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What Are the COVID-19 Risks for MPN Patients?

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Published on March 30, 2020

Key Takeaways

Experts Dr. Ruben Mesa and Dr. Robyn Scherber, both from the UT Health San Antonio MD Anderson Cancer Center, answer the MPN community’s pressing COVID-19 questions, and offer both words of caution and hope to patients and care partners. Watch to hear their perspectives on the impact of the coronavirus outbreak on MPN care and recommended protective measures.

As information continues to emerge, Patient Power is taking your questions. Send them in to comments@patientpower.info to be answered on future programs.

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Transcript | What Are the COVID-19 Risks for MPN Patients?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Recorded March 25, 2020

Andrew Schorr:
Greetings, I'm Andrew Schorr in Southern California near San Diego. I am an MPN patient with myelofibrosis since 2011, and I'm vitally interested in today's live webinar during this time of COVID-19, or coronavirus. Joining me are two experts from Texas. There's Dr. Ruben Mesa, and he is the Director of the Mays Cancer Center there, and that is his colleague, Dr. Robyn Scherber. Both of them are hematology oncology experts, but specifically in MPNs. Ruben, welcome back to Patient Power.

Dr. Mesa:
I'm pleased to be here. I know this is a very stressful time for folks, and we're hopeful that this conversation will help answer some questions and help provide some reassurance.

Andrew Schorr:
Absolutely, and, Robyn, thank you. I know we've had you together with your mentor a number of times. Thank you for your devotion to MPN patients and being here.

Dr. Scherber:
It's a great pleasure, and I know we've been getting a lot of questions from our end, and so being able to help address these questions for people that maybe wouldn't have had a chance to ask yet or maybe not even thought of some of the questions that have come up, it's a great opportunity.

Andrew Schorr:
Well, thank you. Well, both of these experts join us from the Mays Cancer Center in San Antonio at the University of Texas, so we're very grateful. Okay, I got a question off the top, which is echoed by all of the people who have been writing in. That is, first of all, are we, living with an MPN, at higher risk for the virus? I know there's a continuum, Ruben, of MPNs, ET, PV, myelofibrosis. First of all, are we generally, or does it vary by where we are? Ruben, you want to tackle that one?

Dr. Mesa:
It's a great question, Andrew, and it's one that people have asked. First, it's important that where an individual stands needs to really be a discussion between them and their hematologist and their MPN doctor, because it really, it depends. If we think about the MPNs as a spectrum from low-risk ET with off-medication except aspirin all the way to the spectrum of MF patients on advanced therapies, there's a tremendous amount of variability.

There are some patients with MPNs that clearly are at higher risk. There are probably a bunch in the middle that we're not quite sure, and there are others that probably are largely like the general population in terms of their risk. But in addition to their MPN, someone's overall risk is also tied to the rest of their health as well as their age. Other key factors that the CDC has in addition to the issue of, let's say, their blood disease is, is there chronic lung disease, is there heart disease, are they obese, are they pregnant, and are they over age 65? I'm hopeful people learn a lot from today, but they really should connect with their doctors specifically as to what their doctors think they should be doing in terms of their risk.

Andrew Schorr:
Okay, so, Dr. Scherber, Robyn, we've known each other a long time. Beyond the risk of getting it, the risk of complications and even death if you do get it, so what about that? One is whether you might get it, which I know we generally don't have immunity, but what about if it shows up in our lives, we're going to be in trouble?

Dr. Scherber:
I think we don't know yet. To kind of echo what Dr. Mesa said, we do know that there are some co-morbidities that seem more common, and these are things that really can complicate the disease much more. The way that COVID-19 works is that it's similar to a lot of other respiratory viruses that we've had, but the difference is that the damage that can be caused in the lungs can cause some fluid accumulation there, and I think that's really why we're seeing patients with heart disease underlying their illness or different types of cardiovascular disease, those really seem to be major risk factors.

I was going back through the literature though from what was published in China, and they honestly saw a relatively low rate of patients with COVID-19 having cancers. What I was looking at this morning showed a rate of 1.5 percent which is, granted, it's going to be relatively lowish in the general population, but I think it does speak to the fact of that we're really seeing heart and lung disease as being two primary variables for bad outcomes with COVID-19.

That being said, a lot of MPN patients that I see take good care of themselves. They try to stay healthy. They try to eat right. They try to manage what they have as other underlying illnesses. That's really the best thing you can do. We don't know yet really about individualized risk with MPNs. There's nothing that's been published, but I have to say that just trying to take good care of yourself is the best thing that you can do.

Dr. Mesa:
I mean, as a more general way of saying it, I would think, overall, I'm more concerned about MF patients than I would be about ET and PV, but that is really a very much of a generality. The key thing, looking through the CDC guidance based on the experiences in Europe and in Asia, is really whether individuals are immunocompromised. It's probably not having cancer itself. It's a result of the immune system not firing at 100 percent. Is that a lower white count? Is that a responsive therapy, but potentially, yes.

In general, we don't view that the therapies for ET and PV are significantly immunosuppressive, but again, there is a spectrum. Hydroxyurea (Hydrea), maybe not, but if you take a little too much Hydrea or the counts are low, then maybe yes. Interferon has been used as an antiviral therapy. I think the jury's still out on interferon. There have been some that have speculated that interferon may have a benefit—difficult to know.

Ruxolitinib (Jakafi), again, a therapy that there have been some immunocompromised infections, but overall, we don't view people as being significantly immunocompromised. It's even been viewed as part of combination therapy for COVID. There are just a lot of questions. That's why connecting with someone's physician is so key, but the issue of the immune state of which it's a difficult thing to measure is probably one of the critical factors.

The other thing we clearly are seeing and that has been advised is that although these are the groups that are more likely to have problems with the infection, there clearly are people that don't have any of these factors that still can become ill. That's truly why the world has almost come to a standstill in that anyone can get very sick from this, and that's why the best way to deal with this infection is not to get it.

Andrew Schorr:
Ruben, let me ask you just a couple of follow-up questions on medicines, because people have asked a lot, and I'm on a different JAK inhibitor now, fedratinib (Inrebic). I've been on Jakafi, or ruxolitinib, for many years, and so I get monthly blood tests as some of us do. I'm used to it over many years, because I have a leukemia as well, CLL, so Hs and Ls, or this is out of the norm. It's like a crazy quilt, my blood tests, and I'm worried about my immunity. What about broader JAK2s or other medicines? By taking the medicine, it sounds like it doesn't necessarily affect your immune system? It varies by patient? Help us understand that.

Dr. Mesa:
Well, if we think again of a spectrum of, let's say, traditional chemotherapy that we're giving for someone with breast or colon cancer that clearly lowers the white cell count, they have clear risk of infection, develop neutropenia, neutropenic fever, we don't really think of MPN therapies really kind of being in that bucket. I would say ruxolitinib is clearly somewhere in the middle, meaning that for the majority of patients who take ruxolitinib, we don't see them getting more infections than the general population. It's not clear that they get more colds and flus or that they are clearly more susceptible to the coronavirus. We don't really know that that's the case.

All of that said, there have been very low rates of some infections that have been more common, very atypical infections, herpes zoster, shingles, a reactivation of TB or hepatitis B. We don't put it in the extreme category, but nor do we say that there's zero effect anyway. I think, again, it's a group that overall our patients with ruxolitinib I think we need to be mindful of. We clearly want to try to prevent them from developing the infection, but by the same token, we strongly are not advising patients to just abruptly go ahead and stop any of the therapies that we're on.

An MPN community, as I've chatted with colleagues across in many different countries, Claire Harrison, who you know well, Jean Jacques Kiladjian, et cetera, they're all very concerned that patients will just drop their medications, potentially have significant consequences from abruptly stopping their MPN medicines.

Andrew Schorr:
Okay. Go ahead, Robyn.

Dr. Scherber:
Oh, sure, if I can add a few things onto that. Yeah, I agree entirely with Ruben. I would not abruptly stop anything. If anything, this should be an ongoing communication and discussion with your healthcare providers. Think about the MPN disease course. Again, we know there's a lot of inflammation that can happen, and a lot of our therapies will either target blood counts or in part the inflammation. With the COVID-19, again, the major cause why people go into—basically pass away from the COVID-19 would be from lung issues.

What happens in the lung is that you can get some inflammation from the virus in the lungs. So it stands to reason that trying to reduce the amount of inflammation would make sense. Now, by reducing anything with the immune system, you could alter your immune system's capabilities of fighting off infections. We know that. But we also know that in cases of certain infections, trying to reduce some of the inflammatory response is a good thing. So that being said, again, it's kind of an ongoing communication and discovery until we really know more.

I'd like to specifically address, I've gotten questions, from the literature I could see in 2014 there was a combination for a different type of coronavirus of an anti-retroviral with interferon that seemed to be effective, but we don't know what would specifically happen in this COVID-19 strain. So it's all hypothetical. The other thing is some JAK inhibitors, like Ruben mentioned, are actually in clinical trial, seeing what would happen to try to reduce some of the inflammatory response that leads to the lung injury with COVID-19. Again, this is all very early in clinical trials. We honestly don't know, but I think it really speaks to the idea that we really need to know more before we could recommend any specific action.

Andrew Schorr:
Okay. I got a question for you about the relationship between the physician and the patient. So, we have questions, and Ruben was talking about sort of our personal situation. Where are we, what's our story? And that's going to be uncovered by what our physician knows about us, what we're describing, what our tests show, et cetera. So I'm scheduled for monthly blood tests. So, I'm going to call Dr. Jamieson, who's my doctor here in San Diego to say, "Well, do you need it on that same schedule, or should I stay away from the lab and the clinic at this point?" So, what about calling related to or even follow-up visits, and what are you doing in San Antonio with what I would call telemedicine? Are you having some contact with patients remotely just like we're doing here? So first, do we keep coming, and are you reaching out to us in other ways? Robyn?

Dr. Scherber:
Well, I have to say behalf of the institution, Dr. Mesa's actually been doing an amazing job of making it capable for us to do telemedicine visits. As of this week, we have begun to implement those visits. So what I've been doing is I've been trying to proactively go on my schedule, and granted that takes time to do this, so we're still in the process. But we're trying to identify patients who might be best candidates for telemedicine, patients who don't have active issues going on that I might need to talk them through an extensive discussion of maybe a new therapy or who aren't on active therapies that they need to come in for. But for some patients on stable therapy, we have been trying to implement the telemedicine, and we've been proactively trying to do that.

But I've also been getting questions from patients that might have a clinic visit coming up in the next few weeks that we haven't gotten to yet. I think that those are wonderful questions, and we are trying to do what we can to accommodate that they don't have to come in and potentially risk excessive exposure. For those that we can decrease the amount of monitoring for coming in for blood count checks, we've been trying to do that.

Andrew Schorr:
What about phlebotomy, Robyn?

Dr. Scherber:
So that's a good question. And for some patients who might be on potentially cytoreductive agents, so maybe interferon or hydroxyurea and are also getting intermittent phlebotomies, it might be worth trying to go up on some of those medications to try to reduce the amount of phlebotomies that they might need. That being said, so we know for MPN patients that thrombotic risk is one of the largest concerns in terms of things that can happen over the disease course that might lead to bad outcomes.

So that being said, I don't think that we should necessarily reduce the amount of phlebotomies. The other thing is if people do get an infection, a respiratory infection, their clotting risk might go up. So I still want to aggressively manage those blood counts, but we have other options to do that potentially other than phlebotomy. So I think it's worth exploring those options—again, speaking directly with your physician about those options.

Dr. Mesa:
If I might add, Andrew, I think our goal as we're trying to manage this, both for MPN patients but for everyone, there are really two different layers. One, I think for patients like with MPNs or with other related diseases, we clearly want people to not have a worse outcome from their MPN out of concern for this other piece. How do we navigate that part?

Second, what clearly the situation is nationally, and interacting with cancer center directors from around the country, is one, health systems are clearly trying to create the capacity for caring for patients getting sick from COVID in terms of hospital beds, other sorts of things. So elective surgeries have been canceled, screening procedures are delayed. So clearly trying to, across the board, provide the care that we really need to provide for people regardless of their conditions now, but be mindful what really needs to occur now versus what would be nice to do but is less urgent.

So, I think, fortunately many things with MPN, not all, but many things can be done remotely in terms of utilizing e-visits. And for people to understand this is brand new—meaning that there were many regulations from insurance companies, Medicare, et cetera, up to last week that primarily had this only used in a very small aspect of primary care. Last week, they completely took the gloves off everything. You can do anything by e-health now as long as you think that it makes sense.

Now, clearly there's the chance to interact by video. Clearly, one can still obtain blood tests, but as you said, blood tests, if you really need to see what those blood tests are, you should still have them. But again, if the blood counts had been stable, maybe you can delay that. Likewise, if you need something done, particularly like a phlebotomy where we know well from trials that if your hematocrit is over 45 percent, you really should have a phlebotomy. I certainly would not in particular defer on something like phlebotomy where we know that there's an increased risk having a hematocrit between 45 to 50. Many of the other things as your doctor is able to visit with you by video, see what the blood counts are, adjust the dose of medicines that you're on—a lot of that can be done remotely, at least for the short term.

Andrew Schorr:
Okay. So one of the questions we're getting is also about the relationship between family members. By the way, folks, if you have a question now, hit that little Q&A button at the bottom. Esther Schorr is our producer, and she'll forward it to me, and we'll get to as many as we can.

So, here's one that came in. This woman, female, is a patient, and her husband is an airline pilot, and she's worried about the risk of her contracting something from him. So, Robyn, I'm not hearing in most cases that MPN patients are at high risk, but it's variable. Okay. But she's worried about whether it's an airline pilot, a husband or your 20-something works as a checker in the grocery store, you're worried about that family-to-family connection. What are you telling people, Robyn?

Dr. Scherber:
It's a hard discussion—especially when you're talking about someone that you live with—as always, practicing per the guidelines from the World Health Organization, even from ASCO or oncology, exactly. So when your loved one does get home, making sure that they are washing their hands, making sure that if they have any symptoms that they're staying away right away. Everything from trying to make sure that when you sneeze, you sneeze into your arm to making sure that if you are going around the house, it's really worth wiping everything down. Trying to get the house as clean as possible and maintaining that on a regular basis. I know some people go, they'll try to take a shower when they first come home and will change clothes, try to keep things away from their loved one.

So, I have had some questions on whether or not people should go into quarantine. And I think that's a really difficult question as well, because again, you're asking someone who may not be at the same risk as you to change their lifestyle for you. Now that's a tricky answer as well, because common things still being common, you know there are allergies out there, there are other things that can cause symptoms. And so I wouldn't necessarily recommend going into a quarantine unless you're having active symptoms, and at the same time I really think it's a good idea to call your physician, talk it over with them, see what they would recommend.

It's true that there can be a latency period. So even when you're initially exposed to the virus, it can take it anywhere on average from five days up to 10, even 14 days before symptoms start to exhibit. So that's why for some folks they will go into quarantine. I think it's a lot to ask of a loved one, but this is certainly something that I'd keep in an open discussion. And again, start to implement those best practices. Wash your hands, try to keep things clean, trying to limit the exposures that you do have.

Dr. Mesa:
I would say just related to the airline pilot piece in particular, in actuality probably even a lower risk than someone whose spouse is a healthcare worker of caring for COVID-19-positive patients. A pilot typically doesn't interact with the majority of the people on the plane. They come on early. Planes are HEPA-filtered. I think planes overall are probably one of the more monitored and cleansed areas one is interacting with. There are probably other jobs where you're probably more likely to run across people or interact in close quarters and other sorts of things.

So, what we're advising all healthcare workers at the current time at our center, and many centers have gone to this, is twice-a-day temperature checks. So again in a group that may be at a slightly higher rate of being exposed to the virus, we are having all of the healthcare workers self-monitor for both symptoms as well as asymptomatic fever. And others that are out there in essential businesses that are interacting with more people than is typical during this period of social distancing—that's probably not an unrealistic thing to suggest.

Andrew Schorr:
Hmmm.

Dr. Scherber:
One thing.

Andrew Schorr:
Oh, well, Robyn, you can answer this. Will someone with an MPN have a different immune response? Now we've covered leukemias and others, and so the question is, will someone or maybe based on their age have the same worrisome fever, or could they still have the virus, but in other words, will their symptoms be any different, Robyn?

Dr. Scherber:
That's hard to say. I'd say the most difficult thing is I think when patients maybe are already having some maybe night sweats or intermittent fevers at baseline, how to distinguish that from the virus. That's going to be difficult, but certainly if you see an increase in the frequency, increase in—if you're usually hovering around a certain number, you see an increase in that number that's potentially maybe one degree, two degrees above baseline. But that being said, we really don't know. We don't know how they're going to respond, in terms of their immune response, compared to other patients.

What I was going to say along the lines, sorry, I have gotten a lot of questions from patients about work. So, for some patients that are in professions that—right now the city of San Antonio is under a shelter in place order. But I've had patients from other areas that have asked what do I do if I'm a school teacher and they haven't canceled school, or I'm a business member and I'm really getting a lot of exposure?

One of the things I've been doing is working individually with patients to try to help either get in contact with their employer and figure out what potential accommodations can be made for them, and for some patients working with them to do things like Family Medical Leave Act just to try to help them if they're in a difficult spot, to try to take some time away from work or to try to make those accommodations that they're not as high of an exposure risk.

Andrew Schorr:
Okay. So, Ruben, so people have been sending in questions, and thank you, folks. Just hit that question button, and we may go just a few minutes longer. So just to be clear, there are a number of people on interferons, and so, Ruben, I just want them to understand, is interferon an immune modifier, and does it put one who's taking it more at risk?

Dr. Mesa:
I'd say it's a question we don't have a good answer to, in that, well one, I would look to see to what degree it's lowering the white count in an individual. I don't think that everyone on interferon we can put one group as being at increased risk or not. I think in some patients we have had the discussion of slightly lowering the dose if their counts would allow to, if their white cell count has been on the lower side, to allow that to creep up somewhat. So in some we have kind of worked with the dose.

Whether interferon itself especially makes people more prone to it, there has been a lot of discussion and the whole virus, the world is only known about for two months. So the amount of information we have is very limited, but interferons do have some antiviral properties. So it is still possible that the interferons may well be somewhat protective, but we can't say that for certain, but that is at least a possibility. So we don't really know.

Again, I think a good discussion between physicians and their patients, but overall, we have been very mindful of the white blood cell count in individuals and if it's lower than normal, again is there the opportunity to slightly adjust the dose? Our goals for controlling the count typically is a white count of under 10, a hematocrit under 45, in PV patients, a platelet count under 400. So the platelets are 150 and the hematocrit is well-controlled and the white count is a little low, then maybe we have a little room to adjust the dose. Is that necessary? Truly none of us know. The medical community is clearly trying to adjust to this in real time long before we'll know anything definitive regarding the specific medications or adjustments that are more or less effective

Andrew Schorr:
What you just said applies to hydroxyurea as well, Ruben?

Dr. Mesa:
I would say yes, except the protective part. Interferons, the name, interferons, is actually a variant of interfere. It's how the name came, because it interfered with viruses. Hydroxyurea probably would not be protective, but nor do I think that an individual with well-controlled counts on hydroxyurea is automatically at higher risk, and that may not be the case.

Andrew Schorr:
Robyn, I want to get to symptoms for a minute. So before we had this fearsome virus come up that we worry about stroke  having any immunity for, there was influenza, there were colds, there were all other kinds of infections, bacterial and some viral. So if one of your patients is saying, "I have a cough, I have this and that," you want them to call, right—you want them to call, and you want to kind of go through it with them, right? Rather than them rushing into the emergency room or panicking, right?

Dr. Scherber:
Right. Well, obviously it depends as well on the symptom, so if it's a cough, if it's fevers, if they're not feeling generally well, potentially more fatigued, I 100 percent want them to call. I want to hear about this. For a lot of those patients, we'll recheck their blood counts, we'll see if they meet screening criteria for the virus.

There are some symptoms that are worrisome enough that I will tell them right on the phone, "You need to go right into the nearest emergency department," and that includes things like bad shortness of breath, feeling like you're not able to, if you're not getting up from bed, if you just feel so fatigued that you really can't get around.

As always, if you're having active chest pain, if you can't catch your breath, if you're having loss of movement in arm or leg. Anything like that may or may not be related to the virus, but things that are bad enough just to go right.

Andrew Schorr:
Right. I mean we worry about in MPN patients.

Dr. Scherber:
Right. Again, I worry about the interplay between potentially a virus on top of an MPN. We know that there already could be some underlying baseline inflammation there and then on top of that being sick we know can be a risk factor for blood clots as well.

Dr. Mesa:
One important point, Andrew, is that at the current time emergency departments, one, if you're having an emergency, I think as Robyn had wisely said, you need to go to the emergency department. If you think you might have the infection, most healthcare systems have an alternative path in place, meaning it's probably not best for either the ED or the patients who think they potentially have this infection to go to the ED unless they are having severe symptoms like shortness of breath.

Many have set up places for either drive-through testing, video visits to discuss the symptoms and determine on testing. Some have set up triage tents, sometimes off-site in other remote locations to separate potentially infected patients from the rest of the population. So again, important for you to get care, but important for you to contact your doctor. At the current time of what they most specifically are trying to avoid is a waiting room full of people coughing and sneezing who think they have the infection. That wouldn't be good for the patient. It certainly would not be good for everyone else involved with the emergency department.

Andrew Schorr:
Right. Robyn, you mentioned night sweats a little while ago. You were talking about baseline. So someone wrote in, they said, "Well, if I've increased night sweats, could this be the virus?"

Dr. Scherber:
Well, the virus has a lot of different symptoms. So I was looking at this as well, again this morning. 80 percent of people with the virus will have mild symptoms. So that could be anything from fevers to cough to traditional things we'll see with a cold, so a sinus congestion, to things like night sweats. So potentially, but I would like to see more symptoms than that before I would get too worried—but that being said, definitely worth talking to your physician about, especially if they kind of came out of the blue and if you're having other symptoms with it, yes.

Andrew Schorr:
Okay, and one thing, sort of what I was asking before, would an older patient with an MPN have a lower temperature but still have the virus? Would they spike the same fever?

Dr. Scherber:
That's a good question. I haven't seen any data that elderly haven't been spiking fevers as much with this specific infection. Certainly it could be lower, but I would gauge it as well as kind of how you're generally feeling. I mean, if you're having a fever, even mild fevers that you're really not feeling well, potentially have a cough with it, it would be worth talking to your physician about.

Andrew Schorr:
Okay, so you're the director, Ruben, of a major cancer center, and you've been talking to directors around, but then around the communities, you also have primary care. So if I'm having symptoms and yes, I'm an MPN patient, do I call the hematologist? Do I call my hematologist nurse? Do I call the insurance company nurse line? Do I call primary care? How would you guide people? How do they think of this?

Dr. Mesa:
Well, I would say either the hematologist or their nurse, clearly communicate with the hematologist or the primary care physician. I think clearly a position that they have a strong relationship with either one of those two, I probably would not go to the insurance kind of triage line as a starting place, particularly at the current time.

Andrew Schorr:
Okay, and the primary care, I'm sorry, do I?

Dr. Mesa:
Oh, I think again, they too would be a strong resource, but I think as long as you have a strong connection with them. So again, you want someone that really knows your whole medical history and can evaluate you for this. Of course, a primary care doctor may well connect with the hematologist as well. I disqualify that, because, again, there are some folks who primarily are seeing their hematologist and are seeing a primary care doctor intermittently, then maybe the hematologist. But if they have a good relationship with their primary care doctor, that would be perfectly fine to reach out to as well.

Andrew Schorr:
Okay. Robyn, we have some people who have statins for heart issues and all that. So somebody wrote in, they said, "Is a statin a good med to take in order to lower inflammation?"

Dr. Scherber:
Well, that's a great question. and there has been some really interesting data on that. We, even in MPN patients, there is some data that statins can potentially help lower that inflammation. That being said, it's not something that I necessarily would start without cause. And it's something that you should discuss with your physician.

Statins do come with side effects. For some patients, they can cause bad muscle aches or pains or even have problems where some of the muscle enzymes go up too much. So unfortunately, they're not without risk. But that being said, yes, there is some data that they could reduce inflammation.

Andrew Schorr:
Robyn, I'm going to go to Ruben in a second as we wrap up, and I want to thank you for being with us, because you guys are our angels, and here, Ruben, you're directing a whole center. I can't imagine all the issues that are on your plate. So healthcare professionals and first responders and so many people doing essential services, but certainly healthcare providers and we want to give you the protection you need in work with people.

Robyn, what do you want to leave as sort of take-home messages, knowing that things are going to change, right? But where we are today, what's your message to your patients and patients worldwide now?

Dr. Scherber:
Yeah. Well, I have seen how concerning this news can be and for some patients, they're really worried that this might be something that's the end of the line. I don't think that's the case for the vast majority of patients. We have weathered through different types of flus, colds. Yes, this is more severe than what we usually see. But this is also something that right now, be it either healthcare providers, be it their neighborhoods, their loved ones, this is something that we can try to help slow down the course, try to help prevent. And this is something that there are active searches into what might be best to fix this.

So that being said, I think we're in a good spot, and it really brings it down to what can you do? I think, again, trying to stay away from sick people as best you can, trying to implement those good practices of handwashing, cleaning up around the house, making sure that you've disinfected what you can, and then trying to stay healthy as well, and keep a good state of mind. I think that's really critical. Surround yourself with people that you love, people that encourage you.

Make the most of every moment. It's never worthwhile living in fear. I think that that's one of the biggest mistakes you can make. But trying to do what you can, be proactive about things and then trying to stay healthy, stay with people you love, I think those are the most critical things.

Andrew Schorr:
Yeah. Ruben, before I ask you for your kind of wrap-up comment, someone wrote us from England, where they're really on lockdown there for sure, and her husband has an MPN, and she's at home with him. They have a little private garden in the back, and they were worried about just going outside in the private garden to be around their plants and all that.

People as you know, the anxiety level is high. That doesn't help. So, I think what Robyn was getting at is how do you lower your stress? And eat, sleep well, lower your stress, exercise if there's a way for you to do that? I've been trying to do that as a myelofibrosis patient, but what do you want to leave us with, Ruben?

Dr. Mesa:
I'd say both of a word of caution and a word of hope. So one, the word of caution, I'd say something that we've learned as this has evolved very rapidly, is that this infection I think was more severe than we have thought that it would be, and that it was more contagious than we thought that it would be. So both of these things, there is a real reason that most of our country is pretty much locked down at the moment. None of us are truly safe against this infection.

So really trying to avoid it, and taking all of these things very seriously, it's tough to do for many reasons, but it's very, very important that we do. I fortunately think that the majority of MPN patients, if they develop the infection and people will, it is just a common infection, and many people will get infected. I think many will, with good medical care, get through it just as well as the general population. But I think all should really take a word of caution and really try to avoid getting it.

Now, the word of hope. I could say that I have never seen a period of more extraordinary scientific collaboration and multinational efforts in a short amount of time as I've seen during these past several weeks. It is without precedent, both the communication, we have a WhatsApp chat of MPN doctors around the world. And as Claire Harrison is finding something different that they're doing there, we discuss it with the people in France. We're learning from our colleagues in China and Japan and South Korea. There's never been collaboration like this.

Three weeks ago, there were hardly any tests. Now, most centers have invented their own tests. We have a new FDA-approved test that UT Health developed that is available as of yesterday. And most centers went around the process of there not being enough tests, and they invented their own tests and got them FDA-approved in an emergent fashion.

There are now truly dozens of scientific therapies being developed and multiple vaccines that have already begun testing. All of this within two months. The first patients in China were the very last week of December. So realize what a short time frame this really is. The entire world community working together on this, I have little doubt we will have effective therapies and likely effective vaccines in the very near future—probably not by Easter, but again, very, very soon.

So, it's important in this time, again, as they say, flatten that curve. The less people that get it severely during this initial wave, the better off we'll all be, the better we can care for those patients that have developed it, the better off we'll be as a society.

Andrew Schorr:
Wow. Well said. And I believe that the woman in England, she probably can sit in her private garden.

Dr. Mesa:
Without question. There is really no harm. I think exactly now getting into the spring; fresh air, being outside, making use of your yard, there is no COVID-19 virus in your yard, enjoy those things. Again, life is at a different pace, but you're right, this is as our Dean every day with the institutional call reminds us, this is a marathon, it's not a sprint. So it's going to be a few weeks of this. So you clearly have to kind of take it in stride. Boot up the Netflix, get some fresh air, read some books. It's a different spring than any of us had anticipated, but together we'll get through it.

Andrew Schorr:
I want to thank you. So these physicians volunteered their time. We need to let them get back to their other work, but thank you so much. We've had 100 people or on this. A couple of other things, folks. We will do other webinars with other experts. Additionally, on MPNs, there's a replay of the one we did with Dr. Pemmaraju, the podcast from last week as well, but the situation changes. As Robyn Scherber was saying we keep learning, right? We keep learning.

In May, we'll do a program with two other MPN experts, Dr. Catriona Jamieson at the beginning of May a two-and-a-half-hour event and Dr. Bart Scott from Fred Hutchinson. Everybody knows everybody here, and we'll be doing that.

And as Ruben was just saying, you got to go on with your life and try to de-stress. Esther and I and our 22-year-old are watching Harry Potter movies every night. Totally escapist, right?

Dr. Mesa:
There you go.

Andrew Schorr:
So whatever you can do. Don't watch Outbreak. Don't watch some of those movies. Don't watch that. Robyn Scherber, thank you so much for being with us from San Antonio. And your devotion to patients, Robyn, in figuring out with people what works in their work life and the combinations you were talking about, thank you so much. We're going to let you go. Dr. Ruben Mesa, thank you so much for being with us.

Both these folks at the University of Texas, San Antonio Health Sciences there, the Mays Cancer Center, Ruben is the director. Thanks a lot, Ruben. We'll let you go.

Dr. Mesa:
Thank you. Thank you, Andrew.

Andrew Schorr:
Okay, ladies and gentlemen, remember you can always send questions to comments@patientpower.info with other questions, and look for us doing other programs as we get through this, other . And also on family issues. Esther, my wife and partner has been working on those as well with social workers, et cetera. All right. Thanks for watching everybody. And as I like to say always, knowledge can be the best medicine of all. I'm Andrew Schorr.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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