COVID 19 in pediatric cancer patients in a resource limited setting: National data from Peru
To the Editor: Peru, an upper middle income country according to theWorldBank, is being severely affected by the COVID 19 pandemic, counting today 285 213 cases and 9677 deaths, and having one of the highest incidence rates of COVID 19 in the world (87.5 per million inhabitants).1 National lockdown policies, transportation restriction, and economic constrains, alongwith disrupted health care services, have significantly impacted access for diagnosis and treatment of childrenwith cancer.2,3 Although recent papers suggest that the pediatric oncology population may not have higher mortality resulting from SARS CoV 2 infection in high income countries (Spain,4 China,5 USA,6 Italy7) these patients would be a potential vulnerable group for worse outcomes,8 especially in lowandmiddle income countries (LMIC) We report 69 pediatric cancer patients (ages 0 16 years) diagnosed with SARS CoV 2 infection from March 6 to July 7, 2020 from six tertiary centers in Peru (National Institute of Neoplastic Diseases, Rebagliati Hospital, Almenara Hospital, and National Institute of Children San Borja in Lima; and two hospitals from Trujillo and Chiclayo) and three cancer shelters in Lima. The main patient characteristics are shown in Table 1. The cancer types included hematological malignancies (69% and solid tumors (31% Most patients were treated as ambulatory and interestingly, 20 (29% were already hospitalized suspected of a potential nosocomial SARS CoV 2 infection source. The most frequent symptomswere fever and cough (66.67% Thirty seven patients were asymptomatic (53.7% Chemotherapy was stopped in all cases. COVID 19 treatment was based on ivermectin, azithromycin, and corticosteroids in nine cases, whereas 60 patients did not receive any treatment. At the time of this report, 62 patients are alivewith no complications due to SARS CoV 2 and seven are dead. Four patients had progressive disease and complications not related with COVID 19 and the rest (three patients) had severe pneumonia with rapid deterioration despite intensive care in one case or unavailable ICU beds in two cases. Patients under noncurative treatmentwere atmore risk of death due to COVID 19 (chi square, P .004) than patients under curative treatment. In our cohort, COVID 19 lethality is 10% much higher than documented for the general pediatric population in Peru (0.34%)1 or other countries.9,10 COVID 19 infection in childrenwith cancer has generatednewchallenges in pediatric oncology worldwide, especially in limited resource settings. It is important to maintain pediatric cancer treatment as a priority; however, some factors such as the increasing number of TABLE 1 Characteristics of study sample
Pediatric blood cancer