Ethical considerations in the treatment of pediatric patients
with SARs-COV2 infection
Key Words : SARS-Cov2, COVID-19, Pediatrics, Ethical
considerations, Treatment.
Since the beginning of 2020, following the outbreak in The City of
Wuhan, China of Coronavirus infeccion (SARS-CoV2), one of the concerns
that was raised is whether it affected all age groups alike or whether
we had a clinical scenario that had varied clinical nuances based on
them.
The paediatric patient appears to be participating with a very small
percentage within symptomatic patients or in need of hospital management
derived from the severity of the disease, as is the case with
multi-inflammatory sistemic syndrome, in a smaller proportion in
relation to the rest of the age groups. (1,2)
An analysis in Medline from December 2019 to April 2020 where 38 studies
(1124 cases) were included, found that from all the cases, 1117 had
their severity classified: 14.2% we were asymptomatic, 36.3% were
mild, 46.0% we were moderate, 2.1% were severe, and 1.2% were
critical (3). As of today, few cases of mortality are reported and
apparently appear to be a constant within what appears to be reported in
different series since the beginning of the outbreak, although if it is
clear that the paediatric patient has a high potential for contagion and
spread of the disease, hence the importance of its detection and
surveillance (4,5).
One of the questions that has been had since the beginning, is what is
the best therapeutic option, being to date that the evidence has not
allowed to support any management strategy as resolute and specific, and
in many cases not even safe, being to date multiple recommendations on
the usefulness of different strategies, without having on many occasions
more value for its support than the anecdote.
On the other hand, we should consider that although there are protocols
in the development of therapeutic strategies for serious expressions of
the disease, as well as effectiveness and safety assessment in vaccine
protocols, the paediatric patient is rarely considered as a target
group.
From the outset, it has been proposed that decision-making in the
context of therapeutic interventions should be evidence-based to safely
support the use of these strategies without causing transient or
permanent harm or involvement in the receiving population. The
paediatric group is of particular interest derived not only from the
ethical considerations involved in including it in drug study protocols,
in which its dosage is estimated based on algorithms determined by
behavior based on physiological responses obtained from adult patients,
but must also be able to justify to all interested parties the benefit
risk of its use, allowing to rule out the impact in acute form as well
as the absence of consequences that impact the biological development
and quality of life of the child (6,7).
Currently there are approximately 30 studies that are being carried out
in paediatric patients in order to have conclusive data regarding the
possibility of having epidemiological and clinical data that allow more
objectively and not by transferring information of adult patients to be
able to have data, these studies are endorsed by the National Institutes
of Health (NHI) and World Health Organization (WHO), however the
limitations given by the Best Pharmaceutical for Children Act and the
Pediatric Research Equity Act do not allow pharmacological studies in
the paediatric group to be prioritized, missing the opportunity to have
rigorous data on potential treatments for COVID-19 (8-9).
It is relevant based on this scenario not to minimize the need for
studies designed for the paediatric population, that does not allow
robust information and that allows to safely support the therapeutic
indications in the management of COVID-19 in the paediatric patient.