What Does COVID-19 Mean for Children with Cancer or Other Illnesses?

Children with cancer who are infected with the virus that causes COVID-19 are more at risk for severe illness than children overall, according to an August 2021 study.

This risk is particularly high for patients who have had a bone marrow transplant.

Most pediatric cancer patients do relatively well if they get COVID-19. However, for some patients, COVID-19 can be life-threatening.

Patients and family members should take extra care to prevent exposure to the virus. If symptoms of COVID-19 develop, contact your doctor right away. If your child is eligible for the COVID-19 vaccine, ask your child's physician if your child should get it. COVID-19 vaccines are available for people 12 and older.

In general, cancer can lower immunity and make it harder to fight infection in different ways:

The cancer or cancer treatment can lower the number of immune cells that attack germs.
Cancer treatments, including radiation and certain medicines, may weaken the skin or membranes lining the mouth and digestive tract. This can allow some kinds of germs to enter the body more easily.

Study Shows Childhood Cancer Patients More at Risk for Severe COVID-19 Infection

The Global Registry of COVID-19 in Childhood Cancer was launched by St. Jude Children’s Research Hospital and the International Society of Paediatric Oncology (SIOP). The registry gathers data on the pandemic’s effect on this unique patient population. Results from the registry were published August 26, 2021, in The Lancet Oncology.

Key findings included:

Severe infections occurred in about 20% of children with cancer who have the virus compared to 1-6% of children overall.
Pediatric cancer patients were more likely to be hospitalized and die than other children. The study found that 65% of patients were hospitalized and 17% required admission or transfer to a higher level of care. It also showed that 4% of patients died due to COVID-19, compared to 0.01-0.7% mortality reported among general pediatric patients.
Cancer care was also affected. Cancer therapy was modified in 56% of patients, and 45% had chemotherapy withheld while their infection was treated.
These effects were observed more significantly in low- and middle-income countries, where the odds of severe or critical disease from COVID-19 were nearly 6 times higher than in high-income countries.

COVID-19 and Bone Marrow Transplant

A study found that bone marrow transplant patients are at a particularly high risk for severe illness due to COVID-19.

Researchers studied 318 bone marrow transplant patients who developed COVID-19. COVID-19 survival was about 68% among bone marrow transplant patients. Survival was 95–99% in the general population. The risk continued even a year or more after transplant.

Bone marrow transplant patients are encouraged to take extra care to prevent infection and to seek medical care at any sign of illness.

What Is COVID-19?

COVID-19 stands for coronavirus disease 2019. It is a respiratory infection that is passed from person to person. A respiratory infection is an illness that affects the nose, throat, airways, or lungs. Most people with COVID-19 have mild symptoms, like a cold or the flu. But some people can develop more serious problems like pneumonia.

Coronaviruses are a large family of viruses that are common throughout the world. The virus that causes COVID-19 is a new type of coronavirus. The official name of the virus is SARS-CoV-2, which stands for severe acute respiratory syndrome coronavirus 2.

When person who has the virus coughs or sneezes, respiratory droplets can land in the mouths or noses of people who are nearby. Droplets from a sneeze can travel up to 6 feet. — When a person who has the virus coughs or sneezes, respiratory droplets can land in the mouths or noses of people who are nearby. Droplets from a sneeze can travel up to 6 feet.

How Does COVID-19 Spread?

COVID-19 can spread from close contact with an infected person. When an infected person coughs or sneezes, respiratory droplets can land in the mouths or noses of people who are nearby or may possibly be inhaled into the lungs.

The virus may also be spread when a person touches a surface with the virus and then touches their eyes, nose, or mouth. The virus may live on surfaces for a few days.

Who Can Get COVID-19?

Anyone can get COVID-19. The illness is spread person-to-person. In other words, anyone can develop COVID-19 after coming in close contact with someone infected with the virus. The virus may also be spread when a person touches a surface with the virus and then touches their eyes, nose, or mouth.

Primary symptoms of COVID-19 include fever, cough, runny nose, shortness of breath, and sore throat.

What Are the Symptoms of COVID-19?

COVID-19 is a respiratory illness (like a cold or the flu) caused by a virus. Symptoms of COVID-19 include fever, cough, chills, shortness of breath, body aches, runny nose, and loss of the sense of smell or taste. Symptoms usually develop 2-12 days after exposure to the virus.

Most people with COVID-19 have mild symptoms. Some people may have the virus and not show any symptoms at all.

In some cases, people with COVID-19 become very ill. COVID-19 can cause pneumonia, severe breathing problems, and even death. Warning signs of severe illness are:

Shortness of breath or problems breathing
Chest pain or pressure
Blue color of lips or face
Confusion
Decreased alertness or loss of consciousness

Are Children at Higher Risk for COVID-19?

Overall, children seem to be at lower risk for serious illness due to COVID-19 than adults. This does not mean that children don’t get COVID-19.

Although the highest risk for complications with COVID-19 is seen in children with chronic health problems such as heart disease, diabetes, lung problems, or people with weak immune systems, healthy children can also be hospitalized and have severe disease.

While the rate of COVID-19-associated hospitalization among children has been low compared with that of adults, hospitalization rates among children are increasing and have reached a new height because of the Delta variant. About 1 in 3 children hospitalized with COVID-19 in the United States were admitted to the intensive care unit, similar to the rate among adults.

Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19

In very rare cases, children may develop a serious inflammatory syndrome associated with COVID-19. This condition is known as multisystem inflammatory syndrome in children (MIS-C). MIS-C is similar to Kawasaki disease. This syndrome occurs in some children who had a previous coronavirus infection. Children may develop the syndrome even if they did not have noticeable symptoms of COVID-19.

Signs and Symptoms of Multisystem Inflammatory Syndrome in Children

Signs and symptoms of pediatric multisystem inflammatory syndrome include:

Fever lasting at least 24 hours
Abdominal pain, diarrhea, or vomiting
Irritability, sluggishness
Swollen lymph nodes
Skin rash, eye redness, red color of the lips or tongue
Swollen hands and feet

Inflammation is a part of the normal immune response. In this syndrome, it appears that there is overactivation of the immune system. It is not known exactly why this occurs. However, children’s immune systems are naturally on alert and ready to fight new infections. If the immune response continues too long, it can cause inflammation and affect the blood vessels in many organs including the heart and kidneys.

Although the syndrome is very rare, MIS-C can damage the heart, kidneys, and other organs. The condition can be life-threatening, and prompt medical care is needed. Call your pediatrician immediately if you suspect MIS-C or observe any of its features, which develop weeks after the infection.

Prolonged Symptoms

Several studies are reporting prolonged symptoms in children after mild COVID-19. This is a similar phenomenon to that observed in adults, and includes symptoms such as headache, fatigue, and heart palpitations. It is unclear at this point how common this is. Researchers are currently investigating this.

What Should I Do if My Child is Immunocompromised?

If your child has a weak immune system or chronic health condition, it is important to take steps to prevent illness. Contact your doctor if your child has been exposed to the virus or has symptoms of COVID-19.

Everyone who is eligible should get vaccinated against COVID-19.
If your child is eligible, they should receive the vaccine but continue to use face mask and practice physical distance since the immune response to the vaccine may be reduced.
Talk to your doctor about the risk of COVID-19 and your child’s individual health needs.
Know what to do if symptoms develop. Call ahead before going to the doctor except in an emergency.
Make sure you have extra medicines and medical supplies on hand in case you must stay home due to quarantine. Talk to your doctor about options to get medicines such as shipping to your home.
Ask your doctor about any upcoming medical visits and if they should be postponed. Your doctor may recommend waiting on some types of appointments. However, do not delay medical visits unless it is recommended by your doctor.
Reduce your risk of exposure by limiting travel, crowds, public places, and contact with people outside of your household.
Always wear a face mask when around others who do not live with you. Ask your doctor which type of mask is best and wear it correctly.
Keep a physical distance of at least 6 feet from others.
Wash hands often using soap and water or use a hand sanitizer.
Watch for symptoms.
Know warning signs that require emergency care.

Wear a mask or face covering as your doctor recommends. If your child is immunocompromised, ask your care team about the type of mask needed and instructions for use.

Simple Ways to Help Prevent COVID-19

Other ways to protect yourself and others from illness include:

Wash your hands often, especially after being in public places. Wash your hands after every time you cough, sneeze, or blow your nose. Use soap and water, and scrub for at least 20 seconds.
If you don’t have access to soap and water, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
Avoid touching your face, mouth, nose, and eyes.
Avoid close contact (within about 6 feet) with people as much as possible. COVID-19 is spread through droplets from a person’s sneeze or cough.
Cover coughs and sneezes and then wash your hands right away.
Wear a mask or face covering as your doctor recommends. If your child is immunocompromised, ask your care team about the type of mask needed and instructions for use.
Clean and disinfect surfaces that are touched often.
Don't spray household disinfectants on people or pets. Know what to do if a family member has symptoms and  how to care for someone with COVID-19 at home.