key: cord-283915-yqj9gzan
authors: Ahmad, Naveed; Essa, Mohammed F.; Sudairy, Reem
title: Impact of Covid19 on a tertiary care pediatric oncology and stem cell transplant unit in Riyadh, Saudi Arabia
date: 2020-07-12
journal: Pediatr Blood Cancer
DOI: 10.1002/pbc.28560
sha: 
doc_id: 283915
cord_uid: yqj9gzan

nan

To the Editor:

The coronavirus disease of 2019 (Covid19) was first reported to be responsible for a cluster of cases of viral pneumonia in December 2019 in the Chinese city of Wuhan. 1 In consultation with World Health Organization (WHO), different degrees of lockdown, social distancing measures, travel restrictions, and restructuring of health services were enforced in different parts of the world, depending upon where the regions were on the pandemic curve. 2 There is increasing evidence on the unintended consequences of pandemic-related lockdown restrictions such as delayed diagnosis and increased morbidity and mortality at the time of initial presentation. 3, 4 We retrospectively reviewed all of our outpatient activity and new patients admitted to the pediatric oncology and hematopoietic stem cell transplant (HSCT) service from December 2019 to May 2020, the last 3-month period corresponding to coronavirus lockdown. In addition to the numbers and types of malignancies, we looked at the pattern of presentation, need for nonelective pediatric intensive care unit (PICU) stay at presentation, and morbidity or mortality within the first week after presentation. In our study, we did not find any significant difference in the number of new hematological malignancies but there was 75% reduction in the number of new solid tumor cases between the two time intervals. It raises the concern that these missed solid tumor patients will present later, possibly with advanced-stage disease impacting their curability, an experience observed by Ferrari at al. 5 With respect to severity of disease, we noticed a significant increase in the incidence of PICU admissions at the time of presentation for hematological malignancies during the time of pandemicrelated lockdown. There was a significant delay in presentation in a 5-month-old infant with high-white-count acute lymphoblastic leukemia who presented with an intracranial bleed and multiorgan failure. She required prolonged ventilation and intensive care support and is fortunately alive but the impact of her initial resuscitation and potential hypoxic brain damage to brain is difficult to quantify now and could eventually impact her neurological outcome.

There was only one death during the first week after presentation, also occurring during the second half of the study. This is something worth considering as a standard practice, even after the pandemic is over, for better utilization of outpatient clinic services.

Despite the concerns that chemotherapy-related immunosuppression is a risk factor to develop severe disease with Covid19, there is growing evidence that coronavirus-related mortality is extremely rare in pediatric cancer patients. 5, 9, 10 Minotti et al, in a systematic review, postulated that cancer treatmentrelated immunesuppression may be a protective factor against the development of cytokine release syndrome, which is highly

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