Mobile Health Study and Chemoprophylaxis for Preventing Severe Illness from COVID-19 in Cancer

2019年底爆发的严重急性呼吸系统综合征冠状病毒2型（SARS-CoV-2）导致全球约140万例新型冠状病毒病（COVID-19）确诊病例，85，522例确诊死亡。美国最近成为全球报告病例最多的国家，截至2020年4月9日，共有395，030例新病例和12，740例可归因死亡。总体而言，约10%的病例发生严重疾病。然而，免疫功能低下的癌症患者发生严重疾病和死亡的风险更大，需要稀缺的通气资源和重症监护室空间来解决这一人群的快速临床恶化。我们建议使用已建立的InsightTM移动健康平台（由斯蒂芬森癌症中心（SCC）移动健康共享资源支持）来监测与这一高危人群的早期感染迹象一致的症状，并自动（安全地）将此信息传输给医疗保健提供者。此外，我们的目标是确定抗菌预防是否可以减轻癌症患者SARS-CoV-2感染引起的疾病的严重程度。具体目标：1。快速部署基于智能手机的评估和干预工具，使积极治疗的癌症患者（N=500）能够实时监测和自我报告症状和疾病暴露。InsightTM应用程序将下载到接受癌症化疗的患者的智能手机上。我们将每天通过智能手机应用程序评估标准的COVID-19筛查问题和单个化疗风险问题。特定的回答将自动触发诊所护士的警报，并提供基于应用程序的访问权限，以联系诊所进行家庭护理或紧急评估的分流。2.在SARS-CoV-2检测之前或同时，对出现两种症状或一种症状并暴露于COVID-19的患者启动抗菌预防。当不需要紧急医疗干预时，患者将被随机分配到标准支持性治疗或使用羟氯喹和阿奇霉素进行抗菌预防，并将使用该应用程序报告症状的每日变化。3.协作记录和分享关于COVID-19大流行对通过远程医疗提供癌症护理的影响的经验教训。我们致力于与其他癌症中心开展合作，通过COVID-19 CCSG补充机制研究远程医疗的使用。这项研究将确定应用程序是否可以用于快速报告SARS-CoV 2症状，以及抗菌药物预防是否可以降低免疫功能低下的癌症患者中SARS-CoV 2的严重发病率和死亡率。通过以下方式可能减少严重COVID-19介导的疾病：1）减少从症状检测到治疗开始的时间，2）使用上述重新使用的药物进行抗菌预防。移动健康平台将用于实时监测症状，并促进高风险患者的医疗分流。抗生素预防将进一步降低COVID-19介导的发病率和死亡率。

The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) outbreak in late 2019 has resulted in approximately 1.4 million confirmed cases of novel coronavirus disease (COVID-19), with 85,522 confirmed deaths worldwide. The United States has recently taken the lead with the most reported cases across the world, with a total of 395,030 new cases and 12,740 attributable deaths as of today, April 9, 2020. Severe disease occurs in ~10% of cases overall. However, risk for severe disease and mortality is greater in immunocompromised cancer patients, requiring scarce ventilation resources and intensive care unit space to address rapid clinical deterioration in this population. We propose to use the established InsightTM mHealth Platform (supported by the Stephenson Cancer Center (SCC) mHealth Shared Resource) to monitor symptoms that are consistent with early signs of infection in this high-risk population and automatically (and securely) transfer this information to health care providers. Further, we aim to determine if antimicrobial prophylaxis can mitigate the severity of disease resulting from SARS-CoV-2 infection in cancer patients. Specific Aims: 1. Rapidly deploy a smartphone-based assessment and intervention tool that will enable actively treating cancer patients (N=500) to monitor and self-report symptoms and disease exposures in real-time. The InsightTM app will be downloaded onto the smartphones of patients undergoing cancer chemotherapy. Standard COVID-19 screening questions and a single chemotherapy risk question will be assessed daily through the smartphone app. Specific responses will automatically trigger an alert to clinic nurses AND provide app-based access to contact the clinic for triage to home care or emergency assessment. 2. Initiate antimicrobial prophylaxis in patients that indicate two symptoms or one symptom with exposure to COVID-19 in advance of or concomitant with SARS-CoV-2 testing. When emergent medical intervention is not required, patients will be randomized to standard supportive care or antimicrobial prophylaxis with hydroxychloroquine and azithromycin and will use the app to report daily changes in symptoms. 3. Collaboratively document and share lessons learned regarding the impact of the COVID-19 pandemic on cancer care delivery via telemedicine. We commit to a collegial collaboration with other cancer centers funded to study the use of telemedicine through the COVID-19 CCSG supplement mechanism. This study will determine if an app can be used to rapidly report SARS-CoV2 symptoms, and if antimicrobial prophylaxis reduces severe morbidity and mortality of SAR-CoV2 in immunocompromised cancer patients. The potential reduction of severe COVID-19 mediated disease through: 1) reducing time from symptom detection to treatment initiation, and 2) use of antimicrobial prophylaxis with the repurposed agents listed above. The mHealth platform will be used to monitor symptoms in real-time and facilitate medical triage of high-risk patients. Antimicrobial prophylaxis will further decrease the incidence of COVID-19 mediated morbidity and mortality.