breast and colorectal cancers within the next decade.
“Moreover, [Sharpless said] the COVID-19 pandemic has caused an unprecedented disruption throughout the cancer research community, shuttering many labs and slowing down cancer clinical trial operations,” Fauci added.
As of this month, nearly 14 million cases of COVID-19 and more than 580,000 associated deaths have been reported worldwide, with essentially no end in sight, according to Fauci.
“The United States has been hit harder than any other country in the world, with 3.4 million cases and 136,000 deaths,” Fauci added. “We have always had emerging infectious diseases. We have them now and we will continue to have them in the future. As emerging infections provide for us a perpetual challenge, we need to be perpetually prepared for them.”
‘The unclear’
Fauci addressed interest in the relative role of aerosol transmission — mainly exposure of respiratory droplets within 3 feet or less.
“It is unclear the extent to which this is responsible for spread, but most experts suggest it has some impact,” he said. “COVID-19 has also been detected in nonrespiratory specimens, including stool, blood, ocular secretions and semen. However, their role in transmission is uncertain at this time. Animals can also be infected, but again, their role in transmission to humans is uncertain.”
What is known, Fauci added, is that between 20% and 45% of individuals who are infected with COVID-19 experience no symptoms.
“This is key when tracking transmission, particularly concerning the idea of contact tracing,” Fauci added. “What I have been most impressed by out of all the viruses we have been dealing with during the past several decades is the extraordinarily wide spectrum of this virus. Some individuals need to stay home for a few days due to symptoms, others are in bed for weeks, and then others require hospitalizations, which may include oxygen, intensive care, intubation, ventilation and even death.”
Evidence shows the clinical presentation of COVID-19 strongly resembles influenza-like illness.
“This includes fever in 83% to 99% of individuals, cough in 59% to 82%, fatigue in 44% to 70%, anorexia in 40% to 84%, shortness of breath in 31% to 40% and myalgias in 11% to 45%,” Fauci said. “Other nonspecific symptoms include sore throat, nasal congestion, headache, diarrhea, nausea and vomiting. One interesting thing that has consistently been reported is the loss of smell and taste, which precedes the onset of respiratory symptoms.”
Although older adults are at highest risk for severe disease, Fauci said it is important to note that people of any age with certain underlying medical conditions are at increased risk for severe illness.
“This includes but is not limited to those with chronic kidney disease, COPD, obesity, sickle cell disease and diabetes,” he said. “Moreover, manifestations of COVID-19 severity include acute respiratory distress syndrome, hyperinflammation, acute cardiac injury, arrhythmias, cardiomyopathy, acute kidney injury, neurological disorders, thromboembolic complications and multisystem inflammatory syndrome in children.”
Agents under investigation
The most promising investigational agent in the fight against COVID-19 is remdesivir (Veklury, Gilead Sciences), which Fauci said has shown a 32% faster time to recovery compared with placebo.
“Other agents under investigation include broad-spectrum antivirals, convalescent plasma and hyperimmune immunoglobulin, as well repurposed drugs including hydroxychloroquine, [and] lopinavir/ritonavir,” he said.
Other research out of the U.K. showed dexamethasone reduced 28-day mortality in the hospital setting by 35% among ventilated patients and by 20% among those receiving oxygen. However, no benefit was observed among patients who did not require respiratory support.
“In fact, dexamethasone may have had a negative effect in these patients, which goes right along with our understanding of the pathogenesis of this infection,” Fauci said. “We know that we want to block the virus early on while keeping the inflammatory and immunological response intact, whereas later on in the disease course, when the disease becomes more advanced, there is a lot of aberrant inflammatory response that we want to damper down, which is what the dexamethasone obviously did for these patients.”
As more clinical data accrue, the NIH has created a “living document” to keep key data in one place, which can be accessed at: www.covid19treatmentguidelines.nih.gov.
“When it comes to prevention, the bottom-line common denominator in preventing COVID-19 is physical distancing,” Fauci said. “This can be accomplished by stay-at-home orders, closing or modifying school schedules, bans on public gatherings and travel restrictions, followed by aggressive case identification and isolation, as well as contact tracing and quarantine.”
The NIH has taken a strategic approach of directly or indirectly supporting several vaccine candidates using different platforms, Fauci added.
“In doing so, we have tried to harmonize this approach, including common protocols ... [and] common primary and secondary endpoints, as well as laboratory data that are compatible and interchangeable,” he said. “Currently, the experimental mRNA-1273 vaccine appears promising and has shown to be safe and immunogenic in healthy volunteers aged between 18 years and 55 years.”
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Keynote address. Presented at: American Association for Cancer Research Virtual Meeting on COVID-19 and Cancer; July 20-22, 2020.
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