Last updated: February 22, 2021
COVID-19, a novel coronavirus (a large family of viruses that can cause cold-like illnesses) first identified in December 2019, is a respiratory illness that can be spread from person to person, possibly through respiratory droplets during close contact. The first case of COVID-19 in the United States was reported on January 21, 2020.
Symptoms and People at Highest Risk
Patients with COVID-19 may have mild to severe respiratory illness with fever, cough, and difficulty breathing, although some report asymptomatic infection. Research indicates that patients may also present with gastrointestinal upset, loss of taste or smell, joint pain, or conjunctivitis. More serious presentations can include severe pneumonia, respiratory failure, and septic shock.
Those at highest risk for infection have had prolonged, unprotected close contact (within six feet for 15 minutes or longer) with a person with confirmed COVID-19, spend time frequently in congregate settings (e.g., assisted living facilities, college dormitories, homeless shelters), or live in or have recently been to areas with sustained transmission. Based on limited data from COVID-19 and other related coronaviruses, older adults, pregnant people, and those with certain underlying medical conditions, including cancer, may be at greatest risk for severe outcomes.
Prevention and Treatment
The best prevention is to avoid being exposed to the virus, practice social distancing with people outside of your home, and follow good everyday hygiene habits:
- Avoid close contact with people who are sick.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Stay at home when you are sick.
- Use a cloth face mask or cover over your mouth or nose when around others outside your home.
- Clean and disinfect surfaces.
- Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based sanitizer that contains at least 60% alcohol when soap and water are not available.
Supportive care of complications remains the primary clinical focus for patients with COVID-19, because researchers have not confirmed efficacy of any specific antiretroviral treatment. However, on May 1, 2020, the U.S. Food and Drug Administration issued an emergency use authorization for remdesivir for the treatment of hospitalized adults and children with suspected or laboratory confirmed COVID-19, and other antiviral agents are being tested. Dexamethasone is also being explored for its anti-inflammatory properties. Monoclonal antibodies are being used to limit the extent of side effects and prevent hospitalization. However, not all patients require medical supportive care.
As of December 2020, several manufacturers secured emergency use authorization for a vaccine to prevent COVID-19. A complete vaccination cycle currently requires two doses by intramuscular injection: an initial dose followed by a second dose three to four weeks later. The most common side effects observed during the trials were sore arm at the injection site and mild flu-like symptoms, including fatigue.
COVID-19 Mutations and Variants
As the virus continues to spread, evolve, and genetically mutate, scientists identified several global variants. Research is limited but suggests that the variants evade the body’s natural immune defenses as well as the pharmacologic immune effects of monoclonal antibodies for COVID-19. Although the variants appear to be more transmissible than the first strain, studies show that the existing COVID-19 vaccines are effective to prevent them. The Centers for Disease Control and Prevention and other global health organizations are monitoring the situation closely.
Oncology Nursing Implications for COVID-19
The situation and recommendations are constantly evolving and are likely to keep changing as more evidence emerges specific to oncology nursing practice, patients with cancer, and COVID-19. Cancer and COVID-19 data registries suggest that patients with a history of cancer who have confirmed COVID-19 infection appear to be at a higher risk for mortality and severe illness from the virus. Vaccination per the National Comprehensive Cancer Network recommendations is critical. The American Association for Cancer Research, American Society of Clinical Oncology, and American Cancer Society have advocated for the prioritization of patients with cancer when determining vaccination distribution.
Some key considerations for nursing practice:
- Staff may need additional training to screen patients for COVID-19 symptoms.
- Telehealth visits are a reasonable option for patients with cancer and their caregivers and should be used when appropriate.
- Consider postponing routine follow-up visits for patients not on active treatment or using telemedicine.
- Home infusion may be a possibility for certain patients.
- At this time, treatment delays are not widely recommended for all patients but may be considered by the interprofessional team on a case-by-case basis.
- Review and update any policies and procedures regarding isolation of infected patients.
- If a patient on active treatment is diagnosed with COVID-19, follow standard clinical management recommendations for infection modifications.
- Patients should be educated about COVID-19 symptoms and instructed to call if they develop a new fever, cough, or shortness of breath.