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Blood cancer and coronavirus

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Which children are at high risk from coronavirus?

This page explains the various guidelines available about which children are at high risk from coronavirus. We hope this information helps you think about your child's possible risk, but always speak to their treating team.

Coronavirus (COVID-19) and understanding the risks

Last updated: 31 July 2020

When we talk about ‘risk’ we are talking about the chance of something bad happening.

With coronavirus, there are two key risks:

  • the risk of catching coronavirus
  • the risk of becoming seriously ill if you do get coronavirus.

There are certain things that can increase or decrease the chances of these things happening, but we can never know exactly what will happen to an individual.

The risk of catching coronavirus in the first place can be reduced by regular hand cleaning, not touching your face with your hands, maintaining a 2 metre distance from other people, and avoiding crowded places. The fewer people you come into close contact with, the less likely it is that you’ll come into contact with an infected person.

You’re also less likely to catch the virus outside than in indoor spaces.

The risk of catching coronavirus also reduces for all of us as the rate of transmission across the country reduces, because less people are infected at any one time. This is why there are guidelines on social distancing for people across the UK.

For those people who do catch coronavirus, most will have a mild to moderate illness and recover without needing special treatment. But some people are more likely to develop serious illness. These include older people and people with certain health conditions, including cancer. This is why there have been stricter guidelines about shielding for these groups of people – because catching coronavirus for these people could be more serious.

Whilst children with blood cancer have a higher risk of becoming seriously ill with coronavirus than children without blood cancer, this does not mean that they will become seriously ill.

National guidelines about which children are at high risk

Last updated: 31 July 2020

Guidance in Wales and Northern Ireland

In March, the government published guidance about who is at the highest risk from coronavirus and should shield. As coronavirus is a new virus, these guidelines were based on prior knowledge about how other respiratory viruses have tended to affect people in the past, and on prior knowledge about how certain conditions and treatments affect the immune system, which plays a key part in recovering from a virus. The NHS worked with the government to produce this list of clinically extremely vulnerable people. The list includes:

  • adults and children who currently have any type of blood cancer
  • adults and children who’ve had an autologous transplant (using their own stem cells) in the last year
  • adults and children who’ve had an allogeneic transplant (using donor stem cells) in the last two years
  • adults and children on immunosuppression medication after a transplant, who have GvHD, or who have ongoing immunodeficiency after a transplant.

These guidelines were intended to apply to both adults and children, although the data used to come up with the criteria was adult data.

These adults and children were advised to shield until 16 August in Wales, and until 31 July in Northern Ireland.

Guidance in England and Scotland

In England and Scotland, the Royal College of Paediatrics and Child Health (RCPCH) has published a new list of clinically extremely vulnerable children, which has replaced the list above.

This means that many children who were previously advised to shield in England and Scotland will not be advised to shield in the future. This new guidance has been adopted because since the start of the outbreak, we have learned that coronavirus usually affects children much less severely than adults. Data also suggests that some children who were thought to be clinically extremely vulnerable have not been impacted by coronavirus as significantly as previously thought.

The new list of clinically extremely vulnerable children in England and Scotland includes children who:

In England and Scotland, these children will remain on the shielding list after 31 July, and may be advised to shield again in the future if shielding is re-started.

In England, if your child was shielding for a condition that's not listed above, it is unlikely they will be asked to shield again in the future. This is because the latest evidence suggests that they are not at high risk of becoming seriously ill if they get coronavirus. If this is the case for your child, their GP or specialist doctor will contact you over the summer, before the new school term, to discuss this.

In Scotland, if your child was shielding for a condition that's not listed above, it is unlikely they will be asked to shield again in the future. Healthcare teams will be contacting children and parents to discuss this. If it is agreed that your child no longer needs to be on the shielding list, you will receive a letter to confirm this. This will be based on the fact that evidence suggests they are not at high risk of becoming seriously ill if they get coronavirus.

Further detail on these guidelines

  • Children are still being identified as high risk and can be added to the shielding list. This is important to ensure you take the right precautions and get any support you are entitled to in the future.
  • If you think your child should have received a shielding letter but didn't, contact your hospital team or GP. They may need to add your child to the shielding list.
  • In some cases, a child's hospital team or doctor may advise you that they don't need to shield. This is because hospital teams and doctors are asked to provide more personalised advice to their patients, and some children will be lower risk than others.
  • If you’re not sure whether your child has a compromised immune system, check with your healthcare team.
  • If you have received a letter but you don't think your child falls into any of the groups above, this may be because your hospital team or GP believes your child could still be at high risk and should take extra precautions (be on the shielding list). Speak to your hospital team or GP if you are unsure why you've received this letter.
  • If you have any questions about your letter from the NHS, speak to your healthcare team - they can give you personalised advice.
  • For children who are not at high risk, follow the general advice on social distancing for people in England, Scotland, Wales or Northern Ireland.

If your child is at high risk

If your child falls into one of the high risk groups, or your healthcare team has advised your child to follow shielding guidelines, then read our information for children at high risk.

The information above is a guide about who may be at high risk. But not everyone has the same level of risk. We have more information on understanding your own level of risk.

What we’ve learned so far about children

Since the first national guidelines were published, we have learned more about how coronavirus affects different people. For example, we’ve learned that coronavirus usually affects children much less severely than it does adults (and older adults in particular).

So for children with blood cancer, having blood cancer does increase their risk of becoming seriously ill from coronavirus, but at the same time, the fact that they are a child could reduce this risk, but we don’t know by how much.

We also now have data available about children with cancer who've had coronavirus in the UK. Although a small data set, it seems to suggest that the increased risk of coronavirus in children with cancer is not as significant as previously thought.

New data and guidance about children with cancer

Last updated: 31 July 2020

We now have some data from within the UK about children with cancer who’ve had coronavirus. This has led to some new guidance about which children are at high risk. Governments in England and Scotland have chosen to adopt this new guidance, as explained above.

After looking at the data on children with cancer and coronavirus, and considering what they know about childhood cancer and treatment, the Children’s Cancer and Leukaemia Group (CCLG) now thinks that only some children with blood cancer need to carry on shielding. They have written some new, more detailed guidance about the risk to children with cancer. The CCLG is continuing to update this guidance - it was last updated on 17 June 2020.

The CCLG is a credible organisation and they have developed these guidelines based on children’s data, working with experts who specialise in childhood and teenage cancer. This guidance has also informed the guidance above from the Royal College of Paediatrics and Child Health, which has been adopted in England and Scotland.

This data suggests that the increased risk of coronavirus in children with cancer is not as significant as previously thought. This is consistent with data being gathered in other countries about children with cancer.

It’s important to note that the data is only based on a small number of cases (52 as of 16 June 2020), but that is because there are only a small number of confirmed cases of COVID-19 in children with cancer.

This guidance groups children with cancer into three different risk levels, with different advice about shielding and school. The guidance is intended for children and young people up to the age of 18.

This group includes children and young people who:

This group should:

This group includes children and young people who:

This group:

Although not completely free of risk, the data available suggests it is safe for children in this group to return to school, as long as the school can ensure good hygiene and social distancing measures.

Most children and young people who completed chemotherapy or radiotherapy more than 6 months ago are not in the vulnerable groups. They should follow the general advice on social distancing for people in England, Scotland, Wales or Northern Ireland.

For more information about these guidelines, see the CCLG COVID-19 guidance for children and young people with cancer.

Summary

The two sets of guidelines above differ in which children they recommend should be on the shielding list and take extra precautions. This could change again as we learn more about the impact of coronavirus on children with cancer.

You may also have questions about how strictly you and your child should be - what's OK and what to avoid.

Guidelines are there to guide clinicians and parents through decisions about reducing risk, but ultimately, it's up to parents to decide what's best for their child. Your healthcare team are there to support you to think through these guidelines and any questions you have.

Blood Cancer Medical Information Card

We’ve made this card so you can keep important details like your NHS number and your medical team with you at all times. This could be especially important if your child is admitted to a different hospital for any reason. It should help ensure your usual doctor or hospital team is aware and involved in any discussions about treatment or care.

Blood Cancer Medical Information Card

To use this card:

  1. Download it and fill in your details (you’ll need to open it in Adobe Acrobat Reader)
  2. Print it, or take a photo on your phone and ‘favourite’ it
  3. Tell family and friends where your card is

Download your card here:

Tell us about your experience

You can help improve support for people with blood cancer by completing our impact of coronavirus survey. The results will help us understand the impact on people with blood cancer and help us support clinicians and the NHS.

Keep updated about coronavirus and blood cancer

Join our mailing list for key updates about coronavirus for people with blood cancer, what we're doing to help, and ways you can help, including campaigns you may be interested in.

Support for you

Call our free and confidential helpline on 0808 2080 888 from Monday to Friday, 10am to 7pm, and Saturday to Sunday, 10am to 1pm.

We are currently receiving a very high volume of calls related to coronavirus, so if you're not able to get through straight away, please leave a message and we'll get back to you as soon as we can.

You can also email us if you prefer to get in contact that way. We'll usually get back to you within two working days, but due to the current rate of calls and emails we are currently receiving it may take us longer.

Talk to other people with blood cancer on our Online Community Forum – there is a group for coronavirus questions and support.

You can also find out what's helping other people affected by blood cancer through coronavirus and beyond in our pages on living well with or after blood cancer.

The following companies have provided funding for our coronavirus support, but have had no further input: AbbVie, AstraZeneca, Celgene, Gilead, Incyte, Kyowa Kirin, Novartis, Pfizer, Sanofi, Takeda.

We're here for you if you want to talk

0808 2080 888

[email protected]