Potential devastating impact of COVID-19 pandemic on the diagnosis and treatment of head and neck cancer

New data from the United Kingdom reveals potential devastating impact of COVID-19 pandemic on head and neck cancer patients. At the peak of the first lock down, there was a 59% drop in urgent referrals for people with a suspicion of head and neck cancer.

The devastating impact on projected five-year survival for people with head and neck cancer sees the pre-COVID projected 5 year survival of 47% will potentially drop to 43% of head and neck cancer patients.

This could lead to an additional 451 deaths in people with head and neck cancer in the United Kingdom.

The data from DATA-CAN (The Health Data Research Hub for Cancer) provided a valuable insight into the effects of the COVID-19 pandemic on all cancer patients and cancer services. The research found:

• A decline in urgent referrals for cancer (70% decrease) during the initial lock down
• A decline in chemotherapy attendances (40% decrease) during the initial lock down
• For certain cancers, these declines had only partially recovered.

The researchers have now looked in detail at the impact on head and neck cancers and found that, at its worst, there was a drop of nearly 60% in urgent referrals for a suspicion of head and neck cancer during the first lockdown. This meant that 6 out 10 people who had symptoms potentially indicating head and neck cancer were not being referred to a specialist to investigate further.

Estimates suggest that this could have a devastating impact on five-year survival for people with head and neck cancer. Pre-COVID, around 47% of people with head and neck cancer would be projected to survive for five years or more. This figure could now drop to 43% which could potentially lead to an additional 451 deaths in people with head and neck cancer as a result of the pandemic.

Watch a video that presents the data and how to mitigate it.

Laryngectomees’ challenges coping with COVID – 19 Pandemic as vaccines are available.

 

Laryngectomees are more susceptible to some respiratory infections because the air they inhale is not filtered by passing through their nose. Consequently, they are at an increased risk of inhaling respiratory pathogens (viruses, bacteria, and fungi) directly into their lungs.

Laryngectomees are also at high risk for poor outcomes when contracting COVID-19 because of their propensity to suffer from collapse of the lower lobs of their lungs (atelectasis). This is due to loss of upper airway resistance and impaired mucociliary functions, and mucosal irritation from cold, or dry inspired air. Further comorbidities such as advanced age, chronic disease (pulmonary, peripheral vascular, cardiac, cerebrovascular), diabetes, and past smoking, increase this risk.

Therefore, laryngectomees have to be vigilant and protect themselves from becoming infected with COVID-19. This can be done by wearing eat and mosuture exchanger (HME) with greater filtering properties ( i.e., Provox Micron TM); using 2 surgical masks (preferably N95), one over the stoma and the other over the mouth and nose; staying at least 6 feet away from others; washing hands often with soap and water for at least 20 seconds; and not touching their stoma, HME, eyes, nose, and mouth with unwashed hands.

Laryngectomees can protect themselves by receiving vaccination against COVID-19. All COVID-19 vaccines currently available in the United States have been shown to be highly effective at preventing COVID-19. Based on clinical trials, experts believe that getting a COVID-19 vaccine may also help keep one from getting seriously ill even when one get infected with COVID-19. Becoming vaccinated may also protect people around the vaccinated person, particularly those at increased risk for severe illness from COVID-19. This also contributes to the curbing of the national and world pandemic.

Among the benefits of being vaccinated is the emotional relief of gaining protection from the virus, and the ability of feel safer in face to face social interactions and when seeking medical and dental care.

Clinical trials demonstrated that the known and potential benefits of these vaccine outweigh the their side effects, and the known and potential harms of becoming infected with COVID-19. The Center for Disease Control’s (CDC) has reported that severe allergic reactions to COVID-19 vaccines are very rare and happened at a rate of 11.1 cases per million vaccinations. 

Vaccination is not expected to relax the CDC recommendations for continued use of masks and social distancing. This is because vaccines are not 100% effective, their protective effect is not maximized for at least six weeks, and vaccines may keep a person from getting sick but not from transmitting the virus. Masks and HMEs reduce the spread of any mutated strain of the coronavirus, while vaccines may not be as effective in preventing the transmission of newer, more contagious strains.

It is advisable to contact one’s physicians for guidance about vaccination or if one gets ill with the Corona virus. There are currently treatments available that can be administered early in the course of the infection to mitigate the illness and prevent complications. It would be prudent to following the guidance and instruction issued by the CDC and the local government health authorities.

Asymptomatic transmission of COVID-19, with or without vaccination

 

One of the problems with this COVID-19 pandemic, from a public health standpoint, is that asymptomatic or presymptomatic persons can transmit the virus to others without knowing that they are infected themselves. Estimates of asymptomatic transmission are 17-20%.

Protection procedure include  isolation (keeping infected persons away from others); and quarantine ( keeping persons who might have been exposed to the virus away from others).

Asymptomatic infections complicate these protective measures since it is impossible to tell who is infected. Current practice is essentially to assume that anyone might be infected and capable of transmission, and therefore masks and social distancing are necessary. Despite trials showing 95% efficacy of the two mRNA vaccines (compared to 70%, possibly higher, for the Johnson and Johnson vaccine), vaccination is not expected to relax the recommendations for continued masks and social distancing. The reasons are:

• Vaccines are not 100% effective;
• Vaccines protective effect is not maximized for at least six weeks;
• Vaccines may keep a person from getting sick but not from transmitting the virus.

Masks (if clean and properly worn) reduce the spread of any mutated strain of the coronavirus, while vaccines may not be as effective in preventing the transmission of newer, more contagious (but not more virulent) strains. There have been several mutated strains appearing in the UK, Brazil, South Africa, California, and other countries and states. As a rule they do not cause a more severe case of the disease but they may be more infective than existing strains.

Based on Dr. Glen Reeves article.

COVID-19 vaccines adverse reactions in the USA

 

     The Vaccine Adverse Event Reporting System (VAERS) receives reports on adverse reactions to vaccines. These reports can be filed by patients, health care providers, or even family members. As of 17 January 55 Americans have died soon after receiving an mRNA vaccination. The FDA and CDC investigate all these reports. Of course, most deaths are due to underlying illnesses; the system does not require proof that the vaccine caused the event in order to accept the report. The CDC has reported that severe allergic reactions to COVID-19 vaccines were happening at a rate of 11.1 per million vaccinations; for a rough comparison flu vaccinations have a rate of 1.3 deaths per million. Norway has changed its COVID-19 vaccination guide to direct officials not to give "very frail" people the vaccines.

based on Dr Glen Reeves article.