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The threat from COVID-19 is particularly intense for those fighting cancer. Medication weakens their immune systems. Treatments may be delayed. Many have lost jobs and insurance coverage. So daily life can feel like a string of life-or-death choices. NPR's Yuki Noguchi has the story.
YUKI NOGUCHI, BYLINE: I reach Alexea Gaffney early one morning in the kitchen of her split-level ranch home. She lives on a tree-lined street in Stony Brook, N.Y. - not far from family - and perilously close to the early epicenter of the virus. She looks onto a backyard with a wooden swing, gazebo and an above-ground pool, once the hub for social gatherings hosted by Gaffney and her 8-year-old daughter Kennedy.
ALEXEA GAFFNEY: And you probably hear my eggs frying in the background, which I'm just about done with (laughter).
NOGUCHI: Gaffney is fortifying herself for battles fought on many fronts. She's an infectious disease doctor treating patients with COVID. She's also a single mom, homeschooling Kennedy. And two years ago, at age 37, she was diagnosed with stage 3 breast cancer. So life is a minefield of risks, one she mitigates with face masks, protective gear and lots of hand-washing.
GAFFNEY: It doesn't stop me from getting nervous every single day about - is this the day that it gets me? And, you know, I anticipate living with this kind of fear for a very long time to come.
NOGUCHI: People living with cancer in the time of coronavirus must navigate many tough choices, ones that pit the risks of catching the virus against other dire downsides, like braving the hospital for cancer treatment versus delaying it and risking relapse or continuing to work versus not working and jeopardizing health insurance or sending the kids to school versus home-schooling and keeping them socially isolated. Even Gaffney, a physician and expert in infection, says these decisions are agonizing, and no option comes free of fear or worry.
GAFFNEY: It's so hard navigating all of this as both a physician and a patient. It's hard on both sides of it.
NOGUCHI: She says normal events become emotionally fraught. Take, for example, her nephew's graduation.
GAFFNEY: He finished high school with an associate's degree in computer science or engineering, things that I can't even begin to comprehend. He graduated with honors.
NOGUCHI: Her nephew, like Gaffney, is Black. Her voice swells with pride for him.
GAFFNEY: And he did all of that with all the stress and turmoil of everything that's happening in the world around him - COVID and racial inequality and protests and people...
NOGUCHI: And the painful specter of police brutality.
GAFFNEY: He defied the odds, you know? And it's like, we're going to celebrate that. It's too important not to celebrate.
NOGUCHI: But, first, her family weighed the many risks - that most of Gaffney's family live in high-rises in New York City, that her mother and pregnant sister work for the Metropolitan Transit Authority that runs the city's subways and buses.
GAFFNEY: There's no social distancing when you work for the MTA. You're going to work every day.
NOGUCHI: They settled on a backyard barbecue, taking every precaution.
GAFFNEY: One set of food for every table. If your table ran out of food, that was it. And separate drinks for every table. Like, it was a big to-do.
NOGUCHI: Yet when life hangs in the balance, no measure seems sufficient.
GAFFNEY: Wipe down the faucets and the doorknob when you come out of the bathroom. Like, it was such a big to-do. And when it was done, I was just freaking the hell out the whole time. Oh, my God, did we stay far enough? Did everybody wear their mask? OK, some people took their masks down. You know, was there enough hand sanitizer? It feels like insanity.
NOGUCHI: And Gaffney wasn't the only one at risk.
GAFFNEY: Four days later, my stepdad, who's chronically ill - he's on dialysis, he's had kidney cancer, he's waiting for a kidney transplant - got short of breath.
NOGUCHI: Gaffney assumed the worst and berated herself until his test for COVID-19 came back negative. Marlee Kiel says the level of anxiety among cancer patients is staggering. She's an oncology social worker for CancerCare, a support group.
MARLEE KIEL: All of the stressors that have already existed for cancer patients and now they're managing everything all at once on triple the scale.
NOGUCHI: Chief among them, she says, is money. So many patients have lost jobs and often insurance coverage with it. For many, alternative insurance is still too expensive. So some push themselves to work. Some delay treatment and try to find emergency funds or negotiate payments with hospitals and drug companies. The isolation from family and friends is not only an emotional burden, she says; it also adds to the financial ones.
KIEL: Delivering meals, driving to treatments, providing child care - those little things that we don't really think about that add up, all of that support is now cut because the social distancing. You can't be near family or friends.
NOGUCHI: Take Roxana Guerra, who has advanced ovarian cancer.
ROXANA GUERRA: As a single mom, I mean, I've had to do things that I know I probably shouldn't be out there. But, like, I'll go to the grocery store.
NOGUCHI: Guerra lives in Alexandria, Va. Her father lives nearby, but his age also puts him at high risk. Her legal assistance job got cut to part time, but she's thankful to still have health insurance. So when her boss asked, she found a way to get to the office.
GUERRA: It's a three-story building, and there's all kinds of people coming in and out. So I was like, you know, I'll come once a week, when it's not that busy in the building, or I can even come on a Saturday.
NOGUCHI: In addition, she has her 11-year-old son Enrique. She tries to fill the space left by school, soccer and friends, all while fighting the fatigue and other side effects of treatment.
GUERRA: He's my reason. He's the reason why I do these things. And I have to continue doing what I can as long as I have the energy to do it.
NOGUCHI: Children, family, making memories - the pandemic adds to the interference from cancer. Abigail Johnston had to scrap plans to take her two boys, aged 5 and 7, on an Alaskan cruise and a trip to her husband's native Jamaica. She was diagnosed with advanced metastatic breast cancer three years ago, when she was 38.
ABIGAIL JOHNSTON: If you look at the limited life expectancy that we are looking at already, layer on top of that the amount of things that have been canceled, eliminated, you're taking away the opportunity to complete a bucket list.
NOGUCHI: Life was already too short, she says, and now it must remain on hold.
Yuki Noguchi, NPR News.
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