Challenges posed by COVID-19 to children with cancer
Rishi S Kotecha
Published:March 25, 2020DOI:https://doi.org/10.1016/S1470-2045(20)30205-9
The coronavirus disease 2019 (COVID-19) pandemic has rapidly escalated into a global crisis. Although children are less likely to develop severe illness than adults, a study1 has now highlighted that infants and younger children (ie, ≤5 years) are more likely to develop severe clinical manifestations than older children (ie, ≥6 years), with immaturity of the immune system cited as a potential explanation. In turn, it is known that viral infections, including with other human coronaviruses, are associated with increased morbidity and mortality in immunocompromised children.2 Although data on the clinical features and outcome of immunocompromised children with cancer infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are scarce, Liang and colleagues3 suggested an increased risk of COVID-19 in adults with cancer. Despite the limitations of this analysis, as highlighted by Wang and colleagues4 and Xia and colleagues,5 experience from previous pandemics, such as influenza A H1N1, suggests that the vulnerability of immunosuppressed patients to infection is likely to manifest as an increased number of cases are described with time. Most childhood cancers behave aggressively and need immediate treatment, often requiring prolonged periods of intensive multiagent chemotherapy. As such, postponement of therapy, which Liang and colleagues3 proposed could be considered on a case-by-case basis for adults with cancer, is not an option for children.
