On this page you will find FAQs about COVID-19 and miscellaneous matters. Find more FAQs on our page FAQs about COVID-19. 1 Q: Can I successfully continue my treatments during COVID-19 or can I safely delay some regularly scheduled treatments? A: Depending on the stage of your cancer, you may be able to safely delay treatment(s). Skipping a treatment is more likely if the purpose is to manage symptoms, such as with palliative care. If the treatment is curative, or meant to control the disease, then your doctor may recommend to continue with your treatment as scheduled, despite circumstances with COVID-19. Visit your healthcare provider’s website for guidance and information. 2 Q: How does COVID-19 affect my Active Surveillance (Watchful Waiting)? A: Talk with your healthcare provider about the options for your current treatment. There is no one answer to this question as it depends on the following factors: The stage of your cancer Active and ongoing treatments Other existing medical conditions (including diabetes, heart disease, and lung disease) 3 Q: What happens if I discontinue treatment, or my treatment is delayed/cancelled, at this point in time? A1: Stopping treatment – DO NOT STOP TREATMENT WITHOUT LOOKING INTO THE FOLLOWING: Visit your healthcare provider or treatment centre’s website for guidance Read all materials, including medications, regarding stopping your medication, or treatment for side-affects, and/or complications If, after following the above advise, you are still considering stopping your treatment, BEFORE you stop, contact your healthcare provider, or treatment centre, as they may be able to offer help or they may need to document your decision in your treatment plan Bear in mind the decision to stop could affect future treatments and outcomes A2: Be prepared for delays, and/or cancellations, under the current circumstances for healthcare facilities and staff. In the event of a delay, and/or cancellation, be certain information is clear to you, your caregiver and your doctor, including any follow-up steps. Also, continue to regularly visit your treatment centre or healthcare provider’s website for developing information and announcements. 4 Q: What are the risks to transmission to the patient from physician and healthcare team? A: In general, the risk of contamination is low as long as safety rules are correctly followed. Policies to consider are: Medical personnel should wear personal protective equipment (PPE) Screen all visitors for any respiratory symptoms that may be related to a virus, including fever, myalgias, pharyngitis, rhinorrhea, and cough, and excluding them from visiting until they are better Restrict health care workers from working if they have any upper respiratory tract symptoms, even in the absence of fever Screen all patients, test for all respiratory viruses (including SARS-CoV-2) in those with positive screening results regardless of illness severity, and use precautions (single rooms, contact precautions, droplet precautions, and eye protection) for patients with respiratory syndromes for the duration of their symptoms regardless of viral test results 5 Q: What kind of services in hospitals have been suspended? I mean for example stopping kidney transplantation. A: In general terms all the “non-urgent activities” can be suspended and postponed. Only high priority cancer surgeries (patients at high risk of progression or metastases in the next 3 months) may be performed. Visits to patients outside the hospital, may be done online, e.g. telemedicine. Kidney transplant programmes have been suspended. Only in case of an emergency, e.g. an urgent dialysis access problem which is considered a life-threatening situation, is a kidney transplant recommended. 6 Q: How often should medical personnel be tested or in what circumstances? A: Healthcare workers with symptoms must be tested for COVID-19. For healthcare workers without symptoms testing is not standardised. The availability of tests may differ per hospital and country. It is important to familiarise yourself with the local recommendations. 7 Q: I am wondering, in this current pandemic is it advised to carry out urodynamic pressure flow studies with outpatients? A: Urodynamic pressure flow studies may be considered non-urgent. Performing these studies results in close patient contact. If needed, they can be postponed with no problem. No PCR is needed for urodynamics in asymptomatic patients. More information about PCR: https://www.iaea.org/newscenter/news/how-is-the-covid-19-virus-detected-using-real-time-rt-pcr 8 Q: Couldn’t you tell us: When and how the COVID-19’s blood test IgG might be appropriate and mandatory through worldwide population and especially among the patients with other illnesses? A: While antibodies might not be appropriate for acute-phase diagnosis (RT-PCR in this phase is quick and has a high sensitivity), they play an important role for COVID-19. Wide-scale antibody testing is an important public health tool. By conducting random antibody sampling of the general public (known as a serosurvey), we can better estimate the true levels of exposure and the consequent population immunity. As a result, we can predict the intensity and longevity of the pandemic to help direct decision-making. Furthermore, by identifying potential geographical ‘hot-spots’ of low population immunity, health systems could better allocate resources to prevent or manage transmissions. Once governments have reduced transmissions, and cases begin to fall, tests will become even more crucial in identifying asymptomatic carriers and infected individuals to ensure they are isolated from the general population. Serosurvey: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30114-0/fulltext What is RT-PCR?: https://www.iaea.org/newscenter/news/how-is-the-covid-19-virus-detected-using-real-time-rt-pcr 9 Q: How reliable is the IgG/IgM spot testing for the health care professionals? A: According to recent literature, this test may not be 100%. Studies and researches are still ongoing. Suggested reading material: https://pubmed.ncbi.nlm.nih.gov/32301749/ 10 Q: My doctor wants to make an appointment using telemedicine, what is that about? A: Currently, there is a global collective effort to ‘flatten the curve’ of the spread of COVID-19. Because people are staying at home and maintaining social distancing, there are significant concerns among cancer patients, and their loved ones, about what that means for their medical treatment. Until measures are lifted, regular doctor visits or routine medical treatment, at a hospital may not be an option, however, telemedicine might be. Telemedicine is a clinical service that allows you to consult with your doctor, at a distance, using telecommunications technology. In the past, this was only a telephone consultation but increasingly there are options involving video calls. In order to use this service a stable broadband is required. You are given a timed appointment, sent a link either by text or email and require a smart phone, tablet or computer. Exactly which software is used will depend upon your healthcare provider. The services are designed to put you in direct contact with your medical team to be able to ask questions, to discuss results and treatment options all from a distance. After the pandemic, it is more than likely that follow-up consultations will continue to be performed in this way. One of the biggest benefits of telemedicine is, it overcomes the obstacle of patients’ having to travel long distances to be seen by a healthcare provider. 11 Q: What is the best way for patients and healthcare providers to prepare for a telemedicine appointment? A: Patients and healthcare providers can prepare for telemedicine visits using the following information as a guideline. Technical preparations for healthcare providers, if it is possible, review the tele visit instructions and test out the connection before the actual appointment, that can save time and stress for all involved with the telemedicine appointment. If this is not an option due to limited time, inform the patient that a regular call will happen instead. In light of these unusual times for everyone, it is important for medical staff to ALWAYS be understanding and patient. Accept that there will be patients who struggle to connect on the day of the appointment and may already be stressed, as a result. Technical preparations for patients, before the day of the telemedicine appointment, get clear instructions from the physician’s office, and if possible, ask if there is a way to test the internet/WIFI connection. If this is not an option and/or there are internet connection problems, be prepared for a telephone call appointment. Practical preparations for healthcare providers, it can be really difficult for patients to not see a healthcare provider in person, and are missing that human connection. Patients may think telemedicine appointments are temporary and will stop once the pandemic is over. If your facility intends to continue with telemedicine appointments from this point forward, make sure to discuss this with the patient. Some patients might even hold off on bringing up specific questions or discussing certain symptoms until things “return to normal”. Remember to listen to your patients, ask questions and do not only talk. Practical preparations for patients, it is important that you approach this as a typical visit, and that means advocating for yourself. You should be asking the same questions and bringing up new, or concerning symptoms, in the exact same way as you would in a face-to-face visit. Make sure to have all questions and points of discussion, written down before the telemedicine appointment. Additionally, have pen and paper on hand during the appointment. If something needs to be evaluated in person, discuss the options with the healthcare provider. 12 Q: Should I keep my follow-up appointment, or is it better to avoid the hospital at this point in time? A: If you are doing well, and have no symptoms, please contact your doctor or ask for a telemedicine appointment to determine if routine follow-up is necessary at this time. Avoiding a hospital visit may limit your risk. If you have mild symptoms such as runny nose or cough, please take the same precautions you would for the common cold. If you have worsening symptoms or shortness of breath, call your doctor. If you are unable to reach either of these, seek immediate medical attention. 13 Q: If someone has only undergone surgery what is the risk of getting COVID-19? The risk of becoming seriously ill from COVID-19? A: Patients who have undergone renal surgery are at no increased risk of contracting COVID-19 or becoming seriously ill from COVID-19 than the general population. However, immune suppressed patients due to e.g. 14 Q: How can I protect myself in my clinic? Triage has been key, with only the most urgent or emotionally charged consultations being managed face-to-face and diagnostic/assessment pathways being modified. Increasingly, urologists are offering video and telephone consultations not just for follow-up but for most patient-clinician interactions. This helps keep physicians safe but is often welcomed by patients worried about attending clinics. For patients who want to, or must be seen, it may be reassuring to note that urologists generally do not perform aerosol generating procedures but are exposed to urine and blood in the course of their work. The risk of contamination from urine splash is minimal. Aerosol risks to urologists may be more significant from patients coughing during intimate procedures e.g. catheterisation or flexible cystoscopy. Patients visiting clinics should be asked about relevant symptoms and contact with COVID-19 cases prior to seeing the urologists and have their temperature taken. Patients with symptoms should be dissuaded from coming to a clinic unless the condition is critical and should be advised to first call their clinic. Patients will be asked to sanitise their hands on arrival and wear a face mask during the consultation. Waiting areas should be arranged to maintain social distancing with additional options for hand sanitising and the waiting room regularly sanitised. Clinic staff should wear a face mask which needs to be changed at least every 4 hours. A plastic apron and gloves should be used to examine each patient and discarded carefully at the end of the consultation. As always hands should be washed for at least 20 seconds in between patients. If patients are at high-risk of COVID-19, medical staff should wear an FFP3 mask, a face visor and surgical gown plus second pair of gloves should be worn and great care must be taking when removing protective equipment. 15 Q: Can COVID-19 be transmitted through urine? It is worth noting, it is unknown to which extent transmission through urine alone is possible. According to A Systematic Review on COVID-19: Information on urinary corona viral load is limited, but seems to be present. Vinson et all found 5.74% (95% CI 2.88-9.44%) of COVID-19 patients had positive viral RNA in urine samples, but the duration of viral shedding in urine was unknown . Kim et al found a much lower percentage . Of samples collected from 74 COVID-19 patients, virus detection rate in urine was 0.8% (2/247), as compared to 2.8% (9/3230 in serum and 10.1% (13/129) in stool. The mean viral load was also low in urine as compared to serum and stool ( 9 ± 301 versus 210 ± 1,861 versus 3,176 ± 7,208 respectively. In all the viral load in urine seems low in infected patients, but caution and normal sterile precautions during catheterisation and cystoscopy seem warranted. Source of information: Vinson Wai-Shun Chan 1 , Peter Ka-Fung Chiu 2 , Chi-Hang Yee 2 , Yuhong Yuan 3 , Chi-Fai Ng 2 , Jeremy Yuen-Chun Teoh. A Systematic Review on COVID-19: Urological Manifestations, Viral RNA Detection and Special Considerations in Urological Conditions. W J Urol 2020 May 27;1-12 Jeong-Min Kim 1 , Heui Man Kim 1 , Eun Jung Lee 1 , Hye Jun Jo 1 , Youngsil Yoon 1 , Nam-Joo Lee 1 , Junseock Son 1 , Ye-Ji Lee 1 , Mi Seon Kim 1 , Yong-Pyo Lee 1 , Su-Jin Chae 1 , Kye Ryeong Park 1 , Seung-Rye Cho 1 , Sehee Park 1 , Su Jin Kim 1 , Eunbyeol Wang 1 , SangHee Woo 1 , Aram Lim 1 , Su-Jin Park 1 , JunHyeong Jang 1 , Yoon-Seok Chung 1 , Bum Sik Chin 2 , Jin-Soo Lee 3 , Duko Lim 4 , Myung-Guk Han 1 , Cheon Kwon Yoo 5 Detection and Isolation of SARS-CoV-2 in Serum, Urine, and Stool Specimens of COVID-19 Patients From the Republic of Korea Osong Public Health Res Perspect 2020 Jun;11(3):112-117. 16 Q: Is there any chance to spread the virus if the patient's urine is spilled? How high is the chance to spread the virus with catheterisation of the bladder? It is worth noting, it is unknown to which extent transmission through urine alone is possible. According to A Systematic Review on COVID-19: Information on urinary corona viral load is limited, but seems to be present. Vinson et all found 5.74% (95% CI 2.88-9.44%) of COVID-19 patients had positive viral RNA in urine samples, but the duration of viral shedding in urine was unknown . Kim et al found a much lower percentage . Of samples collected from 74 COVID-19 patients, virus detection rate in urine was 0.8% (2/247), as compared to 2.8% (9/3230 in serum and 10.1% (13/129) in stool. The mean viral load was also low in urine as compared to serum and stool ( 9 ± 301 versus 210 ± 1,861 versus 3,176 ± 7,208 respectively. In all the viral load in urine seems low in infected patients, but caution and normal sterile precautions during catheterisation and cystoscopy seem warranted. Source of information: Vinson Wai-Shun Chan 1 , Peter Ka-Fung Chiu 2 , Chi-Hang Yee 2 , Yuhong Yuan 3 , Chi-Fai Ng 2 , Jeremy Yuen-Chun Teoh. A Systematic Review on COVID-19: Urological Manifestations, Viral RNA Detection and Special Considerations in Urological Conditions. W J Urol 2020 May 27;1-12 Jeong-Min Kim 1 , Heui Man Kim 1 , Eun Jung Lee 1 , Hye Jun Jo 1 , Youngsil Yoon 1 , Nam-Joo Lee 1 , Junseock Son 1 , Ye-Ji Lee 1 , Mi Seon Kim 1 , Yong-Pyo Lee 1 , Su-Jin Chae 1 , Kye Ryeong Park 1 , Seung-Rye Cho 1 , Sehee Park 1 , Su Jin Kim 1 , Eunbyeol Wang 1 , SangHee Woo 1 , Aram Lim 1 , Su-Jin Park 1 , JunHyeong Jang 1 , Yoon-Seok Chung 1 , Bum Sik Chin 2 , Jin-Soo Lee 3 , Duko Lim 4 , Myung-Guk Han 1 , Cheon Kwon Yoo 5 Detection and Isolation of SARS-CoV-2 in Serum, Urine, and Stool Specimens of COVID-19 Patients From the Republic of Korea Osong Public Health Res Perspect 2020 Jun;11(3):112-117. 17 Q: Do you have any idea about using stem cells to fight COVID-19? Is there any research using this method? As this is a newer area of research and study at this time there is no specific source for answers. Contact your national health services and the WHO for details and information. 18 Q: I hear the term "flattening the curve" with corona cases. What does this mean? Flattening the curve refers to the goal of slowing the spread of an infectious disease in an effort to make the disease more manageable for the public health system. Preventive steps, such as social distancing, are used to help slow the spread of an infectious disease to prevent a rush of sick people that can overwhelm hospitals which help to keep the curve flatter. A taller curve shows a possible outbreak with no intervention. A shorter (or flatter) curve shows a possible outbreak with interventions. Flattening the curve can help reduce the number of sick people at any given time, giving hospitals and other parts of the health system a chance to respond without becoming overwhelmed.