Although recent studies have found that adults with cancer and COVID-19 have a higher rate of death, this does not appear to hold for pediatric cancer patients, who are neither more like to acquire the new coronavirus (officially known as SARS-CoV-2) nor to develop severe illness if they catch it.
“We are encouraged by these latest findings that kids with cancer are not more endangered by COVID-19 and their symptoms are mild like in healthy children,” senior study author Andrew Kung, MD, PhD, chair of MSK Kids at Memorial Sloan Kettering Cancer Center in New York City said in a press release. “These findings allow us to continue lifesaving cancer-directed therapy with standard precautions and safeguards but without heightened concern about adverse effects from COVID-19 infection.”
Kung and his colleagues screened children and adolescents receiving inpatient or outpatient care for COVID-19 symptoms or exposure to people known to have the coronavirus. MSK Kids is one of the largest pediatric cancer programs in the United States.
The researchers performed PCR tests for the coronavirus on three groups: 1) children and teenagers who had symptoms or were exposed to the virus; 2) asymptomatic pediatric patients who were scheduled to be admitted to the hospital, undergo sedation for a medical procedure or receive immune-suppressing chemotherapy; and 3) caregivers who accompanied these children.
Between March 10 and April 12, 2020, they tested 178 children and teens (107 boys and 71 girls) out of the 505 pediatric patients seen at the center. The average age of those tested was 11 years.
Overall, 20 pediatric patients (11.2%) had positive PCR test results. This subgroup had an average age of about 16 years and all but three were boys—a “significant sex skewing,” according to the study authors.
Looking just at the 58 children and teens who showed symptoms or had been exposed, 17 (29.3%) tested positive. By comparison, among the 120 remaining children without symptoms or known exposure, only three (2.5%) tested positive.
Most of the pediatric patients who tested positive had mild illness (95%). Only one required hospitalization for COVID-19 symptoms but was not in critical condition. Three other patients without notable COVID-19 symptoms were admitted for fever and neutropenia (low white blood cell count), cancer-related problems or for planned chemotherapy. All the rest had mild symptoms and were managed at home.
Among the 74 adult caregivers tested, 13 (17.6%) tested positive for the coronavirus. Three of the six caregivers (50.0%) with symptoms or known exposure tested positive, compared with 10 of the 68 asymptomatic and unexposed caregivers (14.7%). In five cases, a pediatric patient and caregiver tested positive at the same time, but five other children tested negative despite close exposure to a positive caregiver.
Based on these findings, the researchers concluded that “the overall morbidity of COVID-19 in pediatric patients with cancer is low with only 5% requiring hospitalization for symptoms,” and that the rate of SARS-CoV-2 infection among asymptomatic children with cancer is very low.
Given the observed sex disparity in positive tests, they noted, “there is a male bias in SARS-CoV-2 infections in children, suggesting a biological basis in skewed infectivity.” Among adults, several studies have shown that men are both somewhat more likely to acquire the virus and considerably more likely to develop severe illness or die, although the reasons are not yet known.
“This report suggests that pediatric patients with cancer may not be more vulnerable than other children to infection or morbidity resulting from SARS-CoV-2,” the researchers wrote. However, they cautioned, unrecognized coronavirus infection among asymptomatic caregivers “is a major infection control consideration.”
Click here to read the JAMA Oncology report.
Learn about “What People With Cancer Need to Know About the New Coronavirus.”