Published on March 26, 2020
The mass quarantine in Italy is raising concerns from cancer patients not only about their risk for coronavirus infection, but getting the care they need. How are patients being protected? Are treatment protocols impacted by the lockdown?
Patient Power founder Andrew Schorr is joined by CML survivor Felice Bombaci and his doctor, Dr. Giuseppe Saglio, in Turin, Italy to give an update on the state of cancer care in the midst of a nationwide coronavirus lockdown.
Watch to hear both patient and doctor perspectives on the pandemic and their advice for other countries as the number of cases grows.
Transcript | Coronavirus Pandemic: What Italian Doctors and Patients Are Doing
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Hello and welcome to Patient Power. I'm Andrew Schorr in Southern California, but joining me are two wonderful people from Turin, or Torino, Italy, and that is my friend, leading patient advocate, and that is Felice Bombaci.
And we're also joined by a gentleman who's been his doctor over many years, who is a professor of hematology at the University of Torino, and that is Dr. Guiseppe Saglio. So, Felice, welcome, Dr. Saglio welcome back to Patient Power.
Thank you very much, Andrew.
Dr. Saglio, so those of us living with hematologic conditions and you are recommending to patients now, we wonder if we're on regular therapy, do we need to come to the clinic as often? How do we know what's right for us when we're otherwise worried about being ?
Yes. I think that this is something that should be decided with your doctor, of course. Your doctor will precisely tell you if something can be postponed, because at the moment it can be a risk to reach and to have a visit at the hospital. Or it's something that needs to be monitored in quite a strict way, and therefore you have to go to the hospital. It depends, of course, also on your condition.
I would say if you are facing a therapy which is highly immunosuppressive, or immunosuppressive in general, of course, you have to try to avoid as much as possible to go out of your home and to have contacts with people potentially infected.
If you are carrying the virus or other types of disease and if you indeed have on the contrary a very good, I would say, stable situation, you are following a therapy which is lasting since, I would say, months, or there is no problem to continue the therapy and to postpone the visit of two months and so on.
But, of course, I would say, those patients who have already a critical clinical condition, the best thing to do is just to avoid the possibility to be infected.
That's why this is a very simple and very, I would say, general rule, but it's probably the most successful I would say. And to try to prevent the diffusion, and the spread of the virus, of this particular virus in particular.
So, Felice, there you are, both of you in Italy, and we in America have been watching, because you've been through so much. And right now the country is trying to regain control. And so, patients with different cancers, and particularly hematologic conditions, are worried. You've been living with CML for many years, but it's been greatly under control. But you get questions from people, most of us have a chronic hematologic condition. Some people need transfusion, and some people have acute leukemias, but others it's more chronic. Are you helping people just take a deep breath, if you will, to know that things don't always have to happen just like that?
Yes. For people, this emergency about the coronavirus creates a big issue in the patient, because the patients are concerned about what they do, what is better for them? Because a physician sometime calls him, says, "Stay at home, see you next month." But the patient says, "My disease is continuing to work in my body, is it correct to stay at home?"
On the other hand, in the other face of the coin, there is another concern. The problem is, but if I go in the hospital to make transfusion or other kinds of the treatment, it's possible to contract coronavirus. Then the infection put me in bad situation.
And another big problem is outside the patient. The donor, for blood donors stay at home in this period, then reduces the storm, the number of, the viability of the blood for patient who needs transfusion, for example. This is another big issue. And we ask the people to go to donate blood for other people. They are safe. And at the same time, say to the patient to stay at home to reduce risk to have coronavirus.
Right. Dr. Saglio, so for people like me who get monthly immunoglobulin infusions to try to boost my immune system, I worry, and tell me what you're doing in Italy, for people who need those sorts of infusions, how you're doing your best to protect them when they come.
The best protection that we can have of course, first of all, you have to continue your infusion. You can delay it one week but no more than one week, it's not enough.
So, it depends on the local system that you have. There are cases in which you need to go to the hospital to get your immunoglobulin. In other cases, the infusion of immunoglobulin can also be done by doctors at home. But this is not generally performed unless there are specific reasons or so on. So, I think that I would say certainly you cannot stop this type of infusion. And probably the most common way to do it is just to go to, with special care, of course, in terms of trying to prevent contacts and so on, to make the infusion in the hospital.
Okay. One other question, and that is how you're doing this in Italy. So, we already had influenza, and we have the cold virus, so it's very possible that any of us could have that and not coronavirus. So what we're being told in America, and I wonder what you're doing in Italy, is call, I have a cough, call. I have a sore throat, call. What are you telling people in Italy?
The same. Don't move from home and don't go to the hospital but just call. There is now a special green number, and there are doctors coming to visit you. Maybe, if it's needed, to just make the test for detecting the virus—but not to move from home. Because at this point, if you are negative, okay, you are happy. If you are not negative, of course, you are spreading the virus at this point, because you are already symptomatic. And therefore, it's better to stay home.
And, of course, to put all the persons who are living with you in a condition of a sort of quarantine to this disease. But in the doubt of having a coronavirus, please call the doctors and call the green numbers, the emergency numbers, but do not go to the emergency room. Otherwise, the risk for the other people in the emergency room is too high.
Okay. Dr. Saglio, last question is, you are in what we would say in English, “in the thick of it,” you're right in the middle of it now. And we are facing that now growing in the U.S. and in some other countries. Do you have any advice to us as patients of this storm that's coming? How we can do as well as we can?
I would say that, as you know, there are different approaches in different countries. There is an approach which is extremely restrictive, now undergoing in Italy, in which everyone, unless that has a special permission or is needed to go to work for essential services and so on, all the others have to stay home and just to work and to follow specific rules.
I must say, the Italians at the moment are extremely compliant. I am surprised by the fact that they are extremely compliant to these rules. And they are apparently, I would say, happy to do it, because they don't want, of course, to get sick and to have the risk of having the disease.
There is another approach which is typically in England, in which, what they do is, they say, "Okay, we must achieve, I would say, a so-called group tolerance, so community tolerance." But to achieve this point, we need to have many people who have faced the infection, they have got the infection, they have overcome the infection. And so, they have an immune system, the sort of barrier that doesn't allow the virus to spread.
I think that in any case, in both situations, I would say, easier, of course, in Italy, a little bit more difficult in England, the people with other problems should be extremely careful. So, even if they are not, I would say, definitely in a sort of quarantine, however to follow strict rules, which is just to wash frequently the hands, to put the barrier just to avoid an exchange of, what we call, the small droplets which can contain virus and so on, just to clean the surfaces, just to sneeze only on the elbow. So, there are a number of rules which are quite easy to follow. And to stay home, because otherwise the risk for them is higher than for the general population.
And what we know now, this virus is highly infective. Indeed, many people who have got now the virus, they didn't know. Or they do not know exactly where they were infected, because probably they just by chance met the person who was already, even without specific symptoms.
One of the problems with respect to the general flu virus is that in this case, this virus is very highly contagious. And it can spread even by touching surfaces and so on. So, it's better to have a place, and generally this place can only be home, in which is protected from the virus. And they have to stay protected from the virus, not to go outside and so on.
Probably there will be, I do not know how long this will last, we hope one month-and-a-half, two months in which we have to be very, very strict. Then, as everything, will end. And therefore, we must be extremely compliant and extremely patient in this situation. Otherwise, it's becoming dangerous.
Right. Well, Dr. Giuseppe Saglio, thank you for your dedication, and the healthcare workers that work with you throughout Italy, where you're dealing with this so much right now, and just so devoted. Thank you for taking the time to be with us. And we're learning from you and the Italian experience as well. Felice, just from the patient perspective, are you hopeful we can get through this?
Yes. It's important to do the suggestion Professor Saglio said before. It's important to stay at home. If you stay at home, you are sure and if you exit from home to go in the hospital for your disease, please take care. Pay attention, don't meet other people. It's not a simple flu, but it's in some cases a fatal flu. Then it's important for us patients to stay at home.
I understand it's restrictive, but it's important also for our caregiver to pay attention how they have contact with other people, because the problem is also transmitted to me from other people. Then it is most important to pay attention in this period. It's not a long period I hope, but two, three weeks to maintain the rule over the health authority said in Italy, now we respect them and we save, reduce the number of the people who are involved in this. And we hope the future coming. We are resilient, but we are not supermen. Then we need to pay attention.
Well said. Okay, Felice Bombaci in Torino and Dr. Giuseppe Saglio, thank you so much for your dedication, each of you, to patients. And we appreciate you bringing the Italian story to all of us worldwide. I'm Andrew Schorr, remember knowledge in following these steps that were outlined here can be the best medicine of all.
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