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.