Cancer treatment delayed due to coronavirus

NHS trust cancels ALL cancer surgery for two weeks as doctors make priority lists to choose which patients get treated first ‘if the coronavirus outbreak cripples hospitals’

  • Barking, Havering and Redbridge University Hospitals has stopped treatment
  • It runs King George Hospital in Goodmayes and Queen’s Hospital in Romford
  • The trust said it had an ‘increase in the number of seriously ill COVID-19 patients’
  • Meanwhile, NHS has written to cancer doctors advising priority lists
  • Those who can wait for treatment or may die within a year will be low priority
  • Coronavirus symptoms: what are they and should you see a doctor?

An NHS trust has cancelled all cancer surgery and chemotherapy for at least two weeks because of a surge in coronavirus patients.

Barking, Havering and Redbridge University Hospitals, which runs two hospitals, is understood to be the first trust to make the unprecedented step.  

It comes as NHS trusts have been told to choose patients which should receive chemotherapy or surgery first as hospitals become overwhelmed.

Patients who have less than a year to live, or who can wait long periods of time without their cancer progressing, have been put on the end of the list.  

It comes despite NHS chiefs reassuring thousands of patients across Britain that cancer treatment would resume as normal.

Barking, Havering and Redbridge University Hospitals Trust, which runs King George Hospital in Goodmayes (pictured) has been forced to turn away cancer patients for the time being

Queen’s Hospital in Romford has will also be halting cancer treatment for at least two weeks

NHS chief executive Sir Simon Stevens said on March 17 that cancer operations would continue to go ahead despite the pandemic. 

A deal between private and independent hospitals and the NHS raised hopes that cancer treatment would resume.

But Barking, Havering and Redbridge University Hospitals Trust, which runs King George Hospital in Goodmayes and Queen’s Hospital in Romford, has already been forced to turn away cancer patients for the time being.  

The trust said it had to make changes because ‘we are now seeing an increase in the number of seriously ill patients (who have tested positive for COVID-19) at our hospitals, which is only going to increase in the days and weeks ahead’.

All planned surgery has been postponed, chemotherapy and endoscopy appointments have been halted and patients cannot see their doctors face-to-face.

Priority level 1

• Curative therapy with a high (more than 50 per cent) chance of success.

Priority level 2

• Curative therapy with an intermediate (15- 50 per cent) chance of success.

Priority level 3

• Non-curative therapy with a high (more than 50 per cent) chance of more than one year of life extension.

Priority level 4

• Curative therapy with a low (0-15 per cent) chance of success.

• Non-curative therapy with an intermediate (15-50 per cent) chance of more than one year life extension.

Priority level 5

• Non-curative therapy with a high (more than 50 per cent) chance of palliation/temporary tumour control but less than one year life extension.

Priority level 6

• Non-curative therapy with an intermediate (15-50 per cent) chance of palliation.

• Temporary tumour control and less than one year life extension.

The trust also said they were reviewing how to run the cancer units so that the patients were protected from COVID-19.

Chemotherapy affects the immune system, making them more susceptible to catching the deadly virus.

It follows NHS guidance to NHS providers, which warns cancer treatment will be compromised if the epidemic worsens.

A ‘speciality guide’ from NHS England and NHS Improvement (NHSE/I) said ‘we need to consider the small possibility that the facility for cancer services may be compromised’.

This could be due to a combination of factors including staff sickness and supply chain shortages.

‘This is an unlikely scenario but plans are needed,’ the document says.

Doctors have been advised to ‘categorise patients into priority groups 1-6. If services are disrupted, patients can be prioritised for treatment accordingly.’

Top priority patients in band one includes those whose chemotherapy has a high chance of success – more than 50 per cent.

Lowest priority in band six includes a patient receiving palliative cancer treatment with little chance of surviving more than a year.

Providers have also been told they will need to assess which patients can wait for their surgery.

The document said: ‘In response to pressures on the NHS, the elective component of our work may be curtailed.’

The lowest prioritisation is where ‘elective surgery can be delayed for 10-12 weeks with… no predicted negative outcome’.

Cancer treatment can damage the immune system by reducing the number of white blood cells, making it harder for the body to fight germs. 

The guidance said patients will likely consider if their treatment is worthwhile if it puts them at a higher risk of serious illness, if they do catch COVID-19.

Patients who want to speak to their doctors will need to speak on the phone or by video call to avoid the risk of catching coronavirus.

Those who are lucky enough to receive treatment will be invited into the hospital by text message under NHS guidance, to avoid them arriving early and potentially being exposed to the virus.

In another document, plans were drawn up which will mean some suspected cancer patients will be sent back to their GPs without diagnostic tests.

Patients with tell-tale symptoms who have been referred to hospital for further tests may be ‘downgraded’.

Another NHSE/I document, sent to cancer alliances, said: ‘Where capacity is particularly constrained providers should ensure processes are in place to prioritise particularly urgent referrals, including greater communication between primary and secondary care to downgrade or avoid referrals where possible.

DEAL BETWEEN PRIVATE HOSPITALS AND NHS HOPED TO IMPROVE CANCER CARE

Thousands more beds, ventilators and extra healthcare staff will be available from next week to aid the fight against coronavirus thanks to a deal between NHS England and independent hospitals, the NHS has announced yesterday.

The extra resources, including nearly 20,000 staff, is said to help the NHS deliver other urgent operations and cancer treatments. 

The deal – the first of its kind – includes the provision of 8,000 hospital beds across England, nearly 1,200 more ventilators, more than 10,000 nurses, over 700 doctors and over 8,000 other clinical staff. 

In London it includes over 2000 hospital beds, and over 250 operating theatres and critical beds.

UK independent hospital group Spire Healthcare is among those which will assist NHS England from Monday 23 March, for a minimum period of 14 weeks, and then on a rolling one month’s basis.

Spire Healthcare will use the first week to prepare its colleagues and facilities for full use by the NHS, while it continues to treat NHS and private elective patients where appropriate.

From 30 March the group will make available the entire capacity of its 35 hospitals in England to the NHS.

NHS chief executive Sir Simon Stevens said: ‘We’re dealing with an unprecedented global health threat and are taking immediate and exceptional action to gear up.

‘The NHS is doing everything in its power to expand treatment capacity, and is working with partners right across the country to do so.

‘But it is absolutely vital that this is matched by successful and comprehensive adoption of the public measures needed to cut the spread of the virus.’  

‘Where referrals are downgraded or avoided… providers should seek to ensure appropriate safety-netting so that if patients deteriorate or their risk of a cancer diagnosis increases, they can be appropriately referred for further investigation.’

Commenting on the developments, Charles Swanton, Cancer Research UK’s chief clinician, said the charity supported the NHS during the coronavirus epidemic.

He told the HSJ: ‘The coronavirus pandemic is an incredibly challenging and fast moving situation. And we support the hard work of the NHS and government and the steps they are taking.

‘The complete picture of how the virus will affect cancer care and over what timeframe is not yet clear. But as the virus becomes more common in the UK, it will undoubtedly add pressure to the NHS, bed and ITU availability and hence service delivery.

‘Unfortunately we are starting to see the impact at individual trusts and treatment decisions will have to be based on resource allocation to those most likely to benefit and most in need across all areas of medicine. It’s likely that cancer treatment decisions will be affected, with treatments known to extend overall survival outcomes prioritised.’

An NHSE/I spokesman said: ‘Hospitals have been told that cancer treatment and other clinically urgent care should continue to be prioritised.’

Macmillan Cancer Support said it was vital cancer patients weren’t missing out on support or treatment, The Times reports.

Rosie Loftus, chief medical officer, said: ‘There must be a clear plan for continuing essential chemotherapy and radiotherapy treatment so that we don’t see people with cancer missing out on critical support and treatment.

‘These are exceptional circumstances for the NHS. In some cases clinicians will be reviewing the treatment plans made with patients and assessing whether the risks involved in treatment have changed, which may lead to a discussion about a revised or modified treatment plan.’

An NHS spokesman said: ‘Hospitals have been told that cancer treatment and other clinically urgent care should continue to be prioritised.

‘Decisions about treatment are rightly taken by expert clinicians who will be carrying out as much cancer treatment as possible, while clearly needing to balance this against the risk to individuals posed by coronavirus.’ 

Last week it was confirmed that a deal between the NHS and private hospitals allowed for more resources to fight the coronavirus battle.

Sir Simon hailed the deal and said: ‘We’re dealing with an unprecedented global health threat and are taking immediate action to gear up.’ 

The 20,000 extra staff would be able to help with cancer treatments and other urgent care. 

The news provided hope that cancer treatment would, in fact, go ahead with some form of normality. 

Karol Sikora, medical director of the independent provider Rutherford Health, insisted that if the NHS used capacity in private hospitals it could be ‘business as usual for cancer patients’.

‘People are thinking of ways to cut corners but we can provide a full service, we just need to expand capacity,’ he said. 

‘We have a series of cancer centres and the idea would be if you have NHS patients who can’t get chemotherapy or radiotherapy they could come there. Use the private sector to keep business as usual for cancer patients.’

WHAT DO WE KNOW ABOUT THE CORONAVIRUS?

What is the coronavirus? 

A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.

The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.

Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.

The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.

Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals. 

‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses). 

‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’ 

The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.

By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.

The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000. 

Where does the virus come from?

According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.

The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.

Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat. 

A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.

However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.

Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.

‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’  

So far the fatalities are quite low. Why are health experts so worried about it? 

Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.

It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however, which killed around one in 10 people, compared to approximately one in 50 for COVID-19.

Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.

Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.

‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’

If the death rate is truly two per cent, that means two out of every 100 patients who get it will die. 

‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.

‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’

How does the virus spread?

The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.

It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky. It can also live on surfaces, such as plastic and steel, for up to 72 hours, meaning people can catch it by touching contaminated surfaces.

Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person. 

What does the virus do to you? What are the symptoms?

Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.

If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients will recover from these without any issues, and many will need no medical help at all.

In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.

Figures are showing that young children do not seem to be particularly badly affected by the virus, which they say is peculiar considering their susceptibility to flu, but it is not clear why. 

What have genetic tests revealed about the virus? 

Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world. 

This allows others to study them, develop tests and potentially look into treating the illness they cause.   

Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.

However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.

This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.   

More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.

How dangerous is the virus?  

The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.

Experts have been conflicted since the beginning of the outbreak about whether the true number of people who are infected is significantly higher than the official numbers of recorded cases. Some people are expected to have such mild symptoms that they never even realise they are ill unless they’re tested, so only the more serious cases get discovered, making the death toll seem higher than it really is.

However, an investigation into government surveillance in China said it had found no reason to believe this was true.

Dr Bruce Aylward, a World Health Organization official who went on a mission to China, said there was no evidence that figures were only showing the tip of the iceberg, and said recording appeared to be accurate, Stat News reported.

Can the virus be cured? 

The COVID-19 virus cannot be cured and it is proving difficult to contain.

Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.

No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.

The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.

Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.

People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.

And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).

However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.

Is this outbreak an epidemic or a pandemic?   

The outbreak was declared a pandemic on March 11. A pandemic is defined by the World Health Organization as the ‘worldwide spread of a new disease’. 

Previously, the UN agency said most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.

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