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Table of Contents
LETTER TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 590-591

Low burden of COVID-19 disease in children with cancer and hematologic illnesses


Nemours Cardiac Center, A I duPont Hospital for Children, Wilmington, DE; Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

Date of Submission27-Jul-2021
Date of Decision01-Aug-2021
Date of Acceptance29-Aug-2021
Date of Web Publication08-Oct-2021

Correspondence Address:
Deepika Thacker
Nemours Cardiac Center, A I duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_174_21

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How to cite this article:
Thacker D. Low burden of COVID-19 disease in children with cancer and hematologic illnesses. Cancer Res Stat Treat 2021;4:590-1

How to cite this URL:
Thacker D. Low burden of COVID-19 disease in children with cancer and hematologic illnesses. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Dec 9];4:590-1. Available from: https://www.crstonline.com/text.asp?2021/4/3/590/327769



I read the article titled, “Clinical profile and outcomes of COVID-19 infection during the first wave in children with hematological illnesses and cancer: An observational study from a tertiary care center in North India” by Bhayana et al. with great interest.[1] The findings of the authors are consistent with what we have seen among pediatric patients across the world. Even as children constitute a rising percentage of new positive cases, most have mild disease. Nevertheless, one has to focus on minimizing the risk of the virus spreading within the hospital to other immunocompromised patients, while ensuring the best possible management of cases found positive for COVID-19. Studies have shown a delay in seeking care for malignancies during this pandemic, resulting in poor patient outcomes.[2],[3],[4] Thus, while the authors highlight the low impact of COVID-19 disease itself on their patients, I am curious about the impact of delayed and modified treatments on long-term outcomes of the primary disease.

Second, I believe that further clarification is needed about some of the testing methods. The authors state, “Patients suspected to have COVID-19 infection without serological evidence were excluded from the study.” Serology typically refers to antibody tests, and I believe that antibody testing was only used for the one patient with multisystem inflammatory syndrome in children. In addition, the authors outline the protocol for repeat testing for inpatients and outpatients till the time of the negative test, with the median time from the onset of COVID-19 to a negative result of 21.3 days. Studies have shown that approximately 14% of patients test positive due to the persistence of viral RNA without the presence of infectious viral agents in the respiratory samples.[5] The need for a negative test may have resulted in further unnecessary delays in treatment.

Another point of discussion is the role of vaccines in children. As vaccines become more widely available for the younger ages, conditions such as post-vaccine myocarditis with the mRNA vaccines have raised fresh concern for parents, leading to some vaccine hesitancy.[6],[7] The low burden of disease in the younger population, even in immunocompromised children, as highlighted by this study, raises the question of the need to vaccinate these children on a mass basis. Countries such as Germany and the United Kingdom have chosen to only vaccinate high risk children under 17 years of age. Instead, their focus is on vaccinating the older population and prevention of spread through social distancing and masking.

And lastly, my kudos to the authors on a well-thought out study with a clear message, providing much-needed reassurance to families and physicians caring for children with cancer and hematologic illnesses!

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bhayana S, Kalra M, Sachdeva P, Sachdeva A. Clinical profile and outcomes of COVID-19 infection during the first wave in children with hematological illnesses and cancer: An observational study from a tertiary care center in North India. Cancer Res Stat Treat 2021;4:262-9.  Back to cited text no. 1
  [Full text]  
2.
Chiaravalli S, Ferrari A, Sironi G, Gattuso G, Bergamaschi L, Puma N, et al. A collateral effect of the COVID-19 pandemic: Delayed diagnosis in pediatric solid tumors. Pediatr Blood Cancer 2020;67:e28640.  Back to cited text no. 2
    
3.
Bansal S, Dolendo M, Hoa Nguyen TK, Sharma K. Survival of children with cancers amidst COVID-19: A fight with two enemies. Cancer Res Stat Treat 2020;3:281-3.  Back to cited text no. 3
  [Full text]  
4.
Saroha M, Moulik NR. COPING with CORONA: A developing country perspective on managing children with cancer during COVID-19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:97-101.  Back to cited text no. 4
    
5.
Lu J, Peng J, Xiong Q, Liu Z, Lin H, Tan X, et al. Clinical, immunological and virological characterization of COVID-19 patients that test re-positive for SARS-CoV-2 by RT-PCR. EBioMedicine 2020;59:102960.  Back to cited text no. 5
    
6.
Marshall M, Ferguson ID, Lewis P, Jaggi P, Gagliardo C, Collins JS, et al. Symptomatic acute myocarditis in seven adolescents following Pfizer-BioNTech COVID-19 vaccination. Pediatrics 2021;148:e2021052478.  Back to cited text no. 6
    
7.
Rosner CM, Genovese L, Tehrani BN, Atkins M, Bakhshi H, Chaudhri S, et al. Myocarditis temporally associated with COVID-19 vaccination. Circulation 2021;144:502-5.  Back to cited text no. 7
    




 

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