Impact of COVID-19 on Pediatric Immunocompromised Patients.

While the COVID-19 pandemic triggered numerous clinical practice changes and resulted in severe consequences either directly or indirectly for select pediatric patients, important lessons were learned, and there are silver linings for immunocompromised children evident among the chaos. At a minimum, the pandemic raised global awareness of infection risk, viral transmissibility, and the immune system. Handwashing, comprehensive disinfection practices of shared surfaces, and mask wearing are more normalized. School shutdowns during the COVID-19 pandemic not only kept children from exposure to SARS-CoV-2 but also decreased the incidence of pneumonia, otitis media, streptococcal pharyngitis, urinary tract infections, croup, gastrointestinal infections, and asthma.104 Strategies to mitigate SARS-CoV-2 infection including ventilation upgrades and cohorting methods are likely to help attenuate infectious exposures as students return to the classroom. In addition, the broad acceptance of virtual learning and incorporation of virtual learners in a hybrid classroom are practices expected to be of value to immunodeficient patients. Beyond schooling, the creative transition of other activities, for example, dance, karate, and enrichment opportunities, for example, art classes and streaming concerts, has allowed immunocompromised children to participate with their peers. As risk of SARS-CoV-2 transmission lessens, immunocompetent children will return to school and other in-person activities; the expanded services offered during the pandemic need to be continued for children with weakened immune systems. From a health care perspective, the massive uptake of telemedicine provided an alternative strategy for patients with compromised immune systems to maintain access to care with increased convenience and decreased cost. Given that immunocompromised patients are likely to benefit from continued telehealth options after the pandemic, it is imperative that action be taken to preserve the expansion of compensated telehealth options, while also appreciating that in-person visits are vital for some patients to diagnose new or progressive disease. In addition, strategies to mitigate barriers for telehealth uptake to improve equity of access as well as parental/patient preferences for care received in-person versus virtually must be explored. Although global efforts have accelerated our understanding and care of SARS-CoV-2 patients, our knowledge of clinical outcomes and treatment in immunocompromised patients is limited, particularly in inborn errors of immunity and pediatric HIV. Challenges remaining for pediatricians include sustained, global collaboration to consolidate knowledge in these rare patient groups, continued adaptation of knowledge gained from immunocompetent patients to immunocompromised cohorts, and further study on the safety and efficacy of current and developing vaccines. Persistent advocacy for rare diseases is even more critical as the clinical, scientific, and philanthropic communities remain focused on COVID-19 care and research. Finally, a comment that immunocompromised parents hear is, “I finally understand what it is like to live like you. I am afraid to get an infection. I cannot just go anywhere I want to go anymore”. Although the COVID-19 pandemic has been difficult for everyone on a personal and professional level, the anxiety of infection and social isolation will persist for immunocompromised families even as the risk of SARS-CoV-2 transmission subsides. It is imperative that we leverage knowledge gained from this pandemic to improve the health and quality of life of immunocompromised children so that they may live without fear.