COVID-19 and childhood cancer
Prof Gita Naidu informs us of what is known about COVID-19 and childhood cancer treatment.
SARS-Coronavirus 2 (SARS-CoV-2) is a new strain of coronavirus first identified, in Wuhan City, China, in December 2019. Coronaviruses are a family of viruses that can cause common colds, as well as more serious respiratory diseases, such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
How is the virus spread?
- The coronavirus is spread by those who are infected when they cough, sneeze, talk, raise their voices (shouting or singing), or even by breathing. Droplets which have the virus fall on people in the close vicinity and can be directly inhaled or picked up on the hands and transferred when someone touches their face. SARS-CoV-2 spreads through close sustained contact with someone who has the virus (being within 2 metres of someone for longer than 15 minutes).
- Some small droplets and particles can linger in the air for minutes to hours. They might travel farther than 1,8 metres or might remain in the air even after the infected person has left, and they might be able to cause new infections, especially in poorly ventilated, enclosed spaces. This form of spread, known as airborne transmission, is not thought to be as common as spread through close contact.
- Droplets may also land on surfaces; which people might then touch. This could lead to an infection if a person then touches their mouth, nose, or eyes. However, this isn’t thought to be a common way for the virus to spread.
COVID in children
The pandemic has caused great concern amongst parents and carers of children with cancer. Children receiving treatment for cancer have a weakened immune system due both to the disease and the therapy. Hence children with cancer may have a decreased ability to fight infections.
However, it seems as if children are less likely than adults to get coronavirus and less likely to transmit the infection to other children. This includes children with cancer. Children undergoing cancer therapy who have been infected with coronavirus have had mild disease. Data until now has revealed that the risk of severe coronavirus infection in children with cancer is low.
Adults are more likely than children to be sick with COVID-19. However, children can be infected with the SARS-CoV-2, can get sick from COVID-19, and can spread the virus to others. Children who have COVID-19 but have no symptoms can still spread the virus to others.
Most children with COVID-19 have mild symptoms or have no symptoms at all. However, some children may get severely ill from COVID-19. They might require hospitalisation, intensive care, or a ventilator to help them breathe. In rare cases, they might die.
Children under the age of one may be more likely to have severe illness from COVID-19. In addition, children with the following underlying medical conditions might also be at increased risk of severe illness compared to other children:
- Asthma or chronic lung disease
- Genetic, neurologic, or metabolic conditions
- Sickle cell disease
- Heart disease since birth
Children with cancer are immunosuppressed due to both the disease and the treatment. The following groups of children with cancer may be at highest risk for COVID-19:
- Children receiving induction chemotherapy for acute lymphoblastic leukaemia, non-Hodgkin’s lymphoma, and acute myeloid leukaemia.
- Children receiving chemotherapy for relapsed and/or refractory leukaemia or lymphoma.
- Children who have received a donor stem cell transplant (allogeneic) in the last 12 months.
- Children who have received their own stem cells back (autologous transplant) in the last six months.
- Children undergoing CAR-T therapy and for six months following CAR-T therapy.
Common symptoms in children
The most common symptoms of COVID-19 in children are fever and cough, but children may have any of these signs or symptoms of COVID-19:
- Fever or chills
- Nasal congestion or runny nose
- New loss of taste or smell
- Sore throat
- Shortness of breath or difficulty breathing
- Nausea or vomiting
- Stomach ache
- Muscle or body aches
- Poor appetite or poor feeding, especially in babies under one year old
Children should be monitored for the following symptoms of COVID-19
- Fever (temperature 38°C or higher)
- Sore throat
- New uncontrolled cough that causes difficulty breathing (for a child with chronic allergic/asthmatic cough, see if there is a change from their usual cough)
- Diarrhoea, vomiting, or stomach ache
- New onset of severe headache, especially with a fever
If you’re concerned that your child has symptoms of COVID-19 or has a known COVID-19 contact, it’s essential that you inform the treating hospital before your arrival so necessary arrangements can be made.
Currently there is no treatment available to cure coronavirus infection. However, vaccines are being given to adults to prevent COVID-19 acute respiratory disease. The best way to prevent infection is to avoid being exposed to the virus. Anti-viral medications have not yet been shown to be effective against coronavirus.
The following precautions should be practised
- Wash hands often – with soap and water for at least 20 seconds.
- Use an alcohol-based hand sanitiser that contains at least 60% alcohol.
- Advise your child to stop touching their eyes, nose, and mouth with unwashed hands as far as possible.
- Avoid contact with people who are unwell.
- Cover your child’s cough or sneeze with a tissue, then throw the tissue in a bin and wash hands again after disposal.
- Clean and disinfect frequently touched objects and surfaces in the home and work environment.
- If other household members develop symptoms, they should stay home (self-isolate) for 10-14 days to protect others. It’s likely that people living within a household will infect each other or be infected already.
- Self-isolation involves avoiding contact with anyone within 2m for 15 minutes or longer. This includes contact with other people in your household. For young children, this isn’t always possible. It’s important to remember that self-isolation doesn’t apply to children undergoing cancer treatment who will need to be assessed in hospital first if they develop symptoms.
- If any child in your house needs to self-isolate, you might choose to have one parent designated as being in close contact with your child, with both isolated from the rest of the household. This may not be possible in all homes.
COVID-19 and cancer treatment
All medication for cancer should be continued. It’s more dangerous not to take the cancer treatment. If you have any questions regarding your child’s treatment, please discuss this with your child’s doctor.
As per usual practice, visitors who are not well or who have any symptoms should not visit your child in hospital. All visitors should be reminded to wash their hands frequently with soap and water or use hand sanitiser. Each hospital has their own policy regarding visitors during the pandemic.
It’s strongly advised not to miss scheduled appointments for treatment or follow-up. Many hospitals are rearranging visits, surgery and treatment for non-urgent patients. This doesn’t apply to children with cancer. The risks of not receiving cancer treatment are greater than that of COVID-19 in children.
Doctors and scientists are studying the effects of COVID-19 on children and cancer and hopefully we will know more in the not-too-distant future.
MEET THE EXPERT – Professor Gita Naidu
Professor Gita Naidu MBChB, FC (Paediatrics), MMed (Paediatrics), PhDis the Head of Paediatric Oncology, Chris Hani Baragwanath Academic Hospital,University of the Witwatersrand and the Chair of South African Children’sCancer Study Group.
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