The deadly threat of Covid-19 multiplies when one’s immune system is compromised, such as the three million HIV-infected individuals not on ARVs in South Africa. But a double whammy is in store for those cancer patients who are undergoing chemotherapy. Not only does chemo kill the white blood cells, whose job it is to keep our immune system working, but in addition to this, a threat lies in the increased potential of contracting the virus. Cancer patients on chemo have no option but to make weekly trips to the hospital, a place where the severely infected need to be. How does someone on chemo right now keep themselves safe? Chris Bateman, a well-known journalist and contributor to Biznews has first hand knowledge on this. Himself a cancer victim currently undergoing chemotherapy, Chris tells us how he anticipates a 12-month lockdown, and the extra measures he is taking to keep Covid-19 away from his door. – Vanessa Marks
Chris Bateman is a member of the Biznews team and has been for quite some time. Chris before you were working with us you’ve had a long and distinguished career in medical journalism. So I guess if anybody knows what this whole Covid-19 issue is or how serious it is, you surely got to be up there.
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That’s quite an elevated way to describe it but I’m in with some severe luminaries. I’ve observed a lot of health matters dating back to Manto Tshabalala and Thabo Mbeki with the AIDS crisis. I’ve been following Covid-19 and curating a lot of your stories which have kept me up to speed and also interviewing a lot of the players including some people in the war room and I have a personal experience, which might also be of value.
It’s definitely of value Chris because you’re going through something extraordinarily personal, and thanks for sharing it with us. Just to start off with you were diagnosed with cancer. How long ago was that?
It was November last year. I had Barrett’s oesophagus which is basically a reflex condition which was intermittent and chronic but happens so seldom that I really didn’t pay the attention it deserved.
And what happened?
I was at a braai with my sister and brother in law and enjoying a juicy steak. I started refluxing quite severely with some pain in my sternum which wasn’t unfamiliar. I’d had it before but this was quite severe and it lasted about 5 or 10 minutes, I couldn’t eat more but it sort of subsided. I was hiccupping, I was severely uncomfortable and sore around the sternum. My sister contacted a friend of hers who is a gastroenterologist. To cut a long story short, I was put under anaesthetic and had a biopsy. A week later when I was at an Emergency Medicine Conference I got the call to that informed me I had oesophageal cancer.
And what has happened subsequent to that?
It has been a bit of a rollercoaster. I managed to stay buoyant and a whole lot of aspects have come to play. The first thing that came to mind is how do I let my relatives know. At that stage I didn’t know that it was stage 1, which is curable treatable. That accounts for a lot of my buoyancy. But the first thing that occurred to me was how do I tell my closest and dearest. I’ve got elderly parents 88 and 90, both in fairly good health but subject to the vagaries of old age. Plus two pre-teenage daughters and my wife. How do you break it to people because everybody’s got a view on cancer and they have a much scarier view than it need be. Diagnoses obviously vary from person to person and mine was a very light diagnosis as these things go. So my first concern was how do I tell my loved ones.
Then we get Covid-19 while you’re going through chemo and you can tell us what chemo does to the body, does it make one more vulnerable to something like cancer treatment?
Cancer treatment has now evolved where they now use immunotherapy which is in human trials and I’m not on it, but the body’s uses its own immune system to fight it. But the predominant chemotherapy today is a shotgun approach which nails both your cancer cells and your white blood cells. So your immune count goes way down, and your immunity becomes compromised similar to the three million South Africans who are HIV positive and are not on anti-retrovirals. So you become very vulnerable hyper aware of the precautions we generally need to take.
And what are those, Chris, what are you doing to protect yourself? I guess for you if Covid-19 were to infect you, it would be far more serious than for most.
Well the oncologist said straight out that if I get a co-morbid infection I will die. Basically the infection gets hold of you and just runs runs riot. I’m very much locked down, have been for well over a month now, longer than the lockdown. It impacts because my wife goes shopping, we try to do it online but as most people know there’s quite a long waiting list before you can get your groceries delivered. So she has to go out to buy food but it’s as good as me going out because if somebody comes back infected that’s me done. The other aspect is education, my kids are at junior school. When the schools re-open I’m not going to send our kids back because if they get a chance to get coronavirus I’m done. I don’t overdramatise it. We’ve got to be incredibly careful. People are being incredibly helpful on chemotherapy days. Neighbours and friends offer to get groceries for us which involves them washing the groceries or arriving masked and they drop it inside the gate. We then also disinfect it. As a journalist, this time not an observer, I’m right in it. So when I write about, it’s with some passion for personal protection and for health care workers there’s a particular issue for me. They really need to be well protected because we don’t protect them we are going to be in trouble.
Chris how do you feel then about so much of the commentary that goes around and people saying it’s not really serious and let’s go back into the economy and so on. Is it just uninformed or is there a case for it?
It depends where on the spectrum you look. I recently curated one of the Biznews stories which gave a global historical view of mortality statistics and Covid is not a huge cause of death but when you zoom in to the South African situation and context and compare it with other countries. The fault that so many commentators make, even in third world countries, we have this unique situation as we’ve got three million people not on ARV’s, we’ve got a very high co-infection with TB and multi-drug resistant TB which is a big problem on its own, and in the Western Cape we are now leading the field and I think that’s got a lot to do with with the TB burden and anybody with pulmonary problems is particularly susceptible. And so we have a population for all the argument you have about the youthful South African population therefore we don’t have the elderly syndrome. I don’t buy that because we have a hugely immune compromised population. You have to look at the numbers and you have to look at the curve which is not flattening to realise that all we’re doing with lockdown is buying time for our health care system, which is pretty beleaguered with quadruple burden of disease already. Time to prepare for what will inevitably be a flood of cases. Now the mortality rate will be relatively low but actually hospitalisation rate may be very high. We’re in unknown territory here but I reckon we need to err on the side of caution.
And from your own perspective going through chemo and having your immune system suppressed, how long does that last? Because I guess what must be going through your mind, when is a vaccine going to come through and when is my chemo going to be finished so that I can get back to normal.
The vaccine is perhaps more speculative, they are talking about before the middle of next year or early next year given what the trials are showing. My op was initially due anytime between July and September and I’ve already had 18 sessions of chemo. I go in there for three hours once a week with a two week break but Covid-19 threw a curve ball for me and for anybody out there who’s going to have surgery that’s life saving or an emergency, there is a little bit of troubled waters because we’re looking at bringing my op forward to June. By June it could be that the private hospitals are coming to the party and putting up Covid patients. My risk will be a lot higher because they’ll have quite a few Covid patients. Now I’ve been reassured that they will completely section off the non-Covid ICU, which I will be in after the operation for two days, and then I go into a general ward for two weeks but all of that increases my exposure and my risk. The op itself is four to six hours, they remove most of the stomach and create a new oesophagus, but I’m confident as the doctor has done many of these. I asked several co-survivors during chemo the other day “what are you more scared of – being infected with Covid or your cancer killing you?” They said they were more scared of Covid.
Once you’ve finished with that side of it. So June comes and goes, you have the operation as you say it is something that the guys have done many times before. How long does it take you to build or rebuild your immune system.
I haven’t asked that question. The doctor is speaking about waiting to build up my immune system before the OP, about a three to four week wait. So that gives you some idea of the parameters. I still need to have another nine sessions of chemo after the op that so there’s no systemic spread. It’s kind of insurance that I get a bit stronger. I would imagine that would be three months and then I have to come off the chemo. That would probably take another two months, so probably mid June next year.
I’m guessing now we’re just getting a feeling because there are many people in a similar situation that you’re in, let alone the 3 million HIV positive South Africans who aren’t on antiretrovirals. The lockdown then for you. Does that mean it’s literally for another year perhaps?
I guess so. It depends how the virus plays out and how the peak plays out. This is the most amazing thing about this. We talk about philosophically and psychologically living in the moment, if anything, this has taught me how to live for the moment. My oncologist says she’s got patients and she’s never been so challenged with her 35 current patients who are immune compromised and firing questions at her all the time. So I can only guess if it’s going to peak in September then it’s going to slow down. Perhaps I could well be in lockdown until the first half of next year.
