'Particularly vulnerable:' Many questions as Hamilton cancer patients begin COVID-19 isolation

The 14 Hamilton area cancer patients who are in isolation after the doctor treating them was diagnosed with the COVID-19 virus are in unknown territory when it comes to the disease.

The doctor leading the cancer program task force for COVID-19 at Toronto's Princess Margaret Cancer Centre says hospitals may soon be faced with "very, very difficult" decisions about which patients get in-hospital treatment and which patients don't — and Hamilton may become the world's test case for the ethical dilemma.

"This is not a decision you want to be making at the last minute, so these are conversations that will be taking place over next days and weeks," Dr. Monika Krzyanowska says.

The questions became more urgent after Wednesday's news that the 14 cancer patients had been in contact with a doctor at Hamilton's Juravinski Cancer Centre who tested positive for COVID-19. The doctor had just returned from a trip to Hawaii on the weekend and saw the patients on Monday. 

Five staff members, one senior oncology resident and three other physicians were also in contact with the physician and are all self-isolating, except for one doctor who has flown out of the country.

Medical officials at a press conference Wednesday described the patient group as a "particularly vulnerable" population since many receiving treatment will already have compromised immune systems. 

Dr. Krzyanowska tells CBC News there are still questions about how at risk cancer patients are, how self-isolation will affect their treatment and what the coronavirus will do to someone living with cancer or being treated for it.

While Krzyanowska says they have pandemic planning from the past, they're starting discussions early to avoid being ambushed by the virus that has infected more than 118,000 in 114 countries, with 4,291 deaths as of Wednesday evening.

Cancer patients may face an extra risk compared to the general public. COVID-19 is especially dangerous for people with compromised immune systems — which would apply to people getting treatments such as chemotherapy and radiation.

"They're a particularly vulnerable group of patients," Dr. Barry Lumb, site director for Juravinski Hospital and Cancer Centre, said during an update Wednesday afternoon.

"I think what it speaks to is our vigilance now, should any of these individuals develop symptoms. That we have an extremely low threshold to bring them in and investigate them."

Speaking to CBC News as he left the hospital today after an appointment for his throat cancer, Jim Douglas, a 70-year-old who is not one of the 14 patients in isolation, told CBC News that "it's scary that it's here."

"That kind of stuff scares me, because I'm in a position right now where my immune system in the next little while could be compromised because of the treatments I'm having. I've got to be very careful," he said.

Tom Koch, a medical ethicist, said a doctor would almost certainly know to pull themselves out of action if infected or feeling COVID-19 symptoms. 

"Doctors and nurses are acutely aware both of the way they might contract but also spread a bacterial or viral disease," he said, "and epidemiologists are well aware that a patient—any patient—testing positive must have his or her contacts traced back for at least a week."

 Krzyanowska feels optimistic that even if patients are in quarantine, they won't have to miss out on treatment.

"At the hospital level, we're trying to discuss what options there may be should we need to proceed with treating some of these patients at risk or screened positive if their cancer requires urgent care."

Dr. Stephen A. Hoption Cann told CBC News while these patients have fewer immune cells, staff also need to be leery, even if it means fewer frontline workers.

"The virus is highly transmissible. This is why it is important for health care workers to stay at home if they have cold symptoms so that they do not transmit their illness to their patients."

Sandra Krueckl, the vice president of cancer control at the Canadian Cancer Society wrote in a statement to CBC News it is adding precautions to many programs like increased screening and infection control measures based on guidance from public health officials.

The biggest barrier is there's currently no data on COVID-19 and cancer patients.

"We'd rather not have the data to some extent in the sense we didn't have enough patients affected in that way." Krzyanowska says.

But Stephanie DeWitte-Orr, an associate professor of health sciences and biology at Wilfrid Laurier University, tells CBC News it's a "learning moment for the world."

"It strikes me this could be something we really learn from to help protect other susceptible health populations," she says.