ABSTRACT
Background: Lombardy region, Italy, has one of world's largest coronavirus disease 19 (COVID-19) outbreak with over 80,000 cases. Here, we report the incidence of SARS-CoV-2 infection in patients with active cancer at the Division of Oncology, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, a comprehensive cancer institution in the capital of Lombardy, Milano. Patients and Methods: From April 15th to May 15th, 2020, SARS-CoV-2 testing has been performed in patients with active cancer by paired real time-PCR in nasopharyngeal swab (NPS) (Elitech, Torino, IT) and chemiluminescent immunoassays for detection of antiviral IgG in blood (Abbot, Sligo, IR or Diasorin, Saluggia, IT). Active cancer was defined as a solid tumor requiring anticancer treatment or supportive care. Tested patients were either outpatients with at least one suggestive symptom of COVID-19 assessed by telephone triage per local guidelines, or inpatients routinely tested at hospital admission, irrespective of symptoms. Additionally, patients with COVID-19 requiring hospitalization at Niguarda Hospital during the study period have been tested and results pooled for evaluating concordance of NPS with serology. Results: 118 patients were tested by NSP, and paired serology is available at the moment for 63 (53.4%). In the outpatient setting, 517 underwent telephone triage and 58 reported at least one symptom (11.2%). Of these, 3/29 and 3/14 (10.3 and 21.4%) tested positive on NSP and serology, respectively. In the cohort of inpatients, tested regardless of symptoms, 2/82 and 4/42 (2.4 and 9.5%) tested positive on NSP and serology, respectively. Finally, among oncology physicians, 2/34 and 2/34 (5.9%) tested positive on NSP and serology, respectively. 7 additional hospitalized patients displaying COVID-19 disease have been tested. Overall, the accuracy between NSP and serology was 82.5% and concordance was 0.415 (Cohen's k). In 5 cases, serology was positive and NSP negative, whereas the opposite was found in 6. Recruitment and testing are still ongoing at the moment of abstract submission and complete results will be presented. Conclusions: In our series of patients with active cancer during a peak period of the pandemic in Lombardy, 11% of outpatients displayed COVID-19 associated symptoms and 10% had positive NSP. Among inpatients tested regardless of symptoms, 2.4% had positive NSP. The accuracy between NSP and serology was 82.5%.
ABSTRACT
In Diabetes Mellitus the loss of capacity to regulate immunity, the reduction of pulmonary functions and the pro-thrombotic state determine the severity of COVID-19.