April, 2020

Whethering the Storm

By Michael J. Katin, MD

It has now been several weeks since our country went into hiding from COVID-19. There will continue to be significant controversy about the best way to deal with this. Whether it is best to practice social isolation with shelter in place (suffer at home) or whether it would be best to ramp up public health approaches such as mandatory quarantine of exposed persons and increased use of antiviral interventions. Whether it is necessary to shut down all group activities or expect that eventually herd immunity will prevent further spread, as is the case with most infectious diseases. Finally, whether billions of dollars should be spent on researching vaccines or other cures or whether billions should be spent to help persons with collateral damage such as layoffs, or both. We can also wonder whether there is any other viral trend that's been less desirable.

Whether this column ever has anything to do with oncology will be answered shortly.

The outcome of this current crisis will most likely be improvement in the ability to mobilize medical equipment and facilities, rapid implementation of testing, and at least temporarily acknowledging the importance of domestic production of medical devices and pharmaceuticals (that should last about six months). This is despite the fact that the risk of a pandemic has been discussed for many years and has even already occurred but did not stir up the level of anxiety necessary to properly prepare.

Now the country is hunkered down, sheltering in place, socially distancing. No restaurants, no bars, no cultural events. Too bad if you wanted to go to the movies -- you won't be able to see The Invisible Man (sorry, open mic nights are also banned). Ironically, No Time to Die was postponed. The only Black Widow I'll be able to see in the next few months would be in the corner of my garage (warning -- not for the squeamish).

Billions of dollars are being held out of the economy and trillions will be spent to get back to where we were two months ago. It's too late to decide whether it would have been better to have been proactive, but it then raises the question as to intervening on other issues before they get out of hand (connection to oncology is coming up).

In a society in which even banning vaping is impossible to achieve, can efforts be made to address the societal and economic consequences of climate change? , homelessness, or......cancer? None of these are associated with sudden events that focus everyone's (i.e., the media's) attention on them. Regardless of how serious COVID-19 turns out to be, the death toll and price for society will be far less. The CDC counted 12,469 deaths in the United States from the H1N1 pandemic of 2009-2010, and 34,200 deaths from influenza in the 2018-2019 flu season (down from 61,000 in 2017-2018), The homeless population in the United States is estimated at 552,830 in 2018, with a death rate that could be over 2-3 % per year, not to mention the burden of chronic disease. There were estimated to be 599, 274 deaths from cancer in 2018, second only to 655,381 deaths from heart disease. The annual death rate, according to the NCI, was 155.87/100,000 in 2016. 38.4% of all adults were expected to get cancer during their lifetime. The estimate is that in 2018 there were 1,735,350 new cancer cases.

We've already been through the War on Cancer in 1971 and the Moon Shot in 2016 but the resources that will expended on COVID-19 will far exceed anything dedicated to curing cancer, not to mention addressing homelessness or preserving the environment. Is it because it's thought cancer, homelessness, or extinction are not contagious?

Whether it is possible to address more than one problem at a time is something that needs to be answered. In the interim, it is the duty of this column to call attention to the potential setback in oncology that may occur as the result of aggressive attention to COVID-19. The 33rd annual meeting of the Association of Freestanding Radiation Oncology Centers and the annual congress of the European Society for Radiotherapy and Oncology have already needed to be postponed, and the annual meeting of the American Urological Association has been cancelled. All examinations of the American Board of Internal Medicine and the American Board of Radiology have been cancelled for the spring. Will the 2020 American Society of Clinical Oncology meeting, with the memorable slogan "Unite and Conquer: Accelerating Progress Together," have to be cancelled as well? If the annual American Society for Radiation Oncology meeting in October is in jeopardy, there may be no way to recover. Eliminating these tentpoles of academic progress could severely set back the course of cancer treatment by decades and could be the ultimate effect that COVID-19 has on humankind. We need to petition our government to do everything possible to make Chicago a sanctuary city between May 29 and June 2 to allow ASCO 2020 to be held. Or at least supply adequate quantities of masks and toilet paper.

C-O-V-I-D-19 (to the tune of D-I-V-O-R-C-E)

Pandemic rules that may seem cruel aren't working quite as planned
We need to spell the words that will make people understand
Like I-C-U or even I-N-T-U-B-A-T-E
But the message isn't getting through to Generation Z.

This C-O-V-I-D-19 won't be going away
If Q-U-A-R-A-N-T-IN-E means time to play
The viral surge will cause a purge of the E-L-D-erly
If we can't put a stop to C-O-V-I-D-19.

Somehow they think it's time for beaches
And St. Patrick's Day
But C-O-N-T-A-G-I-O-N takes the fun away.
There still may be a chance to save
What's left of this country
Before the virus does in Trump,
Mike Pence and AOC.

This C-O-V-I-D-19 will be with us to stay
Unless we wash our H-A-N-D-S twenty times a day
Stay in your place, don't touch your face, or you could D-I-E
If we can't put a stop to C-O-V-I-D-19.

Asteroid JF1 Countdown: Asteroid JF1 will be impacting with or passing by Earth May 6, 2022, which, counting May 6, is 766 days from now. Plenty of time left to stock up on batteries and plywood.