Starting from Wuhan, China, SARS-CoV-2 has been a catastrophic epidemic involving many countries worldwide. After China, Italy has been heavily affected, and severe measures to limit the spread of the virus have been taken in the last weeks. Radiation oncology departments must guarantee optimal cancer treatments even in such a challenging scenario of an ongoing aggressive epidemic. Adopted preventive measures and recommendations are highlighted for patients, professionals, and clinical operations to minimize the risk of infection while safely treating patients with cancer.

Timeline of Spread of the Virus and Health Ministry Recommendations

1 Liang W.

Guan W.

Chen R.

et al. Cancer patients in SARS-CoV-2 infection: A nationwide analysis in China. From the first days of 2020, SARS-CoV-2 has been the main topic discussed all over the world. Starting from Wuhan, China, its diffusion has been facilitated from the continuous migration of people , both for travel and work purposes. The related disease, COVID-19, was designated a Public Health Emergency of International Concern by the World Health Organization on January 30, 2020, and was considered a pandemic on March 11, 2020. Epidemiologic data published so far in China suggest that onco-hematologic patients are at increased risk of contracting the virus and face severe consequences from SARS-CoV-2 infection, with greater need for intensive care and higher mortality rates, thus calling into question the risk–benefit analysis of potentially immunosuppressive cancer treatments, especially in elderly patients or in the case of adjuvant therapies.

The main measure to limit the SARS-CoV-2 diffusion is quarantine: People are forced to stay at home to prevent its spread. China, as the first nation affected, adopted these measures at the end of January.

On January 31, 2020, Italy met SARS-CoV-2. A Chinese couple from Wuhan was hospitalized for malaise and high fever in Rome during their trip. The positive tests alarmed the whole country, and a series of precautionary measures were taken: identification of people who were in contact with the couple, cancelation of direct flights to and from China, airlift of Italians in Wuhan back to Italy with a mandatory 14-day quarantine, temperature screening for passengers arriving at any Italian airport, and 14-day self-isolation for people with symptoms or who are at risk.

On February 20, 2020, Patient 1 was identified in Codogno, near Milan, Lombardy: he was the first Italian affected by SARS-CoV-2. Lombardy remains the principal cluster of the outbreak. He was involuntarily responsible for the first diffusion of SARS-CoV-2 in Italy, in light of his active social life and his hospitalization for “malaise” erroneously attributed simple influenza. The patient was treated by health professionals with no adequate protective devices. This was the beginning of the spread of infection, resulting in a second cluster in Veneto, and the first “red zone” was created.

The “red zone” included 11 towns in these 2 regions. People living here had to stay at home and were not allowed to leave, and no one was allowed to enter the area. Public transportation was blocked, and only shops selling necessities were open. Nearby, a moderate-risk “yellow area” was established with the mandatory closure of schools and universities and some public areas and the strong recommendation to follow some general rules: maintain 1 m safety distance between customers in shops and restaurants; cancel events and ceremonies; and close all shopping centers during the weekends.

Starting from the initial shutdown of universities and enforcement of social/work life restrictions, a massive migration of people from the north to the south of Italy potentially contributed to the spread of SARS-CoV-2 in the southern regions. On March 8, 2020, all northern Italy became a “red zone” with the same restrictions applied previously. The next day, the lockdown was extended to all regions of Italy, affecting around 60 million people.

1 Liang W.

Guan W.

Chen R.

et al. Cancer patients in SARS-CoV-2 infection: A nationwide analysis in China. , 2 El Ramahi R.

Freifeld A. Epidemiology, diagnosis, treatment, and prevention of influenza infection in oncology patients. , 3 Ministero della Salute

Raccomandazioni per la gestione dei pazienti oncologici e onco-ematologici in corso di emergenza da COVID-19. Special recommendations for oncologic patients were published on March 10: avoidance of crowded places, wearing of a surgical mask in public spaces, need for careful hand hygiene, and restriction of visits from relatives and friends were all requested.The government indication for hospitals concerning patients with cancer was to postpone follow-up visits whenever possible and to establish pathways and spaces dedicated to oncologic patients.