key: cord-325619-qmszgw66 authors: Ferrari, Andrea; Zecca, Marco; Rizzari, Carmelo; Porta, Fulvio; Provenzi, Massimo; Marinoni, Maddalena; Schumacher, Richard Fabian; Luksch, Roberto; Terenziani, Monica; Casanova, Michela; Spreafico, Filippo; Chiaravalli, Stefano; Compagno, Francesca; Bruni, Federica; Piccolo, Chiara; Bettini, Laura; D'Angiò, Mariella; Ferrari, Giulia Maria; Biondi, Andrea; Massimino, Maura; Balduzzi, Adriana title: Children with cancer in the time of COVID‐19: An 8‐week report from the six pediatric onco‐hematology centers in Lombardia, Italy date: 2020-05-26 journal: Pediatr Blood Cancer DOI: 10.1002/pbc.28410 sha: doc_id: 325619 cord_uid: qmszgw66 nan Lombardia is the central region of northern Italy, covering an area of 23 863 km 2 with a population of 10 million (population density 421.6/km 2 ). The region has six pediatric onco-hematology centers. Cancer incidence in the region's population aged 0-18 years is approximately 19/100 000, with 320 new cases expected to occur each year. 1 In addition, 40-50% additional patients come from other Italian regions (often from the south) or from abroad. In the days following the outbreak, the pediatric oncology centers in the region were suddenly faced with an unexpected emergency situation exceeding the capacity of Lombardia's health system 2 and had to urgently adjust accordingly: they continued to develop oncological treatments, while implementing measures to minimize the risks of infections, to test for COVID-19 high-risk cases and to adequately manage COVID-19-positive patients, 3 as reported in Table 1 . In all, in the study period, there were 347 accesses for inpatients registered by the six centers and 4138 for outpatients (total 4485). Most patients accessed a center multiple times during the 8-week period. Overall, 286 patients were tested for COVID-19, 212 of them asymptomatic (187 tested for screening purposes and 25 due to close contact with diagnosed cases) and 74 symptomatic ( Table 2) . Twenty-one cases of COVID-19 infection were identified (48% of them males), with a median age of 6 years (range 1-17). In particular, six cases emerged from among the 187 patients screened, six among the 25 tested due to close contact with diagnosed cases, and nine among the 74 patients tested because they had flu-like symptoms. Tumor types of the 21 positive cases were as follows: 10 leukemias, five soft tissue or bone sarcomas, two lymphomas, two hepatoblastomas, one the pediatric onco-hematology units; adopting strict hygiene measures for patients, parents, and staff; paying particular attention to hand washing; imposing the use of personal protective equipment (surgical masks) by staff, patients, and caregivers; allowing only one parent to assist patients; and refusing access to educators, teachers, and even volunteers to comply with the central government's legislation. 2) Rescheduling nonurgent hospital visits and relying on telephone consultations for follow up. 3) Specific and accurate triage on the day before appointments necessitating admission. Test for COVID-19 a) Tests were based mainly on molecular testing on swabs. b) Chromatography was used for subsequent validation at one center. c) CT scans occasionally enabled suspected cases to be diagnosed, and molecular testing subsequently confirmed these cases. d) Asymptomatic patients and healthcare professionals were not routinely tested for COVID-19, in accordance with Lombardia Health Authority guidelines (this was partly due to a shortage of test kits). e) Testing was reserved for symptomatic suspected cases or their contacts. f) Screening tests were reserved for hematopoietic stem cell transplantation recipients prior to conditioning, for stem cell donors, and for candidates for surgery or invasive procedures such as endoscopy, and any procedures requiring general anesthesia. g) At specific pediatric centers, all patients accessing the facilities could be screened on admission for a limited time for research purposes. Management of COVID-19-positive cancer patients 1) Patients with no coronavirus symptoms: The feasibility of postponing their chemotherapy was considered, either for 2 weeks or until two negative tests were obtained. 2) Patients who experienced symptoms were managed according to regional and institutional protocols. disease, that is, one, with a diffuse intrinsic pontine glioma and existing neurological respiratory impairments, developed ab-ingestis pneumonia requiring inward respiratory support; another, with Hodgkin's lymphoma, who had previously been given radiotherapy, developed atypical bilateral pneumonia with mild symptoms. As further finding, we registered a total of 42 newly diagnosed cancer patients <18 years old, representing 55% of the number expected. Although preliminary, our findings suggest that anticancer treatments for pediatric patients can continue with no major adjustments. Since pediatric tumors are generally very aggressive and require intensive treatment, postponing or modifying these therapies may jeopardize their efficacy and reduce patient cure rates. In the present scenario dominated by COVID-19, it is crucial that we provide patients and families with adequate support and information on measures to prevent the infection and associated risks. An adequate awareness is essential to avoid panic and inappropriate behavior, and to ensure prompt reporting of any suspicious symptoms of the viral infection, to facilitate early diagnosis and treatment modulation. 11 Trend di incidenza dei tumori in bambini e adolescenti Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response Lessons after the early management of the COVID-19 outbreak in a paediatric transplant and haemato-oncology centre embedded within a COVID-19 dedicated hospital in Lombardia, Italy. Bone Marrow Transplant Impact of SARS on development of childhood acute lymphoblastic leukaemia Systematic review of COVID-19 in children show milder cases and a better prognosis than adults Early advice on managing children with cancer during the COVID-19 pandemic and a call for sharing experiences Pediatr Blood Cancer. 2020:e28327 Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China Prevalence and characteristics of acute respiratory virus infections in pediatric cancer patients Flash survey on SARS-CoV-2 infections in pediatric patients on anti-cancer treatment Risk of COVID-19 for patients with cancer How young patients with cancer perceive the COVID-19 (coronavirus) epidemic in Milan, Italy: is there room for other fears?