Individuals in Paediatric/Teenage and Young Adult Oncology Long Term Follow Up who may be at increased risk of COVID19 infection
Updated 23 June 2020
Whilst there is relatively little information available, experience in the UK and other countries suggests that children and young people are at very low risk of getting seriously unwell even when infected with COVID-19.
We recognise that many of the recommendations below are based on a very low level of evidence, or even conflicting evidence. In some cases they are based only on clinical opinion. Adoption of these recommendations or of alternative recommendations is at the discretion of the individual patient with advice from their clinician.
We are also aware that the recommended precautions for individuals who are considered to be at moderately or significantly increased risk from COVID-19 are changing rapidly, and that it is likely that there will be changes in risk group definitions (especially in children) over the coming months. We intend to reflect these in future versions of this guidance.
Long-term follow-up patients who may be at moderately increased risk from COVID-19. These individuals therefore fall into the Government’s 'clinically vulnerable' category who are advised to practice STRICT SOCIAL DISTANCING but do NOT need to shield:
Patients with
- Significant chronic cardiac morbidity (this does not include patients with mild reduction in left ventricular fractional shortening / ejection fraction but who are asymptomatic)
- Symptomatic lung disease, but which is not severe enough to warrant shielding (this does not include patients with asymptomatic mild restrictive lung function test abnormalities or patients who have received bleomycin but who are asymptomatic)
- Significant chronic renal morbidity
- Significant chronic liver morbidity
- Significant chronic neurological disease (this does not include patients treated for CNS tumour who have mild cerebellar symptoms or weakness)
- Adrenal insufficiency taking replacement steroid therapy (only applies to patients aged 16 years and over, and only when specifically advised by the patient’s endocrinologist)
- Diabetes mellitus (only applies to adult patients)
- Pregnancy
- Obese (body mass index [BMI] of 40 or higher) (only applies to adult patients)
- Patients who have previously received Total Body Irradiation (TBI) or left sided abdominal radiotherapy treatment (this is different to the current government recommendations but is in agreement with recommendations from both the UK BMT community and the Royal College of Paediatrics and Child Health)
- Patients under any organ specialist should follow the specialist advice from these teams.
For these long-term follow-up patients and circumstances, we recommend:
- Avoid contact with someone who is displaying symptoms of coronavirus. These symptoms include high temperature and/or new and continuous cough
- Avoid non-essential use of public transport when possible
- Work from home, where possible. Your employer should support you to do this. Please refer to employer guidance for more information
- For survivors in education, to return when social distancing can be followed. Please discuss this with your school, college or university
- Use telephone or online services to contact your GP or other essential services
Long-term follow-up patients who are at significantly increased risk. These individuals therefore fall into the Government’s “extremely vulnerable” category who are advised to SHIELD:
- Solid organ transplant recipients
- On immunosuppressive therapy or severely immunocompromised
- Sickle cell Disease, HbSS (this does not include patients who have had a haemopoetic stem cell transplant with normal engraftment)
- Severe symptomatic respiratory morbidity (depending on advice of patient’s relevant treating specialist team)
- Severe symptomatic cardiac morbidity (depending on advice of patient’s relevant treating specialist team)
- Pregnant with known heart or lung disease.
For these long-term follow-up patients and circumstances, we recommend Strict SHIELDING following the current Government/NHS/PHE advice.
Prepared by the CCLG Late Effects Group Steering Group.