key: cord-1013208-ru2wc65s authors: Bansal, Minakshi; Sachdev, Mansi; Chakraborty, Sohini; Dua, Vikas title: Second wave of COVID-19 – Not a matter of great concern for pediatric hematologist/oncologist date: 2022-01-15 journal: Pediatric Hematology Oncology Journal DOI: 10.1016/j.phoj.2022.01.002 sha: d96d866afd7f6c95543c26ed98648036283618f1 doc_id: 1013208 cord_uid: ru2wc65s Coronavirus disease-19 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic and is giving rise to a serious health threat globally. SARS-CoV-2 infection ranges from asymptomatic carrier state to severe illness requiring intensive care unit (ICU) management. It is postulated that with COVID-19 infection, children are less prone to develop severe symptoms as compared with adults. The data on immunocompromised children affected with COVID-19 infection is limited and not many publications are there on the effects of 2nd wave of COVID-19 infection in pediatric hematology/oncology patients till date. In our experience during second wave, 17 patients were found to be positive for SARS-CoV-2 with a male: female ratio of 2.4: 1 and median age of 8 years (range 1–18 years). Out of these 17 patients, 10 (58.8%) patients required hospital admission whereas the remaining were managed at home. Only 1 patient required ventilatory support and there was no mortality. Though the number of pediatric patients with COVID-19 infection were more during the second wave but majority had mild to moderate symptoms and were easily managed. COVID-19, caused by SARS-CoV-2, has become a global pandemic and is giving rise to a serious health threat globally. Most of the countries have already seen a two-wave pattern of reported cases. SARS-CoV-2 infection ranges from asymptomatic carrier state to severe illness. Approximately 15% of patients progress to severe pneumonia, and 5% require ICU management. 1 As of October 2021, around 244 million confirmed cases of COVID-19 have been reported worldwide including around 4.9 million deaths. Case fatality rate reported is around 2%, but J o u r n a l P r e -p r o o f this varies widely by location. In India, from January 2020 till October 2021, more than 34 million confirmed cases have been reported and around 0.45 million patients have lost their lives with a case fatality of around 1%. 2 From the beginning, it is known that the severe COVID-19 infection mostly affects the elderly population and is rare among children and young adults because of the comorbidities like diabetes and hypertension which are associated with age and a weaker immunity of the elderly leading to a dismal outcome. 3 Another postulation as to why children are less prone to have a complicated course compared with adults includes the possibility of differences in the distribution of their angiotensinconverting enzyme 2 (ACE 2) receptors which may limit viral entry and subsequent inflammation, hypoxia, and tissue injury. 4 Relatively unaffected during the 1 st wave of COVID-19 last year, a high number of children and adolescents contracted the novel coronavirus during the 2 nd wave in India. In the 1st wave of COVID-19, those children who had infection were asymptomatic, but in the 2 nd wave, they were showing symptoms such as fever, diarrhea, cold, and cough. 5 Experts in India believe that the double mutant COVID-19 variant alongside a cocktail of other strains has a higher tendency to infect children. Other explanations for children getting infected more in the 2 nd wave can be lack of precautions taken, more exposure to vulnerable areas, and non-approval of vaccination for children. There is also a higher concern for children with underlying hematological and oncological conditions, who, because of their suppressed immunity, are thought to be at high risk for an unfavorable course of infection. Although data on the clinical features and outcome of COVID-19 infection in immunocompromised children is limited, data on adults with cancer suggest increased susceptibility and more severe clinical course. 6 We are sharing our experience of pediatric hematology/oncology patients affected with COVID-19 infection during the 2 nd wave. Retrospective data analysis of patients under the age of 18 years with underlying hematological and oncological conditions including those who underwent stem cell transplantation. All SARS-CoV-2-positive cases confirmed with the presence of viral RNA in respiratory swabs by reverse transcription-polymerase chain reaction (RT-PCR) were included in the study. Demographics included were age, sex, type of underlying disease and disease status at the time of infection, symptoms, neutrophil status, treatment required as well as clinical outcomes. A total of 17 patients were found to be positive for SARS-CoV-2 during the period from 1 st April 2021 to 15 th May 2021. All patients were tested for SARS-CoV-2 by RT-PCR because they were symptomatic except one who had a strongly positive contact history. Demographics of the patients are shown in Table 1 . Male: female ratio was 2.4: 1. The median age was 8 years (range 1 -18 years). Sixteen out of 17 patients had fever at presentation and 5 patients had cough along with it. None of the patients had gastrointestinal symptoms. Out of these 17 patients, 10 (58.8%) patients required hospital admission whereas the rest 7 were managed at home with proper isolation measures. Eight out of ten patients, though had mild symptoms, required admission as they were neutropenic and were initially managed with broad-spectrum antibiotics. The remaining two non-neutropenic patients were admitted as they had high-grade fever with high inflammatory markers. CT scan of the chest was done in 6 (35.2%) patients. The reason for performing CT was high inflammatory markers (serum ferritin and C-reactive protein). Two patients had normal chest and 264 respectively and age-wise distribution showed that the cases during the 2 nd wave were younger as compared to the 1 st wave (58 ± 26 vs. 67 ± 18 years; p <0.001). Out of the total 264 patients during the 2 nd wave, 21 were of the age between 0 -9 years and 12 were less than 1 year. Duration of hospital stay was also significantly shorter in the 2 nd wave (14 ± 19 vs. 22 ± 25 days; p < 0.001). A total of 49 and 35 deaths occurred during the 1 st and 2 nd wave respectively and the case fatality rate came down from 24.0% to 13.2%. In our center, we did not see any case of reinfection in pediatric hematology and oncology patients. In our study, only 1 patient (5.88%) out of a total of 17 had a complicated course of the illness and that too was because of co-existing bacterial sepsis, while the rest had mild symptoms. We conclude that, though the number of patients with COVID-19 were more during the 2 nd wave but the outcome of the children remained excellent. Thus we feel that 2 nd wave of COVID-19 infection was not a matter of great concern for the Pediatric Hematologist/Oncologist in the developing world. J o u r n a l P r e -p r o o f Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention COVID-19) -World Health Organization Why does COVID-19 disproportionately affect older people? Aging (Albany NY) SARS-CoV-2 in children: spectrum of disease, transmission and immunopathological underpinnings Nasal ACE2 Levels and COVID-19 in Children COVID-19 in cancer patients: risk, clinical features, and management First and second waves of coronavirus disease-19: A comparative study in hospitalized patients in J Effect of the new SARS-CoV-2 variant B.1.1.7 on children and young people A Preliminary Report of COVID-19 in Children in India Severity of COVID-19 in children with cancer: Report from the United Kingdom Paediatric Coronavirus Cancer Monitoring Project Flash survey on severe acute respiratory syndrome coronavirus-2 infections in paediatric patients on anticancer treatment COVID-19 infection in febrile neutropenic pediatric hematology oncology patients. Pediatr Blood Cancer COVID-19 in Children With Cancer COVID19 in children with cancer in low-and middle-income countries COVID-19 reinfection in two children with cancer