April 21, 2020

Kids, Cancer and COVID-19

1. Do kids with cancer have a higher risk of contracting COVID-19?

  • YES! YES! YES! AND, YES!
  • Majority of childhood cancers are AGGRESSIVE and REQUIRE IMMEDIATE TREATMENT that often requires prolonged periods of intensive, multi-agent chemotherapy, radiation, and/or surgery
  • YOUR CHILD’S CANCER LOWERS THEIR IMMUNITY, RENDERING THEM IMMUNOSUPPRESSED
    • Pediatric cancer and required treatment can lower the number of immune cells needed to attack germs
    • Treatments, including radiation and certain drugs, can weaken the membranes lining the mouth and digestive tract, allowing germs to enter the body more easily
  • Viral infections, INCLUDING OTHER HUMAN CORONAVIRUSES, have been associated with
    • HIGHER RATES OF SERIOUS INFECTION in immunosuppressed children
    • HIGHER RATES OF DEATH in immunosuppressed children

2. But I thought kids have a lower risk of contracting COVID-19 than adults, right?

  • NO!
  • HEALTHY KIDS have the EXACT SAME RISK OF CONTRACTING COVID-19 as HEALTHY ADULTS under age 65
  • However, healthy kids who do contract COVID-19 are LESS LIKELY to DEVELOP SEVERE ILLNESS from the virus
    • About 6% of healthy children who contract COVID-19 will develop severe or critical illness compared to 20% of healthy adults
    • Infants and children 5 years or younger are MORE LIKELY TO DEVELOP SEVERE CLINICAL SYMPTOMS than children 6 years or older
    • Infants have the highest rates of severe infection at 7%, compared to children ages 1 to 10 at 4%, and tweens and teens at 3%
    • No major differences in the rate of contraction or recovery between boys and girls
  • While current data shows that kids with the virus fare better than adults, CHILDREN WITH CANCER ARE THE EXCEPTION

3. What should I do if I suspect my child has cancer during COVID-19?

  • DO NOT go to the emergency room
  • Call your pediatrician and request a telemedicine appointment
    • If they do not offer remote, virtual appointments, either
      • Speak with your pediatrician by phone and ask them how to proceed, or
      • Download and sign up for a pediatric telemedicine service on your phone so your child can been evaluated immediately
  • While laws are rapidly changing to encourage healthcare professionals and patients to use telemedicine during the pandemic, insurance coverage, both public and private, varies by company/institution and state
  • DO NOT go into a hospital, clinic, or office until it is absolutely necessary and tests/scans have been ordered

4. What should I do if I suspect my child has COVID-19 while they are undergoing cancer treatment?

  • If you suspect your child has COVID-19 CALL THEIR PEDIATRIC ONCOLOGIST IMMEDIATELY
  • DO NOT go directly to the emergency room or to a testing facility without a plan made with your pediatric oncology care team because if your child does not have COVID-19, they are likely to contract it at those sites
  • According to the recently passed Families First Coronavirus Response Act if your child needs to visit their healthcare provider for coronavirus testing your insurance, public or private, should cover both the test and the visit
    • IMPORTANT NOTE
      • Some patients who were tested received bills from the hospitals where they were tested because they were out of network
      • HOWEVER, on Friday, April 3rd, the President announced that his administration will use money from the recent stimulus bills to pay hospitals for treatment of uninsured coronavirus patients
      • It is UNCLEAR exactly how privately or publicly insured patients will be billed by hospitals
      • Contact me if you need assistance with this issue

5. My child is undergoing cancer treatment and I am scared for them to go to the hospital for treatment, do they have to go?

  • One would hope that your child’s oncology team is acutely aware not only of your child’s individual risk, but the risk that is posed by having multiple patients in a treatment center at this time. However, it is critical to find out what protocols they have in place. Contact them and ask how they plan to modify the clinical procedure.
    • DO NOT ASSUME THAT ANY PERSONAL PROTECTIVE EQUIPMENT (PPE) WILL BE PROVIDED TO YOU OR YOUR CHILD! Procure your own or strategize with your child’s oncology team about how and where to get it.
  • Unlike adult cancers, the MAJORITY OF PEDIATRIC CANCERS are AGGRESSIVE and REQUIRE IMMEDIATE TREATMENT
    • The recommended postponement of adjuvant chemotherapy and elective surgery for stable adult cancer patients IS, IN GENERAL, NOT AN OPTION FOR PEDIATRIC CANCER PATIENTS
  • It is important that your child stay on their treatment schedule to complete their individual protocol, however, some treatments can be administered from home
    • Your child’s oncologist, nurse practitioner, and social worker may be able to work with you to have your child’s treatment administered at home
    • You, and your child, can be trained to administer certain treatments, and a home healthcare aide can come to your home to administer those that need to be done by a professional
  • ASK YOUR CHILD’S ONCOLOGIST THE FOLLOWING QUESTIONS
    • Can my child keep some/all of their appointments through telemedicine?
    • Can my child get any of their treatments from home so they are not in public?
    • If my child’s treatment must be administered at this hospital, out or in-patient, what can I do to minimize their risk of contracting COVID-19 before, during, and after our visit?
    • What is the best way to get to and from the hospital right now?
  • Asking your child’s oncologist hard questions is not only your right, according to The Patient Bill of Rights, but it makes you a better advocate for your child and the decisions you make about their health. Any pediatrician who does not welcome your questions may not be the right pediatrician for your family.

6. I know my child is considered high risk because they are immunosuppressed, so what steps can our whole family take to protect them?

  • STAY HOME
    • Everyone in the household who can, PLEASE STAY HOME! Think of COVID-19 as very dangerous glitter; once you bring it into your car, house, life….you cannot get rid of it!
  • ALL HANDS (AND PAWS) SHOULD BE WASHED REGULARLY
    • Especially after use of shared devices, controls, switches, knobs, handles, and keys
    • Have each of your kids pick their favorite 20 second song, or piece of it, and have them sing it while they wash their hands...Your sanity may be at high risk, but you will be able to hear exactly how often and long each of your kids is washing their hands!
  • DO NOT TOUCH YOUR OR ANYONE ELSE’S FACE
    • My brother spent a lot of our childhood putting my sanity and focus at high risk by playing the “I’m Not Touching You” game! Bring it back for each other and yourselves!
  • PRINT, READ, AND POST THIS ON YOUR FRIDGE:
  • Clean Your Home with EPA and CDC APPROVED PRODUCTS that kill COVID-19
  • Quarantine your immunosuppressed child from
    • Family members who still have to work outside the home on a regular basis
    • Family members who have travelled or attended a public gathering in the last 14 days
    • Children who have not been home or isolated for 14 days
  • Groceries/Takeout Food/Packages/Mail
    • WATCH THE FOLLOWING NOW:
    • HAVE ALL GROCERIES, TAKEOUT FOOD, PACKAGES, AND MAIL DELIVERED TO YOUR DOOR, PORCH, OR GARAGE; do not allow the delivery person into your COVID-19 free home
    • Groceries
      • Use a delivery service or have someone, preferably outside the home, shop for you
      • If you cannot get delivery, call your local grocery store and tell them that you have an immunocompromised child; they will with either deliver groceries to you or assist you with curbside pickup
      • Leave items not needed for immediate use to sit on your porch or in your garage for 72 hours
      • Otherwise decontaminate all items in accordance with the above video
    • Takeout Food
      • If you order takeout, order dishes that can be heated so that you can microwave it to assure it is not contaminated
      • Remove packaging and serve in accordance with the above video
    • Packages/Mail
      • Leave packages and mail on porch or in garage for 72 hours unless it is necessary to open immediately
      • Otherwise decontaminate outside of package and potential contents according to the above video
  • Laundry
    • Wash clothes, towels, and linens regularly on the warmest setting possible
    • Disinfect your laundry hamper
    • Don’t shake dirty laundry
    • WEAR GLOVES if you are laundering anything that has been out in public
  • Pets
    • Dogs and Cats cannot get sick from COVID-19
    • That said, they may get it and test positive for it, but unlike humans, they will not fall ill
    • FOR THAT REASON, AND BECAUSE THEY ARE FURRY CARRIERS of COVID-19 MOLECULES ON THEIR COATS, FACE AND PAWS
      • Supervise your pet in your backyard
      • It is okay to play with them outside of your home, JUST KEEP YOUR, AND YOUR PET’S 6ft DISTANCE FROM OTHER HUMANS
  • Guests
    • ONLY VIRTUAL ONES PLEASE!

7. I know my child is considered high risk because they are immunosuppressed, but is there anything I can do to boost what immunity they do have?

8. Having cancer has already made my immunosuppressed child feel isolated; the pandemic has only exacerbated that. What can I do to help them?

  • Make Zoom, Skype, or FaceTime appointments with family and friends
    • Enjoy virtual Smoothies, Milkshakes, Lunch, Dinner, or Game Nights
  • Engage in Some School Activities
    • While it is unlikely that your child’s treatment and energy level will allow them to fully participate in online school, consider having them participate part-time for the academic and social interactions with teachers and peers
    • Essentially every child in the country is learning what it is like to have to stay home because of neutropenic precautions, THIS IS A GREAT THING and will allow your child’s peers to better appreciate and understand their cancer experience
  • Limit Everyone’s Media Exposure
    • Learn everything you need to know to keep you and your family safe; then just check-in once or twice a day by TV or web
  • Have your child check-in with their fellow patients; if anyone has the capacity to understand how your child feels, they do
  • Download and have your child try an online pediatric psychotherapy session; many are currently offering free trials

9. One or more of our family members need to work through the current quarantine; what do we need to do to protect my immunosuppressed child?

  • Never fear, if you have a door, disinfectant and determination, YOU CAN DO THIS!
  • Decontaminate your home, see Question 6
  • Isolate all family members who leave the home daily in another room and, if possible, ask them to use a separate bathroom
  • Be aware of ALL HIGH TOUCH SURFACES and be ready to be constantly wiping them down multiple times a day
  • Do not share the following items:
    • Designate specific plates, cups, and cutlery for family members who leave the home daily and have them clean all of the items themselves
    • Designate a specific set of toiletries including toothpaste, shampoo, conditioner, and body wash/soap for family members who leave the home daily
    • Upon return, have them remove their clothes before entering your COVID-19 free home and have them immediately launder those clothes, including outerwear, on the hottest setting
  • WEAR GLOVES if/when you are doing communal dish/clothes washing
  • WASH YOUR HANDS FREQUENTLY
  • Ask all family members who leave the home daily to WEAR A MASK in the presence of those who do not, as it will severely decrease the amount of potential viral particles in their air
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10. Cancer is stressful enough on my family; what can we do now that we are all home together for the foreseeable future?

  • DON’T PANIC. No parent or child, regardless of age, was ready to be home, indefinitely, full-time, TOGETHER!
  • Contact your child’s oncologist and let them know that you now have family at home that was not only unexpected, but may have been exposed to COVID-19
  • Make a plan with your family about how you are going to handle quarantine
    • Designate one person to interact with the public and be the errand-runner
    • Set up a disinfecting station outside or in a low traffic area for all packages, groceries, and goods entering the home
  • At present, almost all public and private universities, high schools, and elementary schools have successfully transitioned to online classes
    • Everyone needs a place to work and think
      • Put a card table up in the attic, basement, hallway or garage, and/or invest in a few pairs of headphones for everyone learning/working around the kitchen table
      • Just make sure everyone has a designated private/semi-private workspace...for your sanity and theirs.
    • Foster Collaboration
      • Ask your older children to help their younger siblings
        • Prepare for online school in the morning
        • Oversee communal breaks
        • Double-check homework at night
  • Encourage Independence
    • In a time where everyone feels out of control, EMPOWER ALL OF YOUR CHILDREN, ESPECIALLY your IMMUNOSUPPRESSED CHILD, to learn and take on specific personal and familial roles and responsibilities
    • THERE IS NOWHERE TO GO and you are right there, so what better time to try this?
    • Have each member of the family
      • Make their bed
      • Make their breakfast
        • Cereal or toast will not burn the house down
        • Once they’ve mastered that, try eggs...Safely cooking on the stove is an important developmental step for both of you.
      • Order and organize their work and personal space before starting work or school for the day
      • Complete assigned chores…Kids have A LOT MORE TIME ON THEIR HANDS, have them help out and reduce your stress
    • When I was diagnosed with leukemia a week after my twelfth birthday, I insisted on I take control of all of my oral medications
      • My nurse practitioner gave me a list of medications with the respective dosage of each
      • I sorted them weekly into a large pill organizer
      • Set alarms for when I need to take the medication
      • In a time when I EXERCISED ZERO CONTROL OVER MY OWN LIFE, I was able to take ONE SMALL PIECE OF INDEPENDENCE BACK
      • In hindsight, my mother must have checked my work, as I was not responsible for refilling the medications and the pills were always there when it was time to dole them out, but that small act of independence made me feel like I still had choices and contributions to make in my life, and my family’s
    • When a child is sick, even with a cold, the instinct is to care for and protect them in every possible way...Try to keep this instinct at bay
      • Often it looks like favoritism to your other children
      • It erodes the independence of your immunosuppressed child who would otherwise be learning if they were healthy
    • Small acts of independence will empower your children, as they will feel a greater sense of control over their own lives, and that will reduce the overall level of anxiety and instability in the household
  • Encourage Distraction and Breaks
  • BE KIND TO YOURSELF AND EACH OTHER. No one is doing this perfectly; the key is knowing when to ask for help as you keep moving forward.

The information contained in this post was sourced from the following:

Please Note:

  • This site uses gender-neutral pronouns, they/them, as a means of including everyone.
  • All recommendations in this post are researched, vetted, and not a paid endorsement.