Last updated: October 1, 2021

Symptoms and People at Highest Risk

Patients with COVID-19 may have (https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html) mild to severe respiratory illness with fever, cough, difficulty breathing, headache, and myalgia, although some report asymptomatic infection. Research indicates that patients may also present with gastrointestinal upset (https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf), loss of taste or smell (https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html), joint pain (https://doi.org/10.1007/s00296-020-04561-0), conjunctivitis (https://www.aao.org/headline/alert-important-coronavirus-context), or dermatologic manifestations (e.g., maculopapular rash, discolored lesions on fingers or toes, hives) (https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html). More serious presentations can include severe pneumonia, respiratory failure, and septic shock. 

Those at highest risk (https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html) for infection have had prolonged, unprotected close contact (within six feet for 15 minutes or longer) with a person with confirmed COVID-19, spend time frequently in congregate settings (e.g., assisted living facilities, college dormitories, homeless shelters), or live in or have recently been to areas with sustained transmission (https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html). Based on limited data (https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html) from COVID-19 and other related coronaviruses, older adults, pregnant people, and those with certain underlying medical conditions (https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html), including cancer, may be at greatest risk for severe outcomes.

In addition, patients can be asymptomatic and still potentially transmit the virus. Reinfection (https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html) following recovery of COVID-19 has been reported and is currently under investigation.

Prevention and Treatment

The best prevention (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/index.html) is to avoid being exposed to the virus, practice social distancing with people outside of your home, and follow good everyday hygiene habits:

• Avoid close contact with people who are sick; when outside your home, maintain six feet of distance from other people
• Avoid crowds and poorly ventilated spaces
• Stay at home when you are sick.
• Use a cloth face mask or cover over your mouth or nose when around others outside your home. Mask use is recommended, regardless of vaccination status, in individuals with weakened immune systems and in locations with substantial or high transmission rates.
• Clean and disinfect high-touch surfaces daily.
• Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based sanitizer that contains at least 60% alcohol when soap and water are not available. Avoid touching your eyes, nose, and mouth with unwashed hands.

In addition, multiple organizations, including the Centers for Disease Control and Prevention (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/keythingstoknow.html), American Society of Clinical Oncology (https://www.asco.org/covid-resources/vaccines-patients-cancer), and National Comprehensive Cancer Network (https://www.nccn.org/docs/default-source/covid-19/2021_covid-19_vaccination_guidance_v4-0.pdf), recommend vaccination against COVID-19 as a preventive measure. Several vaccines (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines.html) are currently available. The most common side effects  following vaccination are a sore arm at the injection site and mild flu-like symptoms, including fatigue.

Supportive care of complications remains the primary clinical focus for patients with COVID-19, although many cases can be managed at home rather than under medical supervision. Inpatient and outpatient treatment options and strategies are rapidly evolving, and practitioners should refer to the National Institutes of Health's COVID-19 Treatment Guidelines (https://www.covid19treatmentguidelines.nih.gov/whats-new/) for the most up-to-date information.

COVID-19 Mutations and Variants

As the virus continues to spread, evolve, and genetically mutate, scientists identified (https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/variant-surveillance/variant-info.html) several global variants. Research is limited but suggests that the variants evade the body’s natural immune defenses. The Centers for Disease Control and Prevention and other global health organizations are monitoring the situation closely.

Oncology Nursing Implications for COVID-19

The situation and recommendations are constantly evolving and are likely to keep changing as more evidence emerges specific to oncology nursing practice, patients with cancer, and COVID-19. Cancer and COVID-19 data registries suggest that (https://voice.ons.org/news-and-views/cancer-consortium-report-reveals-high-mortality-rates-in-patients-with-covid-19-and) patients with a history of cancer who have confirmed COVID-19 infection appear to be at a higher risk for mortality and severe illness from the virus. Vaccination per the National Comprehensive Cancer Network recommendations (https://www.nccn.org/covid-19/pdf/COVID-19_Vaccination_Guidance_V1.0.pdf) is critical. 

Some key considerations (https://www.asco.org/sites/new-www.asco.org/files/content-files/blog-release/pdf/COVID-19-Clinical%20Oncology-FAQs-3-12-2020.pdf?cid=DM4727&bid=39530727) for nursing practice:

• Telehealth visits are a reasonable option for patients with cancer and their caregivers and should be used when appropriate.
• Home infusion may be a possibility for certain patients.
• Review and update any policies and procedures regarding isolation of infected patients.
• If a patient on active treatment is diagnosed with COVID-19, follow standard clinical management recommendations for infection modifications.
• Educate patients about COVID-19 symptoms and instruct them to call if they develop a new fever, cough, or shortness of breath.
• Provide patients and caregivers with information about COVID-19 vaccination as a preventive measure.