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Alicia Morgans: Hi, this is Alicia Morgans, Associate Professor of Medicine and GU Medical Oncologist at Northwestern University in Chicago, Illinois. I am so grateful to have here with me today, Dr. Oliver Sartor, who is a Professor of Medicine and the Medical Director at the Tulane Cancer Center in New Orleans in Louisiana. Thank you so much for joining me today, Oliver.

Oliver Sartor: Right. Thanks, Alicia. Glad to be here.

Alicia Morgans: Well, Oliver, we really wanted to restart our series on understanding the response of cancer physicians, GU cancer, oncologists and urologists in the setting of this ongoing COVID-19 pandemic, which continues to just be present and really insight hotspots at various places around the United States and around the world. And you in New Orleans have been facing some of this. Can you tell us where things stand now? How you're viewing the COVID-19 pandemic in New Orleans right now?

Oliver Sartor: Yeah. So first of all, Alicia, we have to understand where we've been in order to understand where we are now. So we got hit early in New Orleans and had a very rapid surge post-Mardi Gras, which a lot of people have implicated in the rapid spread that was initially here. And then because of the seriousness of the spread and there were a lot of deaths, particularly among the elderly, New Orleans actually locked down. I mean, all the bars were closed. All the restaurants were closed. People masked, people socially distanced. And the dramatic effect of those relatively simple measures, we're seeing about six to eight weeks later after that initial bake surge.

So we actually entered a period where there was relatively low levels of the virus and particularly in the hospital, just a couple of patients in the hospital. Unfortunately, there's been a resurgence. And I think in general, it's because people have become more relaxed, and particularly the younger population. There was a phase two reopening in New Orleans where individuals could go into restaurants at a limited capacity. But of course, a limited capacity was not always respected. The bars were able to reopen and turns out, of course, people flocked into the bars. It turned out that this social distancing was difficult, I think, for a lot of people. We're a relatively social species as a whole. And before you know it, the COVID infections are back.

Now, there's a real distinction that I see between the first wave and the second. In the first wave, the most vulnerable, in particular the elderly, and the immunocompromised were the ones that were hardest hit. Now we're seeing a lot more infections among younger populations. And the good news is that they're not being hospitalized at nearly the same rate as the elderly populations. My patients, as a whole, average age about 72, at my prostate cancer practice, are really continuing to social distance, mask, and be safe. So there's a bit of a dichotomy going on. Yes, the virus is back, but my population is continuing to stay quite safe. The hospitalizations are going up, but not nearly at the same rate as the population viral infections are going up. So it's kind of good news, bad news in this, but the virus is here and it's not going away anytime soon.

Alicia Morgans: Yeah. So I feel like what you're saying is actually really representative of what we're experiencing across many parts of the US, including places like Miami and Phoenix and other places, even California I've heard has just had a record-setting day in terms of infection rate. And it does seem to be these younger individuals.

But as cancer patients listen to your thoughts and your experience with this, I'm sure they're saying, "Well, what does that mean for me?" And certainly, my patients are asking that. And just because it doesn't seem to be my prostate cancer patients or my bladder cancer patients who are necessarily getting the virus, it certainly could be spread through individuals who may be younger, who are out and about in the bars, in the restaurants, loving life and then coming home to their families, spending time with their grandparents or with their aunts and uncles, their loved ones over the summer. And what are your thoughts on that? What does this mean for the GU oncology patient today?

Oliver Sartor: Well, first of all, I agree exactly with what you said and this sort of dichotomy between the younger and the older is really a strong dichotomy at this time. I will say that we are continuing to screen all of our patients undergoing chemotherapy, all of our hematologic malignancies, all of our patients going into radiation and those receiving other immunosuppressive therapies, including some of the PD-1 inhibitors have been shown to have increased risk for infection and severity of infection.

So our practices in the clinic are pretty much the same as they were during this initial wave if you will. I'm not sure if that's the proper term, but this initial set of infections. But when people leave, when my patients leave, I counsel every single one of them on the dangers of the virus, particularly in their age group and for those with cancer. Now, you know that prostate cancer is not subject to the same degree of immune suppression as, say, the hematologic malignancies, but nevertheless, our age group, and I'll say our age group, because the prostate cancer patients, we both treat, is quite susceptible. And I counsel every patient. They really are being careful. There are very, very few patients who are cavalier at this time.

Alicia Morgans: So I agree with that, but I would say, and I wonder what your thoughts are on the fact that we are also experiencing a lot of fatigue, many of us. Whether you're young or you're old, you want to get out. It's summertime and we've been locked up, not literally, but because of our own concerns and our statewide mandates that have asked us to really socially distance and we've done so with diligence. And now people want to get out there. How are you helping guide your patients, particularly those with prostate cancer, who, as you mentioned, are not necessarily undergoing immunosuppressive regiments, though some of them may be with chemotherapy, how are you guiding them in terms of their social interactions as they wish so much to get back out there?

Oliver Sartor: Great question. One of the things that I try to explore is to understand what patients enjoy. And that can be pretty variable. I'll tell you one of the things that's very enjoyable in Louisiana, and I think is actually a relatively safe endeavor is going fishing. We have world-class fisheries down here in our bays and marshes. We have a lot of coastline and it turns out that people can go out, maybe with a friend in a boat, and they could be outside. And I think it's a pretty safe environment.

So as I talk to people and ask about, "Well, what do you enjoy?" It turns out, first of all, that a lot of people enjoy good movies, and there's never been better stream choices. I mean, not only Netflix but all the other streaming opportunities that have come in from Amazon Prime on down. So people were watching more movies and they're staying at home. People are taking more of an interest in cooking. And one of the things that Louisiana people sort of enjoy is good food. We're either famous or notorious for the good food that we have down here. And lots of people are taking extra pains to cook, to bake. You probably seen a shortage of baking goods across the country, well New Orleaneans are doing the same. And at times they're very kind in bringing ... they enjoy the cooking, they bring things over to their neighbors or friends whilst socially distancing.

So by exploring what people enjoy doing, whether or not it might be cooking or fishing or watching movies, a lot of people are adapting to this lockdown environment in ways that I consider to be pretty healthy, actually. So, I think that's a good piece of news.

Alicia Morgans: That's actually a great idea, a great piece of advice for all the clinicians who are listening to really take the time, take a few extra minutes and explore what our patients actually like to do, because it may not be that they're asking to go to a crowded bar on a Saturday night. It may be that they just want to know if it's going to be okay for them to socially distance in a boat, across the boat from their friend while they're fishing. Or perhaps be on a patio and have a chat on an evening, everybody being six to eight feet apart, and outside. But just sharing that time together, which is what we really crave when we've been so distant.

So taking that few extra minutes might help us understand what people want to do, and then help them find ways to do those things in a way that is safe. And I really appreciate that you bring that up and give us all that suggestion. And when things get better, I'm sure many on this podcast want to head down to New Orleans and check out that food and cooking and fishing, because we all know that you are quite a center for those things.

And then as we wrap up, Dr. Sartor, I'd love to hear your thoughts on what we can do as academic institutions, Tulane and Northwestern, both academic institutions, both facing potential colleges restarting, coming back to our cities, to our campuses. Are there any thoughts that you have or recommendations for patients as these colleges get back into the swing of things, if they do, as they're moving forward?

Oliver Sartor: Well, I hate to say it, I'm advising my patients probably to avoid being around too many younger people. At times, that's not very kind advice because they may have children or grandchildren that are in that younger population. But I'm continuing to advise my patients to avoid crowds and probably increasingly to make them aware that the younger populations that are not socially distancing are potential vectors for this virus.

So that may not be the nicest advice if you have children or grandchildren. But I think it's important for people to hear. The schools that are getting back together, 18 to 21-year-old undergraduates, they really are bulletproof in their mind and they're not really cognizant of the potential to damage others by exposing either the elderly or those who may be immunocompromised to the virus. They're pretty much fine and maybe they get a little cough, have a little fever, but I typically find, I hate to say it, that the younger people are not very cognizant of their ability to transfer the virus to those who are more vulnerable.

Alicia Morgans: And I appreciate you saying that. And I am probably on the end of the spectrum too, that is, as you put it, maybe a little less kind in terms of that. I think as all of us think about these college students coming back, we applaud their dedication to academics. We applaud their resilience and their need to continue their lives. But as cancer patients who think about this and oncologists and urologists who take care of cancer patients think about this, I think we need to recognize that the risk is higher around certain age groups, particularly those college-age students, those people up even into their 30s, who could potentially, not necessarily — which is completely developmentally appropriate — but not necessarily understand or think about the way that their actions could affect their grandparents and others in the community who are elderly or who have these other comorbidities that might put them at higher risk.

And I have children of my own, they're not college-aged yet, but I know that this is just the way that young people feel, that they feel like nothing can really harm them. And in this case, it may not harm them directly, but it could harm all those people around them. So I'm advising exactly the same thing. And I appreciate your guidance on that. So as we wrap up, what would your final message be to those who are dealing with this and thinking about how to continue to try to have as normal of a life as possible in this ongoing era of COVID?

Oliver Sartor: It might simply be serving iteration of: find the things that you enjoy, that you can do safely. And it turns out, I think that many people can find enjoyment, whether it's movies or books or fishing or outdoors. There are things that people can do that are safe. And that's where you need to orient your efforts and time. Be wary of crowds, be wary of those individuals who are younger and who may in fact not be doing the social distancing as I think is appropriate. Wear your mask. And of course, when you do go out and inevitably people do go out, please be careful and watch the social distancing rules that are now familiar to everyone.

Alicia Morgans: Great. Thank you. And just some encouragement to everyone listening that we are all becoming fatigued, but if we can take Dr. Sartor's advice and think about those things that make us truly happy, there have to be at least a few of those things that are innately distanced and innately limit the number of people to which we're exposed. And we should really embrace those, enjoy those, and maximize every minute that we can. Thank you so much for your guidance and your advice, Dr. Sartor.

Oliver Sartor: Thank you, Alicia. Always enjoy the chat.