During the coronavirus disease 2019 (COVID-19) pandemic, The ASCO Post will be interviewing oncologists on how they and their centers are dealing with the crisis. Here, we speak with Miriam A. Knoll, MD, a radiation oncologist at the John Theurer Cancer Center, Hackensack University Medical Center, New Jersey. Dr. Knoll is a contributor to Forbes, HuffPost, KevinMD.com, and blogs at ASCO Connection, writing about women in medicine, oncology, and social media in medicine. Dr. Knoll has been using her many social media platforms to engage physicians everywhere in sharing their experiences in treating patients with cancer amid the coronavirus pandemic. She encourages readers of The ASCO Post to do the same and to follow her on Twitter @MKnoll_MD and on Instagram @Dr.Mimi.K.
Miriam A. Knoll, MD
Frustration for Health-Care Professionals
You are practicing near the current epicenter of the COVID-19 pandemic. How are health-care providers at your hospital feeling about their situation?
Anxiety, frustration, and confusion are off the charts, and I know I speak for health-care workers across New York and New Jersey, because I participate in Twitter, Facebook, and Instagram. As health-care professionals, we are all comfortable dealing with the level of risk to ourselves and our patients from the virus, but what is really not acceptable—and where the frustration comes in—is that leadership is sorely lacking at the federal and state levels. We just don’t have adequate protection and are being asked to do things we are just not comfortable with.
True, every hospital has its leadership and individual resources, but the problem is a lack of coordination. Each hospital is left to do its own thing. It shouldn’t be that way. For instance, there are people raising money to buy personal protective equipment for health-care workers who don’t have them, and the thing is you can get supplies. You can order them, and some places may have extra, but there’s no coordination in doing so. There is so much that could be done that is not being done. The general sentiment is that health-care providers are being thrown under the bus.
Personal Experience With COVID-19 Testing
We understand you have a personal experience with testing for COVID-19. Can you tell our readers about it?
I myself needed to be tested for COVID-19 because I was not feeling well. I called my local testing site in New York and, after an hour and a half, was told I would be called back with an appointment time. Some 12 hours later, I had not heard from anything, so I called again, waited another hour and a half, and was told once again that I would receive call with a time. By the next day, my husband drove me to the testing site, where 10 people were standing around with clip boards, and no one was in line for testing. They refused to test me, saying they could not test anyone without an appointment. I showed them my hospital identification, and they said, “Sorry.” And the national guard was onsite providing security!
You almost feel like some of the efforts being done are simply so people can point and say, “We did something.” Forget whether they are doing something that actually makes sense.
Health-Care Workers at Highest Risk
You’ve made a strong case for testing health-care workers. Can you elaborate on that?
We health-care workers have the highest rate of exposure and the highest rate of contracting the disease, and we are one of the highest-risk groups for developing a serious case of the disease and actually dying—yet we are the least prepared. The public is doing what it can to stay safe by staying home. We are not staying home, so you would think the test, at minimum, would be prioritized for health-care workers. Even those with subclinical disease can pose risks to patients. If we are sick, the patients we care for will likely get sick.
Oncology Professionals Share Experiences
You’ve mentioned that in your experience, physicians in the trenches have not been involved in discussions about the management of this pandemic. How so?
It seems that many of the people making decisions have not been talking with doctors, such as my colleagues, who every day must have conversations with their patients about end-of-life care while wearing masks and gloves—not being able to hold their patients’ hands and cry with them. The fact is we have physicians from all over the world participating in group discussions about this situation—sharing experiences from the front lines. We want our government also to be listening.
Tell us about some of the ways in which oncologists are sharing experiences and suggestions with colleagues.
Social media is the only way we can share our voices. I do this on several platforms—Twitter, Instagram, and Facebook—and also participate in the Physician Mom Group (PMG), a women-only physician group with more than 75,000 members; there is now a PMG COVID-19 Subgroup, which men can also join, and it now has 30,000 members worldwide. I think physicians in all specialties should join this group, where they can get answers to questions in real time.
Another wonderful resource is OncoAlert (@OncoAlert on Facebook and Instagram and #OncoAlert on Twitter), which I recently described in my blog on ASCO Connection. The group was founded by Dr. Gilbert Morgan, an oncologist trained at MD Anderson who now lives in Sweden. On March 17, Dr. Morgan moderated a roundtable discussion of six prominent oncologists from Italy, Sweden, and the United States, which can be viewed on YouTube.
I encourage oncologists to get involved in social media in any way in which they’re comfortable, to share experiences, post questions, and obtain helpful information. Personally, I collect lots of information that I can share with the media. I talk to lots of people. It’s very important for doctors to let others know about what we are seeing on the front lines.
Focus on Radiation Oncology
What is being done in your own field of radiation oncology to address the risk for your patients?
In radiation oncology, we treat patients across a large spectrum of disease. I personally treat mostly patients with breast cancer. For patients who are not at risk for any adverse outcomes by delaying treatment, we delay. For everyone else, we have strict policies in place to protect patients and staff. In this regard, I am concerned for my colleagues who are radiation therapists and who are physically handling patients. As I said, we are all comfortable putting ourselves at risk for patients who require our care, but for those without an immediate need for radiation, we try to push treatment forward.
Are you hearing from patients who say they just don’t want to come in for their radiation treatment?
Surprisingly, no. I have not seen that. I’ve had occasional patients who have just one or two treatments left cancel them, but 99% are still coming in. It’s like when we have a snowstorm. Patients want to come in for their cancer treatment.
Has your specialty society, ASTRO, issued sufficient guidelines for you?
Yes, the American Society for Radiation Oncology (ASTRO) has published Frequently Asked Questions about all aspects of radiotherapy during this time, from consultations to follow-up. And the expansion of coverage for telehealth by the Centers for Medicare and Medicaid has had a significant impact on our work. Lots of departments, in fact, have made an immediate switch in cases where they can. Anything that can be done remotely is being done that way. Telehealth has been available for years, but it took a crisis like this to get it on its feet. I hope that will be a permanent change for the better, with the flexibility to offer it to patients for whom it is the right fit.
DISCLOSURE: Dr. Knoll has served as a consultant or advisor to Bristol-Myers Squibb.
Disclaimer: This commentary represents the views of the author and may not represent the views of ASCO or The ASCO Post.
