Collateral COVID-19 damage

In mid-February, doctors diagnosed 48-year-old Christine Rayburn from Olympia, Wash., with breast cancer that had already spread to her lymph nodes. Her doctor recommended immediate surgery to remove the tumor. But the hospital canceled the surgery as the COVID-19 outbreak ramped up in Seattle, just an hour north. “It just felt like one of those really bad movies, and I was being sacrificed,” Rayburn told NPR.

Rayburn’s physician decided to start chemotherapy immediately even though the treatment typically does not work on that type of tumor. But she needed an echocardiogram first, and the hospital had temporarily suspended that procedure, as well. Rayburn had to get local lawmakers involved before the hospital rescheduled her surgery.

The number of infections and deaths from COVID-19 rises daily, but those who die from the disease aren’t its only victims. Many hospitals have called off elective surgeries and “nonessential” treatments to conserve dwindling supplies of personal protective equipment for medical workers, keep resources available to treat coronavirus patients, and prevent unnecessary exposure to the virus. Some experts fear well-intentioned restrictions may result in more cancer deaths.

Len Lichtenfeld, deputy chief medical officer at the American Cancer Society, told NPR that patients across the country have told him their chemotherapy or surgery has been delayed or canceled. “There was someone who had a brain tumor who was told they would not be able to have surgery, which was basically … a death sentence for that patient,” he said.

Other countries have the same problem. Because hospitals in England needed all available resources to cope with COVID-19, doctors postponed 67-year-old Maggie Hollick’s surgery to treat metastatic cancer in her lymph nodes. Now she worries the cancer will spread elsewhere in her body before she can have surgery. “I don’t know where to turn,” she told The Guardian. “I am very frightened.”

Other delays in medical treatments may not have life-or-death consequences but still leave patients in prolonged suffering. An Edinburgh, Scotland, hospital canceled 68-year-old Hilery Williams’ hip replacement surgery on March 24, leaving her nearly immobile and in a great deal of discomfort, The Guardian reported.

Delaying even routine tests and exams puts patients at risk. Skipping a colonoscopy or a dermatological exam could leave cancer undetected. “It’s hard to know exactly what an elective visit is,” Noah Lindenberg, an oncologist in Marlton, N.J., told ABC News. “A lot of them start off as elective procedures until you find the cancer.”

A child receives a polio vaccine last month in Lahore, Pakistan. Associated Press/Photo by K.M. Chaudary

Polio goes on the backburner

Efforts to fight COVID-19 may come at the cost of losing control of polio and other infectious diseases, experts warn. The Global Polio Eradication Initiative on March 24 recommended suspending polio vaccination campaigns until at least the second half of this year to the slow the spread of the coronavirus, Science magazine reported.

The suspension threatens the three-decade effort to wipe out polio. Michel Zaffran, head of the polio eradication initiative, said he feels “caught between two terrible situations.” If the organization continues sending people door to door to deliver drops of the oral polio vaccine, it would put health workers and the communities they serve at risk. It would also limit the workers and resources available to fight the pandemic. But halting them will hurt the effort to eliminate the wild poliovirus from Afghanistan and Pakistan, the last two places it still exists. Zaffran said countries with weak health systems like Iraq, Somalia, Syria, and Yemen could see a return of the disease if polio jumps the borders.

Stopping the campaign also leaves Africa at risk from recent outbreaks of the vaccine-derived poliovirus that paralyzed 350 children last year. The live virus from the vaccine mutated and regained its ability to spread.

The World Health Organization’s Strategic Advisory Group of Experts on Immunization recommends suspending all preventive mass vaccination campaigns for infectious diseases, including measles and yellow fever. Measles is already reemerging in many countries, including the United States. —J.B.

A child receives a polio vaccine last month in Lahore, Pakistan. Associated Press/Photo by K.M. Chaudary

New hope for diabetics

More than 31 million Americans suffer from Type 2 diabetes, and many cannot control the disease with diet and exercise. Some require oral or injectable medications with unpleasant side effects or costly insulin injections multiple times a day.

But in a recent study, patients with poorly controlled Type 2 diabetes who underwent the outpatient Revita procedure showed improved blood glucose levels and better liver sensitivity to insulin. The Journal of the Endocrine Society plans to publish the results.

Early in the development of Type 2 diabetes, the lining of the small intestine begins to thicken, causing hormonal changes that lead to insulin resistance. During the Revita procedure, doctors insert a small balloon catheter through the mouth and guide it into the upper small intestine and apply heat to destroy the mucosal lining. After the damaged tissue flushes out, the body begins to form a new lining, restoring normal hormonal functioning in the small intestine.

In the study, the procedure appeared safe, effective, and durable for at least two years. The treatment could help patients for whom drug therapies don’t work or want a nondrug alternative. —J.B.

A child receives a polio vaccine last month in Lahore, Pakistan. Associated Press/Photo by K.M. Chaudary

Vaccine from a tobacco plant?

London-based British American Tobacco announced on April 1 it is employing new plant technology in its work on a potential COVID-19 vaccine. The company has already begun pre-clinical testing. The technology can produce elements for a vaccine by growing an antigen to the coronavirus in tobacco plants. Researchers estimate they could manufacture 1 million to 3 million doses per week beginning as early as June, though the vaccine would need approval before going out to patients. —J.B.