Doctors Share Reality of Caring for Cancer Patients in Italy During COVID-19 Outbreak

Two doctors penned an essay shedding light on the reality of cancer care during the COVID-19 pandemic in Italy, which was hit hard by the virus. The essay, written by Filippo Pietrantonio, MD, and Marina Chiara Garassino, MD, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, was published in JAMA Oncology.

From Disbelief to Anger: The Reality of The Virus

The doctors recalled returning from trips abroad to the news that the first case of COVID-19 had been identified in Codogno—bringing with it feelings of “disbelief” as well as a sense that the virus “still seemed very far away.”

“It did not help that scientists and politicians were divided into alarmists and nonalarmists. Even we, people of science, could not disentangle ourselves from what was true and what was blown out of proportion,” Drs. Pietrantonio and Garassino wrote.

When the initial disbelief wore off, they became concerned for the most vulnerable members of the population—the elderly. As the reality of the virus set in, residents of Italy clung to hope, but the death toll continued to rise at an alarming rate. Feelings of anger soon settled in—anger toward people who continued to go on with daily activities despite the severity of the situation.

The virus hit close to home when one of the doctors recalled their first personal experience with the virus. A patient, identified as a relative of a close friend, exhibited symptoms of the virus, including a fever. Two tests yielded one negative and one positive result: “And there, in isolation, without ever seeing family or friends again, the person died. The people who die from COVID-19 have no rights—no right to be visited, no right to a hug, no right to a funeral. They die alone.”

Virus Hits Home: Healthcare Workers Are Not Immune and Cannot #StayHome

The virus next began to strike their colleagues, stripping away not only their health but their feelings of invincibility. In this, the tables turned, with the doctor turning to patient, and the sound of ambulance sirens now signifying cause for alarm among all. However, while doctor and patient alike have this in common, one stark difference remains: while patients and non-essential personnel are staying home, doctors and healthcare workers must continue to show up, not taking part in social distancing or taking part in the #StayHome campaign on social media.

“As physicians of a referral center facing the lockdown of the whole country, we had to decide what to do for some patients with cancer already enrolled in clinical trials, and the patients who faced travel disruptions and the lack of flights from the south of Italy to our hospital in the north, and the fear these patients with cancer had of being infected with COVID-19 while traveling,” Drs. Pietrantonio and Garassino wrote.

Today, working in health care remains scary and places Drs. Pietrantonio and Garassino and their colleagues in jeopardy every day. Health care workers who come in contact with patients known to have COVID-19 are not tested themselves unless they develop severe symptoms in the Lombardy region. Both doctors know colleagues who have tested positive and are in intensive care.

Despite the host of uncertainties and their own fears, Drs. Pietrantonio and Garassino continue to show up for one reason: their patients.

“Our region has left us to fight the cancer battle and the COVID-19 war without true protection, without knowing whether we are infected with the virus. We go to work every day because we love our jobs, and this is the life we have chosen. But we are people too; we are afraid of getting infected, of going home in the evening, of infecting our children, our parents. When entering our homes, we take the stairs and not the elevator, afraid of infecting the condominiums and buildings where we live. But above all, we live with the absurdity of trying to cure patients of a disease like cancer at the same time potentially being the vehicles for a virus that might kill these very patients.”

#KnowYourStatus

The doctors are calling for high standards to be maintained in cancer care amid COVID-19 and have launched a social media campaign, #KnowYourStatus.

“Our aim is to guarantee separate and ‘clean’ pathways for patients with cancer. Even if this objective is failing in front of our very eyes, we will not give up on maintaining the involvement of institutions, patients’ advocacy organizations, and oncologist associations” they shared.

During a time of uncertainty, sharing is key—sharing love for their patients and profession.

“We do not know if we will ever go back to how we were before this ordeal. We want to thank everyone who has been with us every step of the way, but we will never forget the loneliness we were left in while fighting this war. In a different way but similar to someone who has died of COVID-19,” they concluded.