Pediatric Cancer Patients May Be No More Vulnerable to COVID-19 Than Healthy Kids

By Linda Carroll

May 14, 2020

(Reuters Health) — Children with cancer don't need to delay treatment over concern about becoming vulnerable to COVID-19, suggests a new study.

After testing 120 asymptomatic pediatric cancer patients for infection with COVID-19, researchers from Memorial Sloan Kettering Cancer Center (MSKCC) found just 2.5% were positive for the virus, as compared to 14.7% of the children's asymptomatic caregivers, researchers report in JAMA Oncology.

Among the 58 children who had been exposed to the virus or had shown symptoms suggestive of infection, 17, or 29.3%, tested positive with only one requiring noncritical care hospitalization for COVID-19 symptoms.

"Going into the current surge of COVID-19, we had a lot of concern about how children with cancer would be affected," said study coauthor Dr. Andrew Kung, chair of the department of pediatrics at MSKCC. "It was reassuring that they didn't appear to be any more vulnerable than other children. With this information we can now feel confident to forge ahead with cancer therapy and not delay out of fears of affecting susceptibility to COVID-19."

Initially, Dr. Kung and his colleagues tested only the children who were displaying Covid-19 symptoms and the ones who had come into contact with someone known to be infected with SARS-CoV-2. As time passed, the researchers started testing all pediatric cancer patients, as well as their caregivers.

Between March 10 and April 12, 2020, a total of 178 children and 74 adult caregivers were swabbed for the virus, with 3 of the 120 asymptomatic patients testing positive and 17 of the 58 patients who either had symptoms or a history of close contact with someone who was infected testing positive. Among the six caregivers who had experienced symptoms or come in close contact with an infected person, three tested positive, while 10 of the 68 who were asymptomatic tested positive.

"Even in that setting we found that just half of the time when a caregiver was positive did the kid also test positive," Dr. Kung said. "This suggests that there is something about kids that makes them less susceptible not just to the development of symptoms but to the infection itself."

Only one child from the symptomatic group ended up being hospitalized and needing some supplemental oxygen. But even that child did not become sick enough to be transferred to an ICU, Dr. Kung said.

An interesting stat, Kung said, is that even among the children males seem to be more vulnerable to the virus with 17 of 107 boys testing positive versus three of 71 girls.

The new findings echo what Dr. Jenna Rossoff has been seeing.

"It seems fairly consistent with our limited data at Lurie Children's Hospital," said Dr. Rossoff, an instructor of pediatrics at Northwestern University Feinberg School of Medicine and a pediatrician at the Ann & Robert H. Lurie Children's Hospital of Chicago. "We have had some on active therapy test positive and in general they are doing well."

With data showing that adults with cancer are more likely to die if infected with SARS-CoV-2, cancer specialists treating children have been worried given the children's immune compromised status, Dr. Rossoff said.

"This study is helpful in that it shows that children with cancer are not necessarily at higher risk of COVID morbidity and mortality," Dr. Rossoff said. "Pediatric cancer is often aggressive and often requires intensive treatment so the risks and benefits need to be considered. This data means we may not need to withhold treatment from pediatric patients because they may not do as poorly (with COVID) as adults."

SOURCE: JAMA Oncology, online May 13, 2020.