Having a child with cancer comes with many unique challenges, and the COVID-19 pandemic presents added stress. Below are several answers to our most frequently asked questions. 

Is my child at a higher risk? 

Children with cancer who are undergoing treatment may have weakened immune systems. Your child may be at a higher risk of contracting any infection compared to the general public, particularly due to frequent hospital visits. However, when weighing the pros and cons, this increased risk may be necessary given the reasons for hospital visits and treatments such as chemotherapy. 

Although much remains unknown about COVID-19, current data suggests that a history of cancer on its own does not increase the risk of infection with COVID-19. However, a child’s risk of contracting COVID-19 may increase if their immunity to viral infections is reduced due to: 

• Certain health conditions, such as chronic graft-versus-host disease 
• Certain medications, such as corticosteroids or immunosuppressive drugs used to treat autoimmune diseases (e.g., asthma, lupus or arthritis), or medications that prevent or treat organ or graft rejection (e.g., after a bone marrow or organ transplant) 
• Recent chemotherapy treatment (within the last six months) 

Based on our knowledge of other viral respiratory infections, it is likely that survivors with chronic health problems affecting the heart or lungs are at a higher risk of complications if they become infected with COVID-19.

What precautions should I take to protect my child? 

Remember that the virus that causes COVID-19 is spread through direct contact with respiratory droplets from an infected person (when they cough or sneeze) and with surfaces contaminated by the virus. The COVID-19 virus can survive on surfaces from several hours up to several days, but normal disinfectants can kill it. Current studies show that the COVID-19 virus is transmitted primarily through contact with respiratory droplets rather than through the air.

To avoid infection and protect your child, follow these basic principles. 

Physical distancing: 

• Keep a two-metre distance between your child and other people when outside the house. 
• Do not allow your child to attend social gatherings or crowded areas. 
• Avoid using public transit (such as buses and subways). 
• Keep your child at home as much as possible and away from anyone sick. 
• Since May 20, the Public Health Agency of Canada has recommended wearing a mask (or face covering, if homemade) whenever you go outside or to a public place. This measure applies mainly to adults, but children ages two and older can wear non-medical masks or face coverings. However, if wearing a face covering causes your child to frequently touch the mask or their face, it is probably best for them not to wear it. This kind of behaviour is common up to age six or seven and varies from child to child, so parents would do best to judge for themselves whether their children should wear them. 

Good hygiene: 

• Be sure to wash your hands very often—at least once an hour—with soap and water for at least 20 seconds each time. Have your child wash their hands often as well, including while at home. 
• If your child is old enough, remind them to avoid touching their eyes, nose and mouth. 
• Clean frequently touched surfaces, such as telephones, keyboards, doorknobs, light switches and counters, with antibacterial wipes or household cleaners at least once a day. You can view the list of disinfectants approved by Health Canada here: https://www.canada.ca/en/health-canada/services/drugs-health-products/disinfectants/covid-19/list.html.  
• Do not let your child shake hands or hug others. 
• Do not let your child share household items (such as cups or napkins) with others. 

Should my child go back to school or daycare in September? 

It is important to keep up with updates from your provincial government. 

If schools and daycares are reopening in your province, you are the best person to decide whether or not your child should return to school. 

In general, if your child normally goes to school during flu and bronchiolitis season, they should be able to do so during the COVID-19 pandemic. 

Some provincial governments advise that children with health conditions that make them vulnerable stay home for the time being. This includes children with severe immune system deficiencies or those who have recently had multiple hospitalizations, especially in intensive care. 

Talk to your healthcare team about any questions or concerns that you may have on this subject. 

What about their siblings? 

As a parent, you are the best judge of whether your child’s siblings should return to school or daycare. 

Remember that their siblings generally attend school in the winter, when many viruses (influenza, respiratory syncytial virus, etc.) go around. This may be a good point of reference when making your decision. 

My child has a weakened immune system. Can they participate in group activities, like sports? 

No. Your child should avoid group activities and all non-essential activities. Also avoid places with many people, for example, soccer fields.

References 

Here are some references on pediatric cancer/remission and COVID-19. 

• Unicef - Coronavirus: What Parents Should Know 
• About Kids Health - Information for parents of immunocompromised children and children with chronic medical conditions
• CHU Sainte-Justine - COVID-19 FAQ
• Science Daily - Study on COVID-19 Risk in Children with Cancer
• Children's Oncology Group - Childhood Cancer Hub
• BC Centre for Disease Control - Children with Immune Suppression
• BC Children's Hospital - COVID-19 and Children