To the Editor,
For the EU funded project PERMEABLE (PERsonalized MEdicine Approach for
Asthma and Allergy Biologicals SeLEction), which addresses the
availability of and access to advanced therapy of asthma in children
across Europe, we performed a survey including 37 major pediatric asthma
and allergy centers between September 2019 and July 2020. In total, the
centers contributing to the survey treated approximately 1.000 young
patients with severe asthma in 25 major European countries and Turkey
with biologicals. In the light of the Corona Pandemic, we extended our
survey asking the responsible clinicians if they experienced a
SARS-CoV-2 infection in any of the children they are caring for. The
questions pertaining to Corona infections were asked between March and
July 2020.
Given the prevalence of SARS-CoV-2 infections in the general population
and in children, one would expect that at least 1% of the patients
would be affected (1). In fact, none of the centers was aware of any
symptomatic COVID-19 case in their patient populations or any positive
SARS-CoV-2 tests.
This leads to the conclusion, that either SARS-CoV-2 infections have a
mild or even asymptomatic course also in children with severe asthma or
that children with severe asthma (and their parents) were extremely
successful in avoiding SARS-CoV-2 infections. Thus, we investigated by
structured interview, how centers in those 26 countries had instructed
their patients to avoid COVID-19. Interestingly, only 4 European
countries (UK, Ireland, Portugal and Malta) had a strict, so called
shielding policy in place which followed a principle of maximal
segregation of severe asthmatics from the rest of the population: not
leaving the house at all, not attending school even when they reopened,
wearing face masks also at home, and social distancing even with family
members. All other countries followed the principle of continuing or
even enforcing asthma treatment in patients and advising to follow the
same Corona rules as the general population.
Both strategies led to the same result: An absence of COVID-19 cases in
children with severe asthma. We conclude from this observation, that
shielding is not necessary in children with severe asthma as they and
their families are perfectly able to avoid Corona infections. The harm
done to children by enforcing seclusion, separation and stigmatization
needs to be acknowledged. Deprivation of school, social contact and
friends weights heavy on children and the absence of any COVID-19 cases
in major European centers for severe asthma in children does not justify
a policy of compulsory shielding of children with severe asthma, neither
in the first nor in any further Corona wave.
Michael Kabesch, M.D.
- University Children’s Hospital Regensburg (KUNO) at the Hospital St.
Hedwig of the Order of St. John, University of Regensburg, Regensburg,
Germany.
- Member of the Research and Development Campus Regensburg (WECARE) at
the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany.
References
Stringhini S, Wisniak A, Piumatti G, et al. Seroprevalence of
anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a
population-based study [published online ahead of print, 2020 Jun
11]. Lancet . 2020;S0140-6736(20)31304-0.