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Food Safety during COVID-19: What People with Cancer Should Know

Source: Memorial Sloan Kettering
Date: 04/21/2020
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During the COVID-19 pandemic, we’ve been told to wash our hands frequently, sanitize surfaces, and not touch our faces. On top of that, conflicting reports are circulating online about how to safely handle the food that we’re bringing into our homes.

The challenges of safely buying groceries and getting takeout may be even greater for people with cancer and cancer survivors, who often have weakened immune systems. This makes it harder for their bodies to fight off infections, including COVID-19. It’s important that people with cancer closely follow steps to protect themselves while still getting proper nutrition.

Memorial Sloan Kettering clinical dietitian Cara Anselmo offers guidance for people with cancer and their families on how to carefully get and prepare food during the COVID-19 pandemic.

What safety measures should you take while grocery shopping?

If you are in active treatment for cancer or you have a weakened immune system because of a cancer history or other medical conditions, it’s better to have someone else in your household or a neighbor or friend go to the store for you, or use a delivery service. That’s the most important way you can avoid exposure to COVID-19 or other infectious germs.

But if you do have to go to the store, here are some important tips:

  • Take a grocery list. Before you go, figure out exactly what you need so you can get in and get out fast. This also helps minimize the number of shopping trips.
  • Bring sanitizing wipes to disinfect the handle of the shopping cart or basket.
  • Don’t browse with your hands. When you are at the store, avoid touching food or other products that you don’t intend to buy.
  • Cover your face with a scarf or cloth mask. (In early April, the Centers for Disease Control and Prevention recommended that all Americans wear a face covering to protect themselves from COVID-19.) If you need to adjust your mask, be careful not to touch the part that touches your face.
  • Check to see if your store has special hours for people who are immunocompromised and read the store’s policies on how many shoppers are allowed inside at once. While you are in the store, be careful to maintain a proper distance of six feet from others.

Do you need to disinfect your groceries after bringing them into your home?

At this time, experts are not aware of COVID-19 being spread by food or food packaging. But it’s still important to carefully wash your hands before and after grocery shopping. You should also wash your hands after putting your groceries away.

If you are concerned about the surfaces of packages, you can use disinfectant products to wipe them off. Fresh fruits and vegetables should be carefully washed with running water. Never use Lysol or bleach on fruits and vegetables, since the chemicals could be ingested.

How can you safely get takeout or food delivery from restaurants?

A lot of the advice for grocery shopping is the same for getting takeout or delivery: You should wash your hands before and after touching bags and food packages from restaurants, and before eating.

If you are picking up takeout, make sure you maintain safe distances. If you are getting delivery, pay in advance and ask the delivery person to leave the food outside your door to minimize person-to-person contact.

With either takeout or delivery, you should always transfer food to your own plates and dishes.

People whose immune systems are compromised by cancer or cancer treatment should be careful about eating certain foods from restaurants. This includes things like prepared salads, cut fruit, and deli meats. This is important to avoid food poisoning and not specifically because of COVID-19.

Do you have tips for healthy eating during the COVID-19 pandemic?

If you can’t get fresh produce, frozen or canned fruits and vegetables can be just as healthy. If you normally buy organic foods and you are not able to get them, don’t worry. Organic foods are not necessarily healthier or safer than conventional foods.

In this time of stress and uncertainty, it’s especially important to practice mindful eating. That means you should only eat when you’re hungry. Don’t eat so much that you feel too full. Do the best you can to include plenty of fruits and vegetables, but give yourself permission to eat what tastes good and feels good in your body. There’s no such thing as a perfect diet.

Some dietary supplements are claiming that they improve your immune function and offer protection against COVID-19. What do we know about these products?

Some of these products may be dangerous and potentially even life-threatening. The government has issued warning letters to many companies making these claims about their products.

There have been claims that some familiar supplements, including vitamin C and zinc, may “boost” your immune system. Some studies show that these supplements stimulate the immune system, but the evidence is inconclusive. They can also lead to unwanted effects.

Make sure you talk to your doctor, nurse, or registered dietitian before taking any supplements. Some of these products may also interfere with cancer treatment.

The best way to keep your immune system strong is to eat a balanced diet, limit alcohol, stay hydrated, manage stress, stay as physically active as you can, and get enough sleep.

During this difficult time, many people may be struggling to put food on the table. What are some good resources for MSK patients and their families?

MSK’s Food to Overcome Outcome Disparities program connects patients with a variety of emergency food resources. This includes a food pantry that MSK operates for patients and their families. If you would like more information, you can discuss it with your MSK care team or call MSK’s nutrition office at 212-639-7312.

New York City is offering three free meals per day for both children and adults, with pickup at more than 400 sites. People who are age 60 and older and need assistance can also get home-delivered meals. 

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How to Cope with Stress and Anxiety during COVID-19

Source: Memorial Sloan Kettering
Date: 05/08/2020
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The COVID-19 pandemic is taking an emotional toll on people all over the world. Feelings of worry may seem overwhelming, especially if you were already coping with the stress and anxiety of a cancer diagnosis or cancer treatment. 

As a psycho-oncologist, Memorial Sloan Kettering’s Christian Nelson is dedicated to safeguarding the mental health and well-being of people with cancer both during and after treatment. “Feelings of uncertainty and a loss of control are some of the biggest sources of anxiety for people with cancer,” he says. “When you add COVID-19 into the mix, it makes the loss of control feel that much stronger.”

Dr. Nelson, who is Chief of the Psychiatry Service in the Department of Psychiatry and Behavioral Sciences, adds, “COVID-19 causes such intense feelings of uncertainty because we don’t know how long the pandemic will last or when we’re going to get back to our normal lives. Until that happens, the most important message for people with cancer is that MSK is here to help.”

Dr. Nelson provides some strategies to help people with cancer cope with anxiety and gain a sense of control over their lives during the COVID-19 pandemic.

1. Acknowledge your feelings.

Accept that this is a stressful time. There will be many emotional ups and downs. Many studies have shown that recognizing the sources of stress can help relieve it. “Acknowledging that others are experiencing the same stresses also normalizes the experience and can help you know you’re not alone,” Dr. Nelson says.

2. Create structure.

People going through cancer treatment are already knocked off their typical daily rhythms, and COVID-19 multiplies that. But having structure in your day can help lessen feelings of anxiety. Try to get up at the same time every morning. Take a shower and get dressed. Make a plan for what you want to do every day and schedule activities to help provide that sense of structure. “These things can help you feel more like yourself,” Dr. Nelson says.

3. Make connections.

Stay in touch with friends and family, whether on the phone or with video calls. It’s not the same as spending time with them in person, but it’s better than being isolated. Many community groups have created ways for people to engage with others online. Most religious organizations are running meetings and services by video. “My patients who connect with their friends through video calls tell me that it’s really helpful to not only hear people’s voices but to see their smiling faces,” Dr. Nelson says. (Devices are available to both inpatients and outpatients at MSK who would like to video chat with friends and family during an appointment or hospital stay.)

4. Engage in activities.

Brainstorm interesting, enjoyable, and meaningful activities that you can do at home, either alone or with others. This may be spending time with family, playing board games, reading, gardening, cooking, or some other hobby. Consider how you can give back to your community, too.

5. Focus on ways to destress.

Because of COVID-19, most people can’t do the things they normally do to relieve stress. Think about new or different ways to help reduce feelings of worry. It’s not one size fits all — it’s whatever works for you to relieve yourstress. If you like to exercise but can’t go to the gym like you usually do, try online classes or go on walks. “One of my patients started journaling, and he found it helpful to write every day about his life,” Dr. Nelson says. “Meditation is also good for many people, and you can easily do it at home.”

6. Trust your cancer care team.

A common concern among people with cancer is that treatment has changed because of the pandemic. Maybe it’s been delayed or the time increments have changed — for example, a therapy might be given every four or five weeks instead of every three weeks. It’s important that people speak with their cancer care team about these worries. “I assure my patients that MSK’s oncologists are managing all treatments exactly the way that they should be and always have our patients’ best interests and safety in mind,” Dr. Nelson notes.

7. Take advantage of virtual resources.

MSK is making many channels of online support available for people with cancer and their families during social distancing.

  • The MSK Counseling Center is providing care though telemedicine. Our counselors provide therapy to help individuals, couples, families, and caregivers cope with stress, anxiety, and other issues. Our psychiatrists can also prescribe medications to help with many mental health problems.
  • MSK’s Social Work staff is providing virtual support groups. Our regular social work programs remain available for patients.
  • Our Resources for Life After Cancer program offers virtual counseling and support groups for people who have completed their cancer treatment.
  • Our Integrative Medicine Service is providing online classes in yoga and other types of exercise. We also have mindfulness classes and offer a number of online meditation programs that people can do anytime to help relax, sleep, or cope with the side effects of treatment.
  • Connections, MSK’s online community, allows patients, caregivers, survivors, and friends to exchange support, information, and inspiration.

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Bioethicist calls out unproven and unlicensed ‘stem cell treatments’ for COVID-19

Source: Cell Press
Date: 05/07/2020
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As the COVID-19 pandemic enters its third month, businesses in the United States are marketing unlicensed and unproven stem-cell-based “therapies” and exosome products that claim to prevent or treat the disease. In Cell Stem Cell on May 5, bioethicist Leigh Turner describes how these companies are “seizing the pandemic as an opportunity to profit from hope and desperation.”

“I’m concerned that individuals purchasing these supposed ‘therapies’ for COVID-19 will be scammed,” says Turner (@LeighGTurner), an associate professor at the University of Minnesota Center for Bioethics. “I’m also worried that they’ll be injured as a result of being given products that haven’t been adequately tested, or that they’ll forgo measures like social distancing because they’ve paid for a product that they think will protect them from being infected or getting sick.”

Many stem cell clinics have a history of selling unproven and unlicensed interventions for injuries and illnesses ranging from Alzheimer’s disease to pulmonary disorders to spinal cord injuries. Since the COVID-19 pandemic began, some have added claims about “immune-boosting” therapies for treating COVID-19 and acute respiratory distress syndrome (ARDS) caused by infection with SARS CoV-2. These companies advertise stem cell interventions and exosome products derived from such sources as umbilical cords and amniotic fluid. Turner says uncritical news media accounts have compounded some of these claims by reporting on preliminary evidence and case studies.

Yet rigorous clinical trials on these stem cell products have not yet been done. “Randomized controlled trials are needed to establish whether particular stem cell products are safe and efficacious in the treatment of COVID-19-related ARDS,” he explains.

Turner has studied the US direct-to-consumer marketplace for stem cell clinics for nearly a decade. “These businesses have a long history of claiming to treat diseases and injuries for which evidence-based therapies do not yet exist,” he says. To find out what these businesses were promoting, he did Google searches on a variety of terms related to stem cell treatments, COVID-19, and ARDS. He also searched YouTube for promotional videos made by these clinics.

“I found more examples of businesses peddling stem cell products for COVID-19 than I had space to describe in detail,” he notes. “I wasn’t surprised at how quickly some of these companies began making these claims. For them, the COVID-19 pandemic is an opportunity to generate a new revenue stream.”

In the paper, Turner also discusses the role of medical organizations, noting that while most are doing a good job of criticizing deceptive advertising, some have been promoting these interventions despite the lack of scientific evidence supporting their use.

“I want members of the public to know that some companies are trying to take advantage of them by selling supposed treatments that aren’t backed by credible evidence,” Turner concludes. “I’m also hoping that this paper will catch the attention of regulatory bodies like the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC), as well as state medical boards and state attorney general offices. The FDA and FTC have issued letters to some businesses, but additional regulatory action is needed.”

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Cell Stem Cell, Turner, L.: “Preying on Public Fears and Anxieties in a Pandemic: Businesses Selling Unproven and Unlicensed ‘Stem Cell Treatments’ for COVID-19” https://www.cell.com/cell-stem-cell/fulltext/S1934-5909(20)30201-0

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Team shares blueprint for adapting academic research center to SARS-CoV-2 testing lab

Source: Cell Press
Date: 05/12/2020
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During the COVID-19 pandemic, as demand for SARS-CoV2 diagnostic testing has far outweighed the supply, academic research scientists have begun converting their labs to testing facilities. In a paper published May 10 in Med, a team of investigators from Boston University School of Medicine and Boston Medical Center (BMC) outline how they adapted their lab to test patient samples for SARS-CoV2, and they provide a blueprint for other labs that want to do the same thing.

“As with other basic biology labs across the country, we were forced to shutter operations due to the pandemic,” says senior author George Murphy (@DrGJMurphy), an Associate Professor of Medicine in the Division of Hematology and Oncology. “We saw that our friends and colleagues at Boston Medical Center were going into battle on the front lines of this pandemic, but that they were having to wait seven to 10 days for results from state and commercial laboratory facilities. This was unacceptable to us, and we decided we needed to take action.”

Murphy is normally co-director of the Boston University and Boston Medical Center (BMC) Center for Regenerative Medicine (CReM) and focuses on stem cell research. As stem cell and molecular biologists, he and the members of the lab had extensive experience developing and running the type of quantitative, real-time reverse transcriptase polymerase chain reaction (qRT-PCR) assay that was needed to detect the presence of viral RNA in patient samples.

The bigger challenge was adapting their lab to the strict policies required to run a Clinical Laboratory Improvement Amendments (CLIA)-certified, College of American Pathologists (CAP)-accredited diagnostic lab. The team requested and received emergency permission from the FDA to repurpose the lab, and they began operating in less than a week. As of April 20, 2020, they had already tested more than 3,000 samples, with a sample turnaround time that’s under 24 hours. Nearly 45% of those tests were positive, a large number due in part to the high-risk population served by BMC, the largest safety net hospital in New England.

“For about a month or so, we were the only game in town,” Murphy notes. “Results from samples that were sent out to large commercial labs were taking up to a week, but even a wait-time of 24 hours delays the ability to make decisions about whether or not someone needs to be isolated and whether precious PPE [personal protective equipment] should be used.”

The team developed a test that could be done with technologies and reagents that are likely to remain available. The test was also designed with the ability to use different reagents at each step of the process. “Our ‘home-brew’ assay is extremely flexible, allowing us to slot in various reagents at multiple points and eliminating potential supply-chain issues,” Murphy says.

He doesn’t expect the need for testing to decline any time soon. “Although we have gotten through the early stages of this pandemic, which involved the testing of critically ill and symptomatic patients during a time of acute need, everyone is going to soon need to transition into asymptomatic and surveillance testing. It may be extremely difficult for large commercial labs to contend with the enormous number of samples this will entail,” Murphy says. “We decided to share what we did so that other institutions can implement their own in-house testing.”

The team is also looking at expanding to other kinds of assays, including saliva-based tests.

Murphy credits his colleagues and coauthors, including laboratorian Chris Andry, pathologist Nancy Miller and bioinformaticist Taylor Matte, for putting together this testing program so quickly. “We think it’s important for the public to see something positive in these very challenging times,” he concludes. “This project was a wonderful example of collaboration and teamwork in which scientists, clinicians, diagnostic laboratory technicians, and administrators came together to solve a seemingly insurmountable problem.”

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This work was funded by the Boston University School of Medicine and Boston Medical Center.

Med, Vanuytsel, Mithal, and Giadone et al. “Rapid Implementation of a SARS-CoV-2 Diagnostic qRT-PCR Test with Emergency Use Authorization at a Large Academic Safety-Net Hospital” https://www.cell.com/med/fulltext/S2666-6340(20)30003-9