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      A War on Two Fronts: Cancer Care in the Time of COVID-19

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          Abstract

          Initial reports suggest that COVID-19 can be particularly lethal in patients with cancer. This commentary discusses how to balance a delay in cancer diagnosis or treatment against the risk for a potential COVID-19 exposure, mitigate the risks for significant care disruptions associated with social distancing behaviors, and manage the appropriate allocation of limited health care resources in this unprecedented time of health care crisis.

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          The effect of public health measures on the 1918 influenza pandemic in U.S. cities.

          Martin Bootsma, Neil M Ferguson (2007)
          During the 1918 influenza pandemic, the U.S., unlike Europe, put considerable effort into public health interventions. There was also more geographic variation in the autumn wave of the pandemic in the U.S. compared with Europe, with some cities seeing only a single large peak in mortality and others seeing double-peaked epidemics. Here we examine whether differences in the public health measures adopted by different cities can explain the variation in epidemic patterns and overall mortality observed. We show that city-specific per-capita excess mortality in 1918 was significantly correlated with 1917 per-capita mortality, indicating some intrinsic variation in overall mortality, perhaps related to sociodemographic factors. In the subset of 23 cities for which we had partial data on the timing of interventions, an even stronger correlation was found between excess mortality and how early in the epidemic interventions were introduced. We then fitted an epidemic model to weekly mortality in 16 cities with nearly complete intervention-timing data and estimated the impact of interventions. The model reproduced the observed epidemic patterns well. In line with theoretical arguments, we found the time-limited interventions used reduced total mortality only moderately (perhaps 10-30%), and that the impact was often very limited because of interventions being introduced too late and lifted too early. San Francisco, St. Louis, Milwaukee, and Kansas City had the most effective interventions, reducing transmission rates by up to 30-50%. Our analysis also suggests that individuals reactively reduced their contact rates in response to high levels of mortality during the pandemic.
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            Author and article information

            Journal
            Journal ID (nlm-ta): Ann Intern Med
            Journal ID (iso-abbrev): Ann. Intern. Med
            Journal ID (publisher-id): aim
            Title: Annals of Internal Medicine
            Publisher: American College of Physicians
            ISSN (Print): 0003-4819
            ISSN (Electronic): 1539-3704
            Publication date (Electronic): 27 March 2020
            Electronic Location Identifier: M20-1133
            Affiliations
            [1]Fox Chase Cancer Center, Philadelphia, Pennsylvania (A.K., D.S.W., M.J.E., E.M.H., R.G.U., R.I.F.)
            Article
            Publisher ID: aim-olf-M201133
            DOI: 10.7326/M20-1133
            PMC ID: 7133056
            PubMed ID: 32219410
            SO-VID: d636005f-5222-4767-8f81-9439b3238bcf
            Copyright statement: Copyright @ 2020
            License:

            This article is made available via the PMC Open Access Subset for unrestricted re-use for research, analyses, and text and data mining through PubMed Central. Acknowledgement of the original source shall include a notice similar to the following: "© 2020 American College of Physicians. Some rights reserved. This work permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited." These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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            Subject: Ideas and Opinions

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