DISCUSSION
In this large pediatric survivor cohort followed in New York City (NYC), one of the earliest epicenters of the pandemic, we found a low prevalence of reported COVID-19-related symptoms or hospitalization. While 7.8% of those tested had positive SARS-CoV-2 IgG and probable prior infection, only one patient (0.3%) required medical evaluation and subsequent hospitalization. Patients residing in just two zip codes, which were known COVID-19 “hot spots,”10 made up 50% of patients with positive SARS-CoV-2 serology. This suggests that living in high prevalence areas of SARS-CoV-2 may put survivors at increased risk of contracting the virus.
This cohort’s relatively low disease burden is consistent with other reports from oncology settings in which patients on active treatment appear to be at similar risk as non-oncology populations for COVID-19.9,11,12 Interestingly, 7.8% of our tested cohort had positive SARS-CoV-2 antibodies, compared to 29.9% of individuals aged 0-17 in New York City.10 We hypothesize that survivors and their families were already adept at mask-wearing and social distancing and thus less likely to contract disease. Alternatively, a subset of survivors may have been unable to mount a serologic response to COVID-19 due to impaired immunity related to prior underlying diagnosis or cytotoxic treatment(s). Our patient population is also less racially and ethnically diverse than the larger New York City pediatric population and may partially accounts for the relatively low disease burden in this cohort. Future investigation is necessary to clarify these findings.
Various limitations must be considered. While the clinical significance of SARS-CoV-2 serology remains unclear, positive antibodies appear to be a reasonable indicator of prior disease in asymptomatic individuals.8,13 Additionally, since only one patient reported severe disease requiring hospitalization, we were unable to assess associations between prior cancer therapies and COVID-19 severity. The retrospective, single-center design and reliance on patient/family recall also likely introduced bias. However, since nearly one-third of visits were conducted via telehealth, the cohort includes patients who were unable/unwilling to travel to NYC and individuals who were too ill to attend in-person visits.
Our preliminary data suggest that pediatric survivors do not experience a high burden of COVID-19-related complications. Based on currently available data, childhood cancer survivors should follow national precautions for mask-wearing, social distancing, and hand hygiene as the country prepares for a potential upcoming COVID-19 resurgence. Longitudinal follow-up of large survivor cohorts will be required to analyze the impact of treatment exposures and existing co-morbidities on COVID-19 severity and inform guideline development for this high-risk population.
Conflict of Interest Statement: Danielle Novetsky Friedman held an advisory role for Fennec Pharmaceuticals in the past 36 months.
Acknowledgements : This study was supported by the Memorial Sloan Kettering Core Grant (P30 CA008748) and the Meg Berte Owen Foundation. The NIH and the Meg Berte Owen Foundation had no role in the design and conduct of the study.