LAUSR

To the Editor: The second wave of COVID-19, outnumbered the first, in terms of cases and deaths [1]. Global data have been variable with respect to mortality (0–6.6%) [2]. We report outcome of patients with COVID-19 during the second wave from the pediatric oncology unit of a tertiary care center in India. Pediatric cancer patients, testing positive for SARSCoV-2 were enrolled. Data on symptoms, hematological/ inflammatory parameters, treatment, and outcome were collected. All cases were followed up till tested negative. Forty-one patients (23 ALL, 5 Ewing sarcoma, 3 retinoblastoma, 2 each of AML/neuroblastoma/non-Hodgkin lymphoma, and 1 each of Hodgkin lymphoma/LCH/ rhabdomyosarcoma/nasopharyngeal carcinoma) tested positive for SARS-CoV-2. While more than half were asymptomatic, 36% had mild symptoms. Twenty-five (60.9%) patients improved on home isolation, 12 were admitted in ward, and 4 in ICU. Out of 5 patients that required supplemental oxygen, 4 needed mechanical ventilation. Systemic steroids and remdesivir were given in 4 and 2 patients, respectively. While hematological parameters were normal in majority, inflammatory markers: CRP, Ferritin, IL-6 and D-dimer were elevated. The mean time to negativity was 18 d, but 5 patients tested negative after 1 mo with the maximum time to negativity being 46 d. Of the 4 deaths, 1 occurred due to terminal cancer, and rest 3 (7.3%) COVID-attributed deaths occurred in adolescent patients and 2 had superimposed bacterial/viral infections. Two patients were treated with IVIG for MIS-C. Additional contributors to mortality were: severe thinness, superior mediastinal syndrome, disease relapse. None of our patients had any nononcological risk factors. Although the rate of severe COVID-19 in our study (10%) is somewhat similar to other developed countries, 7.3% COVID-related deaths in our cohort is higher than those of the developed nations [3]. Pediatric cancer patients in developing countries might be at increased risk of superinfections, severe disease, and death.