Guidance for Cancer Patients—and the Rest of Us
This webpage is for all of us who are at risk of COVID-19.
COVID-19 has affected our lives in unprecedented ways. We are learning about COVID-19 faster than we’ve learned about any other contagious disease.
We’re all being challenged to find meaning and peace in the face of social, economic and health upheaval and uncertainty. More than one cancer survivor has told us that the whole world is now finding out what it’s like to live with cancer (see Leda Dederich’s story, for one). Perhaps you are finding new perspectives on your life, health and relationships (see Exploring What Matters Now for more information).
We also are finding ways to connect with family and friends without increasing exposures. We see many, many examples of people who are reaching across miles and isolation barriers to chat, to laugh, to make music together, to celebrate and to carry life forward despite the challenges. We’ve found that gathering online has even improved opportunities and access to some events! We invite you to send us your favorite videos and events that bring people together for fun, make you smile, or help us all appreciate the blessings of each new day even during a pandemic. Submit your items in the Commentary box at the end of this page.
Prevention and Reducing Risk
BCCT seeks to support you, your families, and communities by sorting out the fact from the myth, presenting the most credible and current scientific evidence on what you can do to prevent transmission and to bolster resilience to infection. We offer guidance on lifestyle practices to support your immune system so that your body is better able to fight the virus. We also list natural products that may help, as well as those that may hurt. We have compiled guidance from credible practitioners on appropriate use of natural products.
The US Centers for Disease Control and Prevention (CDC) does good work promoting hygiene measures. What is remarkable is the absence of widespread awareness of the possible benefits of health promotion and the potential value of integrative medicine. BCCT hopes to help bridge this gap.
Prevention Recommendations from the CDC
These recommendations are your “outer shield” to reduce your risk of coming into contact and being infected with the virus.
Wash your hands often, and avoid touching your eyes, nose, and mouth with unwashed hands.
- Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
- It’s especially important to wash:
- Before eating or preparing food
- Before touching your face
- After using the restroom
- After leaving a public place
- After blowing your nose, coughing, or sneezing
- After handling your mask
- After changing a diaper
- After caring for someone sick
- After touching animals or pets
- If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Avoid close contact (within six feet) with those outside your household and avoid groups.
- Cover your mouth and nose with a cloth face cover when around others.
- Cover coughs and sneezes.
- Clean and disinfect frequently touched surfaces daily.
Avoid close contact (within six feet) with those outside your household and avoid groups.
- Inside your home: Avoid close contact with people who are sick.
- If possible, maintain 6 feet between the person who is sick and other household members.
- Outside your home: Put 6 feet of distance between yourself and people who don’t live in your household.
- Remember that some people without symptoms may be able to spread virus.
- Stay at least 6 feet (about 2 arms’ length) from other people.
- Keeping distance from others is especially important for people who are at higher risk of getting very sick.
Cover your mouth and nose with a cloth face cover when around others.
- You could spread COVID-19 to others even if you do not feel sick.
- The mask is meant to protect other people in case you are infected.
- Everyone should wear a mask in public settings and when around people who don’t live in your household, especially when other social distancing measures are difficult to maintain.
- Masks should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
- Do NOT use a mask meant for a healthcare worker. Currently, surgical masks and N95 respirators are critical supplies that should be reserved for healthcare workers and other first responders.
- Continue to keep about 6 feet between yourself and others. The mask is not a substitute for social distancing
Cover coughs and sneezes.
- Always cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow and do not spit.
- Throw used tissues in the trash.
- Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol.
Clean and disinfect frequently touched surfaces daily.
- Clean AND disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.
- If surfaces are dirty, clean them. Use detergent or soap and water prior to disinfection.
- Then, use a household disinfectant. Most common EPA-registered household disinfectants will work.
Monitor your health daily.
- Be alert for symptoms. Watch for fever, cough, shortness of breath, or other symptoms of COVID-19.
- Take your temperature if symptoms develop.
- Don’t take your temperature within 30 minutes of exercising or after taking medications that could lower your temperature, like acetaminophen.
- Follow CDC guidance if symptoms develop.
- CDC Article: Summary of Guidance for Public Health Strategies to Address High Levels of Community Transmission of SARS-CoV-2 and Related Deaths, December 2020
- Information related to vaccines in More Information below.
Integrative Approaches to Reducing Risk of COVID-19
Time-tested approaches can build your resilience and boost your “inner shield”, improving your ability to fend off infection and reduce the severity of disease if you do become infected.
We list what is known about supplements and natural products. Some herbal and nutritional supplements and other integrative practices may also be of benefit. Equally important, some herbal and nutritional supplements may increase your risk. But first we tell you about 7 Healing Practices to get healthier—and some of which you may have overlooked.
What is remarkable is the absence of widespread awareness of the possible benefits of health promotion and the potential value of integrative medicine.
But even before you show symptoms, you can bolster your immune response, alleviate stress and inflammation, and promote wellness.
Some of the better integrative health websites and resources that we respect:
- ConsumerLab.com report on the known effects of several supplements and natural products on viruses: Natural Remedies and Supplements for Coronavirus (COVID-19)
- The Institute for Functional Medicine’s recommendations:
- Boosting Immunity: Functional Medicine Tips on Prevention & Optimizing Immune Function During the COVID-19 (Coronavirus) Outbreak
- COVID-19: Functional Medicine Resources
- Wayne Jonas, MD: Resources to Support a Healthy Immune System Right Now
- Cynthia Li, MD: How to Shield Yourself against COVID-19: Science-Based, Integrative Medicine Strategies for a Once-in-a-Century Pandemic (free e-book)
- The Natura Institute at Commonweal: Resilience and Covid-19 Integrative Medicine Recommendations, authored by Anna O’Malley, MD
- The Andrew Weil Center for Integrative Medicine:
- Integrative Approaches to COVID-19
- Integrative Considerations during the COVID-19 Pandemic, authored by Lise Alschuler, Andrew Weil, Randy Horwitz, Paul Stamets, Ann Marie Chiasson, Robert Crocker and Victoria Maizes
Specific to children:
- Healthy Kids, Happy Kids: A Pediatrician’s Pandemic Immune Support Plan
Note that recommendations from these sites differ, yet there is considerable overlap.
Health professionals may also want to review further information at the end of this page in the “For Healthcare Professionals” section.
The 7 Healing Practices Build the Foundation
The healthier you are at any age, the more likely you are to mitigate the severity of an infection and improve chances of recovery. Our 7 Healing Practices promote health and wellness. Each of these seven practices has strong research support for making you a healthier and more resilient person at any age.
- Eating well, especially 5-7 servings of vegetables and 2-3 servings of fruits a day, particularly naturally colorful fruits and vegetables high in flavonoids, such as tomatoes, apples, onions, oranges, nuts, parsley, celery and berries. Also consider eating foods high in zinc, especially if you have a deficiency (see the box at right). Avoid foods that disrupt the immune system or promote inflammation, such as sweets, sugar, and processed foods with chemical additives. If you have food allergies or sensitivities, such as with gluten and dairy, avoiding those foods can lessen inflammation.
- Moving more is beneficial, especially outdoors in nature. Based on studies of other respiratory viral infections (pre-Covid-19) moderate intensity exercise may improve immune function and lower the risk and severity of infection. Prolonged, intense exercise can compromise the immune system.2
- Managing stress: Fear causes stress, and stress disrupts the immune system, increasing pro-inflammatory cytokines that can lead to more severe disease.3 Moving from fearful to careful can make a difference. Dr. Martin Rossman’s website offers Free Audio and Video Resources to Help with Your Stress and Self-Care, which can help you let go of stress. Many other techniques and approaches are described on our Mind-Body Approaches summaries.
- Sleeping well: Many integrative physicians say this is the most important thing you can do. Sleep allows the immune system to reset.
- Creating a healing environment: See Is COVID-19 making you stay at home or “shelter-in-place”? Turn your home into a healing space! from the Andrew Weil Center for Integrative Medicine.
- Sharing love and support may reduce susceptibility to respiratory infection.4 Free counseling and 100 online support groups are available through CancerCare. Also see our Healing Circles: Share Your Experience page.
- Exploring what matters now: A diagnosis of cancer creates much uncertainty in your personal world. The COVID-19 pandemic makes for uncertain times for the entire world. Many more of us are looking carefully at what really matters. What we learn from that exploration may change our lives in profound ways.
Other notes about health-promoting behaviors:
Supplements and Natural Products
When considering supplements and natural products for reducing your risk, keep in mind:
- Many people are interested in taking supplements and natural products to reduce their risk of getting COVID or getting serious symptoms. Sorting through all the information (and misinformation) out there can be overwhelming. To help you make sense of all this information, we at BCCT have drawn from trusted sources to provide a list of supplements and natural products that are promising in building your resilience and reducing disease symptoms and severity.
- Researchers (and BCCT) do not recommend that people use treatments without appropriate evidence.
- Follow dosing guidelines to avoid overloading your body or producing needless side effects. There’s no need to trade one set of risks for another or to introduce a risk of harmful side effects.
- Some suggested preventive measures and treatments are based on studies of other viral illnesses (influenza, the coronavirus that caused the 2003 SARS epidemic, or others). Although we may have reason to think the effects could also apply to COVID-19, without human studies in COVID-19, we cannot be sure. Having said that, some natural products boost your natural immunity. Others are effective at reducing common symptoms of COVID-19.
Supplements Recommended by Knowledgeable Integrative Health Practitioners
Some herbal and nutritional supplements and other integrative practices may be of benefit.
In general, supplements and products that regulate a healthy immune response are beneficial before infection. But no human trials have been completed with natural products and COVID-19. Balance the potential benefits with costs and potential harm from supplements. See our list at right of some trusted websites for recommendations from credible practitioners. Note that these recommendations vary.
Recognize that supplements that boost immune function may be beneficial before infection but afterward might contribute to an inflammatory cascade. At that point, recommendations often shift.
These supplements are recommended to reduce risk of COVID-19 infection and/or to lessen symptoms or severity of infection. No one is claiming these supplements cure COVID-19, but they may lessen the risk or the severity of disease. Dosing recommendations are available from the Andrew Weil Center for Integrative Medicine and ConsumerLab.
- Astragalus (Astragalus membranaceus)
- Elderberry (Sambucus nigra) (see below)
- Garlic (Allium sativum)
- Licorice root (Glycyrrhiza glabra)
- Medicinal mushrooms (full mycelium mushroom extracts, but not polysaccharide extracts)
- Turmeric / curcumin
- Vitamin C
- Vitamin D: six medical societies from across the globe have published Joint Guidance on Vitamin D in the Era of COVID-19
- Zinc (see below)
Zinc and Respiratory Infections
Zinc deficiency, which reduces immunity, is common in the elderly, strict vegetarians and people taking medications including ACE Inhibitors and those that reduce stomach acid (such as omeprazole or esomeprazole).
Shellfish, legumes, dark chocolate and pumpkin seeds are good sources of zinc. Other foods are listed by HealthLine.
Supplementing zinc in people who are deficient may reduce the chance of getting a respiratory infection.6
Some providers recommend pills or lozenges for about a week or so when symptoms of COVID-19 begin (even if you don’t have a zinc deficiency). Some caution against nose sprays or swabs that contain zinc, as these have been linked to loss of smell.
According to integrative oncologist and BCCT advisor Keith Block, MD, zinc supplements are not needed to reduce risk by most people and could have adverse effects if taken for too long.
Elderberry: What Do We Know?
Elderberry (Sambucus nigra) is somewhat controversial. It is widely considered helpful for reducing risk of viral infections, and some experts think it may help reduce risk of COVID-19, but there is no scientific evidence of this. With an active viral infection some practitioners recommend discontinuing it, while others do not believe it will be harmful. See the Commentary below.
Complementary Medical System Approaches
Naturopathic medicine, functional medicine, traditional Chinese medicine, Ayurveda and other systems each have approaches to wellness, to immune support, and to fighting viral infections. Following a specific approach may help you avoid overloading your body by using a shotgun approach—taking everything that anyone recommends, irrespective of possible interactions or side effects, or of its potential benefit for your situation.
Advance Care Planning
Those at greater risk for more serious COVID-19 illness may be thinking about how you’d like to be cared for should you become critically ill. Could a ventilator help me? If I’m nearing the end of my life, are there effective ways my pain and distress can be controlled at home or in a palliative/hospice care unit? These are important questions.
People who can help you sort through this and make your wishes known: Advance care planning facilitators such as oncology social workers and hospice and palliative care teams are some examples. If you’d like to discuss your wishes, start with your doctor. You may also want to make an appointment to talk to an advance care planning facilitator. For more information on Advance Care Planning:
- Respecting Choices: Proactive Care Planning for COVID-19
- National Hospice and Palliative Care Organization: Advance Care Planning
- POLST: POLST (physician orders for life-sustaining treatment) and COVID-19