Previous Coronavirus Pandemics, COVID-19 and Cancer Care

To keep the scientific community abreast of the continuous stream of new research data related to COVID-19 and cancer, on July 20, the American Association for Cancer Research (AACR) launched a three-day virtual COVID-19 and cancer meeting.

AACR’s President, Antoni Ribas, welcomed attendees in his opening address, discussing the parallels between COVID-19 and cancer and highlighting the challenges and opportunities that have resulted from the COVID-19 pandemic.

COVID-19 and cancer are both linked to the dysregulation of proteins that drive human disease and interact with the host immune and inflammatory processes. In light of this, Ribas proposes that “the same principles of sequencing genomes, developing targeted drugs for these dysfunctional proteins, modulating inflammatory responses and inducing protective immune responses apply to the virus and to cancer.”

Ribas also explained that social and racial differences in cancer care have become even more evident during the pandemic: “To the racial disparities in cancer care, that the AACR has been studying for over 20 years, we now have to add the increasing incidence and mortality of COVID-19 in people of color and Native Americans.”

Clinical cancer research has been faced with significant challenges during the past few months – patient referrals have slowed, clinical trials and treatment regimens have been impacted and cancer care providers have had to adopt new measures to minimize risk to patients and staff. But, Ribas explains that this has resulted in an unprecedented level of innovation: “They [cancer clinics] went from near-complete paralysis during the first few weeks of COVID-19 shutdown to officially incorporating telemedicine, home treatments and remote evaluations in a process that would have otherwise taken years.”

Ribas finished his address by acknowledging the impressive collaborative approaches that have developed between investigators from industry, academia, research foundations and governments in response to COVID-19.

“It is inspiring to see how previously competing enterprises are now working towards the common goal of beating COVID-19 in the shortest possible time,” said Ribas.

The meeting’s keynote address was delivered by leading infectious disease expert, Anthony S. Fauci, MD, director of the National Institutes of Allergy and Infectious Diseases (NIAID), National Institutes of Health. In his introduction, David Tuveson, program committee chair of the meeting and AACR’s President-Elect, highlighted many of Fauci’s achievements: “Beyond his own laboratory Dr Fauci has led national and international efforts to manage outbreaks of Ebola, severe acute respiratory syndrome (SARS), Middle East respiratory virus  (MERS), tuberculosis, swine flu and many others. He is credited for listening to, and working with, AIDS activists to productively introduce combination therapy for HIV patients.”  

Now as a member of President Trump's Task Force against COVID-19, and as director of the NIAID, Fauci is applying his comprehensive knowledge of disease outbreaks to the current pandemic.

Coronaviruses – A brief history

Fauci began his presentation with a historical perspective of coronavirus diseases – focusing on the SARS pandemic and the MERS pandemic which were both caused by coronaviruses: “Prior to SARS and MERS… there were four coronaviruses that were responsible for about 15–30% of the recurrent common colds that we all get, usually during the winter season. However, the issue of the possibility of a coronavirus leading to a pandemic came upon us in 2002 with SARS and then again in 2012 with MERS.”

Fauci explains that the SARS outbreak, caused by SARS-CoV, was successfully contained using a number of strategies to minimize the spread of the disease – cases were isolated, infection control measures were put in place, quarantining was initiated along with short-term hospital and school closures. In addition, travel advisories were issued, and health alert notices were distributed to airline passengers arriving from affected areas.

“It became clear that although this [SARS] was transmissible relatively easily from person to person, it did not have the absolutely overwhelming efficiency and capability of spreading from human to human,” said Fauci.

He continued: “Measures like physical separation, mask-wearing and quarantine actually turned the outbreak around… the outbreak was controlled purely by public health measures – without any drugs and without any vaccines.”

In 2012, MERS‐CoV emerged in Saudi Arabia, causing the MERS pandemic. More than 2,500 people have been diagnosed with MERS, and the disease resulted in 866 deaths. While the spread of MERS has slowed, the disease still exists, unlike SARS which subsequently disappeared.

COVID-19 – The current situation

Similarly to the coronaviruses causing MERS and SARS, SARS-CoV-2 likely originated from an animal host.

Fauci shared his surprise at the extraordinarily wide spectrum of disease that is observed in COVID-19 patients. “It is so extraordinary that we have so many people who have no symptoms at all, and then those whose outcomes are very, very difficult, including hospitalization, and death.”

“So, here we are right now, in the middle of July with close to 14 million cases globally and ~580,000 deaths thus far – with essentially no end in sight,” said Fauci.

As his opening address came to a close, he refocused his attention towards COVID-19 and cancer: “COVID-19-related reductions in cancer screening – because of the total country lockdown that we and other nations have experienced – project that over the next decade, could actually result in 10,000 or more excess deaths from breast and colorectal cancer.”

“We’ve always had emerging infectious diseases. We have them now, and we will continue to have them in the future. Just as emerging infections provide for us a perpetual challenge, we need to be perpetually prepared,” concluded Fauci.

A closer look at SARS-CoV-2

Virology

• Defined as a beta coronavirus. Belongs to the same subgenus as SARS-CoV.
• Enveloped, positive-sense single-stranded RNA virus
• Large genome (~30,000 kilobases)
• Comprised of four structural proteins: Spike protein, envelope protein, matrix protein, nucleoprotein
• Spike protein facilitates attachment, fusion and entry of the virus to the host cell via the ACE2 receptor
  
  

Transmission

• Respiratory route of transmission
• Direct person-to-person transmission when in close proximity
• Infected surface transmission
• SARS-CoV-2 is detected in numerous non-respiratory bodily fluids – however their role in transmission is uncertain
• No current evidence that animals play a major role in human infection
• Asymptomatic persons seem to account for up to 45% of SARS-CoV-2 infections
  
  

Clinical presentation

• Fever
• Dry cough
• Fatigue
• Anorexia
• Shortness of breath
• Myalgias (muscle pain)
• Other reported symptoms include nasal congestion, headache, conjunctivitis, sore throat, diarrhea, loss of taste/smell or a rash on skin or discoloration of fingers or toes
  
  

At-risk groups

• Older adults
• People of any age with certain underlying health conditions