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Caring for Patients With Cancer During the COVID-19 Outbreak in Italy

Educational Objective
To understand how Italian health workers cared for patients with cancer during the COVID-19 outbreak
1 Credit CME

At the time of this writing, the novel coronavirus 2019 (COVID-19) outbreak was detected in Italy only 5 weeks ago, and it has changed our lives and the lives of our families forever. After a 12-hour shift at our hospital, The National Cancer Institute of Milan, we decided to turn off the lights, put a candle near the screens of our laptops, and share our feelings with the oncology community.

We had come back from Australia and Peru on the previous Saturday morning to the news that the first case had already been discovered in the city of Codogno. We were expecting the first case; we knew that it could happen; we knew it would happen; but we did not know when or where. In the beginning, there was a bit of disbelief and, although the virus was close, it still seemed very far away. It did not help that scientists and politicians were divided into alarmists and nonalarmists. Even we, people of science, could not disentangle ourselves from what was true and what was blown out of proportion. In the second phase, we felt afraid for the elderly, for the most fragile people in the community, but we never thought that the virus would touch all of us so closely. As the time passed we felt more patriotic, and at 6:00 in the evening, when the numbers of the dead were published, people took to their balconies and began singing to life and the national anthem, as they had done in China in the months before. Children hung rainbows out with the words “everything will be fine.” We have all been afraid; we have been glued to the web for hours in a desperate search for comforting news or falling numbers. We tried doing math: if only they locked everything down, within 10 days we will start to see a decrease in the number of deaths. But no, the numbers went up. Today, we rejoice that there were only 600 deaths instead of 800. We felt outrage toward those who refused to stay at home while we were still working. We felt anger toward those who went out for long rides with the dog, those who jogged, and for those who did not understand that their lack of responsibility was putting our lives and the lives of our families at risk. The first great pain I felt was when a dear friend’s relative became sick in a community for the elderly. The fever went up; the first test results were negative; the fever stayed high; and then the second test results came in positive. And there, in isolation, without ever seeing family or friends again, the person died. The people who die from COVID-19 have no rights—no right to be visited, no right to a hug, no right to a funeral. They die alone.

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Article Information

Accepted for Publication: March 25, 2020.

Corresponding Author: Filippo Pietrantonio, MD; Marina Chiara Garassino, MD, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1-20133 Milan, Italy (filippo.pietrantonio@istitutotumori.mi.it; marina.garassino@istitutotumori.mi.it)

Published Online: April 10, 2020. doi:10.1001/jamaoncol.2020.1426

Conflict of Interest Disclosures: Dr Pietrantonio reported personal fees from Amgen, Roche, Merck-Serono, Bayer, Servier, Sanofi, and Lilly, and grants from BMS outside the submitted work. Dr. Garassino reported personal fees from Merck, BMS, AstraZeneca, Roche, Takeda, Celgene, Pfizer, and GSK. No other disclosures were reported.

References
1.
Li  R , Pei  S , Chen  B ,  et al.  Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2).   Science. 2020;eabb3221. doi:10.1126/science.abb3221PubMedGoogle Scholar
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