key: cord-0922866-a6dvyfp2 authors: Sajid, Mir Ibrahim; Altaf, Sadaf; Mushtaq, Naureen; Belgaumi, Asim; Fadoo, Zehra title: Pediatric hematology oncology during SARS‐CoV‐2: A brief communication of 28 patients and changes in clinical practice from a single institute in Pakistan date: 2020-06-23 journal: Pediatr Blood Cancer DOI: 10.1002/pbc.28527 sha: 9b2788056979248bb44c49b111c8872c6c60d042 doc_id: 922866 cord_uid: a6dvyfp2 nan It has been 5 months since "social distancing" and "staying at home" became the key defense tactics against an invisible enemy, declared as a global pandemic by the World Health Organization (WHO). 1 With a rapid increase in SARS-CoV-2 cases and a limitation of resources, such as critical care units and staff, ventilators, and isolation rooms, health care delivery had to undertake a paradigm shift. Elective surgeries were put on hold, inpatient admissions were restricted, and teleclinics were introduced to limit exposure. This is a case-control study that assesses all the hematology/oncology patients who underwent SARS-CoV-2 nasopharyngeal swab reverse transcriptase polymerase chain reaction (RT-PCR) testing at our institute. This included those patients who were characterized as medium to high risk on the SARS-CoV-2 screening tool, and all patients who were electively admitted in the inpatient services and prior to a bone marrow transplant. The patients were then classified into two groups, group A (patients who tested positive) and group B (patients who tested negative). Clinical presentations of these patients and the reasons warranting testing were evaluated. In accordance with the policies of the Department of Infection Prevention and Hospital Epidemiology, universal screening of all patients who visit the daycare facility or are admitted to the hospital is done before and on arrival to the hospitals. A SARS-CoV-2 screening tool classifying patients into low-, medium-, and high-risk categories is used for all elective and emergency room admissions during this period. Febrile patients regardless of neutropenia are declared as medium risk and undergo RT-PCR testing for SARS-CoV-2. Due to the low sensitivity of the test, any patient who remained with high suspicion was retested and was not admitted into the oncology ward unless tested negative on both occasions. A total of 28 patients were tested, the details of which can be found in Table 1 . The demographics of patients in both groups can be visualized in Table S1 . The bullet bar chart of the patient's hematological/oncological diagnosis can be visualized in Figure S1 . All patients with any febrile illness, including febrile neutropenia, were isolated and tested for SARS-CoV-2 and managed in consultation by the pediatric infectious diseases service according to WHO and Center for Disease Control (CDC) guidelines, until testing results were negative. All suspected SARS-CoV-2 patients were kept in a designated ward space to minimize nosocomial exposure. Symptoms warranting testing of the patients can be visualized in the range plot shown in Figure S2 . Practicing pediatric oncology in the lower middle-income setting amidst a pandemic is a major setback to any progress made thus far. 1. Testing every febrile neutropenic patient for COVID-19 led to an additional cost, which was burdensome for most self-paying families. Abbreviations: A, abdominal pain; ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; B, preoperative biopsy; C, cough; D, diarrhea; E, exposure to known positive patient; F, fever; FS, facial swelling posttransfusion; M, myalgia; MPD, modified procedural demand; N, neutropenia; pre-CR, prechemotherapy relapse; pre-HSCT, prehematopoetic stem cell transplantation; R, respiratory difficulties; S, septic shock; T, travel history; V, vomiting. A novel coronavirus outbreak of global health concern Clinical strategies for treating pediatric cancer during the outbreak of 2019 novel coronavirus infection. Pediatr Blood Cancer The COVID-19 pandemic: a rapid global response for children with cancer from SIOP Additional supporting information may be found online in the Supporting Information section at the end of the article.