One of the few bright spots in the Covid-19 pandemic has been the perception that children are mostly spared from its worst effects. But what about kids already at risk of contracting serious infections due to a compromised immune system? Do they have the same protection?
"One group we always worry about when it comes to viral illnesses is immunocompromised children," said Dr Reggie Duerst, director of the stem cell transplant programme at Children's Hospital of Chicago. These kids are typically more at risk of known viral illnesses, such as chickenpox, common cold viruses and flu.
But, he said, because there's so little information available on Covid-19 infections, it's hard to know how much higher the risk might be for children with compromised immune systems.
So far, he said, the incidence of Covid-19 infections in his hospital is very low.
'Take all precautions'
Dr Basim Asmar, chief of infectious disease at Children's Hospital of Michigan, said it's just not clear yet whether or not children with compromised immune systems are more likely to get Covid-19 infections. It's also unclear if they would have more severe complications if they got an infection.
"We're not really sure right now. We're still learning, and every day we're learning something new. But with other viral infections, immunocompromised children tend to have a more prolonged course," Asmar said.
Dr Mehreen Arshad, a member of the Infectious Diseases Society of America and an assistant professor of paediatrics at Northwestern University in Chicago, agreed that there's just not a lot of data on children and Covid-19 yet, especially kids with compromised immune systems. She said that immunocompromised children likely have less risk from Covid-19 than older adults do, but they may have more risk than children with healthy immune systems. She added it's important to "take all precautions" to lessen the risk of infection for these children.
Which kids have a compromised immune system?
Duerst said many children who are being treated for cancer and those receiving stem cell transplants or organ transplants tend to have compromised immune systems. There are also inherited immune deficiency conditions. Children who have certain autoimmune diseases, such as rheumatoid arthritis or lupus, may take medications that dampen their immune system's response.
Other children who might be at a higher risk include those with cystic fibrosis and other lung diseases because their lung capacity is already compromised.
A little more stringent
Among children who've received a stem cell transplant, the immune systems of those who get their own cells back (autologous transplant) are close to normal after a year or two, Duerst said. In kids who get stem cells from a donor (allogeneic transplant), "they are on ongoing immune suppression for three to six months, and often longer. If they have a smooth course, by two years they begin to return to normal," he said.
Kids who've had an organ transplant may remain on immune-suppressing drugs for a long time, often for life.
So, what steps do parents need to take to keep these youngsters safe?
Arshad said, "I would be a little more stringent for children with compromised immunity. Stay inside as much as possible. Don't have contact with anyone at higher risk, like grandparents, or anyone with symptoms. Don't go to stores. Avoid crowds."
She noted that "these families are used to taking precautions already. They may be more aware of the potential dangers."
Asmar agreed that it's important to follow common-sense infection prevention. And, he added, "If someone is ill within the family, even the mother or father, they should try to avoid coming in contact with the child, and should stay in a separate room."
Hospitals relatively safe
In addition, Asmar said that children with compromised immune systems should be as up-to-date on immunisations as possible.
If your child has a compromised immune system and gets sick, Duerst said to call the physician treating the immune-compromising condition to get instructions. "There are multiple reasons you do not want to enter just any emergency room entrance," he said. But with a number of precautions and screening in place, hospitals are "still a relatively safe place to be," he added.
Arshad said that for more routine visits, kids can often be seen via telehealth. And if there's something a doctor needs to see your child for, the doctor might have your child stay in the car and come out to you.
"While we're not seeing immune-compromised children get an overwhelming number of infections, there's no reason to be complacent," she noted.