Challenges and Countermeasures of Thoracic Oncology in the Epidemic of COVID-19

Haoyue Guo; Xiaoxia Chen; Chunxia Su; Yu Liu; Hao Wang; Chenglong Sun; Peixin Chen; Minlin Jiang; Yi Xu; Shengyu Wu; Keyi Jia; Sha Zhao; Wei Li; Bin Chen; Lei Wang; Jia Yu; Anwen Xiong; Guanghui Gao; Fengying Wu; Jiayu Li; Lingyun Ye; Bing Bo; Shen Chen; Shengxiang Ren; Yayi He; Caicun Zhou

Disclosures

Transl Lung Cancer Res. 2020;9(2):337-347. 

In This Article

Abstract and Introduction

Abstract

Since December, 2019, a 2019 novel coronavirus disease (COVID-19) infected by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) emerged in Wuhan, Hubei province, and the epidemic situation has continued to spread globally. The epidemic spread of COVID-19 has brought great challenges to the clinical practice of thoracic oncology. Outpatient clinics need to strengthen the differential diagnosis of initial symptoms, pulmonary ground-glass opacity (GGO), consolidation, interstitial and/or interlobular septal thickening, and crazy paving appearance. In the routine of oncology, the differential diagnosis of adverse events from COVID-19 is also significant, including radiation pneumonitis, checkpoint inhibitor pneumonitis (CIP), neutropenic fever, and so on. During the epidemic, indications of transbronchial biopsy (TBB) and CT-guided percutaneous thoracic biopsy are strictly controlled. For patients who are planning to undergo biopsy operation, screening to exclude the possibility of COVID-19 should be carried out. For confirmed or suspected patients, three-level protection should be performed during the operation. Disinfection and isolation measures should be strictly carried out during the operation. At last, more attention to the protection of cancer patients and give priority to the treatment of infected cancer patients.

Introduction

In December, 2019, a pneumonia named as 2019 novel coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) outbroke in Wuhan, Hubei province, China and then spread to multiple countries around the world.[1] Coronaviruses can attack multiple systems in a variety of animals and primarily the respiratory tract in humans.[2]

After up to 3-to-14-day incubation period, most patients with COVID-19 initially had fever, cough and shortness of breath. Additional systemic symptoms were muscle pain, headache, confusion, chest pain, and diarrhea.[3] As the progression of the disease and the conduction of related medical operations, some patients started to face life-threatening multiple organ dysfunction, including acute respiratory injury, acute respiratory distress syndrome (ARDS), acute myocarditis, severe hepatitis, acute renal injury, septic shock, and so on.[3]

According to the latest treatment plan proposed by National Health Commission of the People's Republic of China, the epidemiological characteristics of COVID-19 include following points: (I) the source of infection is the clinical and asymptomatic patients of COVID-19; (II) human-to-human transmission is confirmed via respiratory droplets and direct or indirect contact with infected secretions. Other transmission routes such as aerosol and digestive tract have not yet been defined; (III) the general population is susceptible. The clinically diagnosed cases of COVID-19 in Hubei province can be confirmed by two of the clinical manifestations with imaging features of pneumonia, where the clinical manifestations include fever and(or) respiratory symptoms, and decreased or normal WBC count, or decreased lymphocyte count. Furthermore, the diagnosis of confirmed cases outside Hubei province requires the following etiological evidence: the nucleic acids of SARS-CoV-2 can be detected in respiratory specimens or blood samples via real-time polymerase chain reaction (RT-PCR) or the virus detected in respiratory specimens or blood samples is exceedingly homologous to known SARS-CoV-2 by viral gene sequencing. Therefore, the epidemic spread of COVID-19 has posed great challenges to the clinical practice of thoracic oncologists.

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