XX: Remission in a Time of Coronavirus
There’s something surreal about watching the world grapple with an existential health crisis just months after doing the same on a personal level.
The emerging COVID-19 pandemic has incited the usual spectrum of responses from exaggerated panic to dangerously careless dismissal of its impact. While the medical community and world at large are still early in the process of understanding this novel coronavirus, a few things seem true. First, young, healthy individuals who contract coronavirus will more than likely be fine. Second, the people who are most susceptible to severe cases and mortality are the elderly, people with serious comorbidities, and the immunosuppressed.
As a 32 year old about four months out from stem cell transplant it’s hard to calibrate exactly how scared I should be of COVID-19. My immune system certainly isn’t at full strength. While my white cell counts have mostly recovered back into the normal range, my 32 year-in-the-making encyclopedia of acquired immunity was wiped clean with conditioning chemotherapy. In a couple months I’ll begin receiving my childhood vaccines all over again.
That said, my immune system is recovering. A couple weeks back I passed the 100 day threshold which typically marks the point at which stem cell transplant patients can return to public spaces — restaurants, grocery stores, work, etc. Around the same time my oncologist felt my immune system had recovered enough to possibly derive some benefit from the flu vaccine.
Furthermore I’m physically getting stronger by the week. I’ve built up from only being able to jog a half mile at a time in December to being able to comfortably run 3–4 miles at a time on weekends. I’ve still got a ways to go physically to get back to my pre-cancer self but for just four months out from stem cell transplant I’d say I’m doing well.
Which brings me back to coronavirus. I’m some crazy hybrid — the body of a very healthy 32 year old with the immune system of an infant. Who knows what that combination means when faced with coronavirus. Its safe to say I’m at higher risk than a healthy 32 year old who didn’t have a stem cell transplant 4 months ago. But am I at more risk than a 57 year old with COPD? A 60 year old with heart disease? What about compared to a healthy 32 year old who had stem cell transplant 2 months ago? Or conversely one who had stem cell transplant 2 years ago?
You get the point. Maybe it’s possible to rank those in order of risk but trying to put an exact number on that risk is largely futile at this stage. It would be a stressful conundrum had I not spent the past four months playing the same game with the possibility of relapse. At a certain point as a cancer patient you slowly learn to live with the fact that it’s impossible to assign an exact percentage risk of something happening that accounts for all of your specific health and lifestyle variables.
Similarly the experience of going through stem cell transplant dampens the fear of COVID-19. Not because the prospect of contracting the novel coronavirus isn’t scary, but because I’ve been confronting the fear of infection for months now. I spent seven days in the hospital with a white blood cell count of zero, spiking fevers at risk of becoming life-threateningly septic from any host of pathogens. Likewise the first few months of recovery were spent taking prophylactic antibiotics and antivirals, being incredibly paranoid about what I ate, being isolated from public places, and living with the ever present smell of bleach cleaning solution.
In other words, you’ve merely adopted the Purell…
None of this means that I don’t take this nascent pandemic seriously. I’ll continue to practice aggressive and frequent hand hygiene. I’ll try not to touch my face — though let’s be real does anyone really succeed 100% at this? I’ll follow whatever precautions are issued by my department and my oncologists. Dying of a respiratory virus would seem remarkably mundane in the wake of everything I’ve gone through in the past several months, but that doesn’t mean it can’t happen.
At this point it seems like this novel coronavirus will inevitably spread throughout the United States and the rest of the world. Most people will survive and have only mild symptoms. A much smaller percentage will be hospitalized. An even smaller fraction will die.
The crucial concept for the good of everyone is that of flattening the curve. Stopping coronavirus in its tracks is unlikely if not impossible but its spread can be slowed and the peak prevalence of active coronavirus infections can be decreased by following guidelines with respect to hygiene, social distancing, and travel. Doing so gives our healthcare system a chance to accommodate those who develop serious symptoms rather than being overwhelmed with a sudden tsunami of critically ill patients — and thus shortages of hospital beds, respirators, personal protective equipment, etc.
There’s no point in panicking. But there’s also no reason not to wash your hands.
Here are a couple of useful resources regarding coronavirus both for cancer patients and the general public:
Coronavirus: What Cancer Patients Need to Know — Fred Hutch
Coronavirus Death Rate: What are the Chance of Dying — BBC
CDC Coronavirus Hub — CDC
COVID-19 Global Map — Johns Hopkins
